The Arizona Republic
Flagstaff mom Jody Borrero was only five weeks along in her pregnancy when doctors told her something had gone awry.
An ultrasound confirmed her placenta had implanted itself at the bottom of her uterus, across her cervix. What's worse, it also had attached itself too deeply, perforating the uterine wall and invading her bladder.
Borrero's physicians at St. Joseph's Hospital and medical center kept her stable for as long as they could. But on Feb. 2, they were forced to deliver Ethan Jr. nearly four months early.
He's still struggling to survive, and his 28-year-old mother, who hemorrhaged during the delivery, can no longer bear children.
Borrero's conditions, called placenta previa and placenta accreta, are both still relatively rare.
But physicians say they're turning up in more women, and medical experts believe the trend is tied to record numbers of moms-to-be delivering their children via Caesarean section.
C-sections, in which a baby is delivered via an incision made through the abdominal wall, leave a scar on the uterus. It now appears that scar is a key risk factor for the complication in subsequent pregnancies, physicians say.
Many women are unaware of the danger, however.
"I wanted to have four children, so after the first one was born by Caesarean, I knew I was going to have lots of C-sections," Borrero said. "I thought it would be fine. It wasn't. It's devastating."
Rise in C-sections
In the mid-1990s, roughly 1 in 5 babies were born via Caesarean section. But over the past decade, the rate of C-section births has jumped more than 50 percent.
Statistics released earlier this month by the U.S. Centers for Disease Control and Prevention showed that nearly 32 percent of babies born in 2007 were through Caesarean delivery.
That's a new record, and the 11th straight year of increase.
Doctors say that in many cases, C-sections are medically necessary, even life-saving.
A woman may be unable to deliver vaginally, for example, if the baby is breech, meaning its feet or bottom has entered the birth canal first. In some instances, labor stops or the baby is simply too big to pass through the birth canal.
But C-sections also have increased in popularity simply because mothers see them as less painful or more convenient than a vaginal birth. They can be scheduled around work and home events. There is no prolonged labor.
Physicians say they fear that women who choose C-sections for these elective reasons may not realize that they are still putting their bodies through major trauma and could be setting themselves up for problems in future pregnancies.
"We tend to think about the immediate circumstance," said Dr. Marlin Mills, medical director of perinatal services with Banner Desert Medical Center. "But it's important to think about the consequences down the line, especially if you want to have a big family."
Future complications
Tracy Alexander, 31, had no reason to suspect that her most recent pregnancy would be any different than her first six. Her last delivery, via Caesarean, had been smooth.
But early in her second trimester, the Queen Creek mother got the bad news. Like Borrero, she had developed placenta accreta, a complication generally characterized by an improper attachment of the placenta to the uterine wall.
And like Borrero, hers was the most severe form of accreta, known as placenta percreta. It went through the uterus and intertwined with her other organs, including the bladder.
Alexander, who had started bleeding lightly at six weeks, eventually contracted an infection in her uterus. Her son Samuel was born at Banner Desert in Mesa 16 weeks early, on Jan. 24. He, too, remains in intensive care.
Doctors aren't sure exactly why Borrero and Alexander developed placenta accreta. But they believe it has something to do with their previous C-sections.
"We think that whenever the uterus has a scar on it . . . for some reason, that scar increases the chance that you have this," said Dr. Linda Chambliss, director of maternal-fetal medicine at St. Joseph's Hospital and Medical Center.
Studies and textbooks suggest that the risk of developing an accreta is as high as 40 percent in women who have had two previous Caesareans; that jumps to 60 percent with three C-sections, their physicians said.
And while Valley hospitals can't say exactly how many women they are seeing with the complication, those that traditionally deliver the most babies say it's a trend they're watching.
Earlier this year, St. Joseph's saw three women with the condition in one week, Chambliss said.
"In the 1950s, the incidence was something like 1 in 30,000 women," Mills said, adding that newer studies, conducted within the last decade, suggest that the rate has climbed to as high as 1 in 2,500 or even 1 in 500.
"So there is definitely an increase in occurrence," he said. "And in women with C-sections, that's where we've really seen an explosion."
New protocols
The uptick in accretas, and the emergency deliveries they cause, has prompted several Valley hospitals, including St. Joseph's in Phoenix and Banner Desert in Mesa, to establish new protocols.
Chief among them: creating on-call teams of surgeons and specialists to lend their expertise during the emergency surgery.
At Banner Desert, for example, the team draws in not only obstetricians but urologists, general surgeons and vascular surgeons. Patients with severe placenta accretas frequently need a total hysterectomy and, in many cases, subsequent surgeries to repair damage to the urinary tract and other organs.
Excessive bleeding is also a common problem. At St. Joseph's, a protocol allows the hospital to notify the blood bank of a "catastrophic situation," Chambliss said, giving the patient the highest priority for blood products.
Last year, one woman needed more than 100 units, roughly the equivalent of 100 pints, of blood. The average human body typically holds 10 pints.
Hospitals also are encouraging more pre-natal counseling of C-section risks, particularly if a woman is interested in having multiple children. They say it is possible for a woman who has delivered her first baby via Caesarean to give birth vaginally the second time.
Physicians have historically shied away from the option because it was thought to carry risks of uterine rupture. But those dangers now are believed to be very small in many patients.
In fact, the American Pregnancy Association suggests that as many as 90 percent of women who have had a Caesarean are candidates to later give birth vaginally.
"The real complications from vaginal births after C-sections are minuscule," said Dr. Mike Foley, a specialist in maternal-fetal medicine and chief medical officer at Scottsdale Healthcare . "Women shouldn't make a snap decision to have a C-section just because they've had one previously."
Most importantly, Borrero said, women need to educate themselves before they decide on an elective Caesarean.
"Women say they are too scared of the pain (of a vaginal delivery)," she said. "But I could lose my baby.
"I can't imagine anything more painful than that."
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