167 Alysa's VBAC + Placenta Previa and Accreta

The VBAC Link

Alysa is a prime example of how every birth is its own unique story. With her first birth, Alysa had a very medicalized vaginal birth. During her second pregnancy, Alysa unexpectedly developed placenta previa, resulting in weeks of hospital bed rest and a very necessary Cesarean. After knowing firsthand how unpredictable birth can be, Alysa’s third birth was exactly the empowering, unmedicated VBAC she had envisioned.

We also talk about placenta previa and accreta-- what it is, how severe it can be, and what the chances are that it will happen to you based on the most current research.

Additional links

How to VBAC: The Ultimate Preparation Course for Parents

Episode 124: Elyssa’s CBAC + Birthing in a Pandemic

Expecting and Empowered Fitness Guides

National Accreta Foundation

Full transcript

Note: All transcripts are edited to correct grammar and to eliminate false starts and filler words.

Meagan: Happy Wednesday. It is The VBAC Link with you today, Meagan and Julie, and of course, we have another amazing story to share with you today. We have our friend, Alyssa, on the line. She actually-- we just were talking about this. She has actually been with us from the beginning, which is so fun to have someone that we recognize and we know. She posts and everything, so thank you, Alyssa, for being so amazing on our social media outlets. We are so excited to have you here today.

She did have a VBAC and it was after a situation that was unexpected. It is placenta previa. We are going to talk about that as well after she shares her story because this is something that is really necessary to have a Cesarean. It truly is. And so, we want to talk a little bit more about that, what it means, what it looks like, and also touch on placenta accreta and talk about the two differences.

Review of the Week

Meagan: Before we jump into the story, of course, we have a Review of the Week. Julie will be sharing that with you today.

Julie: Hey, hey. I am so excited. I really get excited when we interview people that have been with us from the very beginning.

Meagan: It is so fun.

Julie: I recognize Alysa’s Instagram handle and I am like, “I know who you are.” It’s so exciting. But do you know what is also really funny? The review I picked to read for this episode is from-- remember back when we shared my client Elyssa’’s story? Elyssa’s VBAC story? This review from Apple Podcasts is about Elyssa’s story and now, after we read the review about Elyssa’s story, we are going to hear Alysa‘s story.

Meagan: Elyssa, we have Alysa.

Alysa: Perfect.

Julie: So don’t be confused. But this is from Cristin Anna on Apple Podcasts and the title is “Thank you for sharing Elyssa’s story.” She says, “Today I listened to the episode when Elyssa shared her story and I found myself identifying with her story so much, and I cried multiple times as she described how she felt, as it was word-for-word the feelings I felt after my first birth. I planned for a home birth, ended up going two weeks late, and ended up having to have a C-section at the hospital after finally going into labor, but my son’s heartbeat started dropping during contractions.”

“Thank you for allowing Elyssa to share her story. The fact that she was able to share her second Cesarean and the fact that it wasn’t like the first one gives me hope that even if for some reason my VBAC is not successful, I can still have a better experience than my first birth.

I struggled with feeling like a failure after my first birth and hearing from her, (and from you guys) that she did what she needed to do for her baby, and she is not a failure, but was still able to exercise her own power during her labor, was all so encouraging. I think reminding women who are trying for a VBAC that they aren’t a failure because they weren’t able to have a vaginal birth the first time around is so important and so healing for them. Thank you for empowering women and also encouraging them to do what is needed for their baby.”

And I love that. I love that. We have talked about before how important it is for us to share all of the stories about VBAC with you including VBAC attempts-- I don’t know, for lack of a better word-- that don’t end in a vaginal birth, repeat Cesarean stories, and we even have a couple of uterine rupture stories. We want you to be prepared for all of the different outcomes that your birth could take. And so, we really appreciate that review from Cristin and we obviously appreciate Alysa for sharing her story with us. And now, we are going to hear from Alysa.

Alysa’s story

Alysa: All right. I just have to say I am so grateful to be with you both. I said before we started that it is just surreal to be talking to you both since I have listened to all of the birth stories. It has meant so much to me through my pregnancy and leading up to this third birth of mine.

I guess I will start with just a little bit about my first, and obviously second birth, and mostly my third birth, but my first I just wanted to touch on. I did have a vaginal birth with my son, but I was a very typical first-time mom and I just was like, “I will go with the flow and see what happens.” I think for some people that can be okay, but looking back, I wish I knew more. I wish I had a podcast like this that I had listened to or something to just know that--

I knew there was something inside of me that wanted something different for my birth, but I was too afraid to go against the norm or to not be a good patient, which is so silly. It’s funny because I myself am a healthcare provider, but I struggle with that sometimes of not wanting to disappoint my providers. I realize now more than ever that that’s not why they’re there. I wouldn’t want my patients to feel that way.

