By Ben Mudaliar, Canberra, ACT Australia
PROM at 15 weeks + 3 days. Delivery at 38 weeks + 2 days.
Story added: 2009-09-11

At 15 weeks, my wife woke me at 3:00am with the words ‘something’s wrong’. Turning on the light, I saw the outline of a large amount of fluid on the bed sheet.

I’ll never forget her saying to me ‘I think I’m losing the baby’ and how at that moment I was both calm and distressed. I looked at my wife’s eyes and saw a similar expression – a calm reservation thinly masking a deep fear. We didn’t know quite what was happening, or if we truly were losing the baby.

I suggested that we ring our midwife. For a minute or two, we wondered if we really should call her at that time of the morning. She had told us to call her at anytime if we really thought something was wrong, and at that moment, we really thought something was wrong. Our midwife asked my wife a few questions, and said that she wasn’t sure what had happened. She had never heard of anything like what we were describing having happened to any of her patients before. She said we could either go to Emergency then or in the morning.

We decided to go then rather than wait for the morning. As we stepped out of our apartment, I noticed that there was the lightest of rain falling – at any other time, it would have been beautiful.
At the hospital we were seen by a young obstetrician who after scanning told us that she was 95 percent certain that everything was okay. There was, according to her, plenty of fluid around the baby, and whatever fluid had been lost, she didn’t believe that it was amniotic fluid. Just to be sure though, she asked us to make an appointment to have an another ultrasound as soon as possible.

We were lucky enough to make an appointment for 2:00pm that day. When we saw our baby, the heart beating and arms moving, we both started crying with relief. Even though we had been told that everything was most likely okay, it was such a relief to see him in such detail. After 10 minutes, the ultrasonographer said ‘I’ve just got to check with the doctor to make sure that there are no more images they want before I let you go’.
When she came back, her first words were ‘as you know, you’ve lost a lot of fluid and they want you to go straight up to the antenatal unit. They’ll take care of you there and a doctor will come and see you soon to talk to you about your results’. Although we had never completely escaped the sense that everything was not quite right, now for the first time people were confirming that something was seriously wrong.

It took some time for us to see the obstetrician on duty. I remember when she walked in to the unit, she looked in our direction, and asked the nurse ‘are they this one’, referring to the notes she had in front of her. The look on her face was as serious as I had seen any face that day. I turned to my wife and said what we had both been thinking but hadn’t dared to say since the night before, ‘something is wrong’.

The obstetrician, when she saw us, told us that there was ‘less fluid’ around the baby and that this wasn’t good. She didn’t seem to move beyond that level of detail for some time until we asked her exactly what she meant by ‘less fluid’ and ‘not good’. She told us that they only found one pocket of fluid (AFI 1.3) and that it was likely that my wife would miscarry in the next 24-48 hours. If the miscarriage did not occur, there was a significant risk of the baby being born without the ability to breathe or with serious neurological and physical defects.

My wife burst into tears and instinctively both myself and the obstetrician reached out and held her in our arms. The obstetrician just said, ‘I’m sorry, I’m so sorry’. After a few minutes, my wife stopped crying enough to know that we had to figure out where we went from there. We were told to make an appointment with their fetal medicine unit first thing in the morning but to come in before that if my wife felt any contractions or experienced any bleeding.

As we drove home, trying to absorb everything we had been told, I started sobbing while driving. My wife comforted me and I saw that it helped her to comfort me. Over the next couple of days we took turns at breaking down and comforting each other. That night at 3:30am my wife leaked again.

When we did see the fetal medicine unit the next day, and had our care transferred to a fetal medicine specialist, we were told after the scan that they had found two pockets of fluid (AFI 3.2). One of three things could happen: my wife would miscarry; or the baby would be born, but without the ability to breathe or with significant physical and neurological defects; or the rupture would heal, fluid would re-accumulate, and the pregnancy would progress and the baby would grow and eventually be born, though when, they couldn’t say. We were told that a decision to terminate didn’t need to be made until the baby was 20 weeks, that viability was 24 weeks and that the chances of survival increased significantly and continued to increase from 26 weeks onward. If we could get to the 32 weeks, there was a very good chance that the baby would be born with the ability to breathe so long as the fluid re-accumulated to the level needed for lung development to occur.

We were also told that if we wanted to terminate then and there, that we could, but we didn’t need to make that decision at least for another 3 or so weeks. We decided to wait and see what both my wife and my baby’s bodies decided to do. We desperately hoped that the rupture would heal, that fluid would re-accumulate and that eventually we would have a healthy baby.

