My Pregnancy Complication: Placenta Previa

My pregnancy story is not at all riddled with groans and pains of labor in a vaginal delivery, as i imagined it would be.  I had to undergo cesarian delivery, not by choice but out of necessity. My baby had to be delivered via c-section because of a pregnancy complication known as placenta previa.

What is it?

The American Pregnancy Association defines placenta previa as a "condition where the placenta lies low in the uterus and partially or completely covers the cervix."  I understood it as the condition wherein my baby can't pass through my vagina because the placenta blocks his passage.  The placenta is the pancake-shaped sac inside uterus that holds blood, nutrients and food for my unborn baby.

[caption id="attachment_465" align="aligncenter" width="300"] Source of Photo: tbh.org[/caption]

How it was diagnosed

Four months into my pregnancy, i was rushed to the hospital because of spotting.  We got worried because it was the first time ever that i leaked some blood.  The OB in the emergency room ordered an ultrasound. I  had to be admitted for overnight observation.

At the ER i was asked several questions like:

• "Nararamdaman mo ba parang may menstruation ka before ung bleeding?"


• "Napagod ka pa recently?"


• "Kailan ang last contact nyo mag-asawa?" Translation: Kailan kayo last nagsex?

Yup. That intrusive. But ok lang, para maliwanagan ako, saka ung mga doctor kung anong nangyari.

When the ultrasound results came out, my OB confirmed it. Placenta previa nga.  Hindi lang basta previa ha. Sa ultrasound report ang nakasulat: Placenta Previa Totalis. This means, sobrang laki nung overlap ng placenta at nung opening. This means the placenta completely covers the cervix. Argghhh...

It was the first time i ever took placenta previa seriously. I read about this haphazardly in the book "What to Expect When You're Expecting" but it didn't really strike me as important. From then on i tried to know everything about this condition.

Doctor's orders

I was ordered to have a 2-week bed rest after the scare of my first spotting event. So bale, naka-emergency leave ako for 2 weeks. Complete bed rest daw talaga kailangan para ma-relax ang uterus ko. Tumatayo lang ako sa kama pag kailangan mag-weewee at mag-poopoo.  OB also prescribed duvadilan twice a day and once when i feel any contractions. In my medical certificate, i was ordered bed due to threatened abortion...yikes!

A note on bed rest, not all previa cases require bed rest. According to my OB, some get by even without bed rest.  It really depends on two factors: how far along in the pregnancy and how profuse the bleeding is.

My OB says the condition isn't really that bad. Having this condition is not life threatening. I just have to take extra care and be on guard for any spotting at any point in your pregnancy. She said i should avoid getting tired.

Complication

The worst scenario is excessive blood loss. The danger is, according to the OB, once you have severe spotting, she’ll need to deliver baby even if i'm months before due date. Ito ay kapag sobrang dami ng dugo ha.  Nung narinig ko ito talagang natakot ako. For the first time sa pagbubuntis ko, napraning ako. Posible pala ako makunan!

We asked our OB about the implications of placent previa on my pregancy.  My OB says that i'm more prone to severe blood loss, so i'm more likely to undergo a cesarian delivery.  According  to her,  I should not reach the point of active labor since placenta previa cases are prone to excessive blood loss. As soon as baby has reached his full term, he'll be delivered.

However i'd like to point out that not all previa pregnancies end with cesarian. Placenta previa may clear up in the late stages of pregnancy.  My OB said the position of the placenta can shift as the uterus muscles stretch to accommodate my growing baby. She said she had one patient whose previa cleared up in the last trimester.

Well we did pray and hoped that later in my pregnancy, it will improve. But in our last ultrasound (7th month), I still had it. So we had to accept that in deed, I had to deliver baby via C section. We were  scheduled for a C section any day from January 6  to 13, 2012, which corresponds to baby's 38^th week of gestation.

