As a doula, you will support clients experiencing a variety of different pregnancies and births. A placental abruption is not a common complication, but it can occur in any pregnancy. Being aware of complications is an important part of being prepared to support clients.
Understanding pregnancy complications means knowing why it is important to remain within your scope and not provide medical advice. If a client expresses concerns about symptoms, you always refer them back to their provider.
You do not need to have a clinical understanding of placental abruption, but basic understanding is helpful.
What is a Placental Abruption?
“In placental abruption, the placenta detaches from the wall of the uterus before or during birth. The most common signs and symptoms are vaginal bleeding and abdominal or back pain. Placental abruption can cause serious complications if it is not found early. The fetus may not get enough oxygen, and the pregnant woman can lose a large amount of blood.”
That is the basic definition from ACOG and a great explanation to use with clients who have questions.
The placenta is meant to stay fully attached to the uterine wall until after the baby is born. Typically, the placenta detaches about 5-30 minutes after birth. Anytime the placenta detaches prior to birth, it is a placental abruption.
Partial Abruption vs Complete Abruption
There are two types of abruptions. A partial abruption is when the placenta does not completely detach from the uterine wall. With this type, there is often some pain, though not always, some vaginal bleeding, but there is not always immediate and obvious signs. Therefore, any second or third trimester bleeding, cramping, pain, etc., should be discussed with a provider if a client is concerned.
A complete or total abruption occurs when the placenta completely detaches from the uterine wall. This type is a serious emergency and often has a lot of vaginal bleeding. Birth is immediately necessary in the case of a complete placental abruption.
How Is Abruption Managed?
In the case of partial abruption, monitoring and rest may allow the pregnancy to continue. It does increase the risk of preterm birth and complications; however, it does not always mean an immediate birth.
For clients who had planned for a homebirth or birth center birth, a partial abruption typically risks them out of that type of birth. While labor can go smoothly, it does increase the risk of a full abruption during labor.
For a complete abruption, birth is almost immediate. This may look like an emergency c-section or an assisted vaginal birth if already fully dilated. Quick action is necessary to prevent fatal hemorrhaging for the parent and hypoxia for the baby.
Unfortunately, if a complete abruption is left untreated, or it occurs before viability, can be fatal to both the birther or the baby.
Is Abruption Common?
While a serious complication, fortunately, abruptions are rare, especially complete abruptions. Abruptions occur in approximately 1 in 100 singleton births. This means that generally, clients have a 99% likelihood of not experiencing an abruption.
Are There Risk Factors For Abruptions?
Generally, the overall risk remains low, and it can occur in any pregnancy. However, there are certain risk factors which can increase someone’s likelihood of having a placental abruption.
Some risk factors include:
- Having a previous placental abruption
- High blood pressure
- Any abdominal trauma (e.g., falling, car accident, etc.)
- Multiples pregnancy
- Uterine infection
- Folic acid deficiency
- Experiencing preterm labor or preterm premature rupture of membranes
It is important to remember that an increased risk is not a guarantee. Whether or not your client has any risk factors, it is important they maintain regular prenatal care. They should discuss any concerning symptoms with their midwife or doctor.
Pregnancy and birth often unfold well without any complications. However, occasionally things deviate from low risk. When that occurs, as doulas, we can provide support and education to help navigate their unexpected birth experience.