Placenta Accreta: What You Need to Know For Your Natural Birth Plan

If you’ve been planning a home birth or natural birth at a birth center or hospital, you may be disappointed to find out that you have a condition called placenta accreta. Placenta accreta is a very serious condition that can change your birth plan considerably.

Find out what it is and what a natural mama can do in this post.

What is placenta accreta?

Placenta accreta is a serious condition where the placenta has attached too deeply to the uterine wall. There are degrees of severity that have different names.

  • Placenta accreta is when the placenta attaches more deeply than it should. These can range from small accretas (called focal acrettas) to larger ones.
  • Placenta Increta is where the placenta attaches so deeply it becomes embedded in the uterine muscle.
  • Placenta Percreta is when the placenta attaches even more deeply and attaches to nearby organs like the bladder.

A placenta accreta is often accompanied by a placenta previa (when the placenta has covered the cervix). So what does this mean?  The reason that placenta accreta is such a serious condition is that the placenta does not detach from the uterus after birth, causing hemorrhaging. As much as 90% of women who have placenta accreta need a blood transfusion and 40% need more than 10 units of blood.

How can I prevent placenta accreta?

There’s not much you can do to prevent placenta accreta, however, there are some risk factors that you may or may not have control over. These include:

  • Previous c-section (particularly with a placenta previa covering the scar)
  • Being older than 35
  • Multi-parity (having more than one child)
  • Having certain uterine treatments that may leave scar tissue (like fibroid removal, dilation and curettage (D&C), abortion, etc)

Placenta accreta is a condition affecting about 1 in 533 pregnancies today. The incidence of placenta accreta has increased in proportion to the number of women undergoing cesarean section deliveries. For reference, in the 1970s 1 in 4,027 pregnancies was affected by placenta accreta. So one way to potentially prevent placenta accreta is to avoid an unnecessary c-section.

Diagnosis of placenta accreta

Unfortunately there aren’t many signs or symptoms of placenta accreta. Sometimes painless bleeding in the third trimester is a sign of placenta accreta (as well as placenta previa) but other times a placenta accreta is diagnosed by ultrasound (and magnetic resonance imaging (MRI) if needed). Though ultrasound is relatively accurate in diagnosing placenta accreta, sometimes it isn’t recognized until delivery, either because no ultrasound was ordered or because the ultrasound didn’t pick up anything. When an accreta is discovered at delivery, usually because the placenta isn’t leaving the uterus within 30 minutes, it can be an emergency situation. That poses the question: Is an ultrasound an important part of prenatal care for every woman?

Obviously an ultrasound would be useful in ruling out placenta accreta, and potentially easing a mom-to-be’s concerns, but on the other hand, placenta accreta is rare for women who don’t have risk factors and ultrasounds may pose risks. Additionally, Ultrasounds and MRI’s are fairly accurate in predicting placenta accreta but not 100%.

The decision is one that needs to be carefully thought through and talked about with your prenatal care provider to come up with a solution that works for you. For example, you may be able to have an ultrasound where the technician only looks at the placenta, minimizing any potential risks.

Treatment for placenta accreta

For women diagnosed with placenta accreta, bed rest is likely. The most effective treatment for placenta accreta is an early c-section (to avoid going into labor) and hysterectomy. This is very disappointing for many women, especially if they are hoping to have more children. Depending on your specific case you may still be able to keep your uterus. If your accreta is small, it may be able to be removed without a hysterectomy.

Can I have a natural birth if I have placenta accreta?

Not necessarily. Because placenta accreta is often accompanied by placenta previa, most women will have to have a c-section. However, if your accreta is small and you have no previa you may be able to have a vaginal delivery. Talk with your healthcare team to determine the best course of action for you.

Can a placenta accreta change through pregnancy?

Unfortunately no. Once an accreta begins to form it doesn’t un-form, meaning once you’ve gotten an accreta diagnosis you definitely have placenta accreta. Though the placenta often moves through pregnancy, if you have an accreta, the placenta won’t move.

What’s a natural mama to do?

First, take a deep breathe. As you know, the point of the natural birth movement is not to have a natural birth at all costs, but to be informed so that we can make the healthiest and best decisions for us and our babies. If that means a c-section is the best choice, you are still an amazing, natural mama! You can prepare for a gentle cesarean birth and have a good experience and a healthy baby. Here are some other things you can do to make this difficult decision:

  • Talk with your healthcare provider about your concerns
  • Ask for a second opinion if needed
  • Come to peace with your new birth plan

How about you?

Did you have an accreta? How did you make your child’s birth as healthy and natural as possible?

 

References

  • https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta
  • http://www.brighamandwomens.org/Departments_and_Services/obgyn/placenta-accreta-myths.aspx
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