[caption id="attachment_3269" align="aligncenter" width="277"] This was baby's last prenatal ultrasound. Can visualize the placenta on the upper left portion? It lies right next to baby's forehead. At 7 months, my placenta still blocks the cervix, which is baby's natural way out![/caption]

Who's at risk?

While doing a research on my condition, I came across a list of risk factors why some women are prone to placenta previa. Here's the list as stated in the Mayoclinic article.

Women are at higher risk for placenta previa if they've 
had previous surgeries involving the uterus, such as:
• A C-section
Surgery to remove uterine fibroids
• Dilation and curettage (D&C), though this is a much lower risk
Placenta previa is also more common among women who:
• Have already delivered at least one baby
• Had placenta previa with a previous pregnancy
• If you are carrying twins, triplets or other multiples
• Are age 35 or older
• Are Asian
• Smoke

I’m really baffled because I did not  fit into these characteristics, except for being  Asian. I don’t smoke. It was my first time to pregnant. I was just 29 when I got pregnant. Hindi ko talaga matanggap noong una na considered "high risk" na agad ang pagbubuntis ko.

So I asked my OB, why and how i had this condition. What did I do that put my placenta in such problematic position? Could i have prevented this? Bakit ako pa eh wala naman akong risk factor?  She said there’s really no clear explanation why and how placenta previa develops. They're no really sure what causes this pregnancy complication.

Moms, if you're diagnosed with placenta previa, you need to take extra care.  Be on guard for any bleeding.  Avoid excessive activities as this can cause uterine contractions. After i was diagnosed, i was not allowed to climb stairs, go on long walks and even have sex. (Sadddd)

The good news is: Placenta previa has no long term effect on baby or on you. Once you pass the 7^th month, you can relax a bit because at this stage almost all of baby’s organs are formed. Past seven months, it’s a matter of waiting for (and preparing for) your baby's full development and maturity.

Also worth reading:

• Placenta previa do's and don'ts!


• Learnings from an emergency cesarean delivery

***

Breastfeeding Beyond 6 Months: Problems and Solutions

I'm glad i was able to pass, with flying colors,  the 6-month exclusive breastfeeding hurdle. And it's been more than 2 months since baby started taking in solid foods.

Honestly, i'm kinda sad about the fact that i'm no longer baby's lone source of nutrition. He's no longer exclusively breastfed and he seems to be delighted by all the new foods he's been tasting! Hayyy... I have mixed emotions about this.

On one hand, i'm glad that he's introduced to solids and he seems to have no adverse reactions so far. On the other hand, the selfish me is tearing up inside as i struggle to breastfeed him some more!

[caption id="attachment_354" align="aligncenter" width="300"] P enjoying frozen fruits in a mesh.[/caption]

According to Unicef, breast milk is best for babies even until 2 years. It's written in the agency's publication entitled  Facts for Life:

 "Breast milk remains an important source of energy, protein and other nutrients such as vitamin A and iron, even when babies begin to consume additional foods after 6 months of age. Breast milk helps protect a child against disease for as long as the child breastfeeds. It is recommended that a mother continue to breastfeed her child up to two years and beyond – as long as she and the child wish to continue. Breastfeeding can comfort a child who is upset and is an important source of nourishment during a child’s illness." 

My husband and I agreed that we'll breastfeed for at least two years. Now, 8 months on, it's getting harder to nurse my son. I keep on thinking, "He seems to be more interested in the outside world than my boobs!"

Here are some of the breastfeeding challenges that  i deal with everyday and some ways to handle them.

Baby’s teething!

My son now bites during our breastfeeding session.  Although he has no teeth yet, it still hurts. I can feel his gums as he bites my nipple and the skin near it.

• When baby does this I ask him to stop and then I unlatch. This way, he'll learn that we can't go on if he continues to bite.  I’m still teaching baby how to stop biting. I expect more hurt from cuts in my nipples as baby has yet to get his pearly whites. But i'm determined to breastfeed even until the time he gets his teeth. I’m keeping my fingers crossed and I hope I get to do this!  Here are more suggestions when baby bites.

