June 20, 2004
Volume 6, Issue 13
Midwifery Today E-News
“Placenta Accreta”
Print Page

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In This Week’s Issue:

Quote of the Week

"Every culture develops rituals around major transformational life events that reinforce the core beliefs of the culture. Our culture's core beliefs relevant to birth are that technology is superior to nature and that women are inferior and untrustworthy."

Henci Goer

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The Art of Midwifery

For turning a baby in posterior position, try having the mom sit in a straight-back chair and keep her feet flat. Have someone kneel in front of her and push straight back right below her kneecaps (they should feel for that little dent). It helps open the pelvis. This one is especially good while laboring.

Susan Mooney, Midwifery Today Forums

ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.

News Flashes

A study examined 3,485 medical records randomly sampled from public hospital clinics, health department clinics, community clinics, private hospital clinics, and physician offices that provided care to at least 50 pregnant welfare-eligible women each year; the aim was to identify an association between providers' compliance with prenatal care guidelines and positive, less-costly birth outcomes—defined as birth weight more than 2500 grams and 36 or more weeks of pregnancy. The study found that the odds of a good outcome were three times as high if women received support services in the form of at least one nutrition, health education, and psychosocial service each trimester.


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Placenta Accreta

Placenta accreta is an abnormally firm attachment of placenta to the uterine wall. Three variants of the condition are recognized. In the most common form, accrete, the placenta is attached directly to the muscle of the uterine wall. This variant accounts for approximately 75 to 78 percent of all cases. In approximately 17 percent of cases, the placenta extends into the uterine muscle and is termed "placenta increta." In the remaining 5 to 7 percent, the placenta attaches through the entire wall of the uterus and is termed "placenta percreta."

The incidence of placenta accrete is fast on the rise primarily due to the dramatic increase in the number of cesarean sections. Any type of uterine surgery increases a mother's risk of developing placenta accrete with subsequent pregnancy, though none more so than cesarean section.

When placenta previa, or a low-lying anterior placenta, is present in a woman who had one previous cesarean section, the risk of placenta accrete is 30 percent. It jumps to 40 percent or more in women who have had more than one previous cesarean section.

Statistics indicate that placenta accreta was a rare occurrence from 1930 to 1950—approximately one case in more than 30,000 deliveries. From 1950 to 1960 the number increased to one in 19,000 and by 1980 to one in 7,000. The most recent information suggests that the incidence has now risen to one in 2,500 deliveries.

Accreta is a potentially fatal complication for the mother due to hemorrhage because blood loss typically ranges from 3000 milliliters to 5000 milliliters. Other potentially fatal complications include disseminating intravascular coagulation (DIC), which can result in death or amputation of lower limbs; transfusion reaction; other blood-transfusion complications such as transference of HIV or hepatitis, allo-immunization, fluid overload, and less commonly, infection and multiple organ failure. Surgery-associated morbidity includes emergency hysterectomy, bowel injury, and urological injuries, including urethral trauma and bladder lacerations requiring surgical resection. Patients with accrete are at increased risk for blood clots (e.g., pulmonary embolism) and adult respiratory distress syndrome (ARDS).

The majority of women with placenta accrete will have their uterus removed in an attempt to control the bleeding, a procedure called "cesarean hysterectomy." Ten percent of women with placenta accrete die of its complications, usually from hemorrhage or the complications of blood transfusions, infection, or multiple organ failure.

These are the risks the obstetrician/gynecologist fails to inform a woman about when she signs the cesarean section consent form.

Excerpted from "Placenta Accreta" by Elphie Hosler, The Birthkit Issue 34, Summer 2002.

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Forum Talk

Have you had patients with history of cryosurgery on the cervix for dysplasia? I know they seem to labor so long with bad contractions and take forever to begin dilating. Once the bands of scar tissue are broken, they progress extremely rapidly. I have only had women who had first birth after cryosurgery. In subsequent births, does it seem to take this same pattern or do they dilate more steadily? Any tricks for gently breaking the bands?


Go to our forums to share your thoughts and experience.

Question of the Week

Q: I have a friend who is presently going to a physical therapist because of injuries caused by forced contortions of her body during second stage. Her hips were injured as she could not feel the pain from the extreme position they had her (unnaturally) pushing in. Does anyone have any information on this subject or suggestions for helping her heal physically? The physical therapist is at a loss.

— Amy V. Haas, BCCE

SEND YOUR RESPONSE to mtensubmit@midwiferytoday.com with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.

