Placenta Accreta

by Guest Author, Elphie Hosler

Copyright 2002 Elphie Hosler. All rights reserved.


DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.

Note about the Author: Elphie Hosler is a mother who had had 4 prior cesareans and who, as a result, experienced severe Placenta Percreta with her last baby.  This article first appeared in the spring 2002 edition of "The Birthkit," a publication of Midwifery Today.  Elphie's Placenta Percreta birth story, the birth of William Andrew (as sent to the ICAN support list), appears after the article.

 

CONTENT

 

Elphie's "The Birthkit" Article on Placenta Accreta 

from Midwifery Today, Spring 2002

Placenta Accreta is an abnormally firm attachment of the placenta to the uterine wall.  Collectively termed, "Placenta Accreta," three variants of the condition are recognized.  

In the most common form, placenta accreta, the placenta is attached directly to the muscle of the uterine wall.  This variant accounts for approximately 75-78% of all cases.  In approximately 17% of cases, the placenta extends into the uterine muscle and is termed placenta increta.  In the remaining 5-7%, the placenta extends though the entire wall of the uterus and is termed placenta percreta (Miller 2000).

Placenta Accreta is a nasty little secret in the world of Obstetrics and Gynecology.  It is fast on the rise, due primarily to the dramatic increase in Cesarean Sections, the majority of which are unnecessary.  Any type of uterine surgery increases your risk of developing placenta accreta with subsequent pregnancy, though none more so than cesarean section.  The more cesareans you have, the greater your likelihood of developing placenta accreta.  

When placenta previa (or low-lying anterior placenta) is present in a woman who has had one previous cesarean section, the risk of placenta accreta is 30%.  It jumps to 40% or higher in women who have had more than one previous cesarean section  (Resnick 2001).  

Statistics indicate that placenta accreta was a rare occurrence from 1930 to 1950--approximately one case in over 30,000 deliveries.  From 1950 to 1960, the number increased to one in 19,000, and by 1980 to one in 7,000.  The most recent information suggests that the incidence has now risen to one in 2,500 deliveries.  

So why then are we not informed of this risk when we consent to cesarean sections, or any uterine surgery for that matter?  Should this risk not be made public?  What about the "Informed Consent" laws?  As women we deserve to know not only the immediate consequences of uterine surgery, but the long term consequences as well.  In cases of placenta accreta those consequences can be exceedingly grave, and typically are.  

Accreta is a potentially fatal complication for the mother due to hemorrhage as blood loss typically ranges from 3000 mls to 5000 mls.  Other potentially fatal complications include Disseminating Intravascular Coagulation (DIC), which can result in death or amputation of lower limbs, transfusion reactions, other complications accompanying blood transfusions such as HIV or hepatitis, allo-immunization, fluid overload, and less commonly, infection and multiple organ failure.  Surgical morbidity includes: emergency hysterectomy, bowel injury, urological injuries including urethral trauma and bladder lacerations requiring surgical resection.  Patients with accreta are at increased risk for blood clots (for example pulmonary embolism) and Adult Respiratory Distress Syndrome or ARDS (Gibson, 2000).  

The majority of women with placenta accreta are going to lose their uterus in an attempt to control the bleeding, a procedure called "Cesarean Hysterectomy."  This rather neatly and effectively puts an end to the woman's reproductive cycle.  Many women are not even going to be that "lucky."  During a time when a woman should be happily nursing her newborn baby, the baby is instead crying in his grieving father's arms as hi mother lies cold on a slab in the morgue.  Does this sound harsh?  Then please consider this: 10% of women with placenta accreta die of its complications, most usually from hemorrhage or the complications of blood transfusions, infection, or multiple organ failure.  

These are the consequences of placenta accreta.  These are the risks a woman takes on when she attempts another pregnancy after previous uterine surgery.  These are the risks the Obstetricians and Gynecologists fail to inform you of when you sign the consent form for a cesarean section.  

