Patient Stories:Shaunna O’Farrell

In 2019 I was six weeks into my third pregnancy when I had a bleed.

In 2019 I was six weeks into my third pregnancy when I had a bleed. I assumed I had miscarried and went into the hospital to get checked out. The scan showed I was still pregnant but there was a haematoma in the middle of my uterus causing bleeding. The blood test then indicated it could be an ectopic pregnancy and I came back in for a further scan. It was confirmed to be a caesarean scar pregnancy. Feeling shocked, upset and confused we had never heard of this before and didn’t understand. During the several weeks of scans and consultations, we were told about placenta accreta, the risks, and how I would need a hysterectomy.

Due to the area of implantation and the haematoma, the doctors advised that it was unlikely for the pregnancy to even reach 20 weeks, and so we made the heart-breaking decision to end the pregnancy. Looking at most likely the loss of the baby, needing a hysterectomy and possibly risking other complications to my health. My husband and I were really scared and upset, but with our two children to think about we had to do what we thought was best for our family.

The doctors asked that if we were pregnant in the future to make an appointment for a scan at six weeks, though this condition was unlikely to happen again, they wanted to be cautious. We were delighted to find out we were expecting again seven months later. In January 2020 at the six-week scan they again detected a possible Caesarean scar pregnancy; we were devastated and in complete disbelief.

After several weeks of scans and appointments it was confirmed, but the implantation was in a different position of the scar tissue compared to the previous pregnancy and we were in a better position to reach 25 weeks.  The risks of how placenta accreta would occur and that I would need a hysterectomy were again explained to us. We knew we wanted to go ahead; we couldn’t go through the pain of ending another pregnancy. We were so lucky to be in the care of the amazing team in the National Maternity Hospital, who supported our decision and dedicated so much time to us.

It was explained to us how closely the pregnancy would be monitored, all the risks to mine and the baby’s health and possible outcomes. I would need to stay in the hospital from 18 weeks. Throughout the pregnancy there would be a lot more appointments than usual including weekly scans, the usual check-ups and then extra appointments with the surgeon, neonatal team etc. an MRI and steroid injections for the baby’s lungs. But we were determined we would do whatever they asked us.

The hospital put us in contact with Placenta Accreta Ireland and we got to attend a meeting where we heard so many stories from incredible women. We felt we weren’t alone, they had difficult journeys, but it gave us hope. A mum from the group kept in touch with me throughout my pregnancy answering all my questions as new things began to worry me. It really helped to have her insight.

Due to Covid 19, it was decided I would better off staying at home than coming in at 18 weeks. With little traffic on the roads, the journey into the hospital was much quicker and should I develop symptoms I would be able to get there in good time. It was very tough not having my husband at hospital appointments due to the restrictions. Dan would still drive me to every appointment and wait outside, often running around the park with our two children. It was lonely and scary not having Dan by my side, but he was so supportive. His strength, positivity, love and good humour really helped me get through it.

As the weeks and months went on it did take a toll, it was a rollercoaster of emotions, a lot of tears. However, we were so lucky to be cared for by the wonderful placenta accreta team. Everyone in the hospital treated me amazingly, the lovely reception staff at Fetal assessment greeted me by name when I came in the doors, and all the midwives would ask how I was getting on and how my husband and kids were doing. They would spend extra time with me if I seemed down or overwhelmed, they made me laugh and let me cry. This all helped so much, the care and compassion shown went above and beyond just being a patient. Our doctor was just incredible in how much time and dedication she gave towards us. She even came into the hospital on her days off to scan me. We could never thank her enough; she monitored the pregnancy so closely and got us over 31 weeks before I would have Elias.

Due to the early diagnosis, they were able to have everything well prepared for the surgery to have the best outcome. They timed it perfectly so there was the least amount of damage done from the placenta accreta and for Elias to grow. Although I was scared, I also knew they had the best people for every job. Everything was explained to me, the medical techniques they would use, and they all took time to reassure me. I was admitted to the NMH the day before the surgery and brought the following day to St. Vincent’s Hospital. I was anxious and emotional, but things like my doctor helping me get the surgery socks on and having my husband outside helped. Dan could come in when they were ready for me to have Elias. The anaesthetist decided it was safest for me be kept awake for the surgery, which at first, I was nervous about but, in the end, I was glad to be aware of everything happening. There were a lot of people in the operating theatre, but with faces I knew so well it made me less nervous and anxious.

Elias had his own team of doctors and midwives there who had prepped us before on their plan for him. After getting to finally meet him, he was brought back to the NMH to the NICU in a special incubator. They finished the hysterectomy, and I was kept in St. Vincent’s for two nights until I could be transferred over to the NMH. It was difficult being in pain and being away from my new baby, but Dan was with him and keeping me updated. The nurses and midwives who cared for me after the surgery in both St. Vincent’s and the NMH were fantastic, not only looking after my medical needs, but it also felt like the same calming, kind maternal energy of having my Mum with me. They gave me sugary tea, made sure I ate and insured I had plenty of rest.

Elias was in the hospital for about four weeks before we could take him home. It was tough to see him so small in the incubator and being fed with a tube. I don’t think anything could have prepared me for it. But he progressed well and other than being small and needing time before he could be feed properly, he was perfectly healthy.

It was a struggle coming in and out every day while in recovery from the surgery, getting in and out of the car and short walks were painful. It also felt heart-breaking to leave him behind at the end of the day. We were trying to get time with him and to keep a routine with our other two children in the evenings, as we all missed each other. We had fantastic help and support from my Mum, Brother and Sister in-law. Also, all the staff in the NICU were so amazing and helpful and knew we wanted to get him home as soon as possible. I was frustrated at my body while in the NICU, even just sitting in the chair for the day was painful, it was difficult to get up to change Elias or feed him, but I just did my best and it did get easier.

Looking back, we missed out on the joys of being pregnant as there was a fear of getting too excited. There was no big pregnancy announcement or baby shower, only close family and friends knew. Having to explain about placenta accreta and the risks made it awkward and uncomfortable to even tell people I was pregnant. Most people just couldn’t understand the condition, so it was easier not to say anything at all. Also, as someone who likes to plan everything and be in control, not being able to be was difficult. Life and plans were put on hold, thankfully covid made it easier for us to bubble away from the world. The recovery from surgery was more painful and the journey was more draining than I imagined. However, we were lucky to be diagnosed early on and receive so much care from the beginning and with everything monitored so closely, the outcome was then better than ever imagined.

Our journey with this pregnancy was one of fear and anxiety, there was an ever-present worry that I could bleed, rupture, and it would be all over, for me and our baby. That I would leave behind my husband and children. While the early diagnosis meant that I received the best treatment, it also meant that for 25 weeks I was keenly aware of the risks. However, I was extremely fortunate, I may have had to deal with the mental burden of the condition throughout the pregnancy but did not have the extra complications usually associated with placenta accreta.

We truly feel beyond lucky with how well looked after we were, almost undeserving of such care, compassion and dedication. We will be forever grateful and so thankful to all the staff at the NMH, they are extraordinary individuals. Finally getting to introduce Elias to his sister Ada and brother Travis was a fantastic moment for us. We are a happy healthy family of five now and Elias is a true treasure to have in our lives.