So anyway, I had a vaginal birth, but it was very medicalized. I was induced starting at 0 centimeters at 37 weeks for not really great reasons. I ended up getting an epidural and I pushed for almost three hours. He was born. He was healthy and it was great, but it just wasn’t what I wanted.

So fast forward with my daughter, my second birth. I was so gung-ho. I was going to have a natural birth. I was going to have an unmedicated hospital birth, and I was reading all of the books, and doing all the things, and I got the absolute surprise of my life with that pregnancy. At 20 weeks we did the anatomy ultrasound and they said my placenta was low-lying, which is actually very, very common at the 20-week mark.

So my doctor said, “Don’t worry about it at all. 90% of the time it moves out of the way by the time you deliver, so don’t even stress.” I looked up all of the research on it and it matched what she said so I was like, “Yep. I’m not going to even worry about this.” I exercised. I went on a vacation. We did all of the normal things not worrying about it.

But then at 28 weeks, I was actually at work. Right in the middle of standing up to examine a patient of mine, I felt a gush and then a subsequent gush. I excused myself from the room and I thought initially it was going to be my water, but I looked down and I saw blood pretty much down to mid-thigh.

Meagan: Wow. Scary.

Alysa: Yeah. It was terrifying. The only saving grace was that because I was 28 weeks, I could feel her move so much. I am a relatively petite person, and so I could see her move and I could feel her move, so I got that comfort right away of knowing like, “Okay. She is still doing okay.” But it was a lot of blood.

And so, we obviously rushed right to the hospital right up to OB and I was admitted for five days. I lost about a unit of blood, but it stopped and it slowed. I got the steroids. I got the whole thing. NICU came in and talked about delivering, but they were able to keep her in there and she did okay. Eventually, I went home with the direction that I could only be within a 20-minute radius of the hospital and, yeah. So we just kind of laid low and then eventually at just shy of 34 weeks, I had my second bleed and my doctor said, “If that happens, this is where you stay now.” So then I stayed in the hospital, had another bleed in the hospital, but eventually did make it to 36 weeks which was the goal, and delivered her by Cesarean. And so like you said, it was a very necessary Cesarean, but it doesn’t certainly mean it was easy by any means.

Meagan: Right.

Alysa: I mean, I had a vision of what my birth was going to be like and it was obviously-- I went from wanting a very hands-off birth to having one of the most hands-on experiences you can have. Being in the hospital for a total of about four weeks over that pregnancy was incredibly hard emotionally, but also just being constantly in the world that things are being done to you was really hard. It was super hard. It made me not want to be anywhere close to that situation again. And so, I knew right away that if I was going to have another birth, I had to have a VBAC and I had to do everything in my power to make sure that was going to happen.

I really thought for me, that was going to be out-of-hospital. That was confirmed when I had an annual physical about a year later and I talked to one of the providers about having a VBAC. I started asking some of the questions really that you guys layout and your resources about how to see if your provider is VBAC tolerant or VBAC friendly. I very quickly found out they were tolerant. I mean, I asked about going past 39 weeks and they were like, “Oh no, no, no, no. But yeah, yeah. We can let you try.” And induction, they just didn’t even really-- yeah.

Meagan: They weren’t following evidence-based practices.

Alysa: No. No, and it was very clear to me that if I attempted to have a VBAC with them, it was not going to happen. So that day I had that appointment, I called-- there is a wonderful, wonderful birth center in my area called Authentic Birth Center, and so I called them and said, “Hey, do you guys even take VBAC people?” They were like, “Yeah, of course.” So I was like, “This is what it is going to be.”

So I got pregnant and started seeing the midwives and they were absolutely wonderful. As you know and you have talked about in other podcasts, this third baby, I had my son and it was COVID, so COVID was part of this journey as well. But I was so, so, so, so grateful that prior to COVID I had already started care with them because during that time with all of the restrictions that were happening in hospitals, there were so many women who were trying to switch it up and change to an out-of-hospital birth. The fact that I was already with them was amazing because they were really struggling to keep up with the amount of women who wanted to switch out of the hospital.

Julie: We saw that a lot here too. A ton of our clients switched. It was just nuts.