Baby’s often distracted.

Since he passed the 6-month mark, I noticed that baby has been more distracted. He's more busy and alert now. He stops breastfeeding for anything.... like  dogs barking, sounds from TV, voices of his lolo or lola. His only decent feeding is during bed time!

I  try to rid him of distractions so he can continue breastfeeding. Here's what i do:

• I dim the lights in our room so he can focus on breastfeeding.


• I close the door to avoid outside noise so he continues feeding


• I turn down the tv or radio volume so he's less distracted

Here are more tips to deal with a distracted baby.

It’s now getting harder to find time for a decent feeding session.

When he was still a newborn, he fed almost every 2 hours. Now i struggle to breastfeed even at 4 hour intervals! Since baby learned to sit upright (with support) and to stand with support. He seemed to be enjoying his new perspectives, he can't stay put and breastfeed for at least 10 minutes!

• I  try to breastfeed at least 6 times per day to ensure that he gets enough milk.  I let him nurse all he want in the morning, before i go to work and at night, when we're about to sleep.


• Just like any prodding mom, i offer him my breast on any chance i get. Sure, i feel hurt when he snobs them. But i still insist and hope that he sucks some more.


• I'm also exploring new breastfeeding positions to keep up with my now semi-mobile son.  I expect that my acrobatic moves will be put to test.

It's getting harder to squeeze in a pumping session while at work.

It's almost 5 months since i got back after my maternity leave and work has been more and more demanding! I was given special treatment as a new working mom. But after 5 months, i'm a less new working mom already. People have been less lenient in the office. More and more deadlines are given to me, like any other ordinary employee. As i  get more busy at work, it's getting harder to squeeze in a pumping session. Read this more for tips for working moms who breastfeed.

Expressing breast milk is important at this stage because baby directly breastfeeds less. Pumping will help maintain your breast milk production so never miss a chance to pump when you can't directly breastfeed.

• When i'm really too busy, i just pump for 10 minutes instead of the usual 15 minutes per session. Frequent short pumping sessions are better than just one long pumping session.


• There are times when i do work outside the office and get back later in the day. I bring an extra manual pump and a cooler bag during these days just in case it's too late and my breasts feel engorged while out of the office. So far, i'm still not able to pump outside the office.


• I squeeze one more pumping session when i get back from work if baby's sleeping.  Eight months on and my mantra's still the same - pump, pump, pump!!!

Since I’m away for about 8 to 10 hours daily, I’m not sure anymore if baby is  dutifully offered breast milk.

My MIL is overly excited to introduce many types of food for baby. I really get paranoid and i hope she delays giving baby meats, eggs and citrus fruits. I  plan to give such foods later, may be in 10 months, so we can reduce risks of an upset stomach. Delaying such food will also allow time to ready baby's stomach for more complex foods.  I've also noticed that his expressed breast milk intake dwindled. From the usual 16 ounces, he just drank  about 10 - 12 ounces while i'm at work!

• What i do to lessen overfeeding of solid baby food is to "ration" his baby food. I just bring out 2 small jars of baby food for baby to consume while i'm away. I put these jars with the 4 baby bottles for his consumption while i'm at work.


• I also give clear instructions that only the food i prepared shall be given to baby. And i pray that these clear instructions are followed by the caregiver, hopefully.

Introduction of complementary food 

This is the main culprit why baby gets less milk.  From the wording itself, baby food is  complementary food! I just want to point out even more, baby food at 6 months is meant to complement breast milk. Kelly Mom says that breast milk should be the main source of nutrition until 1 year.

I'm not undermining the benefits of baby food. Baby food is vital so that he can get nutrients like protein. Introducing  baby food will also ensure that  he'll get used to different tastes and texture of foods.

My pediatrician already warned that baby's breast milk intake will decrease once solid foods are introduced. So here's what i do to ensure he's getting adequate amounts of breast milk:

• I nurse him before i give him solids. This ways he'll be less hungry and be satisfied with just 3 to 4 spoonfuls of solids.


