By Vanessa Smith, Christchurch New Zealand
PROM at 23 weeks + 6 days. Delivery at 27 weeks.
Story added: 2013-04-21

At first we had what seemed to be a dream pregnancy. I had no morning sickness and was running or biking 10km to and from work each day. Our 12 and 19 week scans were all normal. Then, at 20 weeks, I was knocked off my bike by a car. I still don’t know for sure if this was connected to pPROM, but for a couple of weeks I felt very damp downstairs. I just thought this was due to hormonal changes from pregnancy. Then, on 2 August 2012, I woke up at 2.45am to find my underwear and sheet soaked through. We were 23 weeks and 4 days pregnant. At the time I told myself that maybe our wee boy had just kicked me in the bladder, but in my heart I knew it was fluid. It was clear and smelled like water that had been in a container too long. I woke my fiancé and we rung our midwife. She said it was probably my bladder and to put a towel under me and go back to bed (!). Then she decided to call the hospital, just in case. Soon after she rung back and told us that the hospital said to go straight in. We arrived there just before 4am and a midwife confirmed my waters had broken. She took swabs and a consultant came to do a bedside ultrasound, which showed an AFI of 4. This would turn out to be our highest fluid level from then until our son was born. She also ‘aged us up’ based on Robin’s size, from 23 weeks 4 days to 23 weeks 6 days. I was given a steroid shot and she explained what pPROM was and the likelihood that I would deliver within 48 hours, although I showed no sign yet of contractions. Then, at 6am we got the news that the NICU in our local hospital (in Christchurch, New Zealand) was full and I would need to be flown to Dunedin (a 5 hour drive from home). My parents had just made it in to see us, and my sister was able to get there just as we were being whisked away in an ambulance to the airport. The hospital and staff in Dunedin were wonderful. One of the NICU neonatologists came to speak to us on the first day with very encouraging statistics about their success rates with 23 weekers. The possibility of a DNR was raised (though not recommended), but after seeing Robin on his scans this really was not an option for us. Making it to the next day, and being officially 24 weeks, was a huge relief. We spent the next 10 days in Dunedin. I leaked constantly and my fluid varied AFIs varied from 2.5 down to 0. I found it really hard looking down at my belly and no longer seeing any real baby bump. Some days it would get bigger again, but then I would have a big gush and my belly would flatten out. Each week that Robin stayed in, we celebrated. I made him an ‘unbirthday’ card and Kevin bought him a small toy. We held on to the fact that each extra day meant on average 2 days less in intensive care. After 10 days, room became available in our home NICU and we flew back. Unfortunately, in Christchurch we ended up with an obstetric team we despised – such a change from our wonderful doctors in Dunedin. The first morning I woke up in Christchurch, one of the obstetricians showed up and told me that I would be discharged to continue my pregnancy at home. Our city had been rocked by 4 major earthquakes over the previous year and a half, and the area in which I live had been one of the hardest hit. We still had erratic power and water and really difficult road access. Every time we left the house we had to go a different way due to road closures. I was terrified of being sent home due to the difficulties emergency services would have getting to our property, and I would be home alone and I do not drive. Yet our obstetrics team tried 5 times in 8 days to make me leave hospital. I think the stress of this contributed to me getting an infection, as my condition in Dunedin had been extremely stable – constant leaking, but of clear fluid only, and no change in my vitals. Once I was back in Christchurch I soon had pink fluid and at 26 weeks I had tightenings across my abdomen and bright red blood on my pads. I was sent down to the birthing suite and they ran extra blood tests, which showed my CRPs (inflammatory markers) had increased. The birthing suite doctor put me on antibiotics and by 7am the next morning the contractions had stopped and we were transferred back to antenatal. For reasons I will never understand, another doctor 2 days later took me off the antibiotics. I believe if I had been allowed to continue the course, Robin would have stayed in utero a lot longer. 4 days after my false labour, I started having tightenings again, with heavy bleeding. This went on from Tuesday night through to Friday morning. In addition, my heart rate increased sharply (my resting heart rate had been in the low 60s and it went up into the 80s and 90s). Uterine infections often show up in a heart rate increase, rather than a temperature. On Thursday my routine blood results came back showing my CRPs had shot up to 134 (they had been 11 when I came back to Christchurch only a week earlier), so my antibiotics were restarted, but by then it was too late. On Friday morning, Robin was exactly 27 weeks. My tightenings eased off about midday and stopped altogether by about 3.30pm, and I and the doctors thought it was another false labour. The doctors and midwives had regularly palpated my abdomen and never felt any contractions in the upper uterus, only tightenings in the lower uterus, so they were convinced it was not true labour. However, even though the tightenings had stopped, I could no longer lie on my left side as it gave me a sharp pain around my pelvis. Also, I was drinking 4 litres of fluid a day but on Friday afternoon I could not go to the bathroom. It felt like something was blocking my urethra and I became extremely uncomfortable. I was going to the bathroom every 15 minutes but nothing was coming out. Then, at about 9pm, I felt something protruding when I wiped after attempting to pee. I called my midwife and she rushed me onto the bed and put me head down, bum up, thinking that it was a cord prolapse. She couldn’t see anything so said not to worry, but when I went to the bathroom I felt something protruding again. After some insistence my fiancé and I persuaded another midwife to do a speculum exam. She said she could not see anything and that I must have felt ‘blood or mucus’. My fiancé, Kevin, asked if she could see my cervix and she said no, but that there was too much blood and discharge to see clearly. I went back to the bathroom and felt the same object, so I took a photo. Then we flagged down yet another midwife and showed her the photo and she said, “that’s a head!” She got me back on the toilet and confirmed visually that it was our baby’s head, then rang the alarm. By this stage it was 10.20pm, nearly an hour and a half after I originally felt his head crowning. I was rushed on a bed to a delivery room and they tried to listen to Robin’s heart but couldn’t find it as he was sitting so low under my pelvis, so for most of my labour I did not know if I was pushing out a live baby or a stillborn one. Since no-one knew how long he had been trapped in the birth canal, it was a race to see how quickly they could get him out. They had to catheterise me as my extremely full bladder was the only thing holding him in (it had been his head compressing my urethra that had prevented me from peeing). When he came out the doctor held him up and he looked into my eyes and flexed his little hand and spluttered out a breath. It was the most amazing thing to see him and know he was okay! Robin was born at exactly 27 weeks, on the 24th of August 2012. He weighed 965g (2 pounds, 2 ounces). We don’t know his height at birth as he wriggled and kicked so much they never managed to measure him! He was rushed off to NICU and had a relatively uneventful stay, apart from sepsis at 6 weeks old that caused his lungs to fill with fluid and put him back on breathing support for 4 days. He was on CPAP for 5 1/2 weeks, then on nasal prong oxygen till 12 weeks old. He stopped having bradys by about 11 weeks old. He took a while to get the hang of feeding, but got there in the end, and went home 3 days after his due date. I struggled to get my milk through, and it turned out that not all my placenta had come out at the birth so my body still thought I was pregnant. When Robin was 10 days old I had to go in for an ERPOC to remove the remaining placenta, which helped a lot with my milk supply, although it never came in fully. Robin has no lasting problems except severe reflux, which caused him to refuse to feed, meaning he had to go back on an NG tube. Otherwise he is developing perfectly, and is a smiley, happy, playful baby who is full of character and is incredibly curious about the world. We are very lucky. He lights up our lives!!!