My Journey to VBAC Now Includes an Anterior Placenta

Posted on December 30, 2009. Filed under: Anterior placenta, VBAC after inverted t incision | Tags: , , , |

I don’t know if every woman planning to VBAC considers the location of her placenta at all when preparing to birth. I don’t know if it is something commonly thought about or it is brought up by the midwife or doctor at some point. I tend to think that if the mom has an ultrasound and the placenta is posterior (on the back wall of the uterus) that nothing is ever brought up at all and most moms probably never really think much of it. On the flip side, if an u/s is done and the placenta is found to be anterior (on the front wall) then it is mentioned and the mom begins to learn about the risks associated with an anterior placenta when planning to VBAC and she begins crossing her fingers that as her uterus grows that her placenta moves up high above her c section scar. For a mom with a prior bikini cut, ‘high above the scar’ doesn’t require a whole lot of movement as the scar is in the lower segment of the uterus.

I went into my pregnancy thinking about an anterior placenta. I didn’t dwell on it, it just crossed my mind a couple of times because of my inverted t incision. I don’t think I manifested an anterior placenta or anything  but because it can create real problems and because I know (too much sometimes) this, I just thought a few times that “I really hope my placenta is not anterior because I don’t want the added worry. ” I began to suspect that it was a week ago though. I found the baby’s heartbeat with my doppler at home at 9weeks and 5 days. It was really hard to find but definitely there. Almost two weeks later I couldn’t find it. I could see it pick up briefly so I knew it was there (plus I totally still feel pregnant!). I never thought I had miscarried or anything like that, I just thought ‘hmm wonder if the placenta is in the way.’ By 11 weeks the placenta is a good size and I figured it was big enough to block the heart tones.

I had my 12 week appointment today and my doc offered to do an u/s. He is a solo practitioner and has a machine in house and I think he likes doing them himself. He would probably offer every month, of course, I have no intention of having a monthly u/s but today when he offered I told him no that I didn’t need one. I found the heartbeat with a doppler and if he wanted to check he could that way. Then I told him I found it a few weeks ago but I couldn’t find it last week and that I thought the placenta was anterior. So he said ‘let’s take a look.’ I knew immediately when I saw the screen and he confirmed. He didn’t seemed worried at all which is great. Most mainstream and American docs would have gotten nervous. He just said, it’s early and it will move and hopefully it moves way up high and out of the way. He also reminded me that scar tissue was very strong. Then he said that if it stayed in the front on top of my scar as it is now, because it is big and my uterus is still small, then it probably wouldn’t cause problems in labor but could cause detachment problems after. He said, ‘you’d still have your vaginal birth and I would take care of everything after, don’t worry.’ I really appreciate his mentality. I can’t imagine too many docs that have that kind of attitude. There are some serious complications that can occur from placentas attaching to c section scars.

AIP= accreta, increta and percreta, where the placenta attaches to the scar or grows into the scar or  grows through the scar to the outside of the uterus. It can cause massive hemorrhage and often require hysterectomy. I’m not going to go into too much detail on all this because I am not really too hung up on it. I just didn’t want the anterior placenta so that none of this would have to cross my mind. Because it has crossed my mind I will now think about it until I see that the placenta has moved up and safely away from the scar. If I find that it hasn’t moved, a 3D u/s or an MRI can detect AIP. If there is any AIP then I will obviously have a very different remainder of pregnancy and birth and I can live with it because our safety would be compromised.

Chances are it will probably move up. There is a lot of growing left to do and I know this. There is not any information to be found on VBAC with an inverted t incision and an anterior placenta so I thought I post about it and see what kind of feedback and response I got.  If anyone has VBACd with an anterior placenta, please share, regardless of incision type.

