My 20 week ultrasound revealed that the cord insertion into the placenta is very near the edge of the placenta and there are large blood vessels near the cervix. None definitely cross the cervix, so vasa previa is not diagnosed at this time. (Vasa previa is similar to placenta previa, but it's blood vessels crossing the cervix rather than the placenta lying over it.) The radiologist recommended a follow-up u/s in a few weeks to see if they have moved away from the cervix. (I have already googled vasa previa and visited the International Vasa Previa Foundation website, as well as looked at the Wikipedia entry about it.)
My plan is to talk to my midwife at my next appointment before seeing my Kaiser Permanente provider (I'm seeking parallel care with plans of a home birth (if there are no complications), which KP doesn't recommend or cover) to get her recommendations and discuss our options. My concern is that the KP OBs will try to insist on a repeat c/s (would be my third), even if vasa previa really isn't an issue.
Has anyone experienced a situation similar, either with a true vasa previa or the threat of it? How did you prepare your self mentally and emotionally, especially if you were trying to avoid a c/s or repeat c/s? Are there any other resources that you know of and would recommend on the subject?
TIA!
Here are the SOGC guidelines for a vasa previa.
http://www.sogc.org/guidelines/documents/gui231CPG0908.pdf
I have not BTDT personally. But since you are relatively early in your pregnancy you could probably monitor with repeat ultrasounds to watch the placement of the vasa previa and your placenta. However, if there is any bleeding or indication that your placenta/previa is content where it is, you will most likely need to either have your baby in a hospital where s/he can be monitored closely or have a c-section.
Sorry.
Me - 29 DH- 31
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On Monday I had an u/s with a KP perinatalogist and things have moved up and away a bit. We're 2 cm from the cervix and have NO blood vessels crossing the cervix. My midwife is, well, not really concerned about any problems occurring during birth, so we are continuing with our HBA2C plans.
She actually pointed out something that I missed in the peri's typed handout to me to give to my midwife: the peri was more focused on the "up to 5%" risk of uterine rupture in her description of my "condition" than on the velamentous cord insertion. (And 5% is 2-3 times higher than any study on VBA2C than I have ever seen.) She mentioned the VCI, but went on to focus more on the rupture risk. She also recommended that a c/s be done at 34-36 weeks, which my midwife thought was way pushing it. So do I. I understand that with vasa previa they don't want you to go into labor AT ALL or even dilate, since that can cause the blood vessels that are crossing the cervix to rupture. But in my case, there is only a risk that the vessels could rupture when the amniotic sac ruptures, and only IF they tear up to the vessels ("about" a 5% chance, according to the peri). I cannot find any studies confirming this, but I really don't know where to look, either. VCI is rather rare, so it seems hard to get statistical data. I've found mostly stories.
At this point, we are comfortable and feel led to continue on track with our plans. For me, it's a matter of trust God alone, or trust God and the doctors. I think I'll trust the one who made me. :-)
I just saw this - I agree with your midwife - as long as you guys are careful and watching baby very carefully after membranes rupture, you should be ok. You definitely want to avoid artificially rupturing the membranes though! Which should be super easy to do in a homebirth. Good luck!! I'll say a little prayer for you!
Susan - 30 married to Chris - 32
Catherine Anne born via c-section June 30, 2008
Rebecca Marie born naturally April 18, 2010
John McNary born naturally January 9, 2012
I hope I don't come off too harsh here but I really want to comment.
No offense at all to midwives, but they are NOT experts in cord insertion issues or vasa previa risks. Vasa previa is extremely rare. To the point where many OB/GYNs might only see it once or twice in their career. It is also extremely difficult to truly diagnose vasa previa via ultrasound - which is why it has such a high mortality rate. Because even with color dopplar trans-vaginal ultrasounds there really isn't a way to look into the uterus and know exactly what is going on.
If your vessels are close to the cervix or there is any chance of complications I would not risk it. Even if the risk is "only" 5%, that is 1 in 20. If someone told you there was a 1/20 chance of you getting into a fatal car accident tomorrow I doubt you would drive. It is too risky.
One of my dear friends lost her son due to vasa previa almost 2 years ago. It was HORRIBLE. A c section would have saved his life. She was very faithful and religious but unfortunately that wasnt' enough to save her son. God gave you this information. Deciding to ignore it and go forward is YOUR choice - not "God's will". I personally think you are putting your baby at tremendous risk and cannot understand why. I get the iimportance of "birth experience" but not at the detriment to your child's survival.
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My daughter was concieved thanks to IVF with ICSI. She was born at 35w4d due to pPROM.
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Kate's twin - 10w1d - 2009 ~*~*~*~*~*~ Missed Miscarriage - 10w4d - 2007
I'll comment here as I think you really need to weigh your options and go with safety first. About 11 years ago in our area the big news story was about a woman that died along with her child during a home birth. She had been DX with Vasa Previa and was convinced that everything would move to where it should so she stopped her prenatal visits found a midwife from another state and did not inform them of the concern. In the end it was determined that even in a hospital had she gone with a natural birth by her insistence both would have been lost. Keep up with your recommended diagnostics and trust the Drs.
