I was 16 weeks pregnant when I thought I was miscarrying. It would be my second miscarriage. I was on a business trip in Minneapolis, 750 miles from my home in NE Ohio. Seven hundred fifty miles from my husband and family. As soon as my plane landed, I realized I was bleeding more heavily than the light spotting I left home with earlier that morning. My cramps were worsening. I climbed into a taxi and awkwardly told the driver I needed to get it the nearest ER as I texted my husband the warning that I thought I was losing our baby.
I managed to hold back tears until I entered the ER and started to explain my situation to the registration desk. I was immediately offered a wheel chair and whisked back to a room. After a painful internal exam, I was finally taken to have an ultrasound. My baby looked great. I breathed a heavy sigh of relief. I texted my husband the good news as soon as I made it back to my room in the ER. He had been an emotional mess, frantically searching for airfare to Minneapolis as we tried to determine whether he should come out to be with me.
The doctor came in a short while after my ultrasound and confirmed I had placenta previa, a condition in which the placenta forms low in the uterus and fully or partially covers the cervical opening. I was told that ninety percent of previa cases resolve on their own as the baby and uterus continue to grow throughout pregnancy. If unresolved by late pregnancy, however, I was destined for a scheduled c-section around 37 weeks. Women with placenta previa have a high risk of bleeding with labor and delivery. To avoid hemorrhage, previa cases are typically delivered via c-section before a woman has the chance to go into natural labor. I was diagnosed with a marginal previa, the least severe and most likely to resolve. My baby’s placenta was on the very edge of the cervix, but not quite covering the cervical opening. In partial and complete previas, the placenta partially or completely covers the cervical opening respectively, blocking baby’s way out. I was optimistic that the previa would resolve on its own so I didn’t dwell on it too much, though I was terrified of the thought of having a c-section. My first-born came into this world through a stress-free vaginal birth and I hoped my second would do the same.
At my twenty-week growth scan, I learned we were having another boy. My marginal previa persisted, though the ultrasound tech assured me I still had plenty of time for it to resolve. The rest of my second trimester went smoothly. I was insanely busy with work, helping plan for my organization’s annual conference. When the conference started, I spent the morning of the first day excitedly setting up and preparing for a full two days. By lunchtime, I was starving. I scarfed down a huge meal and had just sat down to prep for my upcoming breakout session when something felt off. I scurried to the bathroom where I realized I was bleeding. Heavily. I was 28 weeks pregnant.
I made my way back to the conference and tearfully explained my situation to my supervisor, who offered to drive me to the campus medical center (I work for one of the largest universities in the nation). I once again found myself away from home in a medical emergency. I spent the night in a hospital two hours from home as nurses and doctors monitored my bleeding. The bleeding quickly tapered and I was discharged the next evening. My baby boy was doing great, but the previa persisted.
A week and a half later, another bleed. This time, I was home. My husband left work and we rushed to our community hospital five minutes from home. I stayed overnight for monitoring. The bleeding tapered and the baby looked great, but the previa persisted. I remained optimistic that my previa would resolve and I could deliver a full-term baby vaginally. I was shocked to learn at my 32-week appointment, however, that if my previa didn’t resolve by 36 weeks my doctors would have me deliver in Cleveland or Columbus since our local hospital doesn’t have the resources for a blood transfusion. Because of the previa and because I had a posterior placenta, I had a high risk of heavy bleeding during surgery. My doctors explained that they were more comfortable having me deliver in a hospital that could better handle a blood transfusion.
As I tried to wrap my head around the idea of having a c-section two hours from home with a doctor I never met, I still tried to remain optimistic that the previa would resolve. My optimism came to a screeching halt, however, when I was 35 weeks pregnant. I had just arrived home from teaching my last big program before maternity leave. I was tired and contracting every 2-3 minutes. The contractions were normal for me. I was diagnosed with irritable uterus earlier in the pregnancy and suffered from periodic episodes of regular contractions. I crawled into bed hoping for a decent night’s rest. Within 20 minutes, I felt a gush of fluid. I thought my water had broken.
I made my way to the bathroom where I realized the gush of fluid was blood. My husband and I woke my two-year old son, Milo, and loaded him in the car before making our way to the hospital. Upon entering the labor and delivery unit, the nurses at the registration desk notified us that the hospital had a restriction on children under 14 due to RSV. Despite telling the nurses that my in-laws were currently on their way to get my son, we were told my son would have to leave. The hospital refused to allow my son to stay in my private room for the hour it would take for my in-laws to drive to the hospital. I refused to be admitted without my husband by my side so we angrily left and decided to drive an hour to a larger city hospital, where my family could be together. At this point, I was still operating under the assumption that, like my previous bleeds, I would spend the night in the hospital and be discharged the next day.
