Before experiencing PPROM or preterm premature rupture of membranes as it is known, I had no idea what it was. As far as I knew from my previous two full-term (37 week) births, when your waters broke it meant you were going in to labour. Well, I was about to learn a lot this pregnancy.
When we found out we were having twins I knew it was going to be higher risk than my singleton births. I had already suffered extreme nausea up until 20 weeks and although I wasn’t that big for carrying twins, the pressure on my back and pelvis were really starting to take a toll on my body as I hit five months pregnant. Aside from these symptoms the pregnancy had been relatively straight forward and we didn’t have any concerns. Our scans had been fine, the boys were growing well, their heartbeats were always strong and there was nothing to imply things were going to go wrong.
At 23 weeks & 4 days pregnant with the twins, I woke up at 4am with a desperate need to pee. What I saw instead was light bleeding and of course I instantly panicked. I called out to my husband and he rushed to my side. I had some mild cramping the night before but that was common in the pregnancy with two babies pushing down on my pelvis constantly so I didn’t think anything of it. I called my midwife and she called the hospital who advised I needed to go in. Not wanting to disturb the kids, I drove in by myself arriving at 5am and was taken to the birthing suites to be checked over. At this stage I really didn’t think much of it and thought it was just a bit of pregnancy spotting which can be quite common.
The doctors came in and took some swabs and told me that I was leaking amniotic fluid. I was shocked. I hadn’t even comprehended that this may have happened. They followed this news with telling me I was now at risk for premature labour and I wouldn’t be leaving the hospital. I was obviously overwhelmed with emotion. How did this happen? Had I pushed myself too far at home? Was it stress? I had relatively straight forward full term pregnancies before (aside from cholestasis) so I didn’t even consider premature labour. Turns out I would never really find out what caused it.
The next few hours were a blur. They did a scan of the babies and although there was still plenty of fluid they could tell my ‘Twin B’ had less and guessed that it was his sac that had a hole in it. They measured their growth and one twin was around 800g, whilst the smaller twin (with less fluid) was around 700g. Apparently these were very good weights for this gestation although they can still be a little off, this was at least a positive for us.
My husband came in a few hours later and we were visited by the doctor along with a head consultant from the NICU department. We were given worst case scenarios and it was possibly the hardest thing we have ever had to hear. Although there are stories of babies surviving at 23 weeks, the odds were slim. We needed to make it to 24 weeks at least for better chance of survival, which was just three days. We were also asked about resuscitation and what we would choose. For us, there was no other option, we wanted everything to be done for these babies.
View from the Hospital window
I was then given a steroid injection to help improve the babies lungs and another 24 hours late and also started on a 10 day course of antibiotics to prevent any risk of infection. After that I was moved to the maternity ward where I would settle in for the foreseeable future. Being in hospital during COVID lockdown was rough. My kids were not allowed to visit. One day they had woken up and I was gone and they had no idea when I would be coming home and it tore through me every day. But I was where I had to be for my other babies.
Every day I woke up pregnant was a blessing and a 3% better chance of their survival. My waters did not leak at all during the day but for the first three nights they leaked overnight accompanied with pinkish blood which they weren’t concerned about. On day 3 there was some brownish/greenish colour in the leakage and the doctors said it looked to be meconium (do not Google this as it terrified me). This can happen in preterm labour and can be a risk to the baby if it breaths it in. However they weren’t sure it was and they would not use this as a reason to induce labour when everything else was going ok. It would just be monitored.
After five days in hospital they did another scan to re-check the fluids and the babies fluid (who’s sac had popped) had increased which was reassuring. They explained that the best outcome would be for the hole to reseal and to continue in the pregnancy as long as possible and the fact that the fluid had built back up to normal was so important for us because it gave us time.
Chance putting on my hospital socks whilst on bed rest
I remained stabled for the next week but the doctors advised me they wouldn’t let me go home until I had reached roughly 26 weeks which was really hard to hear as I just wanted to be with my kids. Rules surrounding PPROM are different in NZ as in America they usually keep you in hospital from viability age (24 weeks) until you give birth whereas Australia & NZ usually only keep you in if you’re presenting really high risk so I was thankful I had the opportunity to return home.