• I limit the amount of  baby food, just 3 to 4 tablespoons per feeding. I serve  solids 3 times a day. I plan to increase to 4 times by 10 months.


• I let him drink 1 ounce of expressed breast milk from the cup after feeding solids. This also serves as his practice sipping from a cup.


• I use breast milk to dilute his baby food, which includes pureed fruits and veggies and infant cereals.


• I also serve frozen breast milk in a mesh feeder. Baby enjoys munching on a feeder because it relieves his itchy gums.

I'm committed to breastfeed until at least two years, so i'm intently researching on ways how i can deal with these struggles.  I really to hope to get through these breastfeeding blunders.

Click here to read about breastfeeding beyond one year!

***

Keeping your Breast Milk Stash Safe during Brownouts

Rains have been pouring hard in the Metro and nearby provinces in the last few days. I'm reminded on the colossal floods caused by Ondoy in September 2009.

On a weather like these, I get worried a lot, especially when brown out strikes! Now that i'm a mom, i have one more reason to be wary about brownouts. I’m afraid my breast milk stash in the ref might spoil.  I remember during Typhoon Milenyo in 2006, power outage in our place lasted for almost one week!

Breast milk is not sterile, it’s full of good bacteria. Spoilage is imminent so handling and storing breast milk calls for extra care. Be on guard, otherwise, you may end up losing your supply of precious gold!

[caption id="attachment_292" align="aligncenter" width="300"] My Refrigerated Milk Stash[/caption]

[caption id="attachment_293" align="aligncenter" width="300"] Frozen EBM[/caption]

Here are some tips on keeping your expressed breast milk safe during times like this.

• First and foremost, manage your breast milk efficiently. Only freeze breast milk that you won't be using in the next 7 days. Breast milk is easier to manage when it's refrigerated. Frozen milk will have to be consumed within 24 hours once it's thawed.  Refrigerated milk can last for 5 to 8 days. For more tips about freezing breast milk, read this.


• Keep the freezer door closed. Opening the door frequently will  only let the cold air out, raising the temperature inside the freezer. Open freezer only when absolutely necessary.


• Consider transferring refrigerated milk to the freezer, where it’s colder.


• If breast milk hasn't completely thawed (if there are still some frozen blocks or crystals),  I can still refreeze.  Locally, there's not much literature on refreezing breast milk.  The Breastfeeding Coalition of Washington  conclude that refreezing EBM with ice crystals is ok. M'ann Oblea of Baby Mama,  also says that as long as it has a frozen core, it's ok to refreeze breast milk.


• Don’t refreeze breast milk that has completely melted. Thawed breast milk is good in the refrigerator for 24 hours. At room temperature, it will  keep for about 4 hours.


• Contact Meralco for brownout schedule in your area. This may give you an idea on just how long the power outage will last and whether you'll need extraordinary means to keep you milk frozen.

If unfortunately, your entire breast milk stash completely thaws, consider sharing you milk. It’s better than wasting you breast milk by letting it spoil!

• Donate to milk banks. I donate breast milk to the Philippine Children’s Medical Center. Contact Ms. Rose of Milk Bank at 9266601. PCMC is located Quezon Avenue corner Agham Road,  Quezon City. PCMC has the equipment to pasteurize breast milk for their baby patients.


• Contact Human Milk for Human Babies – Philippines on Facebook which is a platform for those looking for and sharing their breast milk.


• Share thawed breast milk to your friends and co-workers who are also  breastfeeding.

Add thawed breast milk  to baby food. This is better than using water to thin out pureed veggies and fruits to feed your baby.

Always check the smell and taste of thawed breast milk before giving to baby. Discard  milk that smells foul or sour.

If you are a breastfeeding mom affected by the floods, here are some reminders:

• According to Unicef, direct breastfeeding is the best way to feed your infant especially during disasters. With direct breastfeeding, there’s low risk for contamination which is common in disaster situations.  There’s no sure supply of  potable water during emergency situations.


