Premature Rupture of Membranes (PROM) can be frightening. When this happens pre-term (PPROM), it is an even scarier prospect. Mother Sider Chloe recently gave birth to twins and has kindly agreed to share her experience of PPROM…
Over to Chloe…
Walking through the arrivals terminal in Birmingham airport on our way back from a family holiday in Spain I felt a slight leaky feeling between my legs. Oh dear, I thought, too much water on the plane; it’s not unusual for pregnant women to lose a bit of bladder control now and again. Except – I’d just been to the toilet and done a huge wee. I kept walking, more liquid kept coming. I couldn’t stop it. I realised I’d felt this exact sensation before… during labour with my daughter. Fear spread through me as I sank to the ground, clutching myself. My waters were breaking. I was just 15 weeks pregnant.
Two hours from home, I was blue lighted to a nearby hospital. Eventually, after a night in A&E where I was never properly examined or scanned, a gynaecological consultant was spoken to on the phone and reportedly said it was impossible for my waters to have gone this early: I must have wet myself. The relief was immense, I don’t think anyone has been so happy to be given a diagnosis of incontinence. Looking back, I had latched on to this assertion because I so desperately wanted it to be true. A hint of doubt and fear lingered however; I think I knew deep down that something wasn’t right.
Five incident-free weeks later, these fears were compounded after our 20 week scan. We were shown into the ‘the bad news room’ – a tiny space with a nice sofa, art on the walls and a box of tissues. A sympathetic midwife informed us that there was a serious problem with the size and development of one of our babies, twin one.
When we’d found out at the 12 week scan we were having twins I was so freaked out and overwhelmed by the news that I cried through the whole thing. Ironically, this time I solemnly listened but my eyes remained dry. The idea of having twins which had then seemed so scary was now eclipsed by the possibility of not having twins at all.
We were sent the following day to John Radcliffe Hospital in Oxford for more scans with specialist doctors, and many theories were thrown at us including TTTS (Twin to Twin Transfusion Syndrome) and Intrauterine Growth Restriction. But whatever the reason for twin one’s small size, and being so ‘shrink wrapped’ by it’s sac that it’s gender couldn’t be identified; several doctors told us that he/she would most likely pass away in my womb.
A week later – still digesting this news – I discovered some pink liquid on my toilet paper after I wiped. Then a bit more. ‘Darling!’ I called my husband with as much calm as my voice could muster – I was running my three year old daughter a bath at the time. ‘Could you pop in here quickly, please.’ I showed him the offending tissue and we decided to get to ADAU as quick as possible.
It was Saturday night, and we were promptly seen by a lovely doctor who gave me speculum exam to check my cervix and take a swab to test the leakage for amniotic fluid. He returned with the results and confirmed very gently that although my cervix was long and closed, my waters were indeed leaking. He urged me to keep calm, but proceeded to tell me just as gently that I needed to be admitted as I might go into labour in the next 48hrs or develop an infection requiring immediate delivery of the babies. I was then only 21 weeks pregnant.
With the babies not yet viable, it was the scariest time of my life. I was on a ward with new mothers and new babies, waiting to see if I was about to lose both of mine. We got everyone we knew praying. Two days passed and despite leaking more fluid – which I was assured would keep happening now – I was sent home.
PPROM (Pre-term Premature Rupture of Membranes) affects 2% of all pregnancies in the UK with varying survival rates. I was alarmed to discover that, in some countries, a termination is recommended if PPROM happens at an early gestation due to the effects that lack of amniotic fluid has on lung development. In the US strict bed rest in hospital is prescribed until delivery. But other than twice weekly ADAU blood tests and self temperature checks every few hours to detect any early signs of infection, I was simply advised: No marathons. No baths. No sex. But otherwise to carry on as normal.
But nothing is really normal with PPROM. As the baby takes water from the placenta and wees it back out into the sac, it replenishes its fluids. But because there is a slow leak – like a slow tyre – the new waters then leak out again. Daily. I could be anywhere, a child’s birthday party, out for dinner, at the park with my daughter… and would suddenly, without warning, feel a gush. Mostly it would be caught be a maternity pad, but sometime it would soak through knickers and leggings. I’d have to carry spares along with my daughter’s nappies in my bag. The liquid was pinky red but, unlike a period, my leaks always felt horrible. Not painful – but just a horrible sensation and plain wrong. Like my body was failing my babies.