Alysa: Mhmm. I can’t imagine. Those midwives were probably just so busy. They have to try to care, they want to care for everyone well, so it’s not like they can take every single person. I just have to say too, and I told my midwives this, but I am so, so grateful that while COVID was going on during my pregnancy and birth, it was never a huge part of my story. I am just so grateful for that-- that they still focused on my healthy pregnancy, my healthy body, this healthy baby and continued to make every appointment about that, about us, and about our care, and about that well-rounded care that midwives are so well-known for. It was so empowering and it was everything I hoped it would be. So I’m just-- I am so grateful.

I did have a lot of anxiety through the pregnancy of feeling like I had all these hurdles to get over in order to make it to my VBAC, which I am sure a lot of women feel with any VBAC, but at the ultrasound, here I am thinking, “Okay, I just have to-- the placenta. Please, please let the placenta not be in the way,” because I knew that there was no changing that and thank God at 20 weeks it wasn’t. It was seven whole centimeters away and I was so, so, so grateful.

Julie: A great distance.

Alysa: Yes, exactly. Every step of the pregnancy was just another hurdle to overcome in my mind. I got to do the glucose tolerance and that was good. My blood pressure kept being good. Baby was head down, and so everything was just lining up.

I guess that brings me towards the end of the pregnancy. I can honestly say that the difference between this pregnancy and my previous two is, I just did so much to prepare between listening to you guys, and general mindfulness, and staying educated on what was true, and then also, I was so physically active. There is a wonderful exercise program called Expecting and Empowered that I absolutely adore and they have a postpartum program too. That helped a ton.

I reread all the typical birth books that were just so helpful too, but definitely towards the end, just lots of mindfulness and lots of visualizing. Visualizing my birth and lots of really just digging into God’s word and his faithfulness. As a Christian, that was a big part of my journey too of trusting in His plan and His amazing way He created women to give birth. So, yeah.

I guess that leads me to birth. I think I stayed pretty patient. I think the main reason for that too was I was just so grateful to have a really normal pregnancy. I got to all these points in pregnancy where I was like, “Wow. I was in the hospital at this point,” or “I had already had my daughter at this point.” It was just so amazing to be past those dates.

So I had my son-- I was induced at 37 weeks and my daughter at 36. So once I got past that 37 weeks, I was like, “I have never been this pregnant.” It was also exciting for me in a way. Of course I, like every woman, was ready at the end physically and emotionally, but I was overall just very grateful.

But, yeah. I guess that brings us to the week. The week of my due date, I had days on and off where I would get contractions. I would get contractions, they would be 10 minutes apart, and then 8 minutes, and 10 minutes, and I am like, “Oh, maybe this is turning into something,” and then, of course, I would fizzle out. Then on the Monday prior to my due date, my due date was on a Wednesday, I had an appointment and I was getting a lot of contractions during the appointment. When they were listening to baby, his heart rate was going down during some of the contractions and they didn’t love that. They were like, “How much have you eaten and drank today?” And I hadn’t. I was super slammed at work. Obviously, with COVID, I am a PA. I am a healthcare provider, so COVID was just so stressful for many reasons, but just mentally stressful of everything was going on.

So they said, “Why don’t you come back later so we can just take a listen again?” And so, I drank a bunch, and ate a bunch, and came back later and they were reassured by that. I got to my due date and I was just doing all the things. I was exercising and going on walks, doing squats. I was drinking red raspberry leaf tea. I had been doing dates for weeks in advance. And again, just really trying to prep my mind more than anything. I kept thinking, “If I am so stressed at work, baby is not going to come when I’m stressed. So I need to do everything possible to reduce stress.”

And so, I had decided that week that no matter what, this week was going to be my last week of work. The following week, I was going to be 41 weeks and I’m like, “I just need to not have so much stress.” And so again, that week I had a couple days where I would get some contractions and they would fizzle out. I thought, “Okay. It’s going to happen. Everything that my body is doing, is doing something.” I just need to be happy that it’s doing something.

My last day of work was Thursday and while I was at work, I was, again, having some of those contractions, but I did not think anything of it. This was the day past my due date. I was 40+1. I was having some contractions on and off, but obviously, I was working, so it wasn’t a big deal. It wasn’t enough to make me stop or really even think that much about it. I literally joked with my coworker like, “I bet since this is my last day of work, when I leave today, I’m going to have this baby.”

