Julie Merritt was pregnant with her second child more than two years ago, at the height of the pandemic, when an ultrasound at 12 weeks revealed she had a condition called placenta previa.
“It was something serious, but they were more worried about placenta accreta,” says Julie, who is a registered nurse in the NICU (Neonatal Intensive Care Unit) at Baystate Medical Center in Springfield. “They just wanted to watch it to make sure it didn’t become placenta accreta.”
Placenta previa and accreta
Placenta previa becomes a problem during pregnancy when the placenta—an organ that develops inside the uterus during pregnancy that provides oxygen and nutrients to the fetus and removes its waste—sits too low in the uterus and partially or completely covers the cervix (opening of the uterus). If you have placenta previa, as the cervix thins and opens during labor, blood vessels connecting the placenta to the uterus could tear and cause severe bleeding during labor and birth, putting both mother and baby in danger and possibly requiring a blood transfusion for mom.
Placenta accreta is an even more serious condition that occurs when the placenta grows too deeply into the wall of the uterus and sometimes attaches to other organs, like the bladder nearby. It can cause life-threatening hemorrhage for the mother and even death. Baystate Medical Center’s team has been treating placenta accreta since 2014. Because it is rare to be able to detach the placenta once it is embedded into the uterine wall, hysterectomy (removal of the uterus) is typically the only option.
“At 20 weeks, the placenta was still in front of my cervix, so they called in Maternal Fetal Medicine and said I would need a follow-up ultrasound,” says Julie. “When they did the final ultrasound at 32 weeks, they found it was placenta accreta. I’d never heard of it, and I worked in the NICU.”
Women are at higher risk for placenta accreta if they’ve had previous cesarean sections. Julie’s first child, Fiona, who is now 4 years old, was born by C-section. Scarring occurs after a C-section, and during future pregnancies the placenta can attach and grow into the wall of the uterus. It cannot be detached without causing severe bleeding and almost always requires a hysterectomy.
“When I went into that last ultrasound, I knew something was wrong,” says Julie. “They just kept staring at the image. That’s when the maternal fetal medicine doctor came in. It was tough because it was during the pandemic and my husband couldn’t be at the ultrasound.”
Dr. Corina Schoen, Maternal and Fetal Medicine, Obstetrics, Women’s Health, sat with Julie and explained that because it was a confirmed case of placenta accreta, she would have to have a hysterectomy to prevent her from having a severe hemorrhage during or after birth.
“She gave me the whole picture and I laughed and cried,” says Julie. “We made the decision then that Hazel would be born by cesarean at 35 weeks.”
Dr. Tashanna Myers on her role
Dr. Tashanna Myers, Gynecologic Oncology, Women’s Health, performed the hysterectomy. She says C-sections are typically planned before full term so that the mother doesn’t go into labor and begin bleeding. Doctors want it to be a controlled birth.
“I consulted with Julie,” says Dr. Myers. “I’m not supposed to be part of the birthing story, but in this case I had to be. I asked her if she planned to have more children and she said ‘no,’ but it was tough that she wasn’t going to have the option.”
A mother herself, Dr. Myers says she is there for women like Julie and understands the emotional pain they go through. She says she does a lot of hysterectomies because of cancer, but many fewer for placenta accreta.
“While I really don’t want to be part of someone’s birth story because that means something is wrong, I am there to save the mom so the baby has her to grow up with – I’m there for the best possible outcome,” says Dr. Myers. “The ability to have more children is huge. You can’t be prepared for this type of news.”
Dr. Myers says having a hysterectomy sounds like the worst possible outcome for a woman, but if the uterus isn’t removed and she bleeds too severely, death could end up being the worst outcome.
“The good news is we were able to save Julie’s ovaries,” says Dr. Myers.
Estrogen and progesterone are made in the ovaries. These hormones play an important role in female traits, such as breast development, body shape, and body hair. They are also involved in the menstrual cycle.
The process and outcome
Hazel was born at 35 weeks and 2 days, says Julie. She’s a happy, healthy 2-year-old today who loves to play with her sister.
As soon as Hazel was born, she was taken to the NICU with her father in tow, while Dr. Myers entered the delivery room ready to do her part and remove Julie’s uterus.
“When you have something like placenta accreta at Baystate Health, there are many, many people in the room with you,” says Julie. “You have teams of people taking care of you.”
The teams include anesthesiologists, maternal and fetal medicine, neonatal ICU, high-risk OB, Myers, nurses, technicians, OR nurses and more.
“I’m telling you, the operating room was full,” says Julie.
Julie is healthy today, as well. She says while the experience is scary for many reasons, everyone at Baystate made her feel at ease. She went in to have Hazel on a Wednesday and was released the following Sunday with her daughter in her arms. Both thrived at home.
“They are all so professional, so kind,” she says. “They answer all your questions and more. The care you receive is the best. They even brought in a urologist, Dr. Starkman, because the placenta can reach to nearby organs and attach [to the bladder]. Mine didn’t.”
Julie says while the teams were taking care of her, some were also talking with her husband, Chris, in the NICU so he knew what was happening.
Julie says while learning that she had to have a hysterectomy to save her life was a shock to her system, after discussing it with all of the professionals at Baystate, she knew it had to be done.
“It was difficult having the choice taken away, but it was necessary, and I didn’t want to take any chances – I wanted to be there for my girls,” she says.
Since her experience, Julie says she feels even better about helping other women through the same.
“There have been a couple of women who went through the same thing since I did,” she says. “Dr. Myers asked if I would talk with them, and they wanted to talk with me. It certainly helps when you can talk with someone who knows what you’re going through.”
Dr. Myers steps back once her work is done and allows the mother’s and baby’s doctors to provide postpartum care.
“I do always go and see the baby and check in with the mom,” she says. “I get a lot of Christmas cards from moms and their families. It’s such a privilege and blessing to do what I do. It can be sad at the moment, but it’s about saving a woman’s life so she can make lots of memories with her baby and family.”
Dr. Myers reminds women to always ask questions – there are no stupid ones.
“This is a big deal and you should know everything you want about it,” she says. “If you don’t understand something, ask. It’s a life-changing surgery.”
If you’re pregnant or planning to become pregnant, meet our team and consider having your baby at Baystate Health, a multidisciplinary team dedicated to supporting you through your pregnancy, birth, and postpartum. With specialists in high risk pregnancy and the only level III neonatal intensive care unit (NICU) in western Massachusetts, you and your family can expect high-quality, personalized care throughout your birthing experience.