What Exactly Is Placenta previa?
Placenta previa is when the placenta implants low in the uterus, covering all or part of the cervix, which is the opening of the uterus. Normally, the placenta attaches to the top or side of the inner uterine wall.

The way the placenta covers the cervix can vary, leading to different classifications:

• Placenta previa: This refers to when the placenta completely or partially covers the cervical opening. The placenta implants over or near the internal os of the cervix.
• Marginal placenta previa: This means the placenta is near the cervix (specifically, within 2 centimeters) but doesn't cover it. 
• Low-lying placenta: Here, the placental edge does not cover the internal opening but is within 2 cm of it, or sometimes defined as 2 to 3.5 cm away from it.

Placenta previa is estimated to affect around 1 in 200 pregnant women at some point during pregnancy. In the majority of cases, approximately 90%, especially with low-lying placentas, the condition resolves on its own by the third trimester. As your uterus grows and changes, the placenta appears to "migrate"—it doesn't actually move, but rather grows towards the richer blood supply at the top of the uterus, while the lower uterine segment grows, increasing the distance from the cervix. This means that only about 1 in 800 pregnant women continue to have  placenta previa at the time of delivery.

What are the symptoms of placenta previa?
Placenta previa may not cause any noticeable symptoms and may be discovered incidentally during a routine second-trimester ultrasound, such as your anatomy scan. However, the primary sign, if it does occur, is sudden, painless vaginal bleeding. This bleeding is typically bright red and usually happens after 20 weeks of pregnancy, often in the second or third trimester. The bleeding can sometimes be accompanied by uterine contractions. 

How is suspected placenta previa confirmed?
 A transvaginal ultrasound is considered the best way to confirm the exact location of the placenta.

Is home birth an option for someone with placenta previa?
For most cases where placenta previa persists until delivery, a cesarean delivery is the safest for both Mom and baby. However, there are specific circumstances where home birth might be an option. If the placenta is classified as a low-lying placenta, homebirth may be an option. Careful monitoring of the position of the placenta is an important tool in deciding what type of birth will be best for Mom and baby. 


Sources:
https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc-20352768
https://www.ncbi.nlm.nih.gov/sites/books/NBK539818/
https://www.yalemedicine.org/conditions/placenta-previa
https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/placenta-previa

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Birith not only creates parents, it can also create big brothers and big sisters. As you are preparing for the arrival of baby, you can help your children to prepare to be a big brother or sister too. 

Even the youngest future big brother or sister can do things to be ready to welcome baby. Here are a few suggestions: 

• ​Putting diapers into a basket, or a drawer at the changing table
• Picking out an outfit for baby to wear in the first few days after birth, or choosing a new outfit for baby at the store.
• Picking out the first book to be read to baby after baby arrives.
• Drawing pictures for baby
• Picking out a toy or toys to give baby.
• Helping set up the nursery
• Making a "baby is here" freezer meal

Other suggestions for things you can do to help a future big brother or sister include:

• Have a big brother/ big sister gift to give after baby is here. My son was delighted with his Worlds Best Big Brother balloon bouquet and Tonka dump truck
• Read some books together that talk about becoming a big brother or sister. I have a few recomendations:
  • Little Critter; The New Baby by Mercer Mayer
  • The Berenstain Bears and Baby Makes Five
  • My New Baby by Rachel Fuller
  • The New Baby by Mr. Rogers
  • The Berenstain Bears New Baby by Stan and Jan Berenstain
  • Babies Don't Eat Pizza by Diana Danzig
  • Socks by Beverly Cleary (this one is my personal favorite)
• Talk about how wonderful it will be to have a new baby brother or sister and what things siblings can do to connect with baby like reading them stories, singing to them, etc.

​Helping siblings get ready for baby can go a long way towards a smooth transition once baby is here.

TriCare, just like the overwhelming majority of health insurance, does not cover my services. However there's a change coming in 2025 that gives service members and their family another option to fund a homebirth.

Starting this year, military members can have a Flexible Health Care Spending Account or FSA. This account can be used to pay for services not covered by Tricare, including midwifery fees for a home birth.

The benefit of a FSA is that it uses pre-tax dollars which effectively gives a discount of whatever your tax rate is for anything you use those funds to pay for.  

Of course there are other ways to fund a home birth including: 

• Start saving for a home birth in a regular savings account. This option is available for everyone and can be a great way to get a head start on funding a homebirth, or to supplement FSA funds if needed. You can start funding the birth before baby is more than a twinkle in your eye.
• Use a gift certificate. Some midwives may offer gift certificates so family and friends can support you in getting the birth you want. If the midwife doesn't offer gift certificates, she may be willing to if asked.
• Add funding for the home birth to your wish list for a baby shower.  
• Declutter and have a yard sale or sell things online.
• Bartering for all or a portion of the midwifery fee may be an option if the midwife is open to barter. 

Having more options to fund a home birth when insurance doesn't is helpful, especially when an option lets you use all your money instead of what is left after taxes.

​I serve many clients who have pets and I have attended births where pets are present and I have some observations and thoughts about pets, labor and birth.

Full disclosure here: Cats have been part of my life from day one. I've been told that when I was brought home from the hospital after birth, our cat decided to sleep with me in my crib that day. So I may be a little biased about pets and infants.

I think dogs and cats know when Mom is pregnant. Cats and dogs have very sensitive noses, and can detect changes in odors and pheromones. While there aren't studies on pheromone changes during pregnancy, we do have research that hormonal changes can change body odor. I strongly believe our pets pick up on these changes. I have been at labors where I could tell that Mom was getting closer to birth because her pets wanted to be closer to her the nearer she got to birth. Even if pets aren't in the room with Mom for labor and birth, they will hear a baby crying, and will know there has been a change and that they are hearing someone new.

I encourage families to introduce pets to their newborn in the first hours after birth. Just as you would introduce your pet to a guest who comes into your home, you should introduce your pet to the new family member. I do recommend a supervised introduction so parents can help pets to stay calm when they meet baby. I also recommend continued  supervision when your pet and baby are together in the future. 

After baby is born, expect a few changes in your pet. If you have dogs, they may become very protective and guarding of your baby and may not be as welcoming to visitors as they used to be. With a little time, they will figure out that visitors are okay when a parent is around. Cats may want to sniff baby and that might be all they are interested in doing. Some cats might want to sleep where baby sleeps in the hopes of getting more attention.

Pets are family members too. Letting pets be part of your baby's journey will make life all the richer for both your little one and your pet.