David Jude
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Ditto Oceanview.
Be careful, please.
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I've already weighed both sets of risks - hospital c/s and home birth, and home birth still wins in my mind. There is NO risk to my health with the VCI, and my midwife is a very experienced CNM. I am to the point that I trust her opinion more than the OBs, because they have been pushing me for a c/s since my first visit to them - simply because I've already had 2 c/s. I have read more than enough statistics and stories of successful VBAMCs and HBAMCs to know that for me, this is my best choice.
We do not know how many more children we will have, and I'd like the best possible chance to have the subsequent children vaginally, rather than surgically.
One reason I have come to respect my midwife more than the OBs is that she has ALWAYS asked my permission before doing something or my opinion before giving her own. On Thursday after we discussed what the OB/Peri recommended, she asked me, "How do you feel about this?", before saying anything about what she thought. The drs I have been working with have not done that. She has also respected my choices without harassment or patronization, again, something the KP OB department has not done (when I refused a 16 wk GTT because of my weight, which had not been ordered for either of my first two pgs when I weighed MORE than I did at the start of this pg, I was badgered by the nurse until my DH had to step in, and then I had to "explain myself" to the OB too).
I completely understand the risk of uterine rupture, but the risks of the c/s are far greater and frighten me far more than the risk of UR.
I appreciate the concern that has been expressed. Thank you. Please understand that for me, this is the right choice. I understand and acknowledge that this decision may not be the one that others might choose, were they in my situation.
I also very much appreciate the support that I have received for my decision from people here and on some of the Facebook forums that I keep track of. It has been affirming to me that I can do this, and that I'm not "out of my mind" for considering it and going forward with it. If something changes for the worse, we will change our plans as needed.
Thank you again.
From what I am reading here, it isn't the uterine rupture risk that your peri is worried about, it is the vasa previa (if your water breaks and the vessels tear) risk that is the highest.
What kind of monitoring are you having for the vasa previa? Because my friend (who did not have a happy ending) had been monitored very carefully by a peri her whole pregnancy and they never saw the vessels near her cervix. And she was having an ultrasound every week. When her water broke (naturally) her son bled to death. And she would have died herself had she not had a surgeon standing right there to save her. Her son was born by crash c-section in 8 minutes (after her water broke they saw the blood and rushed her immediately into surgery).
She considers herself lucky that her water didn't break on it's own when she was just out and about in public.
I am just shocked that with all of this information you are still risking your child's life. Future children shouldn't be your main concern right now. THIS baby should be your main concern.
oceanview: From what I am reading here, it isn't the uterine rupture risk that your peri is worried about, it is the vasa previa (if your water breaks and the vessels tear) risk that is the highest.
Exactly. I don't think anyone is urging you to rethink your plans due to previous c-sections. After re-reading all of your posts (OP), it's the previa they're worried about--and rightly so.
oceanview: I am just shocked that with all of this information you are still risking your child's life. Future children shouldn't be your main concern right now. THIS baby should be your main concern.
I was glancing through this thread the other day and couldn't believe what I was reading. During a slow-moment at work, I showed a floating Peri this thread and she couldn't believe what she was reading either. As others have said, vasa previa is extremely dangerous because it cannot be reliably evaluated by any of the usual OB evaluation means (sonograms, dopplers, labs, ect.).
I applaud you for sticking to your guns and going for a homebirth, but in this specific case I don't think you're making a wise decision. After all, as others have posted, it's not the minimal uterine rupture risk that's cause for concern. It's the very real possibility that you and/or your baby can bleed to death before any kind of intervention would assist in saving you and/or your baby.
I hope you'll reconsider more in-depth research and possibly gaining a few more medical opinions re: vaginal delivery and VP before you jump into this relatively blind. This really isn't an issue that should be tackled with a closed mind and faith.
Yup. I'm concerned for you and your baby. I'll leave it at that. Good luck to you.
Ok, I frankly was trusting your midwife's advice, but after reading the other posts, it got me thinking - what are the real actual risks once your water breaks? I would be talking to multiple providers and looking for research on the issue. It's definitely something to think about. I applaud you in going for your HBA2C, but... in the end you've got to be sure you're making the right decision for this pregnancy. C-sections suck, trust me, I know and I would never advise you to just get one for no good reason. But they can also be lifesaving procedures for mama and/or baby. This may be one of them. Or it may not be. Just be sure you do your research.
KT1280: One reason I have come to respect my midwife more than the OBs is that she has ALWAYS asked my permission before doing something or my opinion before giving her own. On Thursday after we discussed what the OB/Peri recommended, she asked me, "How do you feel about this?", before saying anything about what she thought. The drs I have been working with have not done that. She has also respected my choices without harassment or patronization, again, something the KP OB department has not done (when I refused a 16 wk GTT because of my weight, which had not been ordered for either of my first two pgs when I weighed MORE than I did at the start of this pg, I was badgered by the nurse until my DH had to step in, and then I had to "explain myself" to the OB too).