References

1.  Miller A, David.  Obstetrical Hemorrhage.  Obfocus. 2000

2.  Resnick, Robert.  Managing Placenta Accreta.  Contemporary OB/GYN.  2001

3.  Gibson, Faith.  VBAC Alert - Placenta Previa/Accreta.  American College of Domiciliary Midwives.  2000.

 

Elphie's Fifth Birth Story: Placenta Percreta

The birth story of William Andrew

It has been nine weeks since William was born. I still feel emotional. It is difficult to describe these feelings. I cry very easily right now, at the drop of a hat it sometimes seems. For the most part they are tears of happiness, of relief, and of gratefulness. Yes, I am grateful. I am grateful that both William and I survived and are here today. I am grateful to have my beautiful little boy safe and warm in my arms. And I am grateful that the knowledge and technology was available to repair what was previously damaged so that this could be a reality.

I had planned an unassisted birth with William. I am Bipolar though and I have to take certain medications to keep it under control. My psychiatrist, upon learning I was pregnant, insisted on an OB consult and ultrasound to make sure the baby wasn't being harmed by my medications. I could not go off my medications. I had tried when I found out I was pregnant and things started deteriorating rapidly. We had a meeting and it was decided that I would have to stay on them. 

I was not happy about seeing an OB but I felt like I didn't have a choice. My psychiatrist would not give me my medications unless I complied. Plus I had been feeling quite a bit of pain and had this niggling in the back of my head that there was something not quite right. I set up an appointment with an OB new to the area. The appointment went very well. I was on guard the entire time but he was nice and respectful.

He sent me for a lab workup and ultrasound. My labs came back just fine. The ultrasound did not. The baby (a boy!) was doing fine but there was a 10cm cyst on my right ovary. The doctor wanted to either perform surgery while I was pregnant or schedule a cesarean section. I did not want either, so we went for a second opinion.

At twenty weeks we went to a group of Maternal Fetal Specialists in Chattanooga. They confirmed the cyst and discovered that I had a condition known as Placenta Accreta. Placenta Accreta is an abnormally firm attachment of placenta to the uterine wall. This is a very serious complication of pregnancy, occurring with more frequency in mothers who have had previous cesarean sections. Any type of uterine surgery increases your risk of developing placenta accreta with subsequent pregnancy, though none more so than cesarean section. The more cesareans you have, the greater your likelihood of developing Placenta Accreta. When Placenta Previa or a low-lying anterior placenta is present in a woman who has had one previous cesarean section, the risk of Placenta accreta is 30%. It jumps to 40% or higher in women who have had more than one previous cesarean section. Not only did I have an anterior low-lying placenta but I had also had four previous cesareans.

We did all sorts of testing to determine with as much certainty as we could that I actually had this. I was not going to give up my Unassisted Childbirth if they weren't certain. Unfortunately every test, including MRI, showed the Accreta. It was decided that I would come in at thirty four weeks for an amniocentesis to determine fetal lung development. If the baby's lungs proved to be mature, we would immediately proceed with a cesarean section.

During the weeks preceding the amniocentesis I began having lots of prodromal labor. At times this was frustrating. I made up my mind to be positive about it and not let it get me down. Two days before I was scheduled to go in for the amnio the intensity of the prodromal labor suddenly changed. With each contraction I felt a deep burning pain. I decided that it was "real" labor beginning. The pain with the contractions was different that what I've previously experienced, but I just kept reminding myself that each birth was different and this was just another variation of normal. For two days I quietly labored, relishing every moment of it as I knew that it would be the last time.

We made arrangements for the hospital's transportation van to take us to my appointment. The hospital I was scheduled to deliver at was a good two hours from our home. Plus my husband's mother had come to stay with our other children and we did not want to leave her without the use of our van while we were gone. They were to pick us up at 6:30 am for my appointment.

The night before I made sure to have everything packed and ready, just in case. I showered and had my clothes laid out. Other than getting myself ready there was nothing left to do. My husband got up first when the alarm clock went off and went to take his shower. I stayed in bed because I couldn't really get ready while he was in the bathroom. When he finished he came and woke me up. This was at a 5:30. I begged him for ten more minutes. After informing me that I was going to regret it, he went to the living room to check his email and give me my ten extra minutes.

I laid there for about five minutes dreading having to get up. Then I felt this little pop and immediately my water started pouring out of me. I was completely and utterly shocked. This was not supposed to happen. Somehow I managed to scream for my husband. He came running into the bedroom and I couldn't even speak, all I could do was point. I will never forget how huge his eyes got and the look on his face. He was very concerned and was trying to figure out what we were going to do.