I got home at around 6:00 p.m. that night. I walked in the door and I had a contraction that was different. I was like, “That was different.” I sat down at dinner with my husband and my kids. I was noticing, but I didn’t want to say anything quite yet. But I knew it was different. We got the kids to bed and I told my husband, “I think this is it, so let’s start gathering some things.” He’s like, “Don’t you want to actually know if this is it?” I am like, “No. I really think this is it.” He did not understand how you can just know.

Meagan: I swear they never believe. You’re like, “Are you sure?” I am like, “Yeah. I am positive.”

Alysa: Exactly. So right after, I called my midwife and she is like, “Great. Just let things get longer, stronger, closer together. Keep doing your thing.” I went to the bathroom and definitely had more of that bloody show, so I was really encouraged that this was it. So I was like full-on, just packing, getting everything ready, getting all this, and, like I said, this was probably 7:30, 8:00 p.m. Around 8, I finally got everything I wanted together, so I decided, “I’m going to rest.” I laid down on the couch and I told my husband, “Use this contraction timer app. I will tap you,” just so we’d know what was going on.

As soon as I attempted to lay my head on the pillow on my couch, pop. Like, just a major pop. Water gush. I hopped off the couch like a ninja because I did not want to get my couch all messy.

Meagan: You wanted to save it. I would have done the same thing.

Alysa: Yes, exactly. I went into the bathroom and jumped in the tub. It was definitely a lot of water. But the water was-- it did have some meconium in it. It was kind of yellowish. And so, that was the first time I was stressed. Prior to that, I was like, “Everything is exactly how it should be going,” and I felt like I was really handling things well, but then I felt stressed.

I called my midwife right away and I told her what was going on and I was like, “Honestly, I am just really stressed out.” All she said to me was, “Okay. I am not stressed out.” It was just perfect. Her response was perfect.

Meagan: Exactly what you needed.

Alysa: Yes. Yes. And you know, she has had a couple of lines like that through my pregnancy. One other time, I broke down to her about how I felt like there was no way everything was going to go right. I felt like there was no way. Was I being irresponsible with having an out-of-hospital birth after the last birth I had? You know, all these things. All these fears we all have. She just said, “I wouldn’t absolutely love my job, I wouldn’t love doing what I do every single day if I had fear. I have no fear when it comes to you and I love doing my job. And so, we wouldn’t be here and we wouldn’t have you as a patient if anything about you made us afraid.” It was just wonderful. So, she is wonderful.

But back to that night. So since my water broke, we decided to call over a friend so that if we needed to leave quickly, we could. My parents were on their way down too. They live about a couple of hours away. They came over and I was just swaying through the contractions. I was handling things really well. I felt really good. It was really great to be able to. I had really wanted to experience that because I really didn’t get that with my other births.

And so, yeah. I would rock and sway through the contractions. I remember right before we left I went upstairs and my kids were sleeping, and I just checked on both of them and then had a contraction right in their bedroom. It was just, yeah. It was great. I walked outside just to get some fresh air. It was the most beautiful night. It was probably 75°, stars in the sky. It was beautiful. We went through some contractions outside too and then we decided, I decided, “I want to go.” I think at that point, contractions were probably three to four minutes apart and getting close to that one minute but I am like, “I don’t-- I have heard horror stories about the car and so, the sooner we can get there, I think I will feel better.”

Everyone is right about the car. The car was so tough because there’s just no way to get comfortable, but like, again from your podcast, it was so helpful to hear from different people what they had done and I did just that. I got on my knees and I faced backward in the passenger seat because being on your bottom is not fun when you’re having a contraction.

Meagan: No.

Alysa: We got to the birth center and we walked outside for just a little bit more before even going in. I think that was my biggest thing is I just didn’t want to pull everyone together too quickly or something. I didn’t want to waste our time or something. Again, that goes back to me not wanting to be a needy patient or something, which is silly in hindsight. But, I wanted it to be right when we got there. So we walked outside before we actually went in for a little while and then a few more, and then I thought, “Okay. I really need to pee. We have got to get in there. Let’s do this.”

We got in there. My midwife was there. A student-midwife was there and then I had a birth photographer who is also a doula. She wasn’t technically acting as my doula, but she also said, “I am a doula, so anything I can help with along the way if you would like me to, I will.” And so, that was wonderful. So I didn’t really need someone to be super hands-on. My husband was really good about that. Plus, I didn’t really need that a lot in labor and in birth, but she was just wonderful support in other ways.