I normally NEVER comment in threads of this nature because well I'm not a doctor and don't feel it's my place to make "medical recommendations". Also this is a very personal choice and I don't feel right about telling someone what they need to do or how they should feel.
However this thread really struck me and I feel compelled to chime in. I totally understand why you wrote this statement, I think a lot of us on here have felt this way toward traditional medical practices and OBs. I get why you respect your midwife more because she cares about how you feel and asks your permission. BUT that in no way makes her an expert on the medical condition you may be facing.
I know at this time you've made it perfectly clear that you've made up you mind unless something changes, but I really hope you'll consider the idea of maybe just getting a second opinion. Do more research, read as much as you can.
I seems the general consensus is that everyone here truly cares about the health of you and your baby and don't want to see anything bad happen. I'll pray that God will give you and your family the wisdom to make the best choice for you.
Adrianne (34) DH (34) =
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Adriannenash: KT1280: One reason I have come to respect my midwife more than the OBs is that she has ALWAYS asked my permission before doing something or my opinion before giving her own. On Thursday after we discussed what the OB/Peri recommended, she asked me, "How do you feel about this?", before saying anything about what she thought. The drs I have been working with have not done that. She has also respected my choices without harassment or patronization, again, something the KP OB department has not done (when I refused a 16 wk GTT because of my weight, which had not been ordered for either of my first two pgs when I weighed MORE than I did at the start of this pg, I was badgered by the nurse until my DH had to step in, and then I had to "explain myself" to the OB too). I normally NEVER comment in threads of this nature because well I'm not a doctor and don't feel it's my place to make "medical recommendations". Also this is a very personal choice and I don't feel right about telling someone what they need to do or how they should feel. However this thread really struck me and I feel compelled to chime in. I totally understand why you wrote this statement, I think a lot of us on here have felt this way toward traditional medical practices and OBs. I get why you respect your midwife more because she cares about how you feel and asks your permission. BUT that in no way makes her an expert on the medical condition you may be facing.
I agree with this and with getting a second opinion. There are perinatologists out there that will give you the warm fuzzies. I had two high risk pregnancies back-to-back and my peri was incredibly warm, receptive, and attentive. I had his home number, his cell number, and we are Facebook friends. I always felt like I had his undivided attention.
I also knew he was brilliant and an expert in my condition. Midwives run the gammot in terms of their education. And honestly, I have met several medical professionals in the baby care field who haven't heard of vasa previa (let alone treated it). My best friend is an OB and when my girlfriend's son died due to VP she was the one who explained how rare VP is and how she would have to definitely pull out her journals and confer with colleagues if she had a patient with that dx.
You are INCREDIBLY and MIRACULOUSLY lucky that they actually see those vessels. Put your faith right in that knowledge. God has given you the gift of KNOWING. Most women with vasa previa don't - and don't have the gift of being able to make a clear and safe decision. I KNOW that my friend would have done a scheduled c-section if she had known her dx before she went into labor. She probably would have done it at 35 weeks (which is typically when they do c-sections for vp babies).
I agree with both of the above posters.
I URGE you to not dig your heels in and write off this wonderful advice you have been given because "those strangers don't know me". Please seek another opinion.
me:38 him:37 (DS20, stepDS 16, DD14, DD11)
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I'm going to agree with the other posters and I will also chime in that it concerns me that your midwife is being so cavalier with your life and that of your unborn baby. In a situation like this my midwife would immediately transfer me to the care of an OB who was experienced in this sort of thing. It is one of the items that we as patients sign off on when we agree to be a patient at our midwife clinic.
Claire (Me) - 36DH - 38DD - 15 monthsDCat - Molly
Married the love of my life July 7, 2007 (he wanted a date we could never forget ;-)
TTC #2Beta 22 dpo? - 6245
September 12, 2011 10 wks, baby stopped growing at 7 wks 2 days http://tcoyf.com/members/kitcat75/pccharts/13.aspx
January 18, 2012 at 12 weeks 2 days, baby stopped growing at 6 wks 5 days http://tcoyf.com/members/kitcat75/pccharts/15.aspx
Has anyone heard from the OP?
My son is an undiagnosed Vasa Previa survivor. We're exceptionally lucky; I had a crash c-section and he was born alive (thank God). Honestly, I feel that the possibility of VP is so incredibly deadly serious that, at this point, a VBAC should be the least of your concerns. I'm just thankful that it was (possibly) diagnosed in your pregnancy prior to delivery. My case was not, and I got lucky. If you read the stories on ivpf.org, you'll find that stories such as mine are far too rare. Most undiagnosed cases sadly end in stillbirth.
There are far too many babies lost to vasa previa. VP deaths are entirely preventable with proper management (the current recommendations are on the International Vasa Previa Foundation 's website). This is a situation in which you have the chance to properly manage a very dangerous complication. Make the best of that, please.
OP, if you want my full birth story, please message me. I'll be happy to share. I'm not a troll; I'm just very passionate about vasa previa awareness.
Just wondering if there was an update? Seems like the OP should be getting close to delivery.
Me 37, DP 45My Chart