A Grave Condition Caused by C-Sections Is on the Rise

But once she was on the operating table, doctors at Piedmont Rockdale Hospital, near Atlanta, found a big problem: Ms. Baumstark’s placenta had fused with scar tissue left on her uterus from the previous surgery, a dangerous complication known as placenta accreta. Her husband, Lee Blasingame, watched blood gush from her belly as their daughter was born.

Fifteen hours later, Ms. Baumstark, 27, died from internal bleeding. She never met their daughter, Nevaeh, now 6.

“We tell Nevaeh stories about Mama Holly,” Mr. Blasingame said in an interview. In February, a jury awarded his family $42 million in damages after he sued a doctor for improperly managing the complex delivery. (The doctor is appealing the verdict.)

Placenta accreta used to be very rare, affecting 1 in 4,000 pregnancies in the 1970s. But as cesarean surgeries have become more common in recent decades, so has accreta. While its prevalence has been hard to pin down, one report found a rate as high as 1 in 272 deliveries.

This year, a study found that accreta diagnoses increased significantly between 2016 and 2021. That’s largely because of C-sections as well as other procedures that can result in scar tissue. Doctors have also become better at recognizing the condition, contributing to the uptick.

The placenta is covered in blood vessels that can cling to scar tissue and, in severe cases, grow through the uterine wall into the bladder. About two-thirds of women with placenta accreta hemorrhage during childbirth, sometimes requiring more blood transfusions than small hospitals have on hand. A patient can bleed to death in under 10 minutes.

Researchers believe accreta is a major cause of maternal deaths, though more research is needed to quantify its consequences. A small study at Vanderbilt University found that 5 to 7 percent of patients with especially severe cases died in childbirth.

‘We’re Going to See More of These’

When Dr. Silver began researching placenta accreta in the early 2000s, there were no medical guidelines for treating it. In 2006, he published a study showing that a woman’s risk of developing the condition jumped with each cesarean. About a decade later, in 2015, accreta was given an official diagnosis code, allowing researchers to systematically study it.

Doctors are getting better at spotting accreta on ultrasounds before birth. But many women still go into labor undiagnosed. Obstetricians often do not have the expertise to handle a complex delivery, or even enough donor blood on hand.

Dr. Julie Kang, a Miami obstetrician, took notice of the condition in 2016, when she treated two severe cases within a week of each other.

“We’re going to see more of these,” she recalled thinking. She opened a clinic specializing in the condition at her hospital, Memorial Regional, and treated nine accreta patients the next year. Her caseload has steadily marched upward, hitting 62 in 2024.

Florida had the second-highest rate of cesarean sections in the country in 2023, according to a New York Times analysis of the most recent national vital statistics. And Miami-Dade County, where Dr. Kang works, had one of the highest rates in the state last year: 44 percent of births.

Florida’s Health Department was concerned enough about placenta accreta in 2016 that it issued a warning to doctors, advising them to be on the lookout for the condition. Twenty-five women died of placenta accreta in Florida between 2010 and 2023, according to data from the Health Department.

“It’s on people’s radars, but not nearly as much as it should be,” said Dr. Erin Myers, a surgeon who joined Dr. Kang’s team in 2021 to help with the growing volume.

Even when doctors know what to expect, deliveries involving placenta accreta can be devastating.

Doctors diagnosed Maribel Sanchez with placenta accreta early during her third pregnancy in 2017, and referred her to a specialized center at the University of California, San Diego.

After hemorrhaging while seven months pregnant, she spent Christmas at the hospital with her partner, Julio Sanchez, and their two young daughters. When she delivered two days later, doctors were unable to control the bleeding and she died at age 31. Her newborn daughter spent two months in intensive care and required frequent visits with specialists.

Mr. Sanchez, a construction worker, said he struggled to care for his children alone. “The last eight years have been the worst experience of my life,” he said.

Risky Surgeries

The Times interviewed more than a dozen women who developed placenta accreta after cesarean surgeries that they suspected had been unnecessary.

One of them, Mykalynn Penny, planned on a cesarean for her first delivery in 2019 because her fetus was in a breech position, legs dangling downward. By the time she arrived at the hospital, the baby had flipped into the proper position, medical records show. But her doctor advised her to go forward with the operation anyway, rather than “risk” a vaginal delivery, she recalled. (Records indicate that the doctor was worried that the fetus was too large. The baby was born at 7 pounds, an average weight.)

Ms. Penny developed placenta accreta during her second pregnancy. She began bleeding at home on Thanksgiving 2021, eight weeks early, before rushing to the hospital. The complicated delivery ended in a hysterectomy. She was 32.

“I had something taken from me that wasn’t my doing,” she said.

Rayven Coleman had her first cesarean, she said, because her doctor said the baby’s heart patterns showed signs of distress. Fetal heart monitoring often produces false positives that lead to C-sections.

“It just felt like, they’re the doctor, they know best,” said Ms. Coleman, a fourth-grade teacher from Hattiesburg, Miss.

Ms. Coleman’s doctors advised C-sections for her next two babies as well. That guidance is common in the United States, where the vast majority of pregnant women who have already had one C-section will go on to have another. Some doctors have argued that repeated surgeries are unnecessary and that more women could have vaginal deliveries after cesareans if given the proper support.

With her fourth child, who was born six weeks early in January of this year, Ms. Coleman developed a severe case of accreta resulting in the placenta attaching to her bladder. After she lost five liters of blood during surgery, she and her premature daughter were treated in intensive care. Ms. Coleman, then 31, had to use a catheter for three weeks.

The University of Utah has one of the largest placenta accreta clinics in the country. About 40 percent of its patients come from out of state, sometimes as far as Washington or Alaska. Most of them move near the clinic for the final stretch of their pregnancies.

“They spend months or weeks here, alone,” said Dr. Brett Einerson, one of the doctors who runs the center. “It’s an incredible burden on them.”

In late June, Dr. Einerson had his first appointment with Oliva Hatch, 36, who had driven with her husband for three hours from their home in Idaho Falls. She had three children, all delivered by C-section, and was nearly eight months pregnant.

Her doctors at home suspected placenta accreta based on ultrasounds, but did not have enough expertise to know for sure.

In a small exam room, Dr. Einerson confirmed the condition and told Mrs. Hatch that she needed to relocate to Salt Lake City as soon as possible.

“I don’t want to downplay that this is a huge ask,” he told the couple. “I don’t want to coerce you with horror stories. But yeah, I’ve got horror stories.”

Mrs. Hatch left the appointment overwhelmed. The next day, she started crying while watching her children play. She and her husband decided she would move in with her brother-in-law in the Salt Lake City suburbs. Her husband and children planned to drop her off — one last family road trip before living apart.

The drive never happened. Two days after the appointment, Mrs. Hatch began to bleed at home and was airlifted to the hospital in Salt Lake City. “Please don’t let me die,” she told a nurse.

Mrs. Hatch’s surgery took three hours and required multiple blood transfusions. But the next day she was able to visit her newborn daughter in intensive care.

Audio produced by Patricia Sulbarán.