By Heidi, San Marcos USAWhat a heartbreak it is to hear confirmation that you have ruptured. For those who don’t go into labor immediately there is the fear and sense of dread that early labor is imminent. I had that fear, and I was extremely grateful to a group of women who pointed me to this website where I cried with every loss story, and was inspired by every success.
PROM at 18 weeks + 5 days. Delivery at 31 weeks + 5 days.
Story added: 2008-01-17
I had a success – and with multiples too – and I vowed to myself to take some time to share my story, like so many wonderful women took the time to share their stories to help me.
Found out in week 8 I was having twins. At week twelve we shared the news with everyone. At week 15 I began having bleeding episodes. Went to my OB who said that bleeding is normal for twin pregnancies and not to worry, babies were fine (confirmed with u/s). Two weeks later I was still bleeding and not feeling very comfortable about the bleeding so I insisted on another appointment. They agreed, “Just to make me feel better.” My OB continued to downplay the bleeding and gave me a vaginal exam, then an u/s. During the u/s she suddenly became grim because I had an 8 cm blood clot pushing against the babies (who were both still fine) and she thought I had placenta previa. She sent me off to a perinatologist consult. At the consult I cried during the u/s, fearful that something very wrong was going to be found. The Perinatologist sounded upbeat; he saw that the blood clot had gone down. He suggested I come back in a month for another u/s to check things out. Peri also noted that I did not have placenta previa.
Week 18 5d - I got up to go to the bathroom and was surprised when I felt like pee came out before I released my bladder. I shrugged and went back to watching TV. That night I awoke at 5am with a sense of confusion – I felt wet. I pulled back the sheets and confirmed that there was a puddle on the bed. Dread shot through my veins. I bent down and sniffed the liquid – no scent. Ugh. I went calmly to the bathroom and looked at my underwear, no tinge of blood, no smell. I decided it must be amniotic fluid and that this probably wasn’t a good thing, but I the severity of the issue didn’t really hit me. I kept thinking, “Amniotic fluid means you ruptured and go into labor, but I am definitely not in labor.” ??
I didn’t tell anyone and I kept an eye on the leaking. It wasn’t continual – it would come in squirts, and then stop. I called the OB and explained the situation. The gal on the phone told me to go to the hospital, I was in labor. Uh, I explained I was only at 18w 5d and would prefer an office visit as I was not in labor. I got in the same day, was seen by an OB who did a vaginal exam and tested for amniotic fluid. Negative, they told me. Just incontinence. I was relieved but baffled. That night I posted to an online messaging board about how the squirts of clear fluid frequently occurred when I sat down to go to the bathroom…and that I was positive the fluid was coming out before I released my bladder. Thank GOD for the eight or so women who immediately posted back shouting at me to leave my OB and go to a perinatologist right away. It got me in the spirit of persistence. The next morning I called my OBs office over and over demanding an appointment because I was sure I had ruptured. They wouldn’t book me an appointment. That day I also found out I had gestational diabetes, and that the numbers were too high to manage the diabetes with food/exercise so I would be taking insulin. At 4pm I called the office and began shouting and crying that I needed an appointment ASAP. They told me to come right in. I met with a different OB who did another test and again confirmed I was not leaking. I stood firm and gave her a description of what was occurring and insisted I had PPROM. She took pity on me and scheduled a perinatology appointment for the very next day.
At 19w I went in for an u/s with the perinatologist. The u/s technician did her thing…the babies were fine and moving and I could see fluid around both babies. I hoped I had made a grave mistake. The sweet perinatologist walked in and asked me to again explain what I was experiencing. Then, without doing another of those blasted amniotic fluid tests he simply said, “Yes, you’ve ruptured.” I felt both vindicated and deflated. He said I must go on immediate strict bedrest. But, he said he wasn’t trying to save the babies at that point, because at 19 weeks there was no way they could be saved. He told me his biggest concern was my safety, because the incidence of infection was VERY high for rupture cases. He put me on antibiotics for seven days. Two different types. He also told me to drink lots of water, and to flush my labia with water after EVERY bathroom visit to attempt to flush bacteria away from the vagina. I was also to check my temperature twice a day to check for the possibility of a rise in temperature – thus an infection. The perinatologist said that if I made it to 24 weeks (the chance the babies would be viable) he would check me into the hospital for the remainder of my pregnancy.
I had weekly visits to the perinatologist to check on the babies. The fluid began to slowly decrease around baby “B” each week. Fluid levels averaged around 4-5 for the remainder of the pregnancy. Sometimes they dipped to 2, and one time I got a 7. At week 22 I had a large bleeding scare. Bright red blood spilled out – but I told no one. I knew I wasn’t hemorrhaging and I didn’t want to put undo stress on my body trying to drop everything and rush down to the hospital 45 minutes away, only to have to go through the stress of hospital admittance, etc. I figured, if one or both of the babies wasn’t making it I would go into labor and so be done with it.
I had my perinatology appointment two days later and I mentioned the bleeding episode to the u/s technician. Though both babies ended up looking great on the u/s, my doctor came into the room very grim. I will never forget that day – I thought for sure he had horrible news for me. Instead he just wanted me to understand the reality of the situation. I think what floored him is that my attitude from the day I found out was simply, “okay, we’ve hit a setback, but this is all going to turn out just fine.” I would come to the appointments cheery and smile and act like I was ready to be put into a basketball game. “Okay, coach, just tell me what to do!” I kept that attitude throughout the pregnancy, never surrendering myself to the feelings of fear I had for my babies. Not sure if that helped, but it was the only way I could cope.
