I feel compelled to share my PROM
story because only a year ago, I
bookmarked this site while on bedrest
and passed my time by reading others'
stories. Reading about good outcomes
gave me and my family hope, as I wish
to do for whomever reads this.
I had complications following the
delivery of our firstborn and was told
that my uterus would likely never
support another pregnancy. There was
little to no endometrium left and lots
of scar tissue where a fertilized egg
could not successfully implant or
grow. And for 10 years that was the
case.
Then amazingly I became pregnant; and
stayed pregnant. We were cautiously
optimistic. Then at 20 weeks I began
cramping and bleeding on and off. A
Level 2 ultrasound revealed no
probable cause, but two days later, in
the 21st week, my water broke. I spent
four days on hospitalized bedrest,
basically preparing to go into labor
and lose the baby. I continued to make
fluid and leak it. My AFI was as low
as 1cm.
The only thing left to do was go home
and continue to lie flat in hopes of
preserving the pregnancy. We knew the
odds were stacked against us, and even
if time went by, the baby's lungs
could be compromised, stuck back at 21
weeks development. The situation was
grim.
I had bathroom privileges, and even
then, on the advice of the home health
nurse, my husband wheeled me in a
wheelchair to and from to keep as much
pressure off the bag of waters as
possible. I drank water like it was
the very air I breathed. And we
prayed. A lot. We didn't know if our
actions would contribute to a longer
pregnancy but we felt like we were
doing something, anything in what
proved to be a very powerless and
uncontrollable situation.
Every week my husband loaded me up in
the car for my weekly ultrasound to
determine the baby's growth and fluid
index. Once we reached the 24th week,
we knew there were measures that could
be taken to help our baby in an NICU.
There was a plan in place if labor was
to begin as I would need to be
transferred out of state to be near a
neonatal intensive care unit. It felt
like a whole new ball game, although
we worried about the effects of little
to no fluid on our baby's development.
During the 26th week I noticed that I
wasn’t leaking fluid for one
day, and then another. Much to
everyone's surprise, I had a normal
amniotic fluid index at the next
ultrasound (I think it was 12 cm). The
ultrasound appeared normal. But the
baby seemed to be growing so slowly
(probably because we were watching so
closely from week to week). We wanted
the baby to be at least two pounds
before he was born, if possible, but
we learned later that gestational age,
rather than size, is a better
predictor of how the baby might do in
an NICU after birth. Naturally we were
holding out for more weeks under our
belt, too, but every day was a
cliffhanger, thinking labor might
happen at any moment.
Later that week I began to cramp and
bleed again. I was put on IV
terbutaline and monitored in the
hospital, but things quieted down and
I was sent home. Labor started up
again within 24 hours and I was put on
oral terbutaline at home, which bought
me two more days, uncomfortable though
they were. Then my water broke again.
I went to my local hospital and was
given the first of two doses of
betamethasone (a steroid to speed the
baby's lung tissue development) and IV
magnesium sulfate to inhibit labor. I
was transferred by ambulance to a
perinatal facility about 2 hours away,
where I was placed on a high risk unit
to wait for the next betamethasone
shot. Within 48 hours they were ready
to take the mag sulfate off, because
with ruptured membranes they do not
want to mask infection with drugs and
because it is believed best to let
nature take its course.
However, nature was not ready. We
waited, literally on the edge of our
seats, for labor to begin, but it did
not. We expected a baby would come
that day. It was almost anticlimactic,
except that we knew it was best for
the baby to remain in utero. I was
moved to a hospitalized bedrest unit
elsewhere in the hospital. I ended up
staying for 5 more incredible weeks.
It was unbelievable that it went on
that long. We were so lucky.
Separation from my family was a most
difficult situation, but we regarded
it as one big family adventure and did
our best to adjust. If we had any idea
how long it might be, passing the time
would have been a bit more bearable
and I might have found more productive
things to do. But thinking the baby
could come at any minute, it was
difficult to concentrate on anything
for any length of time with so many
variables up in the air. In addition
to the uncertain future of our baby,
we were concerned about how the
delivery would go. Due to my past
complications, I was at risk for
hemorrhage. A surgical delivery was
planned in order to control bleeding
if it should occur.
At week 31 I awoke to a feeling that
something just wasn't quite right
which quickly gave way to active
labor. The baby was breech, as many
pretermers are, having not turned yet,
and he was determined to come out
before the surgical team was ready. He
was footling breech so the C-section
was unavoidable, much to my relief
because I was still in a panic about
postpartum complications. Thankfully,
there were none. Our beautiful boy was
3 lbs. 2 oz. and 14 ΒΌ inches long.
He gave a weak cry. Despite the
betamethasone, he had respiratory
distress syndrome, or RDS, (formerly
known as Hyaline Membrane Disease)
which means the alveoli don't have the
elasticity they need to facilitate
breathing in and out due to the
immaturity of the lungs. (It is not a
permanent condition.) He was given
artificial surfactant through a
ventilator and placed an incubator.
Within 48 hours he was off of the vent
and we were able to hold him. He had a
high bilirubin count and received
phototherapy for 14 days. He did
receive a low dose of oxygen through a
nasal canula for a few days afterward
as he was having trouble breathing
easily on his back (he had strider
from the intubation and was retracting
a bit). He began feedings of
breastmilk by the fourth day and
steadily progressed with only one
temporary setback. Within two weeks he
was moved to a step-down unit and by
the end of the third week he was moved
to a level 2 nursery back home so we
could see him every day. He spent two
weeks there as a “feeder and
grower” and came home at 36
weeks gestation, 4 lbs. 8 oz.
The only issue relative to his lack of
amniotic fluid that we are aware of,
other than the RDS, was contractures
of the arms and legs. This is
basically stiffness and minimized
range of motion due to being
“stuck” in one place. His
left leg was dramatically curved
inward and upward and his left ankle
was curved in enough that the
neonatalogist considered the
possibility of a clubfoot. (The right
ankle was turned in slightly, too.)
However, it was pliant and flexible so
they addressed it as a
“positional deformity.” An
occupational therapist established
range of motion exercises for all
extremities and placed splints on both
feet.
By the time he reached his due date he
was doing his own range of motion
exercises in the crib! He had also
outgrown his splints and his feet were
doing fine. At one year he is cruising
furniture and standing briefly, doing
all the things a 12-month old should
do.
He had ear tubes placed at 6 months,
but that was likely hereditary more
than anything. He also had bilateral
inguinal hernia surgery at 2 months,
but this is common in boy babies born
full term, and a likely result of his
having hydroceles (sacks of fluid that
follow the testicles as they descend).
Hydroceles often resolve themselves,
but in his case, loops of bowel
slipped through the opening, resulting
in hernias. The surgery went without a
hitch.
Our PROM experience was frightening. A
tiny life hung in the balance and
there was so little anyone could do.
We know how lucky we are that the
pregnancy held out for so long,
allowing the baby to grow and develop
in the best incubator yet – the
womb. And lucky, too, that despite his
prematurity he seems to have caught up
and suffered no adverse effects.
We hope knowing that we made it will
help others hang on (to the bedpost,
their sanity, their hopes) for as long
as possible.
Tummy pats to all (but not too hard
because we don’t want to start
any contractions!)
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