He handed me a towel and I got up and went into the bathroom while he went to the living room to tell his mother what was going on. I stood there for a second, water gushing everywhere, and tried to think about what to do. All of a sudden I felt this sense of calm come over me. I put my towel down on the floor and just let the water pour out. Then I went and peed, made sure the water was clear, and cleaned that up. I got out all my hair and makeup supplies and proceeded to get ready.

During this time I felt a contraction. It was different from what I had been experiencing the two previous days. It felt more "real." I remembered this! I was truly in labor. My husband kept coming in and asking me what to do. I very calmly told him he could figure it out as I was in labor and didn't care. I reminded him that he had the cards from my doctors and he could call them and ask how they wanted to handle this. I kept on with my hair and makeup, pausing every few moments to enjoy a contraction. 

During this time the transportation van showed up. I was still getting ready and told my husband he could deal with them. They decided my husband would drive me as I was still pouring water and the van seats were cloth, plus the driver still had to pick up a little boy who was going to the Burn Center. After the van left my doctors decided on a game plan. My husband would drive me to our local hospital, where my regular OB/GYN would check me, and then we would be sent by ambulance to the hospital where I was going to have the surgery.

After getting ready I sat down at the computer and sent a few emails while my husband loaded all of our things into our van. I still felt very calm. I was privately relishing the fact that I had gone into labor on my own before the cesarean. I didn't let myself dwell on what was going to happen. I was very happily engrossed in laborland. It felt like the baby and I were in our own little world that no one else could penetrate.

My husband came in and helped me to the car. It was an adventure trying to walk. I had my panties stuffed with cloth diapers. On the way to the hospital my husband talked to me. I really don't know what he was saying. I just concentrated on my contractions. By then they were intense enough that I needed to breathe through them, but it wasn't anything I couldn't handle. I timed them at around four minutes apart. Just before we got to the hospital I did inform him that the only way I would go by ambulance was if he were allowed to go too, otherwise he would just have to drive me.

We went in through the emergency department. My husband went in and told them I was there and someone came out with a wheelchair. I accepted the wheelchair because I didn't relish the idea of walking all over the hospital soaking wet. We were taken up to the labor and delivery department. When we got off the elevator there was no one around. So we just kind of hung out looking at pictures on the walls. Then the Director of Nursing (Mildred) appeared and wanted to know if I thought I was in labor. I told her yes and that my doctor would be meeting us at the hospital. She looked very surprised at this and raised her eyebrows, saying "oh really?" This was because at their hospital you don't see the doctor until the nurses determine you are indeed in labor and call them. I was special. <smile> She then gave me a funny look and asked if I was "Brenda's daughter." I said yes in an extremely firm voice and could see by the look on her face she remembered me. Good. She had caused me nothing but grief when I had Elizabeth.

She passed me on to a young nurse and we went to my room. We briefly filled the nurse in on what was going on. She handed me a gown and helped me up so I could go change. We had a bit of a laugh over the amount of fluid I was still gushing. Once I changed I got into the bed and raised it to a sitting position. I was not going to lie down. I felt if I stayed upright I would retain a sense of power. 

The nurse then attached the fetal monitor so they could get a reading before transporting me. Once everything was in place she could not find the heartbeat. This did not worry me as I could feel the baby moving. After about ten minutes of her trying I started getting tired of it. I very politely suggested that she go get a doppler as it could be the machine acting up. You could see the look of relief in her face. She went out into the hall and I could hear her talking with Mildred, the DON. She was very frightened that she could not get the heartbeat. Mildred came in, checked the position of the baby, and announced he was transverse and high. That was interesting, as he had been head down the week before. Mildred took the Doppler and found his heartbeat right away.

Then my doctor arrived. He did a quick check and found that I was 1 cm dilated. He let us know the ambulance would be there in about fifteen minutes and they were making the arrangements so that my husband would be able to accompany me. I told him that was good because I was not going without him. My husband laughed and said "You'd better listen to her. She really means it." Then my doctor went ahead and started an IV line, just in case they needed it in the ambulance. He was extremely gentle and got it in with no problem. 