• Breast milk will provide your baby protection against diseases like diarrhea and respiratory infection, which is common during the rainy season.


• Stress will only slow you’re milk production so try (hard as it is) to be calm. Breastfeeding will release hormones that can lower your stress levels.


• Find a quiet private place where you can directly breastfeed.

Good luck moms and stay safe!

Also worth reading:

• Breast milk storage tips from a working mama


• A working mom's guide on thawing and serving breast milk

***

Alarming Facts about Breastfeeding in the Philippines

August is Breastfeeding Month!

I would like to highlight some alarming facts about breastfeeding in our country. Statistics mentioned here are from 2008 National Demographic Health Survey by the National Statistics Office.

[caption id="attachment_251" align="aligncenter" width="256"] Source of Photo: Unicef[/caption]

Average duration of exclusive breastfeeding is only 21 days! 

[caption id="attachment_2568" align="aligncenter" width="268"] Source: NDHS, 2008[/caption]

This means that on the  average, Filipino babies are fed with breast milk alone for just 3 weeks! From day 22 onward,  most moms needed to supplement with formula or water. This is alarming because baby’s first few weeks are crucial in establishing breastfeeding. Breast milk alone is sufficient until 6 months.

I’ve encountered moms who stopped breastfeeding early on. Here are some of the reasons why they stopped:

•  She thinks she doesn't have enough milk


•  She said her milk came in late


•  She said she had to work

To take on the breastfeeding challenge, moms need to toughen up! The first weeks of breastfeeding will be a test of your patience and determination.

My sister was reduced to tears at times when no milk came out. This was at the first 2 weeks postpartum. She panicked and pleaded my parents to let her give formula to baby. Thankfully, they resisted and now she's continuing to breastfeed. If this happens, just stand back for a while and relax. Moms need to get through the agony of doubting if she can produce enough milk for baby. But I dare say that formula should be the last option.

While sharing the a hospital room with a mom who had just delivered and just started to breastfeed, we heard a lot of screams and shrieks from the newborn. After about a whole day of baby’s crying while attempting to latch, the MIL seemed worried and summoned a relative to buy formula.  She thought giving formula would suffice baby’s hunger. True enough, baby stopped crying as he happily downed a bottle. But this does not solve the “learning to latch problem”. I think crying is just a phase. Resist the urge to supplement with formula early on. The key to producing milk is to empty breasts regularly. You won’t be able to do this if you add formula to the equation.

When you’re just starting to breastfeeding, it’s normal for baby (and you ,too) to cry because both of you are still learning. Crying is baby’s only way to say what she’s feeling so best to decode her cries first before deciding that you breast milk is not enough. Check if your posture and latch position are correct. Put hot compress on your breast before latching to encourage milk production.

Before offering any formula to baby, make sure to check with your pedia.  Here are some clues to check if baby's getting enough breast milk:

• if he's gaining weight (it's normal for newborns to shed some weight in the first week as he excretes black waste called meconium)


• if he wets more than 6 diapers in 24 hours


• if he seems satisfied after a feed (to the point of sleeping)

Only one of three babies under 6 months are exclusively breastfed

[caption id="attachment_2569" align="aligncenter" width="300"] Source: NDHS, 2008[/caption]

Breast milk alone has enough nutrients to cover baby’s needs. Read this if you want to know more about the benefits of breastfeeding both for baby and mom. Both Unicef and World Health Organization recommend 6 months of exclusive breastfeeding for optimal growth and health of the baby.

Introducing formula can sabotage your breastfeeding plans. At the early stage it's normal that you produce just a few mL.  Always take note that the amount milk you produced is enough to suffice your baby's need. At just days old,  your baby's stomach is as large as a cherry, so you produce that much milk.  Don't be pressured if you don't see milk oozing out at this this stage.  Focus on learning to latch and soon enough, you'll see satisfaction as your baby begins to swallow your breast milk.