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26 Responses to “My Journey to VBAC Now Includes an Anterior Placenta”

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Fingers crossed that it moves for you!! I had a low lying placenta (not sure if it’s called placenta previa at the early stages) with my first pregnancy but it moved up at some point between 13 weeks and 22 weeks. Glad your doctor is low key… 🙂 If the placenta is in front, does that mean they couldn’t see the baby, or had to look from the side? Just curious…

Thanks Desiree! He could see it coming from the top but he couldn’t see the head. It was too far back on the posterior wall of the uterus. He did get a shot of it but it was quick and very unclear.

I’ve been kind of wondering where the placenta is too. I swear I’m feeling kicks way down low and feelings in the area where my scar would be but I don’t know, maybe I’m losing it. Still really need to find a doctor though because the one I saw is NOT going to do. He seemed rather freaked out by my weight and the weight my daughter was when she was born. I weighed in at 325 pounds (not sure how many kg that is but over 150, I’m sure) and my daughter was about nine and a half pounds (or 4.3 kg at birth). The doctor looked worried and everything I asked about was answered with a “IF there are no complications.” He also told me that it was the first time for him dealing with someone with my weight and there’s already some issues because they don’t have a blood pressure cuff big enough for me there. Between all that and having to squat over an in-the-floor toilet had me wanting to reserve a plane ticket ASAP. And I’m still not sure what to do. Your doctor sounds great; wish I had the six million won or insurance that would cover him. As it is, I’m not even covered on the national insurance yet. 😦

Makes me wish I had done more to plan ahead for this but the plan never was to have a baby here. Now, I really don’t know what to do.

I would be really surprised if you were feeling kicks this early. I guess it’s possible but 12 weeks or so is way early even for a second baby. Could be gas 😉 Sorry that it didn’t go well with the doc you saw. Is Dr. Chung really 6 million won? Maybe he would consider a payment plan if you talked to him. I would at least go talk to him before you write him off. When will your national insurance kick in?

I don’t know. That’s part of the problem. Here, I’m totally dependent on my husband and that means waiting for him to get things done. He still wants to change jobs in March which means everything gets turned upside down all over again. Not enough that we’ve moved twice already in the last year, we have to move three times. I’m not sure what is supposed to get done and he tends to be really bad at getting things done. The last time around I did everything. I got the insurance, I scheduled the appointments, I did all the work and he just took me where I needed to go. But I can’t do that here because I don’t know Korean and I don’t know who to talk to. We are not well off by any stretch of the imagination. We were on county assistance from the time I got pregnant with my daughter until we came here. We’re not military. DH is an ESL teacher which leaves us at the whim of whomever we are working for. Not an easy thing to be dealing with when I’m in such a vulnerable position right now.

As for the movements, I’m not sure. It’s when I’m hunched over and they feel like distinctive thumps. Gas doesn’t feel like that but could be uterine twitches too or something.

Hi Janeen, Just wanted to say good luck and I’m sorry your doctor is not supportive of your weight. I am also overweight and my son was 9 lbs. I feel lucky that so far it hasn’t been an issue; I know that in other places there is discrimination (probably some is based on Korea’s lack of medical experience with overweight patients) and I hope it goes well for you! As far as feeling movement, I felt kicks at 14 weeks with my first baby and 9 weeks with this one – definite little thumps (I’m 20 weeks now, so of course they are much stronger!) Anyway, good luck. Fingers crossed for you.

Wow, Des, you felt movement that early??? I didn’t know that was even possible.

Yes – it was crazy. Definite movements though. I seriously would’ve thought I was farther along except I had an ultrasound at 5 weeks… :p Everything has been earlier this time – EVERY THING! – including the bh contractions (which have calmed down some now) – if I hadn’t had two ultrasounds to confirm dates (and both matched within a week) I would think I was at least a month farther along… crazy second pregnancy!

**hugs** I had an anterior placenta with my primary VBAC after my Inverted T. 😦 That was usually the cake topper when I was calling the home birth midwives, they already didn’t want to take me because of the scar, but then when they heard me say “oh yeah, my placenta is anterior” they would give a very quick “No.” You are SOOOOO lucky that you have such a great doctor, he truly sounds like one of the good ones that REALLY gets it. 🙂 The midwives that I did find said pretty much the same thing – shouldn’t affect your birth at all, we will just have to pay very close attention after. Then when I had my VBAC my placenta came out in pieces. lol So we had to guess if it was all there. I obviously didn’t have any signs of retained placenta so we were good, but it was a little disconcerting to see it in pieces like that.

