pPROM Story
On December 22nd 2006, I was 23 weeks
pregnant and enjoying a few days at
the beach with friends who came to
spend the holidays together. But on
December 23rd I was awoken at 4:30
a.m. by a gush of water mixed with
blood that came down my legs, soaking
my pants and the bed. Previous to
this, I had been experiencing severe
exhaustion for months, was anemic, had
low blood sugar and protein and had
just a few days before had a bad cold
and yeast infection that I was being
treated for. I usually travel 60-70 %
of the time for my job, but because of
all this had to reduce it a lot, and
had just two weeks before gone down to
part time. I wanted more than anything
to get back on track and concentrate
on what was important, even though to
that point our baby was always
healthy.
We live in Cambodia, and were 4 hours
from any decent medical care when the
water broke. We first went to the
local hospital – basically a large
room with several filled beds and some
machines. I was in bare feet and wet
pants and we struggled to explain in
broken Khmer that my water had broken.
Finally, a doctor did an ultrasound
and confirmed that our baby still had
a good heartbeat but also told us that
he saw no water in the amniotic sac.
During the trip back to the capital
city in the ambulance, I began having
slow tightenings and was still leaking
a bit of fluid. I was so scared that I
would deliver in the back of that
ambulance with no medical care around
and all I concentrated on was getting
to the city.
We arrived in the hospital in Phnom
Penh 3 hours later – by this time it
was 8:30 a.m. The GP did not examine
me because of concern for infection,
but put me on steroids to strengthen
the baby’s lungs, antibiotics, and a
drug to stop contractions. The baby
was still fine, and I tried to put out
of my mind the possibility that this
would not work out, and to think
positively. But when the doctor did a
second ultrasound and there was still
no fluid I broke down, and began to
feel the devastation that our baby
girl might not make it. We spent six
more hours in this hospital, laying
there, peeing in a bedpan, waiting for
a plane to arrive so we could be
evacuated to Bangkok. I couldn’t have
wanted any more to get out of
Cambodia, to a place where they could
take care of us and save the
baby.
We didn’t get there until 14 hours
after my water broke. They did another
ultrasound and I saw our baby girl
inside, restful, not surrounded by any
fluid, but still alive and well. The
doctor told me that it was possible
that the fluid could come back if I
rested and, if they prevented
infection, we might have a 50/50
chance of our baby surviving. I was
poked and prodded with needles, and
spent most of the night and day in
bed, with Jake near me at all times.
Thank god he was allowed to stay in
the room with me. I believed that if I
relaxed, stuffed myself with fluids,
had hope and faith and communicated
this any way that I could to our baby,
that things could still work out. I
played music and sang to her, rubbed
my belly, to let her know that I loved
her and that we were in this together.
She was still so active, responding to
the music a lot, which made me smile
and cry.
But I started bleeding the next day,
and the doctor said it was my body’s
way of trying to terminate the
pregnancy. I only realized later that
her mind was made up about the outcome
of the pregnancy from the time I had
talked to her at 4:30 in the morning
on the 23rd. She said my wbc was very
elevated, I had a temperature and
rising heart rate. She believed I had
early signs of infection (she wrote
chorioamnionitis) that would be
potentially life threatening for me.
I believed the doctors were doing the
best they could for me and the baby at
this point.
In the evening, we met with a MFM
specialist who did yet another
ultrasound and exam and again told me
our baby was still strong and fine and
my cervix was nice and long. But he
gave morbidity and mortality rates for
babies born at 23 w 2d, and said in
that hospital – probably the best in
Thailand - they had never delivered
babies that lived without moderate to
severe disabilities at 23 weeks. They
said “maybe in the United States” but
not here, which was very hard to hear
since there was no way we could be
there. We deliberated, and asked a lot
of questions, and grilled them on
where their studies were from and how
big were the samples and what if we
could hold onto the pregnancy until 24
weeks, 25 weeks, 26 and on. They said
they were fairly certain of infection,
there was low likelihood that the baby
would live, that she was 95 % likely
to have trouble breathing and a whole
range of other disabilities. We had
huge communication issues – they asked
what we wanted, and we said over and
over that we wanted a healthy baby. We
did not want for our baby to suffer
either in the short term, or through a
life that was likely to be very short
and difficult.
We felt rushed to make a decision, but
spent the night talking and crying,
holding each other. We wanted to
believe there was hope, and I kept
second guessing that maybe the sac
could reseal, maybe infection would
stop and getting more confused about
the information we were getting. But
at the same time we did not want to
put my life in danger – and honestly I
could not do that to Jake - or the
possibility that we could try again
some day. The fact that we had to make
a decision has made this so hard; I
have felt so guilty that I had to
decide to end my own daughter’s life.
But we didn’t know what else to do. I
have never had to make such an
important decision and we had so
little information – even what caused
this in the first place.
I swear that I felt her die inside of
me, even though I cannot be sure. I
know that as the drugs set in, and I
had violent diarrhea, vomited and
proceeded to contract that she was not
going to be delivered alive. After I
delivered her, I could not stop crying
and did not want to see her because I
was so afraid of what she would look
like. I am so ashamed of this. It was
just the most horrific thing I had
ever been through.
We saw her the next day to say
goodbye. We named her Ella. She was so
small, but still strong looking to me.
It was hard to look at her, but I am
so glad we did. As Jake put it, “she
is just a tiny baby” and if we had not
seen her I guess I would have wondered
constantly about the little being that
was inside of me for nearly 6 months,
who went to sleep with me and woke up
with me. She was so sweet – tiny
perfect hands, feet and ears, tiny
scrunched up face, dark hair. I saw
the strong legs that kept kicking me
constantly – she was a very active
baby in the womb. We said goodbye to
her that day, and I think of her all
the time, every day. I imagine her
swinging between us and laughing as we
walk, lying in bed between us, holding
her to my chest. I look at Jake and
know what an excellent dad he would
be. I do love her, and I have no idea
how we get through this time because
this grief has so many sides and I
want to honor her life in whatever way
I can.
She was the first baby we have had
that went this far. Our first was a
molar pregnancy - terminated after 5
weeks - in 2001, our second an
incomplete miscarriage at about 5
weeks nearly exactly a year earlier
than the pPROM to the day.
We want to try again when physically
and mentally ready. In case it helps
anyone else, so far the most concrete
advice for PAP I’ve been given under
my circumstance is:
1. Monthly urine culture
2. Monthly cervical culture for
ureaplasma and mycoplasma and treat if
necessary
3. Rule out any GI infection
(because I’ve had chronic amebic
dysentery and recurrent giardia in
past few years)
4. Increase protein and iron
intake
5. Decrease stress (though one
doc did not seem to think this was a
factor)
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