We arrived at Akron City Hospital and I was quickly taken to labor and delivery triage. I was hooked up to the monitors the doctor performed an excruciating internal exam. After looking at my records and consulting with my OBGYN over the phone, the doctor advised that I would need a c-section. We assumed we could wait until morning (it was about midnight at this point), but the doctor explained they were going to start prepping me for surgery and I would deliver within the hour. I tearfully called my parents to let them know we were having a baby as my in-laws made their way to the hospital to pick up Milo.
Before I had time to process what was happening, my beautiful baby boy was born. Doctors held him above the drape just long enough for me to catch a glimpse of his face before he was whisked away. He was taken to the NICU for what we hoped would be a short transition. I remained in surgery with my husband by my side as doctors began to close my incision. I was losing a lot of blood and I remember feeling lightheaded and nauseous throughout the almost hour it took to put me back together. Once in recovery, I continued to lose blood. Each time the nurse massaged my uterus, more blood would pour out. I begged to see my baby, but was told I would have to wait until the bleeding subsided and the feeling in my legs returned before I could go to the NICU. At one point, the doctor came into recovery to break the news that I would need to go back into surgery and have a D&C under full anesthesia to stop the bleeding. I tearfully asked if I could see my baby boy before surgery. The nurses graciously wheeled my bed into the NICU where I was able to see and touch my boy for the first time. At this point, it was about 6 hours after delivery. Little Leo was in an isolette with tubes and wires covering his little body. He was 5lbs 8oz.
After holding his hand for a short while, my doctor advised me that they would try an injection of Methergine, a drug meant to help the uterus contract, before taking me back to surgery. Fortunately, after several injections of Methergine and lots of massaging later, I stopped bleeding enough to be taken to a room. At some point amidst the chaos of the early morning, we were told that Leo had been admitted to the NICU rather than just being there to transition to the well baby nursery. When asked how long he could be in NICU, doctors told us it could be one week or three, depending on how well he does.
Leo would spend two full weeks in the NICU as a “feeder/grower.” He didn’t have the stamina to take a full feed by mouth so much of his food was given via a feeding tube. My milk supply was very slow to come in, most likely due to a combination of blood loss and stress. Our hospital did not offer a guest room program for parents of NICU babies, so once discharged, I would not have had a room to stay in while Leo was in the hospital. I would not have a private bathroom, a shower, or a bed and I didn’t have time between feedings to go home since we lived an hour away and I was attempting to nurse every three hours for each feeding. In addition to having no guest room program, the NICU lacked a bathroom (parents had to go to the hospital lobby to use the bathroom) and although I was told I was welcome to stay at Leo’s bedside, I barely had room to recline my chair. The facilities weren’t exactly parent-friendly, especially for any mother dedicated to breastfeeding her baby around the clock.
After conversations with numerous nurses and doctors, I was allowed to stay in my hospital room for three nights beyond discharge at no cost. While I was appreciative of the accommodations, I was reminded multiple times each day of how lucky I was for the hospital to have made “unprecedented” accommodations for me. The floor was half-empty for the length of my stay, so I couldn’t fully understand why it was such a big deal. For three days, I worried non-stop that I would lose my room. During that time, Leo’s NICU doctor attempted to facilitate a transfer to our local community hospital in Wooster so we could be close to home. Our local hospital has a “special care nursery,” which is a step-down from a NICU. Wooster, however, only has five beds and they were full. It would take three days for a bed to open and for us to be transferred. Ironically, once transferred, we were the only family in the nursery for the remainder of Leo’s stay. The space we had in Wooster was massive compared to what we had in the NICU at Akron. The lights were dimmable and noise was kept to a minimum, which allowed for my family to get much needed rest. I was also provided a free room and two free meals per day since I was breastfeeding (Akron also offered two free meals per day for breastfeeding mamas).
After one week in the NICU at Akron and one week in the special care nursery at Wooster, Leo was discharged. He was finally taking all his feeds orally. In a matter of 48 hours, we went from thinking we’d be stuck in the hospital forever to preparing to come home. We were elated that Milo would finally be able to meet his baby brother and we could return to some sense of normalcy.
Although hospital policies made our first week in NICU a nightmare, the nurses and doctors that cared for me and Leo were nothing short of amazing. It’s a shame that hospital policies prevent staff from subjectively assessing each patient’s unique situation. From not allowing our son, Milo, in our local hospital for an hour while my in-laws made their way to pick him up to making me fight for a guest room so I could be near my son in the NICU at Akron while I continued to recover from my c-section, stagnant policies added unneeded stress to our already stressful situation.
In the end, Leo is a beautiful, healthy baby boy. He’s eating well and gaining weight accordingly. Our nurses and doctors listened to our concerns, provided emotional support, and fought to have our needs met and for that we are forever grateful.
Story and photographs submitted by Danae W.
What a brave journey you made!!!
By the way Any info on conservative management of placenta accreta ?