A word of hope – I’m sure that at least part of my placenta was covering some part of the vertical portion of my scar (at surgery it was 8 cm long and extended into the fundus), it still detached the way it was supposed to. I hope that yours does too!!

I am lucky to have Dr. Chung. He was so nonchalant about it that if I didn’t know what i know it would have been concerning. But really he is just trying to have the attitude that there is no need to worry until there is a reason to worry. Being anterior at 12 weeks in and of itself is not a real reason to worry it just creates ‘what ifs’ that wouldn’t otherwise exist. I really appreciate that from him. Like you said, the mw’s were very quick to say no when they heard you had an anterior placenta, imagine how a mainstream OB would react. I shudder to think. My hope is that at the 21 week anatomy u/s the placenta has moved up towards the fundus.

My operative report didn’t indicate how long the vertical cut was. I can’t believe yours was 8cm, that’s seems really long. All mine says is ‘into the contractile portion of the uterus.” It doesn’t mention the fundus so I am assuming it didn’t go that high. I HOPE. I guess if the placenta is still center anterior at the 21 week u/s then at 30 weeks or so I will have a level two 3/4D to determine if there is any accreta. I just need the peace of mind that there isn’t. I can’t go into this labor worrying a) about an inverted t scar rupturing and b) an undiagnosed placenta accreta hemorrhaging.

I think my biggest concern at the moment is that I did have two weeks of spotting from 6-8 weeks. That’s the same time the placenta begins to form and implants and I now believe that it was caused by the location. Placentas look for blood rich areas to attach to and scar tissue is only connective, no vessels so if the placenta is on the scar and it isn’t getting proper blood supply it goes to find it elsewhere. That’s how AIP happens. The spotting makes me think there was some kind of placental ‘disruption’ or something.

Totally a wait and see thing at this point, something I am not good at at all!

I can only speak for me(no C-section), but I had an anterior placenta with both of my kids and I had bleeding with BOTH of them at about 8 weeks. Maybe it is more common with an anterior placenta?

That’s interesting Amie. I haven’t found anything on it but I’d be curious to know. I was worried that the bleeding was due to it implanting into the scar but who knows. I have had no trouble since. I still really can’t feel the baby move at 18 weeks but otherwise everything is normal. I’m more concerned about having an OP babe at this point!

I hope your babe cooperates! And I honestly had trouble feeling movement with both kids throughout the pregnancy. Patrick said that was probably due to the anterior placenta. Never stopped me from worrying though!

I had spotting and then two bleeding episodes with my first pregnancy. I had an anterior placenta. It was a placental hematoma that caused the bleeding in my case.

I guess these anterior placentas like to be trouble makers.

I talked to Dr. Wilson last night at the birth I attended (another fantastic birth with her. LOVE her). She actually pulled me aside after the birth to see how things went with Dr. Chung. She was very supportive of everything Dr. Chung was doing and said that if she were to take me on that he was doing everything she would do in my situation. She told me not to worry about the scar and accreta. She said after one c section that the risk if only 1.5% that it would accreata and if I am going to be ok with a 1.9% rupture risk then I need to be ok with a 1.5% accreta risk. She said that even looking for the accreta was pointless as the 3/4D and MRI scan were not accurate at detecting it. She said that the bigger issue is like he said, detachment after the birth but that it could be managed safely and he sounds confident and has experience with it so no big deal. First healthy mom and baby, second vaginal birth., worry about everything else after the fact. She said all this even if the placenta is still center and anterior and right on top of the scar. So I guess I just need to relax 🙂 I also had no idea she is pregnant and due in February. She is a tiny person anyway but I really had no clue she was pregnant. I so want to talk to her about her birth plans. I am sure she is aiming for a vaginal birth but I want to know the details!

