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Thursday
Mar102011

Placenta Accreta After Cesarean

A for-real recommendation regarding a mom’s concerns about placenta accreta over her previous cesarean scar: 

“In the most unlikely event that your placenta doesn't come after 24 hours (24 HOURS?!?!) or so, and if you pull gently on the cord yourself it doesn't budge after that time, and if you have some cayenne and honey and it doesn't budge, and if you have some of Gloria Lemay's tea for postbirth placenta release it doesn't budge, and you've done a wee, eaten, walked around, squatted a coughed, had lots of booby, released any residual pain/fear/grief after your birth then you might consider going to hospital to see if there's something else going on. Since there's no actual problem till postbirth, that's the best time to go to hospital. They can't frighten you about your baby dying blabla if the babe is already earthside and fine. 

She might "consider going to the hospital to see if there's something else going on"?!?

She may not get frightened by the hospital about the baby dying, but I wonder if they tell her that she might die counts.

The “advisor” neglects to mention watching for signs of infection, especially since pesky bacteria might be climbing up that cord even as she waits for the placenta to come out. Wouldn't it just be a drag to have to be hospitalized for a two-week course of IV antibiotics because of leaving the cord dangling? Just like long-ruptured membranes and a zillion vaginal exams can introduce buggies into the pelvic arena, the baby's lifeline (no longer needed, of course) acts as a super-highway for super-bugs.  

The "advisor" also doesn’t say what to do if the concerned mom bleeds a torrent (with or without the placenta birthing). Forgets to add that when she pulls “gently on the cord” she could cause a partial detachment and subsequent hemorrhage. Or when she pulls “gently on the cord” her uterus might fall out. Doesn’t tell her the signs to recognize an occult abruption. And there certainly isn’t any acknowledgement or encouragement to listen to her instinct to not birth at home. 

Oh, I forgot. That’s the side ignored lest it sour the birth experience. Too much doom and gloom. See all the FEAR I have? No, it isn’t education and experience; it’s flat out fear. rolling eyes And who wants that at their birth? (That was a rhetorical question.)

Perfect thoughts = perfect birth, right? 

Riiigghhhht.

Reader Comments (18)

Where is this from?

And doesn't accreta almost always come with pretty significant bleeding?

March 10, 2011 | Unregistered Commenterchingona

Looks like a post from Mothering.com forums!! eek!

March 10, 2011 | Unregistered CommenterDawn

I purposefully left out where it was from. Any birth junkie has a pretty good idea the type of forums this was found on.

No, accreta might have zero bleeding... if it is imbedded into the decidua, it either needs surgery to remove or the uterus is taken out. But, determining if the placenta is stuck, an accreta, a percreta or other variation can't be seen and diagnosed until after the fact.

March 10, 2011 | Registered CommenterNavelgazing Midwife

Okay. That's what I thought. (About the source.)

Thanks for the other info. All the accreta stories I'd heard involved bleeding.

March 10, 2011 | Unregistered Commenterchingona

Placentas should not have enough time to begin to rot before being expelled from the body. Ewwww, warm meat.

March 10, 2011 | Unregistered CommenterJane

Now you know why I just can't deal with it anymore : )

March 10, 2011 | Unregistered Commentermichelle Wilbert

24 hours? WTH?

March 10, 2011 | Unregistered CommenterEthel

i just keep loving you more and more each day :)

a fellow snarkian

March 10, 2011 | Unregistered Commenternancy

Oh. Hell. No.

March 10, 2011 | Unregistered CommenterColleen, LM

I understand that you are writing this post to vent - but perhaps you could include some helpful information and alternative advice, rather than just lambasting the original post? With respect.. it seems catty and out of place on your blog.

Somebody stumbling upon this article could be quite frightened by what you've said about risk of death, prolapse, etc - particularly if they are already worried about the risk of accreta to begin with.

As someone who is yet to birth and has concerns about placental issues, this article is pretty scary - death, prolapse, massive infection - eek! Though I personally wouldn't wait 24 hours to find out what was going on, reading this article makes me think - how long is too long? 10 minutes? 20 minutes? An hour? 3 hours? Will I die if I wait more than an hour? Will my uterus fall out if my care provider tries to help it along? Will I be hospitalized for weeks?

.. and off I go in a ball of stress to see what I can find on the web.

This is your platform, it's certainly nobody's place to tell you how/what to write, but this post struck me as unnecessarily sarcastic, not at all constructive, and quite unhelpful to people who might actually want information on this subject (in that it doesn't give any information other than what can go terribly wrong). I understand that you are venting, of course, but without balanced advice or info to balance things out, it just comes across as unhelpful snark.

