You’re having a baby! Commence the joy…and also the worry. As beautiful as this moment is for so many, it often comes with unique concerns. Carrying to term is your number-one goal, but you may also have certain preferences, like having a vaginal birth over C-section or home birth over a hospital stay, for example. Or maybe you simply have your eye on the prize—a happy, healthy, baby to love—and whatever happens along the way is par for the course. That said, there are a variety of reasons a C-section is recommended at a certain point in a pregnancy, and one of them is due to placenta previa.
What Is Placenta Previa?
If you’ve never stopped to really think about your placenta, it’s actually pretty incredible. The placenta is a sac-like organ that grows in your uterus to supply oxygen and nutrients to your baby via the umbilical cord. As it stretches and grows over pregnancy, it usually moves to the top of the uterus. Placenta previa occurs when the placenta covers all or part of the cervix—the opening to the uterus—blocking the birth canal for vaginal delivery, according to the National Library of Medicine1 . If the placenta moves to the top as expected, the cervix is cleared, resolving the placenta previa and allowing for a vaginal birth.
“We actually don’t know why placenta previa occurs,” says Dr. Robbye McNair, a clinical instructor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine. “Where the placenta attaches is random,” she adds. And whether the placenta grows and moves to the top of the uterus as it should is an uncontrollable aspect of pregnancy. That said, there are a few risk factors for placenta previa, including being 35 and older, having been pregnant several times before, and being pregnant with twins or triplets.
“Ninety percent2 of cases diagnosed in mid-pregnancy resolve by a patient’s due date,” Dr. McNair continues. So the chances of complete placenta previa resolution are indeed high. “The 10 percent that doesn’t resolve will require a C-section,” she says. Close monitoring throughout the pregnancy is important to ensure the safest delivery method possible. The three types of previas—marginal, partial, and complete—are typically diagnosed at the 20-week ultrasound, Dr. McNair says. With marginal and partial placenta previa, only a portion of the cervix is covered. These previas often resolve naturally over the course of the pregnancy. However, if a partial previa does not resolve, vaginal delivery can still cause severe bleeding3 and a C-section is recommended. Complete placenta previa is the diagnosis that most often ends in C-section.
During her 20-week ultrasound appointment for her first child, Jayla Fisk, now a mother of two, noticed the technician taking a lot of measurements throughout the appointment. “She left the exam room to confer with colleagues several times,” Jayla says. At the end of the exam, she and her husband were referred to their midwife for additional information. “Our midwife had a lovely, relaxed attitude. She was clear that it could be a situation that required a C-section for safe delivery, but [that] most previas resolve prior to birth.” The couple was assured they would have plenty of warning if a vaginal delivery wasn't safe.
“I had additional ultrasounds every few weeks to monitor the position of the placenta,” Jayla says. “Our midwife determined it was no longer a risk around 32 weeks, and I had one final ultrasound to confirm at 36 weeks.” Jayla was then cleared for a vaginal delivery.
Complications of Placenta Previa
The reason placenta previa is monitored so closely is because serious complications can arise for both you and the baby, including4 :
Severe bleeding: The most common complication is bleeding that can occur during pregnancy, labor, or delivery.
Premature birth: If bleeding is severe enough, an emergency C-section may be required prior to your pregnancy being full-term.
Anemia, low blood pressure, and shortness of breath: These are all side effects of losing too much blood.
Placenta accreta: This happens when the placenta grows deeply into the wall of the uterus and can also cause severe bleeding at delivery.
Placental abruption: A rare complication from placenta previa, where the placenta separates from the uterus before term, decreasing the supply of oxygen and nutrients to the baby.
For mother of two, Deborah Dwyer, placenta previa was diagnosed in her second pregnancy. “I chose to have an amniocentesis done during my second pregnancy because I was older than 35, and it was discovered at that time, during a 16-week ultrasound,” she recalls. “My doctor saw a lot of blood then, and very gently explained that I might lose the baby.”
From then on, Deborah’s activity was limited to no exercise classes, no travel, and pretty much not being anywhere she couldn’t get to a hospital quickly, she says. “I was tending to my older son one night, and when I stood up, I thought my water had broken,” she says. “But it turned out to be blood!” It was early December, and Deborah wasn’t due until the end of January. “We rushed to the hospital, and they managed to stop the bleeding, but then kept me there to monitor the baby and do another ultrasound.” They discovered that her baby’s lungs weren’t fully ready for a C-section delivery, so she remained on hospital bed rest for nearly a week. Her son was born via C-section in mid-December, six weeks early. “When I first started bleeding,” Deborah says, “I got very scared and began to feel guilty, believing it was surely my fault.” Her provider had predicted a C-section from the start, since she’d had one for her first pregnancy, but assured her that the previa diagnosis and subsequent preterm delivery for her second was not due to anything she had done over the course of her pregnancy.
Deborah’s advice? “Get as much information from your doctor as possible,” she says. Regular ultrasounds should be scheduled to monitor the progress of the growing placenta—and definitely see your doctor if you feel like something still isn’t right well after giving birth.
Dos and Don’ts with Placenta Previa
In general, any type of bleeding during pregnancy should be investigated by your healthcare provider. When it comes to previa, bright red bleeding without pain is the primary symptom, although it is possible to have it with no bleeding, too. Placenta previa is typically diagnosed at 20 weeks via ultrasound, but you should see your provider immediately if you experience any bleeding.
With marginal or partial previa, your doctor may advise bed rest, reducing any strenuous activities, taking a hiatus from sex, and having frequent ultrasounds, according to the Cleveland Clinic. For moderate to severe cases, other treatments may be used, including hospital bed rest, medications to prevent early labor, steroids to help the baby’s lungs develop, or blood transfusions for heavy bleeding.
In Jayla’s experience, she had regular ultrasounds through 32 weeks, and then, when her previa was declared resolved at 36 weeks, she was cleared for a vaginal delivery. For some people, though, placenta previa will not resolve, and you’ll need to have a C-section for the health and safety of you and your baby. (And that’s okay!)
Moving Forward with a Placenta Previa Diagnosis
Getting any kind of diagnosis while pregnant can be a little frightening. That’s why both Deborah and Jayla say it’s important to maintain a healthy mental focus. Jayla suggests doing whatever you need to do to relieve any anxiety about the diagnosis.
“Whether that’s opting for a scheduled C-section right off the bat, or taking a wait-and-see approach like we did,” she adds. To avoid any concerns the second time around, Jayla and her husband opted to deliver their second son at a hospital with a midwifery practice.
“A good relationship with your care providers and access to quality care is key,” advises Dr. McNair. “This helps you get the most information, best care, and quality ultrasounds.”
You know your body best, even in the new frontier that is pregnancy. When you see or feel something out of the ordinary, you should always say something to, and schedule an appointment to see, your care provider. “With placenta previa, as Jayla Fisk puts it, “There’s often nothing to do but monitor it and be grateful for modern medicine!”