While her first two pregnancies resulted in two healthy babies, fourth-time mom-to-be Kim Kardashian West endured a life-threatening condition during childbirth.
PEOPLE confirmed Wednesday that the Keeping Up with the Kardashians star and husband Kanye West are expecting another baby via surrogate, almost a year after a gestational carrier gave birth to their daughter Chicago following Kardashian West’s battle with placenta accreta in previous pregnancies.
Also known as retained placenta, placenta accreta occurs when part or all of the placenta remains connected to the uterine wall after childbirth. Under normal circumstances, it detaches, which allows the mother to push it out after the baby. The condition affects three in 1,000 pregnancies, and often results in severe blood loss. In rare cases, the hemorrhaging can be deadly.
“My doctor had to stick his entire arm in me and detach the placenta with his hand, scraping it away from my uterus with his fingernails,” she wrote.
“My mom was crying; she had never seen anything like this before. My delivery was fairly easy, but then going through that — it was the most painful experience of my life!”
That’s why Kardashian West, with the guidance of her doctors, ultimately decided to use a surrogate to add a third child into her family, and likely why she chose to do so again for her fourth child on the way. (She and West welcomed youngest child Chicago in January 2018. They’re also parents to son Saint, whom Kardashian West gave birth to in December 2015.)
In a November 2016 episode of KUWTK, Kardashian West’s obstetrician, Dr. Paul Crane, told her, “You never know if you might have the same type of problem that could be more serious this time … You’re always taking a little bit of a chance. There are situations where retained placenta could be life or death.”
Then, Kardashian West’s mother, Kris Jenner, clarified, “You could bleed to death.”
Later on in the episode, the KKW Beauty mogul explained in a producer interview, “If the two doctors, that I trust, have told me it wouldn’t be safe for me to get pregnant again, I have to listen to that. But because I don’t know anyone that has been a surrogate or used one, I didn’t really think about that as an option for me.”
To thoroughly research her decision, Kardashian West talked to a fellow mother named Natalie who both birthed her own child and hired a surrogate.
“I’m more worried, because I gave birth to two. There’s a sense in me that because I went through all that pain for these two babies and that I know we did this together … ” Kardashian West told Natalie. “There’s no one that would feel your love [like that]. They are literally near your heart and inside of you.”
“My bond with my kids is so strong,” she continued. “I think my biggest fear is that if I had a surrogate is: Would I love them the same? That’s the main thing I keep thinking about.”
Natalie then assured Kardashian West that it’s not an issue.
“There’s not a day where I have any thought that my love for my kids [is] different, that my connection to my kids is different,” Natalie said. “You get to carry one and have them close to you, but then the other is because you so desperately wanted them in your family.”
Before finally deciding that surrogacy was right for her, Kardashian West underwent a surgery in an attempt to make conceiving one last time possible, but it wasn’t successful.
“Having more kids is definitely going to be a struggle,” she explained in an April 2017 episode of the E! show. “I’ve gone through so much with really bad deliveries that the doctors don’t feel like it’s safe for me to conceive again myself. This surgery is really the one last thing I can try. I want my kids to have siblings and I want to know that I did everything I could to make this happen.”
She concluded later in the episode, “After talking to Kanye … I always knew surrogacy was an option. Now it’s my reality … Whatever is meant to be will be.”
At the time of Chicago’s birth, Kardashian West announced the big news with a heartfelt post on her website. “We are incredibly grateful to our surrogate who made our dreams come true with the greatest gift one could give and to our wonderful doctors and nurses for their special care,” she wrote.