About 5 days in to my stay the doctors said they might have to transfer me to another hospital in a different city due to their NICU being full. Their NICU was consistently running at over 100% capacity so if I did go in to labour it meant they wouldn’t be able to safely care for my babies. Hearing this really tipped me over the edge emotionally. Obviously processing everything that had happened that week was hard enough but hearing I would be leaving to a city where I knew no one and my husband and kids would not be able to go to, was too much. I contacted my midwife and told her what was happening and she was firm that this should not be happening unless absolutely necessary and she contacted the hospital. The doctors then returned as I was preparing myself to leave for a plane trip and told me I was ok to stay for now. They apologised for the miscommunication and said although it was a possibility, they could hold off me leaving for now. I felt wrecked. That day was a rollercoaster of emotion, stress and shock and it took me a while to come down from it. However, this is something I now had to prepare for but at least I had some time to process it instead of being told I had to leave immediately.
After a week of facetiming my kids, I was able to meet them downstairs at the park (as visiting restrictions were still in place) and it was SO good to see them. My poor little Leo struggled when I had to go back and it broke my heart. Thank God for Facetime!! I know my husband had been doing such a good job of ensuring this was as less traumatic as possible but I also worried about him at home doing it on his own. I missed them so much.
In the days that followed I had no leaking at all and I was hopeful I had resealed. Unfortunately that wasn’t to be our journey as I started leaking again BUT thankfully after 10 days in hospital a different doctor came in and told me I was stable enough to go home!! I was to only do “light” activities but I put myself on strict bed rest whilst the kids were at preschool and school to avoid any chance of going in to labour. There is actually no studies that show bed rest improves your chances of prolonging pregnancy but frankly I was too scared to continue on with normal life.
I joined a fantastic page on Facebook for PPROM and we all shared our journeys and advice. I found a great vitamin routine to start taking as well as things to take to avoid infection like cranberry juice, URAL, and SO much water as urinary tract infections were the most likely. I set up a trolley beside my bed with snacks, water, my supplements, the remote and settled in.
The vitamins below were basically to give the twins a better chance of survival. Things like magnesium were for their brain development and probiotics was for my own gut flora to prevent infection. Also, protein!! Please invest in some protein powder. I started taking it after I pprom’d and I can say hand on heart that it immensely helped with their growth. Our smallest twin whose sac was leaking was at risk of slowed growth so I started drinking protein shakes and he grew like 200g a week which was incredible in utero as babies usually do their biggest growth spurt in the final trimester.
After discharge, I was in and out of hospital for constant monitoring every two days for infection markers and heartbeats. During this time I continued to leak. Some times I would go a few days without anything and then overnight it would start up again so I tried to never get my hopes up. Quite often it would present with light pinkish bleeding but if it did become dark red fresh blood I had to report to the hospital immediately. I lasted a week back home before this happened and I had to be admitted again until it stopped so I was in for another week and then sent home before finally being readmitted about a week later for heavy dark bleeding where I could sense things were getting worse and my leaking was getting heavier.
The doctors were trying to avoid checking my cervix internally as it can risk infection so they just monitored my bloods for infection and the routine checks and honestly the whole time since I PPROMD my infection markers were perfect, my blood pressure was never an issue and the babies heartbeats were always strong. It wasn’t until they went to send me home for a 3rd time after being admitted that I asked them to check my cervix “just to make sure” as the bleeding and leaking of fluid had been heavier this time and it was at that moment of checking that the doctor found Charlie’s foot (the twin who I had pprom’d with) lodged in my cervix and it was all over. We were rushed in to emergency and they were both delivered at 28 weeks & 2 days and off to NICU where they spent 10 weeks ( I will share more on our NICU journey in another post) but they are now both thriving and happy little new-born babies.
If there’s any advice I can offer to a mama going through PPROM is trust your instinct at all times. Be your biggest advocate. Ask questions and NEVER be afraid to go in and get checked because it could make the biggest difference in the overall outcome. There are so many success stories out there! We held on for five weeks but so many other women have held on for months and had happy healthy babies.
If you’re experiencing PPROM and have any questions or just need support, please reach out. You’re not alone in this.
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[…] we were already in hospital due to previous complications from PPROM (which I have wrote about here) and we were able to be taken away immediately to deliver. Within an hour both the boys were born […]