So, yeah. We got to the birth center. They checked baby and everything was good. This was a surprise, also. I did not know if “he” was “he” at the time. So we got into the birth center-- let me look at my notes here. I think that was at 10, 10:30, yeah. We got in at 10:30. Everything was good and they just let you be, which was again, so incredibly different than, obviously, my other experiences in the hospital. They were just like, “You’re doing great. You keep doing your thing. Everything is looking really great.” And so, we just continued to labor.

We walked around the birth center. I would squat with contractions and sway with contractions and overall, I felt like I was coping really, really well. There was that one point where I knew based on the way I was feeling and where the contractions were at, I knew I had to be pretty far along, but I also doubted myself for a second. I thought, “There’s no way that I can be doing this well. I am not strong enough. There’s no way. There is no way. I am probably 3 centimeters. I don’t know.” They didn’t check me. They didn’t say they needed to check me and I didn’t want to be checked at that time, so we just didn’t. We decided to forego that. But then I am like, “No. I really do think this is going exactly the way it should go.”

I talked to my doula a little bit about what I should be doing, like if I should be trying to push things along and doing a bunch of squats, or lunges, or different things, or if I should try to rest and she was like, “If you feel like you can rest, you should rest.” So I laid down for maybe five minutes and then I wasn’t loving that. But she just really reminded me too, during contractions, just to really relax my pelvic floor as much as possible, so during contractions then, that was exactly what I would do, which is a really odd feeling because most of us as women are used to holding that in. You know, like with coughing, or sneezing, or things like that, or keeping that tight for different reasons.

Yeah, so truly just letting the floor feel loose was crazy. But it was also-- this is another thing that I can totally speak for the exercise program that I referred to before, Expecting and Empowered, is every single one of their-- you do three different exercises a week, or days a week that you were supposed to do their program, and they always have pelvic floor exercises. They helped me so much be able to actually target those muscles during birth which was awesome.

I did that a lot and I had music playing. You know, just some Christian music that I love, worship music playing, which was really wonderful. I remember things were getting pretty intense and I had these cards that just had different scripture on them. I remember reading through those right before things got really intense. It was just what I needed at that time to really feel like, “No. You can do this.” One of my favorite ones about, “Pain may endure for the night, but joy comes in the morning” and I just remember thinking like, “That’s where I am in right now and so soon I’m going to meet this baby and there’s going to be so much joy.”

My midwife came back in. They watched me have a couple of contractions where I was definitely vocalizing through the contractions and they were definitely intense. They said, “I think it would be a good time to get into the tub.” My husband tells me later that he literally thought they were crazy. He was like, “Why are we getting in the tub? We have like 6 to 12 more hours of this.” He, of course, is thinking of our first birth and again, also thinks there’s no way this can go as fast as it’s going.

So I get into the tub and that was-- I got into the tub and I was only in the tub for about 20 minutes until he was born, actually. But I got into the tub. Everyone asks me if the tub was helpful and I think it was. The hard part to tell-- the reason I say I think it was is because it was hard to sometimes tell if the water was super helpful because at the same time they were by far the most intense contractions. I mean, transition is. And so, while I was in the tub, I very much felt out of control. It was very much the first time where I was like, “I could crawl out of my skin.”

Meagan: Some people say if you are in there before the transition hits, it is more manageable, but man, I would be with you. I was in the tub and I was like, “I just need to move.”

Julie: And I loved the tub. I loved it. My whole labor was in the tub. Birthed in the tub, all of it. It’s so funny how it’s so different for everybody.

Alysa: Yeah. Well, and I think if I had another, I would probably get into the tub sooner. I think I didn’t want to use it too soon and then it wouldn’t help me or something, but I think I would get into the tub sooner, like you said, Julie. But you know, it was that moment where I said, “I can’t do this.” I was like, I told my husband, I am like, “Joe, I don’t think I can do this.” He was like, “You’re doing this.” I remember having a very vivid thought in my head like, “Alysa, the only way is through. This is it. There’s no going back. There’s no changing where I’m at right now and so, just try to lean into that.”

My doula, like I said, was also taking pictures, but she saw me again have a very intense contraction. My midwives had left. I mean, they were literally outside the door, but they were like, “You know what? I am going to go grab the midwives,” my doula said. Of course, they just know. They have done this so many times. They have seen so much unmedicated birth that they just-- they know. They came back in and my midwife was like, “You’re going to meet your baby so soon,” and seriously, I still was in complete disbelief that this was actually happening and the way everything had gone.

