PPROM

Many pregnant women have a fear of their water breaking in a public place. That’s what always happens to the pregnant women on TV and in the movies, right? I didn’t know that only about 10-15% of labors start before the onset of contractions. I was mildly nervous about my water breaking at work. All my coworkers are men, and I could see them being freaked out instead of helpful. If I’d only known that instead of being worried about where my water broke, I should have been more concerned about when. My water broke at 19 weeks gestation.

Nothing about my pregnancy had been easy or routine. I’d always had difficult periods, so I’d long had a fear that I wouldn’t be able to get pregnant. When I got pregnant after five months of trying, my husband and I were very excited. I still felt a bit uneasy, though, and wanted confirmation from my OB that everything was okay.

At nine weeks I went in for my first meeting with my obstetrician. I had the regular work ups and all of that, but my ultrasound is where things got interesting. While we could see a little blob (the baby) with a flickering heartbeat, we also discovered a bigger blob that was somewhat ominous looking. My OB wasn’t sure what it was, but suspected it was a twin that “didn’t take.” She took lots of pictures of the image, and said she’d send copies to a specialist she knew. We set an appointment for me to return two weeks later.

A few days later, my OB called me back. The specialist that she had consulted wanted more images. My OB asked me to come in sooner than scheduled, only two days later. I started to get nervous, because when does a doctor ever want you to come in sooner?

When my husband and I went in, the news wasn’t good. The bigger blob was still there. That meant it wasn’t a twin, as it would have started reabsorbing at that point. My OB ran a bunch of different scans on the mass that the specialist requested, and then tried to look at the baby. Unfortunately, she couldn’t get a good look at the baby because the mass was in the way. We could still see the little flickering heartbeat, but that was it. My OB feared that the baby wasn’t developing the way it should. She told hubby and me that she would send the images on to the specialist but that this was an abnormal pregnancy and that things didn’t look good. She told us not to get attached to the pregnancy because the odds were that I would miscarry. Obviously, we were devastated.

Two days after THAT appointment, my OB called. She said that the specialist she’d been consulting with wanted to see me in person. We were very happy about this since she is a Perinatologist, which is a OB that specializes in high-risk pregnancies. My regular OB didn’t deal with complications like mine, so we felt encouraged that we were going to get some answers about what went wrong with this pregnancy. I set my appointment with the Perinatologist for the following week.

We went in with pretty low expectations. The Perinatologist was very guarded when she started her exam but was quickly surprised when she discovered a perfectly-developed baby. We saw and heard the little heart beating, the little arms and legs, and we could also see the brain and the two tiny hemispheres that comprise it. She spent a few minutes making sure the baby looked good, and then she started looking around at the other things. She discovered that there wasn’t one mass in there, but two. One mass was inside the sac with the baby, the other was outside of the sac. After doing a bunch of different scans, she determined that the masses weren’t getting any blood flow, and that they weren’t connected to the baby or to each other. The doctor was fairly confident in her assessment that the masses were actually giant blood clots (they were about three times the size of the baby). The worry then was that the clots could attach themselves to the baby, the umbilical cord, or the placenta. If this happened, the clots could steal nutrients from the baby, and then there would be a whole new mess of problems. However, at that time, the doctor seemed encouraged by the fact that the baby was developing normally, and the clots weren’t attached to anything. She was cautious because in all the cases where she’d seen masses like this, there had only been one mass and I had two.

When we went back three weeks later, everything still looked good. The masses were definitely two large organized blood clots but they weren’t impacting the baby’s growth at all. We were so relieved that our ordeal was over. IF WE ONLY KNEW.

At 20 weeks I was scheduled to go in to find out the sex of the baby. However, I woke up in the middle of the night when I was 19 weeks to go to the bathroom. When I sat down, I realized my shorts were soaked with what I’d originally thought was sweat caused by a hot summer night, but was actually red colored. I looked in the toilet and dark reddish-brown liquid was EVERYWHERE. I called for my husband in a panic and we then called my OB. She said that since I was only 19 weeks, I should just come in in the morning. I wish we’d followed our instincts and gone into the emergency room. Instead, it was a long six hours until her practice opened. I got no sleep, and when I’d get up to go to the bathroom, reddish-brown liquid would gush out. I was so terrified I’d miscarried.