During this time I was still having contractions. I would take time out from conversing to focus on them. I started to get a bit nervous about being in the ambulance in labor as I had experienced it before and found it to be excruciating. I did not want to experience that during such a long trip, especially as the majority of it would be going through the mountains. I told my doctor this and he suggested I try Stadol. I thought about it for a minute and decided since I'd never had it before I would like to try it and see what it was like. 

My doctor wished us all the best and I thanked him for everything he had done. I also thanked the young nurse for being so kind. Then the ambulance crew came in and got me up on the gurney. I felt a sense of relief that I was leaving that hospital with no damage having been done. 

The ambulance ride was basically uneventful. They put me in the back on the gurney and my husband rode up front with the driver. Because of insurance purposes he was not allowed to ride in the back with me. It really didn't bother me as I was still quietly ignoring everyone, lost in my labor. I really felt it was just baby and me. No one else was allowed in, not even my husband. 

I did get a bit annoyed with the EMT who was riding in the back with me. He kept messing around with the blood pressure cuff and wanting me to let him know when I was having a contraction. Finally I just decided to tune him out completely. That worked pretty well. Between contractions I watched the scenery from the back window. It was a new experience going down the mountain backwards. I've always loved the mountains and seeing them helped keep me calm. I focused on them and not what was ahead. I felt extremely mellow.

We arrived at the hospital after what seemed like only a few minutes. The hospital was in the middle of a major construction project so we were able to have the grand tour as they tried to figure out how to get me up to labor and delivery. They finally found it, only to be told I needed to be taken to Labor Triage. That was a new one. I had never heard of Labor Triage before. After seeing even more of the hospital they finally found it.

We were met by a very nice nurse. She told my husband where he could put our things down and helped get me off the gurney and onto their bed. She hooked up the monitors and we started filling out paperwork. She was very respectful of the fact that I was also in labor and would stop talking during my contractions so that I could focus on them. 

After the paperwork was filled out everyone started coming in. Lab techs needed to draw blood, residents needed information, administration needed this, and someone else needed that. It was a bit overwhelming not only for my husband and me but for our nurse as well. I decided I would ignore them as well. By this time I was an old pro at ignoring people who dared to intrude on my labor. 

I had made up my mind that I was going to enjoy labor with William. I knew that whatever happened he would be my last baby. It was the last time in my life I was going to feel labor. It was something intimate that William and I alone shared. I knew what was going to happen soon but until then my labor was mine. No one was going to take it away from me. I won't lie and say the contractions didn't hurt. They were nice and strong and they hurt like the dickens. I had to completely focus all my energy on breathing through them and relaxing. What really seemed to help was making this low guttural noise that was kind of a cross between a deep sigh and a long moan. Even though they hurt I was truly loving each and every one of them. I savored them; they were precious to me. 

My doctor called and told them it was time to take me to pre-op. So off we went with our entourage down to pre-op. Once they got me settled I couldn't believe all the different people who were swarming around my bed. I was still sitting up. I would not let them lay me down. Not yet.

The anesthesiologist came in to talk with me. He had spoken with my doctor and the doctor wanted him to do a central line and put me under with a general. At this point I started panicking a bit. I absolutely did not want a central line. And we both agreed that I should be awake to see the baby as it very well could be our only chance to meet. We discussed the options and decided together on a spinal/epidural combination that would supposedly provide good coverage during the surgery as well as post-op pain relief. He got on the phone and really went to bat for me with my doctor. We won that round.

At some point I looked up after having a contraction and my mother was there. She had gotten her best friend, who is also a nurse, to drive her up there. My mother doesn't like making that trip through the mountains so I knew this was really something. I cannot begin to describe how good it felt seeing her there. I teared up a bit just seeing her. She was there as my mamma, not as a nurse. That was special. Seeing her love and concern from a mother's perspective instead of the cool professionalism of a nurse made such a difference in the way I felt. My Mamma was there. She loved me and she cared about me. I really felt like we had come full circle from the birth of my first child. 