I did get pretty nauseous at one point and I thought I was going to throw up. I did that with my son with my first birth, but I didn’t throw up. They had peppermint oil and I was able to work through that. I’m glad I didn’t throw up, but that’s a pretty normal feeling, I think.

And then, the craziest feeling I’ve ever had in my entire life is when my body started pushing. I say that I had no part, zero part in pushing my baby out. My body completely took over. All I can say, like the way I have described it to people is that it literally felt like a vice had a hold of my insides and was rocketing something out of my vagina. It was the craziest feeling I have ever felt and it was both an intense-amazing, but also a scary, out-of-control feeling. But yes, the fetal-ejection reflex was insane. When my body started pushing, I was like, “I am pushing,” and I screamed louder than I have ever screamed. My throat was literally sore from just like letting out this unbelievable roar. I remember I pushed. I had a little bit of a break and I was like, “I’m sorry for being so loud.”

My midwife was like, “Don’t ever be sorry. Just think about tennis players like Serena Williams, Venus Williams, they roar when they are doing their sport. You roar.”

Meagan: I love that.

Alysa: I was grateful for her, yeah. But yes, two big pushes, like I said, which were completely my body pushing in two minutes. I started pushing at 12:29 a.m. I was 40+3 and at 12:31, he was born. His head came out and I said, “Come and get him out. Get him out. Get him out. Get him out,” and then the rest of his body came out and he came right up on my chest. It was incredible.

My husband was right there next to me. I looked over at him and I just kept saying, “I can’t believe I just did that.” I had visualized my birth so much over the previous 10 months, but especially in the last month leading up to my birth, and the fact that it had gone so much of the way I had visualized was-- I mean, I felt so grateful. But also, I think it was telling that that was helpful. Not that that happens for everyone, obviously. I know full well things don’t always go as planned or as you want them to, but in this case, it really did. I was just overwhelmed. Overwhelmed with joy and gratefulness.

We were just hanging out a little bit and my husband again later tells me that he was like, “Are we going to find out if it’s a boy or a girl?” because I was just so wrapped up in what had happened, and snuggling this new baby, and I didn’t even care. I was like, “I don’t even care.” I didn’t even think of whether he was a boy or a girl. But yes, we took a look and he was a little boy. 6 pounds 1 ounce which also, I was like, “What in the world? He is so tiny.” He was smaller than my other two and I had carried him three weeks longer than any of my other kids.

Meagan: Crazy.

Alysa: It just shows how crazy that is. But my little peanut, Silas Cecil was born on August 14th. It was just so cool. The birth center experience was just so amazing, being able to chill there and truly have that golden hour of hanging out with him, and looking him over, and then getting out and just snuggling in bed, and then they just let us be for a while. Then, they came back and did all of the checks and measurements right there, right on the bed.

It literally felt like family was around me and it was so wonderful. So much so that I-- you know, I still follow the social media pages of the birth center that I was at, and whenever I see women who are close to their due date, or in labor, or whatever, I almost have this like-- I am jealous of them in a way. I know that sounds crazy, but just because I know they are about to experience something, yes, hard, but really amazing.

I felt like after my first, and not that either of my first births were horrible or traumatic. I am so grateful for, especially with my second birth, the medicine that was there that really, truly in years past-- well, decades, centuries past, we could have not lived through, so I am grateful for those advances. But just to be able to experience the beauty of truly no interventions was so awesome and I am just so grateful.

Julie: That’s incredible. There are parts of your stories that I can really relate to. I really love when you said when you got past the point of your longest pregnancy, you were so excited to be pregnant that long because you had never made it to that point. With my first VBAC baby, I was like that.

My first was born via Cesarean at 36 weeks on the dot and when I got to 36 weeks and 1 day, I almost let out a breath, like, released air. Like, “Okay. I made it. We can do this. I am good now.” I am like, “I have never been this pregnant before. This is so cool.” People would ask me, “How are you feeling? Are you just so miserable?” And I am 39 weeks pregnant-- well, I didn’t quite make it to 39 that time, but I was 38 weeks pregnant, waddling around, and I’d be like, “No. I am just so happy to still be pregnant,” and people just looked at me so strange.

Alysa: Yep.

Julie: It’s just really funny what perspective you have when you have dealt with or been through a birth with complications. Every single milestone you hit, like you said, gives you another release of air.

Alysa: It does.

Julie: Until all of the things are gone and you can just enter into your birth space worry-free and without any other type of concerns. So I was totally right there with you when you were talking about that.

