As being in labor goes, this time wasn’t so bad. It was the culmination of a smooth and uneventful pregnancy. My baby boy was full term, measuring big, blessedly healthy by all indications. And there was a marathon of The Golden Girls on the hospital TV — so along with my husband, I had the four sauciest seniors in Miami to keep me occupied.
Plus, this wasn’t my first rodeo. This was my third time giving birth, so it wasn’t accompanied by the first-time jitters of going in with zero idea of what was in store. I knew exactly what to expect.
… Or so I thought.
I’d had my epidural and was close to being ready to push. My husband stood by my side as my nurses busied themselves and the room in preparation for bringing my son into the world. But all of a sudden, stationed between my knees and peering into my nether regions, my nurses started murmuring to one another. Whatever they were doing down there, the pace quickened, and I could sense the atmosphere in the room darkening with concern.
I looked at my husband, who was looking at whatever the nurses were looking at. He had a wide-eyed, deer-in-the-headlights expression frozen on his face, with a forced smile that didn’t match the obvious panic in his eyes. I could tell he was trying not to worry me, but the poor guy was doing a terrible job.
“What’s going on?” I asked him nervously. He didn’t answer, just shook his head slightly as if to say I don’t know.
One of my nurses left the room – not quite at a sprint, but quickly enough to indicate that she needed something, or someone, on a fairly urgent basis. The remaining nurse started asking me questions: “During your pregnancy were you ever told anything about having placenta previa, or anything like that?”
I told her no. I’d never had any indication that anything was even slightly amiss; by all accounts, it had been a perfectly normal nine months.
“What’s going on?” I asked my husband again, a bit more frantically this time. Then, when he still couldn’t answer, I practically bellowed my question at the nurse.
“You’ve delivered quite a large chunk of your placenta, which wasn’t supposed to come out yet,” she told me. And as she was telling me this, the other nurse returned with what seemed like an entire team of people, flooding into the room. My panic ramped up. Someone squeezed my upper arm with a gloved hand; I looked, and it wasn’t a hand at all, but a tourniquet.
“I’m a phlebotomist,” said the person tying it, “and I’m going to take some blood samples in case you require a transfusion. Okay?”
A transfusion?! What? “Okay.”
I knew that they were doing everything they could, so I tried to stay as calm as possible. But though I could be calm enough about the risk to myself, I was growing absolutely hysterical with worry for my son. “Is my baby all right?”
“He’s fine,” the nurse assured me. “We’re going to place an electrode on his scalp so we can monitor his heart rate more closely.” She mentioned the possibility of a C-section if he was found to be distressed, in a “we’ll cross that bridge when we come to it” sort of way.
After the initial flurry of activity, things began to calm down – especially when the internal fetal monitoring showed that my son was in no distress, his heart rate strong and constant. I’m not sure what they did to slow or stop my bleeding, but I didn’t end up needing a transfusion, despite the possibility. And it wasn’t long at all before I delivered my baby, all nine pounds, two ounces shooting out so fast that the doctor joked he should’ve brought a catcher’s mitt.
It was a happy ending to a birth story that had gotten kind of scary there at the last.
I later found out that I’d had what’s called a placental abruption. It’s relatively rare; according to the American Pregnancy Association, it only happens in about 1% of pregnancies. As anybody who’s given birth knows, the placenta does have to come out – but in a normal delivery, it comes out after the baby, not before.
In the case of placental abruption, the placenta detaches from the uterine wall, usually in the third trimester of pregnancy (thankfully in my case, I was already in active labor and at the hospital; I didn’t know then just how lucky I was that it happened close enough to delivery to be a minimal threat). Since the placenta is the baby’s method of receiving vital oxygen and nutrients, an abruption puts the baby’s ability to get these things in jeopardy. Cleveland Clinic says that placental abruption “[C]an lead to premature birth, low birth weight, blood loss in the mother, and in rare cases, it can cause the baby’s death.”
I didn’t personally have any of the risk factors for placental abruption, which, according to the Mayo Clinic, are as follows:
– Placental abruption in a previous pregnancy that wasn’t caused by abdominal trauma
– Chronic high blood pressure (hypertension)
– Hypertension-related problems during pregnancy, including preeclampsia, HELLP syndrome or eclampsia
– A fall or other type of blow to the abdomen
– Cocaine use during pregnancy
– Early rupture of membranes, which causes leaking amniotic fluid before the end of pregnancy
– Infection inside of the uterus during pregnancy (chorioamnionitis)
– Being older, especially older than 40
Not only did I not have those risk factors, but I also hadn’t had any symptoms, at least not that I’d noticed — unless my epidural masked anything I might have otherwise felt. March of Dimes states that the main symptom of placental abruption is vaginal bleeding, along with discomfort, tenderness, and abdominal or back pain. But they also note that [s]ometimes, these symptoms may happen without vaginal bleeding because the blood is trapped behind the placenta.”
I can only think of one possibility, and it’s a long shot. My labor was induced — and though that’s generally safe (I’ve had four inductions in total with no obvious issues), WebMD lists placental abruption as a possible complication of induction because the resulting intense contractions can cause the placenta to separate from the uterine wall.
I don’t know if that’s what happened, or if it was just some sort of weird fluke, a wrench my body decided to throw into an otherwise-smooth birth process. But I do know that my baby and I were both extremely fortunate that I was already at the hospital and being monitored when it did.
“It was huge,” my husband later recounted, still aghast, in reference to the piece of placenta that had made its appearance before our son. “I thought you’d, like, pooped out your liver or something.”
No wonder he had that look on his face.