When we arrived at my OB’s office, my leaking had stopped. She couldn’t even tell there had been bleeding until she did a vaginal exam and there were small traces of blood. She said it looked like one of the blood clots had burst, but the baby and my amniotic fluid levels were fine, although she couldn’t rule out that my water had broken. She didn’t do a nitrazine test. I wish I’d known about them then. I was put on bed rest until the end of the week and sent back to the Perinatologist I’d seen at the beginning of my pregnancy. After a thorough exam, the Perinatologist was still not able to rule out amniotic leakage. She determined the fluid around the baby was slightly lower than what it should have been, and there was some blood in the fluid. The placenta was also not functioning as well as it should, so as a result, the baby’s heart was slightly enlarged from working much harder than it ought to be. I was then placed on bed rest for the duration of my pregnancy.

After that, I was seen by my OB and three other Perinatologists, including an extremely well-known Perinatologist in Los Angeles. The doctors all told us that terminating the pregnancy was something we should consider as they didn’t expect the baby to make it and if s/he did, there was a strong likelihood that he or she would have health problems.  My OB said to me, “I would be medically irresposible  not to to tell you about the option of terminating. You would be induced and deliver vaginally.” That idea horrified me. I couldn’t imagine going through that. I know some women make this choice, and I respect that. I just couldn’t do it. I’d been feeling my baby move at that point and that just wasn’t going to be an option for us. I said as much to my OB and she said back to us, “I understand. I just wanted you to know that you might not like what comes out.” I was stunned by her gall. It wasn’t like I was going to give birth to a murderous alien; I was pretty certain that a babywas going to come out. MY baby. We didnt care if she had health problems, we would love her how she came.

Her thoughtless words motivated me more than anything. I was so determined to prove her wrong, that at the end of this I would have my baby and he or she would be perfect.

We kept going with the first goal being 24 weeks. I was on extremely strict bed rest. I was only allowed to get up to use the bathroom. I could take a 5-minute shower if I sat on a stool. I had to eat 2500 calories a day to help my insufficient placenta. I drank GALLONS of water. I could feel my muscles tingle as they atrophied. My mind easily wandered.  I couldn’t concentrate on anything except my baby. I did tons of internet research, typing my symptoms into Google, and I diagnosed my condition myself – Preterm Premature Rupture of the Membranes (PPROM). I had every symptom except I hadn’t gone into labor. Most women with PPROM go into labor within a week of their water breaking. I was more depressed than I’d ever been in my whole life. My wonderful family and friends did all they could to cheer me up. My husband took amazing care of me…I never would have made it without him.

I often worried that I was being selfish, that I was potentially allowing a baby to be born that would have painful diabilities, simply because I didn’t want to go through the pain of termination. I knew that the odds were against my daughter, and she would likely not survive the whole ordeal. But my husband and I decided that we were going to give her every chance possible. I just knew that I would spend my whole life wondering “what if” had we chosen termination. As strange as it sounds, we decided we’d rather have her die after birth than make that decision for her.

When we got to 24 weeks, I had a bag packed for the hospital but my OB decided not to admit me since I was doing well at home. It was nice to be at home, but I was devastated – I really wanted to be admitted so I could be monitored. I should have insisted on it, but instead I went back to bed. I was told to limit visitors to help prevent sickness. None of the doctors could believe I hadn’t gone into labor or developed an infection. At every visit, I had the nitrazine test and it always came back negative, which was SO FRUSTRATING because I KNEW my water had broken. It came out in small bursts, smelled sweet, and had an amber tint to it. I never leaked when I was at the doctor’s.

At 26 weeks, I had another appointment with the well-known Perinatologist. He did a sonogram, and managed to get the shot that had eluded us for weeks – there was a little girl in there. We were so excited – we knew who we were fighting for.

At 26 3/7 weeks, I got the flu and my temperature started to rise. I called my OB and she said to go by the hospital to be monitored. I was attached to monitors that watched the baby’s heart rate and checked me for contractions. A nurse took an initial amount of blood to check for an elevated white blood cell count (an indicator of infection), and then they started giving me cool fluids to help hydrate me and lower my blood pressure. After what felt like a million years, the hubby and I were finally left alone to sleep at about 12:45 am.

At 3:45, I went to the bathroom and started to feel a little stomach tightness. Worried I might be having contractions, I called my nurse, who came back in and hooked me back up to the monitors. While she was there, it was FINALLY positively determined that my membranes had prematurely ruptured. Despite the 10 previous appointments I’d had since I’d woken up bloody, I hadn’t had an episode when a doctor was present – until I was in the hospital.