Alysa: Yeah, it was. I feel the exact same way.

Placenta Previa and Accreta

Meagan: So Alyssa had placenta previa. Placenta previa is-- I don’t know if anyone has ever had this, too. I am going to backtrack even more. At the 20-week ultrasound, one of the things they look at is where the placenta is lying. If you have ever heard about a low-lying placenta, it’s likely that they are looking at where it is in conjunction with your cervix.

Sometimes the placenta attaches low by the cervix and sometimes it even attaches over the cervix. Which, the cervix has to open, and dilate, and efface in order to get a baby out vaginally. So if you can understand what that means if it’s covering the cervix, you know, this is our baby’s home, and how they breathe and eat, and everything. And so, if it is covering the cervix, it is a true need for a Cesarean because they cannot deliver a baby through a cervix that is covered with a placenta.

Sometimes when it is low, it’s low, but it’s not covering the cervix quite yet or it’s really, really close. But then as pregnancy continues, and the uterus grows and stretches, and the baby grows, it goes up with the uterus. That happens a lot of the time, in fact, most of the time, but once in a while, like Alysa‘s case, it did not. She had accreta.

She mentioned bleeding and that’s one of the number-one signs that there are accreta issues. If you have ever experienced anything where you are experiencing blood like that or things like that, don’t hesitate to go in immediately and get things checked out. I’m so proud of you, Alysa, that you were able to keep that baby in nice, safe, and sound until your goal because that is hard work and it’s amazing. So, congrats on that.

And then, so there is previa and then there is accreta. Julie, you may have to help me out because you are the statistic guru. But accreta is when it is actually, it is partially in and grown into the scar of the uterus--

Julie: The uterus. It doesn’t have anything to do with the scar.

Meagan: That’s true. It’s not the scar. It is just in the uterus. It has grown in, sorry. Cesarean moms have a higher risk of it because we have had cuts. So that is where my mind is going.

But, yeah. It grows into it. That can be very, very dangerous as well. Do you know the stats, Julie, on how many people get accreta? Just stats?

Julie: Yeah, I actually have some information up right here on my computer right now. I want to direct you guys to a really good foundation called The National Accreta Foundation and its website is preventaccreta.org. It’s spelled a-c-c-r-e-t-a, accreta. Preventaccreta.org and their whole mission is to reduce the Cesarean rate, which in turn, reduces the chance of having accreta.

And so, it goes over a lot about the statistics about Cesareans. 87% of women that had a Cesarean will go on and have a repeat Cesarean which increases the risks for placenta accreta in future pregnancies. Now, 1 in 272 births will develop placenta accreta. Placenta accreta ranges in severity. It can be just barely growing into the uterine lining and in the most severe cases, it actually can grow through the uterus, and outside of the uterus, and start attaching to other organs, which is when it is very, very dangerous. The cases of a placenta accreta have actually quadrupled since the 1980s, which is really interesting because you can see the rates of accreta increase right along with the Cesarean rate as the Cesarean rate rises.

Meagan: Cesarean rates, mhmm.

Julie: Right. In 1980, it was 1 in 1200 pregnancies that had accreta, and in 2016, 1 in 272. So quite a big difference.

Alysa: I know that the risk of previa after a Cesarean is 1 to 6 times higher and the reason, like you said, is exactly right, Maegan. Because of that scar, no matter where the scar is, almost all Cesarean scars are lower or closer to the cervix.

Meagan: Right, the cervix.

Alysa: And so, when the placenta first wants to place itself somewhere in the uterus, it tends to want to go to that spot where that scar is. Normally the placenta, the best place is to be far away from the cervix because that’s where the best blood supply is. And so, when it’s down there, it’s not a great place for the placenta to be in general, but also yes, like you said, as the cervix changes and stretches throughout pregnancy, that’s where that risk of bleeds goes up, too.

Julie: Well, and I have a source from ICAN right here. We have a little graphic that we made on the risks of C-section with each Cesarean. Your risk of placenta accreta after your first C-section is .24%, so 1 in 417. Just listen to these numbers. They increase exponentially. Instead of saying one-in-so-many, I’m just going to say percentage, okay? Just for full transparency.

After your first C-section, your risk of accreta is .24%. After your second C-section, your risk of accreta is .31%. Not too big of a jump there, .24% to .31%. Your third C-section, it doubles to .57%, so half a percent, which is actually bigger than your chance of rupture I will say there. But by the time you have your fourth Cesarean, your risk of having placenta accreta is 2.13%. 1 in 41 people who have four or more Cesareans will have placenta accreta.