Living with the daily worry of infection or pre-term labour was a challenge. Family and friends were so supportive – our church even started praying every day at noon for our twins which gave us hope and strength. We stuck up a hand drawn calendar on the wall with the gestation weeks stretching from the day PPROM was confirmed until our goal of Christmas and 30+ weeks. Every night we would cross off that day, happy that the babies were getting closer to our next goal – viability initially (celebrated with very nasty steroid shots to help boost the babies’ lung development) – then the next significant milestones.
One of those milestones was 28 weeks as that was when, if anything happened, we could stay in our local hospital, Milton Keynes, as their neo-natal unit accepted babies from this gestation onwards. At 25 weeks my pinky leaks had turned bright red and I’d been transferred twice to Oxford, an hour away, and stayed two nights each time which was a real strain. My mum had to move in to help look after my daughter, because at that point I was told I needed bed/sofa rest. One night the bleeding increased significantly and our upstairs resembled the set of a low budget horror film, with bright red soaking through to the mattress on our bed, down the legs of my pyjamas, splattered over the carpet and up the walls of our bedroom and landing from a mad dash to the toilet.
My fetal medicine consultant, who had up until then been unable to determine the source of the bleeding, confirmed from a scan that my placenta was slowly lifting away and was at risk of full abruption. If this happened the babies would need immediate delivery so I needed to stay in hospital for the remainder of my pregnancy. By strange synchronicity – I was exactly 28 weeks.
The four weeks I lived in hospital were pretty horrendous. Being separated from my daughter was heartbreaking. Although I knew she was well looked after by my mum, I spent a good deal of time crying with the pain of saying goodbye after her daily visits. I also had to come to terms with the reality of having premature babies as I was told I wouldn’t be able to go past 32 weeks. Knowing I would be separated from them immediately after the birth so they could be taken to NNU for treatment, and knowing I couldn’t breastfeed them initially but would need to pump milk for tube feeds all felt horrible and overwhelming. There was also the constantly re-iterated fact that twin one was only given a 50 % chance of survival due to the possible under development of the lungs.
However, the strangest thing was being in hospital but not feeling at all ill. I didn’t want to sit in bed all day, and had got so used to the extreme bleeding it didn’t bother me anymore. Every time I bled, I was monitored on a CTG machine But the babies heart rates were always healthy and never once worrying.
A few times I was taken to labour ward and the doctors came close to delivering me – the staff were all shocked I could bleed so much and yet continue with pregnancy. My iron levels were fine, the babies were seemingly fine. But each time they came close to making the decision I held on to out goal of reaching 30 weeks and Christmas. And each time the day of execution was stayed.
After a Christmas spent in hospital – which was actually filled with as much fun and laughter as it was tears and terrible turkey – the bleeding ramped up and my uterus was so irritable it began to contract continuously. On Thursday 27th December, after another large bleed, I was wheeled down to labour ward, and told I would have a section that night. They gave me magnesium sulphate to reduce brain bleeds in the babies after delivery and help prevent conditions such as cerebral palsy. All worth it, but it did feel like being injected with actual fire and not an experience I’d wish on my worst enemy. Then I was put in a gown and taken, with my husband, down to theatre. The day had come – my horrendous pregnancy was about to end – my babies were about to be evicted early from their precarious home into the world. One quick last bump shot of me in tears trying to smile and keep calm, then I was onto the operating table. I had made it to 31 weeks.
Thankfully, our little miracles, true to their in-utero nicknames (Rocky and Rambo), came out fighting. They were wrapped in plastic bags and taken to incubators, but were soon stable and even twin one (aka Rocky), with her 50/50 odds, was off ventilation after a day. I’m all too aware that this happy outcome isn’t the case for all babies who are born after PPROM, and feel so blessed that I get to watch them grow and progress in the NNU going from strength to strength. I so look forward to bringing them home and putting our past struggles behind us. But if my journey can bring hope to anyone else suffering with PPROM, or a high risk pregnancy, it’s story worth telling.’
Editor’s note: We are so happy to report that both twins are now home and doing well.
Chloe, writing for The Mother Side x