When we went home and started to do our own research, we realised the chances of that happening were very slim. Spontaneous ruptures, we read, were less likely to heal than those which occur after amniocentesis. We also knew that the chance our baby would make 24 weeks let alone 26, 28, 30, or 32 weeks was very slim, but we didn’t want to give up on our baby. There were moment, brief moments, when I thought seriously about termination. I don’t know if they were moments of weakness – but I do know that the desire to see my baby make it, in the end, always obscured any commitment to a termination.

That evening, my wife leaked again for the third time in as many days. But this leak occurred while she was awake. On every other occasion, she had been sleeping. It occurred to her that the other leaks and this one had happened after she had been lying on her left. We decided then to avoid lying on the left and thought that lying on the right would be best.

The next day, my wife leaked again, but after having gone beyond the perpendicular while on her right. We then decided that lying on her back and with her left slightly elevated were the only two positions to lie in. The resultant back pain over the next weeks was difficult to manage. Massage helped, but the pain would always return. The positive was that my wife seemed to stop leaking altogether after that point.

A week later, the fluid levels had not increased. But neither had my wife miscarried. Another week passed and the fluid levels had increased noticeably (AFI 5.4). Our doctor told us that she thought the rupture had healed and that she hoped we had turned a corner. She told us to come back in a couple of weeks. Two weeks later and despite not having leaked, the scan suggested that our fluid levels were back where they had been when this first happened (AFI 3.2).

We were thrown back into confusion and uncertainty. Our doctor ordered another round of blood tests. A week later and the blood tests gave us no cause for concern and the fluid levels were up again (AFI 8.4). We were told to come back in another three weeks. Thankfully, this time the fluid levels were the same as they had been three weeks before (AFI 8.5).

We reached 24 weeks a week later. The first of our milestones. A week later, my wife woke early complaining of contractions. We rang the delivery suite who told us to come in straight away. After the examination we were told that the cervix was closed and to go home. The contractions came and went and then stopped about 12 hours after they had first begun.

Two weeks after that my wife noticed a larger amount of fluid in her underwear. We went to the hospital again and saw the obstetrician that had first told us that she was 95 percent certain that everything was ok. After an internal, she said that she thought everything was ok but to contact the fetal medicine unit and to bring forward our appointment.

Our next scan suggested that the fluid levels had been maintained (AFI 9.1). We breathed a sigh of relief. Week after week passed without incidence. Our doctor believed that the leak had certainly healed and that we could be fairly confident that our baby would be born without any serious problems. There was a chance that he could be born with dislocated hips. And there was also a chance that our baby might not be able to breathe – our doctor simply could not rule it out.

Our baby was also in a breech position. We hoped that the little one would turn in time but in our hearts we knew that the chances were slim. We tried acupuncture, swimming, walking up stairs sideways – nothing worked. At 34 weeks we were asked if we wanted to try External Cephalic Version (ECV) once we reached 36 weeks. Having made it this far, we declined. We just decided to have a caesarean delivery. We were told that an ECV had a 1 in 200 chance of developing complications and for us, 1 in 200 was too great a chance to take.

At 38 weeks and 2 days, we went to hospital hoping that the caesarean delivery would end with a healthy baby entering the world, screaming and breathing. Unfortunately our little boy’s first moments were without a heartbeat and not breathing. A code was called. My wife could not see what was happening and I had to talk her through what was happening. All I could say was ‘he’s struggling... he’s struggling’. We both wondered whether the initial loss of fluid had occurred at that critical moment when his lungs were developing and realised that this might be the end of his life. I can recall thinking that even if it was, he had already brought us much joy. The medical team hadn’t given up on him though, and just before the code team arrived, they got his heat beating and his little lungs working.

I saw and heard him cry and the doctors started saying ‘he’s ok, he’s ok’. In less than five minutes, he was in my wife’s arms. He weighed 3165 grams. He was alive. Within an hour he was feeding.

Tobias Micah is now four days old. He did not need to spend any time in the nursery. He is very strong, hates getting his nappy changed but settles almost immediately once he has been changed. We can already tell when he wants to be fed and when he wants to be changed. There are two distinct cries. Otherwise he sleeps very peacefully.

My wife is expected to leave the hospital tomorrow with our little boy. We never expected to get this far. We feel so blessed. Like so many others, the stories on this site gave us so much hope. Our hearts equally go out to those parents and families who have not been so lucky. But to be able to hold on to hope is so important. There were times when our difficulties seemed insurmountable but my wife and I would always fall asleep and wake in hope that we would get through another day and then another. And somehow we did.