Then my doctor, Dr. Kipikasa came in to talk to me. He's a short man with curly long hair in his 40's or so. He has such a wonderful personality. During our office visits he was always so upbeat and cheerful. Even when things were looking bad he was the first to offer reassurance. I never saw him when he wasn't smiling, until then. His voice was gruff and he didn't spend much time talking to me. He had the strangest look on his face. He went over to the corner and stood with his arms crossed looking at me. I was puzzled. Was he mad at me? What had I done? Why wasn't he acting like he normally did?

It was time to go. My husband kissed me and went off to suit up. He was not allowed in the operating room until they were ready to start the surgery. Mamma came over and hugged me and kissed my cheek. Both of us were softly crying. She told me she loved me and I told her I loved her and thanked her for being there. She went over to the corner, still crying, and in a choked up voice told Dr. Kipikasa that he had better take care of her daughter. He reassured her that he would do everything he could and that was when I noticed he was tearing up as well. He wasn't mad at me at all. He was worried. 

That scared me more than anything.

When we got to the operating room it was like I had stepped into an episode of ER. It became quite obvious to me that this was not going to be handled like your typical cesarean. For one thing, we had been booked into the largest operating room the hospital had. Room 12. And I could see why. There had to have been at least 40 people in that room, all rushing about doing their own thing. The noise level was overwhelming. 

My anesthesiologist came in and they sat me over the side of the table to do the spinal/epidural. I sat perfectly still, even through contractions. They joked about how I was an old pro at it. After what seemed like forever it was in place. And it was wrong. It had to be taken out and completely redone. I felt a brief moment of panic. Then I made the conscious decision to just zone out and let them do their thing. And I did. It was finally in place and working. They helped lay me down.

I was lying there stark naked and spread eagled. I decided to just not think about it. I pretended like it was a perfectly normal, everyday occurrence to be lying there so utterly exposed with all these people about. A nurse wanted to insert the Foley Catheter but I asked her to please wait until I was numb. It was not a problem. Meanwhile they worked on shaving me and attaching the heart monitor electrodes.

A couple of residents were busy trying to start IV lines. Because we had opted out of the central line I was going to need quite a few. During this I just ignored them and let them try their best. My anesthesiologist was trying to see if I was numb yet. It was taking a bit longer than average. He would pinch my arm as hard as he could and then do the same to my leg. He was gauging by how loud I screamed "ouch!" One of the residents laughed and said he was sadistic. After what seemed like forever I was not feeling the pinches on my legs.

He checked on the residents' progress with the IV lines and was not impressed. So he gave it a go and just started matter-of-factly inserting one after another. One of the residents asked why he was not numbing me up first and he said there was no point in it, it would hurt either way. By the time he was finished I had a grand total of six IV lines, two of which had numerous ports. I was literally a human pin cushion. I am terrified of needles but I handled it quite well by just reminding myself that anything was better than a central line. 

Next the Foley was inserted and they started piling warm blankets on me. They felt so good as I was freezing. My stomach was then prepped and the drapes were put in place. I looked over and my husband was finally there. I asked him to let me know when they started and he said they already had. My mouth was getting very dry so he asked for a wet washcloth and squeezed water into my mouth. Then he used it to bathe my forehead. I was fluctuating between being freezing cold and burning up.

It took about an hour until they actually got to the baby. They were going extremely slow because of the location of the placenta. Just before he was delivered I started feeling the surgery. It was an extremely deep burning pain. I told the anesthesiologist and he said the only thing he could do at that point was put me under. I decided to stay awake until I saw the baby. 

William was delivered at 1:13 pm. They held him over the drapes for just a second. He gave this tiny little whimper and they whisked him off to the corner to work him up. He was floppy and slow to start. They suctioned him with the DeLee and then gave him oxygen. It seemed like it took forever. My husband went with him over to the corner where they were working on him. A doctor from the NICU team came over and told me he was doing just fine and was healthy. He appeared to be a full term baby and was not going to have to go to NICU. He would go to the regular nursery. I was extremely happy to hear this. My baby was okay. 

A few minutes later they brought the baby over to see me. This was the moment I had been anticipating and dreading at the same time. I was going to get to see my little boy at last. I was so sad though because I knew it could very well be the only time. My eyes were swimming with tears so badly I could barely see him. I told him how much I loved him as my voice broke. They put him down close to me so I could kiss him. I had to close my eyes and fight the tears. It didn't really work. I tried to literally send every ounce of my love into him as I told him goodbye. I willed him to remember how much his mommy loved him if I didn't make it through the rest of the surgery. Even if he could never remember me I at least wanted him to know how much I loved him.