Don’t be misinformed about formula. Check the can of every formula. It's indicated there that "Breast milk is best for babies!"

College graduates are less likely to breastfeed than other moms with lower educational attainment. 

[caption id="attachment_2570" align="aligncenter" width="300"] Source: NDHS, 2008[/caption]

Breastfeeding rate drops as educational level rises. Yes, there’s an opposite relationship between breastfeeding and mom’s education. I guess this may be related to moms’ career. Most moms need to go back to work after a month or so after having a baby so they opt to stop breastfeeding.

Again I’d like to remind moms that breastfeeding while working is possible! Here’s my previous blog post about pumping at work.  Your commitment to breastfeed will be tested during this time. Except some adjustment as you squeeze in pumping in your busy schedule. But keep in mind that you're extracting the best milk there is for your little one. That should be motivation enough for you!!

Pump at work, it’s your right!  Read the Expanded Breastfeeding Promotion Act  so you know your rights.  The internet has been abuzz recently about the proposed revisions of the Milk Code. One of my beef regarding the revisions is the changes regarding lactation period. What's previously paid lactation period is now being proposed to be unpaid.  Imagine how hard it will be for pumping moms if such revisions are passed!

Babies from poor households are more likely to be breastfed than babies from richer households 

[caption id="attachment_2571" align="aligncenter" width="265"] Source: NDHS, 2008[/caption]

I'm glad about this fact! This means that the poor won’t need to spend on formula milk. I hope more and more poor families opt to breastfeed. I do hope the richer population realize that breast milk is superior to formula. No pricey formula can bump off the benefits breastfeeding brings.

The biggest purchase, if a mom decides to breastfeed is a breast pump, which could be worth  at least P5,000 depending on the model. But in the long run, breastfeeding is still more economical than opting to regularly buy formula.  I  checked out formula milk prices from several stores. A big can of formula costs about P1,500, depending on the brand.  According to Unicef, the minimum cost of formula feeding an infant per month is P2000!

Mothers who delivered baby in hospitals are less likely to breastfeed than those who delivered at  home. Those assisted by health personnel are less likely to breastfeed than those assisted by a hilot. 

[caption id="attachment_2573" align="aligncenter" width="300"] Source: NDHS 2008[/caption]

This mirrors the sad state of most of our hospitals. Most of our hospitals are  not breastfeeding-friendly. I do hope government programs like the Unang Yakap, improve the breastfeeding policies of hospitals (public, at least).

Always assert baby’s right to be given breast milk. Hospitals should accommodate breastfeeding moms.  I was disappointed at the hospital where my sis gave birth. The nurses turned down my expressed breast milk for my nephew. At that time he had to be bottlefed in the NICU.  The nurses said there's no more space in their freezer. What? Why don't they have a freezer that's big enough to accommodate donated milk? Oh well, i'm just sharing my frustration.

Look for breastfeeding - friendly ob and pedia who will guide you in the first steps to establish breastfeeding.  Let them know of your intention to latch right away after baby's birth. This will hasten milk production.

Inform your pedia that you intend to breastfeed you baby. I've noticed that some pedia are keen on recommending formula to their newborn patients.  Here are some guidelines when looking for a breastfeeding-friendly pediatrician. Read up of breastfeeding so you can be informed.

•  Know that the decision on what to feed baby belongs to you.

The facts mentioned above call for vigilance from breastfeeding moms and their families. More so now that proposals to jeopardize the very law that protect the rights of breastfeeding moms.  Atty. Jenny Ong of Chronicles of a Nursing Mom gave a comprehensive primer on the bills pending in congress that will spread (mis)information about formula and make breastfeeding harder for working moms.

Ever since i started breastfeeding, it's been my goal to encourage fellow moms to try it as well. I also believe that breastfed babies make healthy children and healthy children make good citizens.

Kudos to all breastfeeding moms!!!

Also worth reading:

• Is your pediatrician breastfeeding friendly?


• For breast milk givers and takers