I guess I was one of the 1.5% with the accreta and my pregnancy was 7 years later at that. I had monthly ultrasounds as well that didn’t pick it up either. Praying that everything goes well for you Amy. Love reading your stuff 🙂

You are actually who I have been thinking about when I think of all this. What confuses me about you is that you said your placenta was posterior so the accreta couldn’t have been related to your c section scar. Accreta happens in unscarred uteri as well and Dr. Wilson told me that after one prior cesarean the risk factors are the same for an unscarred uterus. So really yours wasn’t the unlucky 1.5% that happens after one prior cesarean, it had to have been the unfortunate ‘luck of the draw’ of having it anyway, if that makes sense. It makes sense because if your placenta was covering your scar it would have been a very low lying anterior and accreta wouldn’t have been the big concern, it would have been previa they were worried about at that point. I am just figuring here, by the way, trying to make sense of it.

Hey Amy,

I am 19 weeks pregnant and attempting a VBAC as well after a low transverse bikini cut. Funny enough, I was diagnosed with Previa at 11 weeks which was resolved by 13 weeks. Now at 19 weeks, they told me I have an anterior placenta.
Which explains why I haven’t felt much movement.
Is it more common to end up with an Anterior placenta after a section?
Does this increase the chances of it happening in future pregnancies?
My midwife isn’t concerned but she has said that everything that we would prefer to not have to deal with is happening. 😦
Just curious what your research has given you. 🙂

Hi Kelly,

It is more common to end up with an anterior placenta after a c section. From what I read (and did not verify and don’t have a link readily available) the scar kind of ‘hooks’ the placenta as the tissue is more sticky than the wall of the uterus. Yours grew up and out of the way of the scar though so you really don’t have anything to worry about as far as the placenta attaching to the scar or anything like that. It’s more of a problem when the placenta is right on top of the scar. You are more likely to have an OP (face up) baby with an anterior placenta so be sure to watch out for that. Here’s a link that might help…

https://doulamomma.wordpress.com/2009/06/10/optimal-fetal-positioning-for-a-better-birth/

Good luck!

Amy

I am trying for a VBAC and am 20 weeks and was just told after my ultrasound last week the the placenta is covering my scar. My midwife can’t deliver the baby because of the added rish IF it doesn’t move up. I will have to find an MD to deliver in the hospital for me and where I live, it is hard to find one that will work with VBAC patients. Too much liability for them. I may have to go out of town, which is what I’ll do to get my vbac. I hope both of our placentas move north! 🙂

Hi Rachel,

I hope it moves for you so that you don’t have to go out of town. I had my VBAC July 24, 2010. My placenta didn’t move high enough to get off of the vertical portion of my scar but my doctor and I were not worried about it. We both agreed that the biggest issue would be detachment at birth and that did prove to be a problem (read my VBAC story for my placenta story) but there were no complications as a result. I bet yours will move though since you (I’m assuming) have the bikini cut. They generally move quite a bit after 20 weeks so try not to worry too much!

Good luck and keep me updated!

Amy

I am 37 weeks, and have just been told my placenta is anterior, and my midwife will not let me try for a VBAC. I live in a rural community and there is not enough blood in the blood bank at our local hospital. I am considering staying in the city, but it is a ferry ride away, plus lots of driving. The stories I have read about uterine rupture sound devestating for both mom and babe, although the risk is so low, I don’t have a lot of time to make my decision, but I really want to try for a vaginal birth, anybody out there have a story to share. Thanks, R

this is something i have never ever read.very detailed analysis.

I love the website layout . How was it made. It is so sweet!

So I know I’m late to the party, but I had 2 successful vbacs with anterior placentas. Both were persistent posteriors, but they were drug-free and they were vaginal, so I was happy! I had a low transverse incision with my c/s. Hope that helps someone else that may be searching for VBAC after inverted T! (I’m searching for a friend 🙂 )

Hi. I want to know what happened to your pregnancy? Did it progress well? Thank you.


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