Meagan: Pretty wild.

Julie: Which it obviously necessitates, makes necessary-- it is necessary to have another C-section because it is not safe to deliver vaginally at that point. It is not safe for you just to contract at that point, so you are at a higher risk because of that, just because of having that major surgery. But also, it’s a big risk for the mom and the baby. A big increase in postpartum hemorrhage for mother, higher instances of loss of life for mother and loss of infant life as well with those.

And so, when you are considering VBAC versus repeat Cesarean, look into the complications that come with each subsequent Cesareans. Now, some providers will say, “Oh, I don’t do VBAC, but I am only going to let you have four Cesareans because it is dangerous to have more than that.” But then there are some providers-- I know one in our state who told a friend of mine, “Oh yeah, I am not worried about your family size. I have done eight Cesareans on someone before.” I am like, “Eight Cesareans?” My jaw hit the floor. I just can’t even imagine. I can’t even imagine.

Meagan: Well, and something too that I just want to point out to you is, a lot of the times providers won’t do VBAC because of the “risks”, right? But when you say, “Well, what are the risks of Cesareans?” They’re, “Oh, there are no risks.” Just this right here alone with each pregnancy, because this can happen with pregnancy, right?

And so, then it can cause issues. I mean, look at what was happening with Alysa. She had to fight to keep her baby in. Just keep in mind that it happens and there are risks. If a provider-- (dog growling) oh my gosh. My dog really wants the mailman driving around out there. There really are risks associated with both. And so, f you ever have a provider that says there are no risks for a VBAC and there are no risks for a Cesarean, then maybe question them a little bit.

Julie: Well, and I think a big part of that is the biggest risks that providers will see with a Cesarean is when they are doing the Cesarean which is your increased risk of blood loss, right? You will need a blood transfusion. But they see the immediate consequences of a Cesarean which aren’t as significant as the long-term effects of having multiple Cesareans.

Alysa: Correct, yeah.

Julie: And so, you have a provider that sees you and he does your Cesarean, but then you might have another provider for your next pregnancy that you get accreta and your provider that did your C-section might never even know you developed accreta. And so, why would they not be afraid to do eight Cesareans? Because they don’t see the long-term consequences that come with that. I’m sure they’re educated in that. I am sure they learned it in OB school, but when it’s not right in front of your face, it’s harder to keep that in the forefront of your mind.

Alysa: Absolutely.

Meagan: Well, thank you so much for sharing your story with us and letting us talk about this topic on your story because it’s important to know the differences. It’s important to know the risks. We are so happy for you that you got the birth that you wanted and you deserved. I mean really, you had a very medicalized, and then you had a necessary Cesarean, and then you had an unmedicated VBAC, and so you have a little bit of everything. It’s fun to hear your story and hear that not every birth is alike.

This is one thing that I mention to my clients. People are like, “Oh, I really want to deliver at home, but because it’s my first, I want to see how things go.” I always just think to myself, “Go where you feel most comfortable.”

Julie: “Just in case”

Meagan: Go where you feel most comfortable and where you can picture that birth because just because it’s your first birth doesn’t mean it will likely be different for your second, third, fourth, fifth, sixth, eighth, you know?

Alysa: Yes. Yes.

Meagan: Your story right there is a prime example of how different each birth can go.

Alysa: Yes. I want to say to that too, like, I would encourage anyone who wants something, don’t be afraid if you want something. I have had friends who were like, “I could never do that. I could never have an unmedicated birth,” and I am like, “You know, you could, but you have to want to.”

Meagan: Exactly.

Alysa: That’s the only difference between me and you. I am not anyone special. But if you want to and you feel like you want to, then do it. I think, maybe it was you guys who said it or I heard it somewhere else, you would never walk up to the start of a marathon having never trained and just being like, “Let’s see how this goes.”

Meagan: Let’s do it, yeah.

Alysa: And if you think it’s something you might want to do, you can do it. Just surround yourself with the people, and the knowledge, and the resources, like you guys, to accomplish those goals. I mean, it’s okay to want that and that doesn’t make you-- yeah. It’s okay to want that.

Meagan: It doesn’t make you crazy. It doesn’t make you unrealistic. It doesn’t make you selfish to desire something different. It does not. So, I love it. I love that you went out and you got that something different and I love that it was all the good things, so thank you again.

Julie: Absolutely.

Alysa: Thank you guys so much.

Closing

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