They took William away and now it was time to say goodbye to my husband. As we both choked back tears we told each other how much we loved each other. I told him to please take care of our children. Paul told me that I would be there to take care of them. Then he had to go. It was so hard seeing him leave and not knowing if I would ever see him again.

I was still feeling too much of the surgery and was starting to panic a bit. They kept calling for more units of blood and that was really scaring me. I was afraid I was going to bleed out. The anesthesiologist decided to put me under. That was frightening too. I couldn't help but wonder what was going to happen after that. Would I wake up or not? 

The next thing I remembered was waking up about halfway and realizing I was in pain again. I was actually very happy to be in pain. It meant I was still alive. I could hear voices calling my name and telling me I needed to wake up. I opened my eyes and saw that I was still in the operating room. Someone told me they need to get my verbal consent for a tubal. I consented and they put me right back under.

When I woke up again I was still in the operating room. It was strange. There were only two nurses in the room with me, everyone else had left. It felt so odd seeing it that empty when before the room had been packed with people. I actually felt pretty good as I wasn't feeling any pain. They moved me off the operating table onto my bed and moved all of the equipment. They put more warmed blankets all over me. That felt good. I was still freezing. Then they rolled me to the recovery room.

When we got to the recovery room I had them sit my bed all the way up. I still did not want to be lying down. I was very happy and could not stop chattering on. For the life of me I can't remember what I was talking about, just that I couldn't seem to shut up. I noticed the patients around me and they were all so groggy and in pain. I felt sorry for them. I couldn't believe how good I felt. It's amazing what some good doses of Morphine will do for you.

I was kept in the recovery room and monitored for an hour. I found out that my surgery had taken around four hours. They had managed to save the uterus and did the Tubal Ligation. Everything was going fine in the recovery room so they took me off the heart monitor and removed some of the IV's. They left three in though, one in my right arm and two in my left. 

My husband and mother were waiting when we got off the elevator to go to my room. They were very happy to see me. No one had told them anything. They didn't even know I was out of surgery and were frightened. My doctor had promised to come and tell them when I was safely out of surgery but had forgotten to do so.

After they situated me in my room I asked where the baby was. He was being held hostage in the nursery just down the hall. No one had gotten to see him yet as they decided he was having problems regulating his body temperature. My husband had stood outside the nursery for the longest taking pictures of him through the window. That was hard on him; he wanted to hold our baby so badly. He begged them to let him hold him and they wouldn't. He watched from the window as they held him and patted him, and even as they fed him.

A nurse from the nursery came in and talked to husband after reviewing the paperwork in William's chart. Because of our state's laws we could not get out of the eye ointment or PKU testing. We knew this and had consented. However we did not consent to circumcision, the Hepatitis vaccine, or the Vitamin K. She tried very hard to pressure my husband into consenting but he stood his ground. I believe that was one of the reasons they kept the baby from us for so long. It was a pathetic attempt to punish us for going against their norms. 

My nurse was having problems getting one of my IV's to working properly. It was causing me a lot of pain. My mother looked at it and told her it was infiltrated. The nurse said that it wasn't. My mother's friend Juanita also looked at it and confirmed that it was infiltrated. They have both been nurses for over twenty years each. The nurse (very young) still wouldn't listen. She left and came back a few minutes later and conceded that yes, it was indeed infiltrated. I was not impressed. Not only was she ignorant but stubborn as well.

I asked the nurse to bring us the baby. She said she would tell the nurses in the nursery and one of them would bring him. My husband wasn't allowed to go get him as they had to go through all the identification procedures first. It was getting late and my mother and her friend had a long drive ahead of them. They wanted to see the baby before they left.

No one would bring him. I lost count of how many times we called and asked. We were told the nurses were busy and would bring him as soon as they could. Finally my mother couldn't wait any longer. She had to leave without seeing him. This really made me angry. The longer we waited the more furious I became. 

