By Shawna, Phnom Penh CambodiapPROM Story
PROM at 23 weeksDelivery at 23 weeks + 2 days.
Story added: 2007-01-31
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)