Once the PPROM was officially diagnosed all hell broke loose!! I was admitted for the duration of my pregnancy. My doctor was called at home, and I was suddenly getting IV antibiotics and a HUGE shot of a steroid called betamethasone. I had another shot 24 hours later.(Steroids help fetal lungs develop more quickly before being delivered preterm.) I settled in with the goal of making it to 28 weeks. My hubby stayed with me as much as possible. We were so relieved that I would now be monitored. I had a private room and I got in touch with some of the other antepartum moms, some of whom also had PPROM. We took a tour of the NICU, which I HIGHLY recommend if it can be arranged. It definitely made the place less scary.

During the time I was in the hospital, I was also diagnosed with gestational diabetes. I started to show the signs of pre-eclampsia (extreme headache, rising blood pressure), but never got far enough in the pregnancy for anything to be officially diagnosed.

After 28 weeks, my fluid started to take on a pink tint. The nurses and my OB were aware of the change but not overly concerned. I started to feel really uncomfortable. I’d have an occasional contraction but nothing regular. I was just miserable. Then, at 28 6/7 weeks, I leaked and when I wiped, the washcloth came back RED. I called the nurse, who took one look at it and paged my doctor. When she arrived I had a sterile speculum exam. It was the MOST PAINFUL exam I have had IN MY LIFE. It was determined that I was starting to transition towards labor, but I wasn’t dilated or effaced, so we decided to stay the course. A few hours later, I leaked and wiped away a huge bright red blood clot. I called the nurse, who paged my doctor again. For some reason, I wasn’t concerned. The exam had given me some security. I went to the bathroom while the nurse was out of the room and wiped away more clots. I flushed them, like an idiot. My husband wasn’t there but I didn’t call him. I really thought everything was fine.

While I was on the phone chatting with a friend, the nurse came back in and briskly announced I was going to have a C-Section RIGHT THEN. I went into shock! I called my husband, parents, and brother, and then I was immediately prepped for surgery. My husband got there as my epidural was being placed. I was shaking I was so scared. Since it was an emergency C-Section, I’d had lunch only a few hours before, which is normally a no-no. I was given a cup of  the nastiest antacid to help neutralize my stomach acids. The nurse told me I’d want to sip it because it was so gross, but I just tossed it back like it was a shot of fine tequila. I learned something in college.

The C-Section didn’t take long and before I knew it, my husband and I were parents. I heard the doctors say, “she’s out,” and then I heard tiny, weak crying. Crying! It was the best thing I’d ever heard. They washed her and wrapped her up, and I was allowed a quick kiss before she was whisked to the NICU with my husband close behind. In recovery, we were euphoric. She’d cried! That meant she could breathe. Our happiness was short-lived, however, when a Neonatologist came in to see us. Our daughter was very sick, sicker than the hospital could treat, and she needed to be transferred to a teaching hospital a few miles away. We were so crushed. We knew she’d be in the NICU for a while but never anticipated she’d have to be at a different hospital than me.

I was wheeled into the hallway so I could see her little isolette roll by with the transport team. I waited in the hallway for more than an hour because the transport ventilator wasn’t providing enough air. I found out later that no one expected her to even survive the transport. She had to be hand-bagged the entire way. My husband left me to be with her. It killed me that I couldn’t go, too.  I had a lot of drugs, though, and I eventually fell asleep.

The next day, things got very bad for my daughter. My husband called and told me she wasn’t going to make it. I couldn’t stand the idea of my daughter dying without me by her side, so I checked myself out of the hospital against medical advice. The nurses were so great, they did everything they could to help get me out of the hospital as quickly as possible. I was rushed the few miles to the hospital where my daughter was, and when I arrived, she stabilized. I went back to my hospital and checked back in so I could get pain medication and a bit of sleep. The next morning, things were worse for my daughter. I checked back out of my hospital, this time for good. My OB signed my discharge form, and then, knowing that things were not looking well for my baby, said, “If you don’t nurse, bind your breasts tightly and use ice packs.” I was so pleased that her tact was the same as always.

My biggest advice to anyone going through this is to follow your instincts. Get as educated as you can so you can make informed decisions. If a doctor is advising you to do something and it doesn’t feel right, don’t do it. Be your own biggest advocate, and most importantly, be your baby’s advocate.  Parenthood starts with pregnancy – you would give your baby every chance if she was born, so why not do all you can before she’s born, too?

It was a long road for my daughter, but she made it. The best day of our lives was when we took her home from the hospital after 68 long days. The second best day of my life was when I took my perfect baby to see my OB so she could see exactly what “came out.”