Finally they brought him to us and all the anger just melted away. My husband picked him up and handed him right to me. I felt such love for him when he did that. I knew how badly he wanted to hold him. But he was unselfish and knew that Mamma should hold the baby first. Oh he was so perfect, so beautiful! He was only a few hours old and already he had my heart and soul in his tiny little hands. He looked right into my eyes. He knew me and was so calm and peaceful in my arms. Being with his mamma was just what he needed. I couldn't get enough of just holding him and loving him. I didn't want to ever let go, but I knew he needed his daddy too, so I gave him to Paul. It was beautiful watching Paul hold him for the first time, Daddy and his son. Paul was just in awe, we had another boy.

My father and grandmother came up to see us that night. While they were there visiting my nurse came in to ask questions, the majority of which were already answered in my chart. She asked me how many pregnancies I'd had and I answered that I had five children. She said "no, how many pregnancies?" I did not want to answer this in front of my grandmother. Some things are private. I was always selective about who knew certain things. But I felt like I had no choice. I quietly answered that I've had nine pregnancies but had lost some. The nurse shouted "Nine? All by the same father?" I was so embarrassed that I said yes, by my husband, even though that wasn't true. I had miscarried before we were married as well as after. My grandmother started to say something but my father hushed her up. I could tell she was just as aghast as the nurse. It was completely humiliating. 

After this fiasco I started hurting. The medications were wearing off and I was really starting to feel the pain. I told the nurse and she returned with Demerol and injected it into the IV. She had mixed a half dose, instead of the full dose ordered by my doctor, with saline. She left and it wasn't a couple of minutes later that I started feeling very nauseated. I told my husband and he and my father ran around the room looking for something. They brought a pan from the bathroom and I threw up into that. My husband called the nurse back and told her I was sick and throwing up. She got mad at me and informed me that I should have told her before she gave me the Demerol that I was sick. She never would accept that I wasn't sick until she gave me the Demerol. So she went back and mixed my other half with Phenergan and injected that into the IV. In a post-op patient you should never give half a dose if the patient is in severe pain, especially after abdominal surgery. And Demerol should not be mixed with saline as it will nauseate the majority of people if given straight. It is a strong narcotic. She should have known this and not taken it upon herself to disregard my doctor's orders that were clearly stated in my chart.

Later on after everyone had left I noticed I was wet. So my husband lifted up the blankets and there was blood everywhere. I was soaked, the bed was, and it was even dripping off into the floor. No one had come in and checked my pads or anything since the surgery hours before. My husband rang for our nurse and told her over the intercom what was happening. She said she would be there when she could. She never came. He kept calling down there and was ignored. 

He went and found the linen closet and came back with bedding and a fresh gown. He helped me up out of bed and gently washed me and put my gown on. Then he stripped the bed and made it back up. Paul carefully situated me back into the bed. He mopped up what he could of the blood with the bedding and then put it all in a pile by the bed. My nurse finally showed up and was annoyed that he had done that. She had to step over the pile of linens to get to me. Each time she had to step over them she would get angry, yet she never bothered to remove them and clean up the mess during her entire shift.

The Demerol I was being given made me rather silly. I was definitely in a drugged out state. We kept the baby in the room with us for most of the night. Finally my husband just had to get some sleep so he asked that the baby go to the nursery for a bit. Up until this point he had provided all of the care for both the baby and me. The poor man was exhausted. He lay down on the cot and was out as soon as his head hit the pillow. Not long after I fell asleep.

A little while later I heard a voice telling me to wake up. I slowly opened my eyes and looked around the room. Everything was exactly the same as when I had fallen asleep. My husband was still on the cot snoring away. Then I felt blood just start pouring out of me. It was literally like someone had turned on a faucet. I was bleeding out at a very fast rate. I felt a brief moment of panic and then that voice told me everything would be alright. A strong sense of peace came over me. I felt like I was disconnected from my body. I was surrounded by love and I wasn't afraid. I knew I was dying and I could see my body laying there. I wasn't sad because I knew everything would be okay and we would all be together again.