At 23w 5d I felt victorious because there was at least a chance my babies could survive. I arrived triumphantly at the hospital, ready to make it to week 32, which is as far as my perinatologist originally told me I could go. [Though he waffled back and forth between 32 and 34 weeks the entire time.]
The remaining 8 weeks of bedrest at the hospital were horrible. Fetal monitoring every six hours for one or more hours was torturous. I had no privacy because of my gestational diabetes there was always something to be done – shots/snacks/glucose checks. I gushed fluid a lot during these days, and it always made me sad. But my perinatologist said it was a good thing – he wanted fluid flushing out to help keep infections away. It was nice that he could spin it that way. ;) Every so often I would have a large gush of deep red blood, but it never could be pinpointed, and never affected the babies.
When I hit week 30 I was in heaven. I started asking about long term effects to my ruptured baby. My perinatologist seemed to believe that baby “B” would have lungs that would work fine, but the neonatologist consult I had wasn’t so sure. I was scared.
A few days before 31w5d I began having severe cramping pain and actually felt strong contractions, but they never led to anything…however, I could not sleep on my back any longer, I had to sleep sitting up. This led to less than restful nights. On the morning of 31w 5d I complained of what I thought was constipation. Apparently I was in labor, but nobody realized it. By 4pm I started feeling STRONG contractions and asked for a fetal monitor. I didn’t realize I was in labor. Suddenly, my perinatologist appeared and did a vaginal exam (for those that don’t know, once you are diagnosed with PPROM you no longer have vaginal exams because it can introduce bacteria to the region). The minute he stuck his hand down there I knew this was it, and I was immediately saddened – I wanted to get my babies to 34 weeks. Can you believe how greedy I became?!
The baby “B”s head had already crowned so it was a mad rush to get me down to the OR ASAP. My perinatologist originally had wanted me to have a c- section because he wasn’t comfortable with the safety of a vaginal birth, but baby “B” was already too far into the birth canal. They literally wheeled me into a prepared room, asked me to push, and in two pushes out popped my PPROM baby. I listened desperately for a cry – none. He was whisked away so quickly I never saw him. My peri started calling out desperately for an amniotic hook as he was surprised to find my cervix closing up and labor stopping. He tried one last ditch effort to rupture the other baby’s amniotic sac but it was too late. My cervix closed and labor stopped. Now what? They were watching the other baby on the u/s. My peri decided to send me to labor and delivery and begin pitocin. He said he would not allow the other baby to stay inside because of the severe risk of infection. I was thrilled to know he was going to let me have both babies vaginally (my first born was vaginal) because I really didn’t want a c-section. But within minutes the order was cancelled. Baby ‘A’ moved and it was no longer safe to put him through a vaginal labor. ARGH! C- section prep was started. I kept asking for the status of baby “B” but no one would give me anything. I grew worried – I wanted to know if he was alive. I wondered if they weren’t telling me because he had died but they wanted me to have my wits about me when they worked on getting baby “A” out. Eventually my anesthesiologist had pity on me and went in search of the answer prior to the c-section. He came back and told me that my PPROM baby was pink and intubated. Thank GOD he was still alive!
Baby “A” was born crying and I was elated. Then I was whisked away to a c-section recovery area and given no information on my babies. I had to sit there for three hours!! FINALLY they wheeled me down to the NICU where I got my first glimpse of my babies. There were both intubated, but my PPROM baby was in bad shape. The neonatologist delicately explained my PPROM baby’s situation. For whatever reason I simply smiled and nodded; I don’t think I fully understood the gravity of the situation. He couldn’t breathe, his lungs needed multiple doses of surfactant, he was on a special breathing apparatus that did short quick blasts to help keep his blood oxygen levels up, and he had collected fluid along one side of his lungs that was being drained in an attempt to help the lung to open up. Apparently the neonatologist wasn’t sure my PPROM baby was going to survive that first 24 hours…but he came through with flying colors. Though he stayed intubated for five days, and did have a meconium plug that kept him from eating for as many days, he left the NICU on home oxygen and nebulizer treatments at six weeks after his birth – two weeks before his due date of Oct 14. My other baby came off of oxygen by day three and spent the rest of the time learning to eat; he discharged from the NICU four weeks after birth.
My PPROM baby was on oxygen at home for 30 days before he was allowed to start weaning. After thirty days he was able to come off of oxygen and he kept his saturation levels at 98 or better! He began to grow quickly. Both are breastfed and have grown very well. They get the Synagis shot for RSV every month, and we have successfully kept them from getting ill – even with a four year old brother who attends preschool!
Those that see my 4 mos old PPROM baby (now a whopping 15lbs – when born was only 4lbs 2oz) can’t even believe he was ever preemie, or that he had any lung issues. He has a cute little squeaky voice compared to his healthy brother, but his respiratory pulminologist says that lungs grow for seven years and that if I keep my PPROM baby from getting too many colds these next two years he has a good chance of growing up with normal lungs. I am thrilled!
I don’t know if the following things I did had an impact on the success of my pregnancy outcome but here is what I did.
Drank at least one gallon of water a day – yes, a real gallon.
Flushed labia region with water after EVERY bathroom visit (and after drinking all that water this meant a lot of squirting)
Took antibiotics for seven days, then off, then on, then off, then on during pregnancy
Took my bedrest seriously, but realized my emotional demeanor was just as important. At the hospital my Dr. agreed to one hour/once day wheelchair rides. On the days my husband/son would visit they would wheel me outside to a grassy area where I could watch my three-year old son play and take in some warm sunshine. Sometimes my dog would even visit me there. It definitely helped to lift my spirits.
If you have ruptured – take it seriously – take good care of yourself. You don’t have a lot of control, but you do have a few things you can do to try to help. Be patient, and keep the faith. HUGS!