Perhaps by saying all the bad things that could happen as a result of the original "advice", you feel that you've offered up a counter argument of sorts - but by only listing the risks and the bad things that could happen, it's not helping anyone (on the contrary, I think it could scare people) - whereas if you gave your own advice about 3rd stage timing and what to do if things aren't progressing "normally", then readers would have a more balanced idea and could make better decisions.

Certainly you can denounce what you consider to be bad advice, but I think you would earn more respect if you added information or advice - rather than writing something that can be whittled down to 'check out this crazy advice - if you follow this stupidity, you could die or have your uterus fall out.' Though I know you are blowing off steam, I felt uneasy and a little scared when I finished reading it.

You owe me nothing, and I'm sure you don't see your blog as a way to win any popularity contests - but I come here for information, and all this article gives me is a bunch of frightening stuff that could happen to me, wrapped up in malice/sarcasm. I didn't think I would see that kind of writing here, from a midwife. I'm left feeling uneasy and confused.

March 10, 2011 | Unregistered CommenterAnon

This scares the LIVING SHIT out of me.

March 10, 2011 | Unregistered CommenterKristina

Hi NGM,
Thank you for your candor. I think that sometimes the homebirth movement needs to check in... or more accurately get checked. There is a lot to be said for birthing at home and decreasing medical interventions and on and on... I definitely prefer the idea of natural and homebirth but let us not take it too far to where we sound like we aren't educated, knowing there are times to go to the hospital and when those times are is essential. Knowing that the equipment and the training of the doctors and nurses in the hospital are sometimes needed. (Even if anyone prefers to think of them as necessary evils, that's okay, as long as you can recognize when those necessities exist.) Just as HBA's (Homebirth advocates) discuss all the reasons not to go to the hospital ~ dangers, risks, unnecessary interventions, and even negligence ~ we should also be fully willing and able to discuss what reasons and risks are associated with homebirth and when a hospital might be a healthful addition or alternative to homebirth.

Thanks again, keep putting it out there. Let's keep a balanced approach to homebirth and hospital birth... the best birth is one where both the health care provider and the parents work together to provide a safe, healthy approach to birth. Sometimes that healthy approach may not need to involve MD's and RN's but let us not rush to exclude them based on an ideal but rather be realistic.

March 11, 2011 | Unregistered CommenterCB in FL

Such a scary little "world" that lives inside the computer, huh?

March 11, 2011 | Unregistered Commenterhousefairy

AAAARRRRGGGGGHHHH- I think my blood pressure just shot up 10 points.

And I suppose if mom died, then just some moms weren't meant to be moms? Like some babies weren't meant to survive birth?

[head smack]

March 11, 2011 | Unregistered CommenterJen B

No, it's not from mothering.com, unless that poster also posted the exact same thing to MDC and it's not showing up on Google. I found it elsewhere.

In any event, though rare, I do every so often see this kind of scary advice on related message boards-- mostly from well-meaning laypeople, but yikes! It's too bad that this is what people think of when you tell people you've thoroughly researched the subject. "You can't believe everthing you read on the Internet." Well, no-- you certainly cannot! But my info is primarily from places like NIH, the New England Journal online, etc.

Of course, there will always be extremes, and in the Information Age, there's a lot of crappy information floating out there along with the good. I guess it bugs me when people commenting to the Blog of the OB Who Shall Not Be Named dredge things like this up as if they're representative of homebirthers. They're not-- even though they need to be squashed with a quickness-- and it's not the fault of the bad advice givers that HB is being painted as for the ignorant fringe. The stereotypes are the fault of the stereotypers.

March 11, 2011 | Unregistered CommenterDreamy

There is a LICENSED midwife in my community, who told me that she once waited THREE days for a placenta to birth. I was mortified and absolutely shocked. This is only one of the outrageous tales I have heard from her and women she has served, and makes practicing in the same community so very difficult, on many levels.

March 12, 2011 | Unregistered Commentermomandmidwife

"Somebody stumbling upon this article could be quite frightened by what you've said about risk of death, prolapse, etc - particularly if they are already worried about the risk of accreta to begin with."

Yes and they SHOULD be frightened about the possibility of unrecognized placenta acreta if they are HBACing! It's a really really bad thing! And then maybe talk to their midwife about how she would recognize/handle it?

March 12, 2011 | Unregistered CommenterKatie

Ok, I have a question related to this - is it possible to have placenta accreta and NOT have it show up on ultrasound?? Placenta accreta is one of the reasons I will never forgo a 20 week ultrasound, but now you've got me concerned that it could be missed...?? Any advice?

March 17, 2011 | Unregistered CommenterSusan

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