Question of the Week Responses

Q: I felt that my son was having seizures when I was about six months pregnant. My obstetrician said it was rare but sent me to perinatology anyway. They performed an ultrasound, but because the baby was not having seizures during the ultrasound, they could not say yes or no. When my son was five weeks old he began having seizures and was put on two medications four times a day. He is now 21 months old and still on seizure medicine twice a day, though he hasn't had a seizure for almost a year. I am now six months pregnant and am feeling the same movements, but I am afraid to go to the doctor and have them tell me that I am over-worrying. Suggestions?

— Mandie Martin, Vancouver, WA

A: Nutrition is the biggest player in your baby's health. I strongly suggest you find a reputable food supplement such as Shaklee Vita-lea multiple vitamin and their B-complex for better neurodevelopment. They guarantee their products' quality and purity. I have had great success with them. Go to www.shaklee.com for more information.

— Terry

A: I am a licensed massage therapist in Arkansas with a passion for home birthing as well. I am also a speaker and educator in the field of glyconutrient therapy. Glyconutrients are nontoxic, do not interfere with prescription medications (in fact they are actually more effective with glyconutrient intake), and have scientific validation behind them.

Your body is displaying symptoms. Symptoms are merely signs that cells are malfunctioning somewhere. Traditional medicine simply addresses the symptoms with toxic drugs. This new disruptive technology that I educate people in is actually being written about in medical textbooks now and even taught at educational seminars for medical professionals to get some Class 1 CME credit hours for maintaining their license.

Glyconutrients are absolutely necessary for pregnant women, babies, children, elderly. If you have cells, you need glyconutrients. Some midwives will not even work with pregnant women unless they are consuming these nutrients.

— Mitzi

Editor's Note: Responses to any Question of the Week may be sent to E-News at any time. Write to mtensubmit@midwiferytoday.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.

Think about It: Public Relations for Midwifery

Why can't midwives charge more? In the United States, the more you charge, the more people value you. I'm not saying this is right or necessarily good, but it is a fact. Can't midwives all agree to charge an extra $350 or $500 or whatever per birth and throw that money into a public relations campaign pool or professional development fund? The money could be used to promote midwives and normal birth by hiring a professional PR firm the way the American College of Obstetricians and Gynecologists has done. Just think of it: 700 CPMs multiplied by 15 births per year times $350 per birth—that comes to $3,675,000 annually! OK, so let's reduce it to a more realistic 500 CPMs times 10 births per year times $350 per birth. It still comes to $1,750,000 annually! Still not realistic? Let's reduce it to 300 CPMs times 10 births per year times $350. That's still well over one million dollars per year that midwives could be putting into an organized, national PR campaign.

The money doesn't have to be about you as an individual midwife; it's about healing birth, families, and the earth. Money really can make good things happen, especially with the right intentions and a well-organized, group effort. The "We can't do anything because we are all too poor" or "We are all victims" mentality is not a valid excuse anymore. Too much is at stake.

Sharon Reilly

Question of the Quarter for Midwifery Today Print Magazine

We hope you'll take a minute to consider the Question of the Quarter for Issue 71 of Midwifery Today. In fact, if you send us a response and we use it, we will send you a free copy of the next issue. Responses are subject to editing for space and style. Try to keep the word count at less than 400. E-mail responses, along with your mailing address, to: mgeditor@midwiferytoday.com.

Theme for Issue No. 71: Drugs in Labor
Question of the Quarter: : How do we educate women about the use and effects of drugs in labor?
Deadline for submission: July 1, 2004.

Question of the Quarter is a feature of Midwifery Today magazine, E-News's parent publication. Responses will be printed in Midwifery Today magazine. Subscribe.

Write to us! (See writer's guidelines.) We love hearing from you!


In response to Think about It, E-News Issue 6:12:

Does the article make any references to the health risks to the baby if mom focuses on her own weight and not on growing a healthy child? It seems that once again unborn children are being sacrificed for a mother's selfish reasons. I have seen firsthand the harm that comes from mothers trying to "keep their figure" while being pregnant. I personally know of a baby who was born at 39 weeks gestation weighing only 3 pounds (mom gained only 5 pounds) and now has multiple problems resulting from what the doctors termed "undernourishment." Is our waistline really that important? How sad.


I'm a French woman of 24 years old who studies midwifery in a Geneva school. I'm interested in working in Jamaica. I would like first to know if my diploma is recognised in Jamaica and if there's a way for me to work. I can do a lot of things. I'm ready to help develop midwifery in Jamaica. I'm interested in working in community health, doing prenatal courses, family planning, and of course midwifery. My Swiss diploma is recognized by the Swiss Red Cross and the European Community. I'm researching any information about Jamaica and midwifery and would appreciate any information readers can offer.


Editor's Note: Only letters sent to the E-News official e-mail address, mtensubmit@midwiferytoday.com, will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will not be considered.

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