Midwifery Today Community

At a scan on monday, we were devastated to be diagnosed with Grade 2 placenta previa. The placenta does not cover the os nor the presenting part of the baby (head) but is about 1cm from the OS. I was scanned at 34+ wks.

I have not had any bleeding as of yet.

We live in hope that the placenta may move up enough to allow vaginal birth to be possible.The local unit are not very supportive of this as an option from this stage of my pregnancy.

However, I have been reading varied articles in relation to vaginal birth with marginal placenta previas.

I would be interested to hear of any experiences/articles/research on when vaginal birth is still considered an option with marginal placenta previa.

Thanks

Sorry, to read you being diagnosed with placenta previa.  I'm glad to see that you and other/s are following you/r gut/s instead of others.  Highly recommend that you check out Gentle Birth, Gentle Mothering:  A Doctor's Guide to Natural Childbirth and Gentle Early Parenting Choices, Sarah J. Buckley, MD.  The forward by Ina May Gaskin, CPM.

Hope this helps you.

Good luck and please keep us updated of course.

I don't know if the above-cited book will be helpful for someone with a possible previa or marginal placenta. I can tell you what's done in my area with someone with a marginal placenta and that's to allow labor to begin on it's own and at the sign of any abnormal bleeding, the woman is asked to have a cesarean.  These things are talked over with the care provider beforehand. We have local CNMs who will "do" a marginal placenta birth in the hospital but it's the hospital with immediate access to an OR and anesthesia.  A partial or complete previa would be a cesarean.  You can check out www.childbirthconection.org to see if there's more evidence-based research in the textbook online on their site. 

Thank you both for replies. I actually forgot to check out childbirth connection - just shows the state my head is in over this. My gut tells me that it 'should' be as mentioned in the previous post - trial of labour. I have had 3 previous spontaneous, un-accelerated, unassisted births...the idea of a section without trial of labour has left my head spinning.

I just found out that the woman I'll be attending next has a marginal placenta and they're going to go ahead and try for labor in the hospital with CNMs.  This is her 3rd baby.  I don't know right now how marginal is marginal in her case, however. I'm assuming that they're going to keep her on the monitor but the hospital has "remote" monitoring now so perhaps it won't be as uncomfortable as having to stay bed bound.

Thanks for that Susan. I am wondering what they do in these circumstances.... is labour allowed to begin spontaneously or is it started by sweep/induction. I am in on Wednesday to discuss this. I cannot have midwife led care now so have a meeting with consultant ob. I would pretty much do anything for a trial of labour at this stage.

 Actually, I've seen it handled two ways.  With the hospital CNMs, they wait for labor and don't poke or mess around.  They do require constant EFM (and now the telemtry unit) with an INT.  With the MDs, they move the woman to the OR during transition and put an epidural catheter in but don't run the epidural. They feel it's safer that way in case something happens during pushing, they have "immediate access" for surgery.  More of my clients and students have the CNMs.  In the case of a full previa, they would transfer care to the OBs, but the CNMs would still be there in the OR for the birth since they've established a relationship with them.  That's how it's done on my local level.  Each area is different. 

thank you again for your reply and information... . I did find some research in regards to trial of labour. It is frustrating that this appears to be based solely on the caregiver and their comfort levels (in my area anyhow).

You're absolutely right.

saoirse:

I did find some research in regards to trial of labour. It is frustrating that this appears to be based solely on the caregiver and their comfort levels (in my area anyhow).

saoirse,

I'm with you and Susan on research part on this.  That also for anything else in my eyes as well and please don't even get me started on the why part of it.  At the same time I do recommend that you check out this Our Bodies, Ourselves Series of books, The Boston Women's Health Book Collective.   In addition them they do have a companion site and blog.  Found all of them really helpful.  At same time do recommend that you do additional learning and research besides the books and website I give you to give you.  For more info on this.

Good luck.

Thanks again for all the support and information.

I am not in the USA so some of the policies are very different.....

Got AMAZING news at scan - placenta not even considered low lying...there was 4.5cm in the difference of the two scans! Not sure if it moved up (sonographer was cynical that it could have moved up this much is such a short time frame) or if first scan was a misdiagnosis. Either way, who cares! Am thrilled to be on track for a vaginal birth! Have transfered my care to the unit where I got second scan as felt the support was not great at for unit. All in all am thrilled though and the new unit has a good track record for women centred care(albeit further for me). Am 36 weeks now so not long now! So looking forward to meeting this little monkey!

Thanks again so much for support, listening, etc xx

That's wonderful news!!!!

Saoirse,

Thanx for the update and relieve that you don't have to deal with it.

Just a quick update... baby girl was born yesterday, Dec 20th at 39 wks. All went perfect, spontaneous natural vaginal birth. We are thrilled!

Congratz on everything and good luck as well.  Even though you hardly need it since you have been though this before as well.