Then I jerked awake. I was still inside my body. I panicked. I yelled for Paul to wake up and help me. I had him check me for blood loss and it looked to be normal. I showed him how to do Fundal massage and had him do that vigorously. I was really shaken by my "dream." Was it just a dream? Was I hallucinating from all of the narcotics? I really don't know. I've thought a lot about it and I don't think so. For one thing the detail was too perfect. And I could literally feel everything that happened. Was I being shown what could, in an instant, happen? Was it a lesson in how quickly life could be taken away? Or was I being shown what was about to happen? I just don't know. But it is something I don't think I will ever forget. 

The next day I talked with Dr. Adair. My doctor had been sent on vacation after my surgery. I imagine the poor man needed it. Dr. Adair was the head of the group I was seeing. I had seen him a few times during appointments. I didn't realize he had been in surgery with Dr. Kipikasa. He had stayed until it was clear I was out of danger. He told me what all had happened during the surgery. Up until then I had no idea what had gone on. 

It turns out they were partially correct about the Placenta Accreta. Technically I did not have Placenta Accreta. I had Placenta Percreta. This is different and much more serious than Placenta Accreta. In Placenta Accreta the placenta is attached directly to the muscle of the uterine wall. In Placenta Percreta the placenta extends through the entire wall of the uterus. My placenta was dangerously close to invading my bladder. If that had happened it would have very possibly been irreparable. 

In addition to the Placenta Percreta it was also discovered that the lower segment of my uterus was in the process of rupturing. It's difficult to describe exactly what had happened. My uterus ruptured along the area of an old cesarean scar. But because the placenta was anterior and low-lying it actually served as a kind of stopper. It literally plugged the rupture up. I believe I had started rupturing a couple of days before. I think that's what I was feeling when the contractions changed and with them I felt that burning pain. 

Dr. Adair said I came dangerously close to losing my life. He told me I owed my life to the skills of Dr. Kipikasa. There was a point during the surgery where it was just too close. He made it very clear that even one more day would have been catastrophic. There was no doubt in his mind that if we had waited any longer they would have lost both the baby and me. That was pretty heavy stuff to hear.

They repaired the uterus as best they could. It was in a horrible condition. Dr. Adair said that my insides were just a huge mess from all of the previous surgeries. They worked hard to keep the uterus because I had already lost a huge amount of blood. If they had done a hysterectomy on a uterus so large there would have been an even larger amount of blood loss and I wouldn't have been able survive that. 

I believe that between the baby and my body they kept us safe. To me it explains why William moved into a transverse position and was so high up. I think too that my water breaking was my body's effort to get things going as well as put less pressure on the rupture. It's amazing to me how everything worked out the way it did. 

The IV's and catheter were removed the second day. I got up as soon as I could and started walking. I didn't want to because it hurt so much and I was incredibly weak but I knew that the more I walked the quicker I would recover. We were released after four days. By then I was more than ready to go home. 

I can say nothing but good things about my doctors; Dr. Kipikasa, Dr. Adair, Dr. DeMay, and the Residents of the UT Maternal Fetal Specialists and Dr. Joe Rivero, my OB/GYN. The entire staff at Erlanger Medical Center, with the exception of the L&D nurses, was amazing. A special thanks to Labor Triage, Pre-op, the Surgical Team, and recovery. They were professional and most importantly they were kind. They were very respectful of my wishes and treated me so well. If you are having major surgery Erlanger is certainly the place to go. But if you are having a baby I would not recommend it because of the L&D nurses. I would say they were just horrible, but unfortunately from what I have seen before they are typical of their profession. 

Recovery has been up and down. I had a rough week or so and then started to feel really good. That lasted until close to week four. At week four I started bleeding very heavily (flooding) and experiencing quite a bit of pain. I'm still having problems nine weeks later. I am tired all of the time, in pain, and having days of flooding. I've tried various herbs and things and my doctor has been trying to get it under control too. We are going to try a few more things, and if nothing helps there is a possibility of a hysterectomy.

William is nine weeks old now and simply thriving. He is beautiful and such a good baby. We are so blessed to have him. Our entire family is just in love with him. 

Bright Blessings,
Elphie

 


Copyright 2002 Elphie Hosler. All rights reserved. No portion of this work may be reproduced or sold, either by itself or as part of a larger work, without the express written permission of the author; this restriction covers all publication media, electrical, chemical, mechanical or other such as may arise over time.


[ Back to Kmom Area ]