48 Hours (Part 1)

When I was in the hospital, I read every story I could find about PPROM (preterm premature rupture of the membranes), particularly those who had ruptured around 20-23 weeks.  It helped to know I wasn’t the only one who had gone through this devastating situation.  Sadly, it’s far more common than I ever realized until it happened to me. 

Once my daughter was born, I tried not to think about that awful night and subsequent weekend when my water broke.  She was here and, against all odds, alive.  However, the memories kept surfacing, sometimes in upsetting ways.  Eventually, I started writing bits and pieces down until I had pages and pages of documents detailing my story of PPROM at 21 weeks pregnant.  It’s a long story, so I plan to break it into a number of posts. 

Everything I’ve written is as I recall to the very best of my knowledge.  I’ve chosen to put conversations in quotations, but all are based on my memory, not recordings or other documentation.  I’ve deliberately omitted my doctors’ actual names.  

The dark felt familiar and safe, the warm quilt and sheets tucked around me. I stretched a little, curling further into the bed, unsure of what had woken me. The baby kicked, tiny flutters I still could barely feel low in my belly. I closed my eyes, preparing to go back to sleep.

Suddenly, I felt a sticky, wet warmth trickling down onto my thigh. Sh*t. I rolled out of bed, glancing at the alarm clock my bedside table as I stood up.

1:19 am.

In the bathroom, I squinted against the bright lights at my pad. Oh, good. No new red blood. Maybe the baby kicked my bladder and I dribbled a little. I finished my business, changed the pad, and shuffled back to the bedroom, eager to go back to sleep.

Crawling back into bed, I thought about my brand new maternity clothes, still in their box in the living room. New pair of jeans, a couple of cute tops that I hadn’t ordered until I was almost 20 weeks and finally bursting out of every normal piece of clothing I owned. First bump shot in my new clothes in a few hours, I thought, excited. Sure, the pregnancy had been a rough one, but the subchorionic hematoma that had caused so much trouble was shrinking beautifully. I was finally settling into the idea that we’d have a baby in late May or early June.

I snuggled back into the sheets, trying to recapture the warmth. Arthur stirred next to me. The baby kicked again.

And then it happened.

No longer a little trickle, I felt wetness saturate the new pad almost instantly. I jumped out of bed, hoping to make it to the bathroom before I got what I presumed to be blood all over the sheets. No, no no! The SCH is supposed to be getting better! I lost all those clots! I haven’t had fresh bleeding in a week now!

In the bathroom, I stared down at the pad, uncomprehending. Sure, there was a brownish, old-blood tone to the fluid. But it wasn’t new blood as I had anticipated. It was far too clear, and I knew beyond a doubt this time that it wasn’t urine.

Arthur came in with a pair of fresh underwear for me. “What do you want to do?” Both of us knew something wasn’t right, but neither of us could voice what we feared.

“Let’s call the hospital,” I offered. “See what they have to say.”

The labor and delivery nurse who answered the phone told us to page the on-call OB. I had just hung up and was preparing to dial again when I felt another gush. “We need to go to the ER,” I told Arthur. “It just keeps happening and something’s not right.”

I remember putting on my black fleece sweatpants, pulling a long-sleeve t-shirt emblazoned with a 5K logo over my head, not even stopping to put on a bra. I figured we’d spend a few hours at the ER, get reassurance that everything was okay, and be home in time to grab a few hours of sleep before Arthur’s 8:30 am doctor appointment to discuss getting his whooping cough vaccine before the new baby arrived. We’d still get to take my bump shot and I’d get to wear my new clothes.

I grabbed my purse, barely sparing a glance around the familiar living room, not realizing that this was the last time I’d leave the place we had called home for nearly ten years. The night was crisp and cool, but not as terribly cold as I expected for late January. I sat on the towel I’d placed on the passenger seat of our car several weeks ago during my last trip to the ER, praying we’d make it to the hospital before another gush hit.

What strikes me now is how worried I was about making a mess in the car. I now recognize it as denial. My brain focused on what it could deal with at that moment, not the unimaginable. It was the beginning of a cycle I’d repeat countless times over the next fourteen hours: panic, fear, understanding, then going back to denial.

Arthur dropped me off at the ER doors and went to park the car. The ER staff had gotten to know my face and story over the many visits I’d made for bleeding during the pregnancy. I filled the registration clerk in on the latest development and signed paperwork. She consulted briefly with one of the ER nurses, made a phone call, and told me that they would triage me straight up to OB. I sat down and waited while they got a wheelchair and relayed the situation to OB, praying I wouldn’t have another gush and soak my sweatpants right there in the ER lobby.

Arthur hurried in just as tech came to wheel me up to the OB unit. The charge nurse put me in a small room beside a supply area, handing me a gown to change into. It was cozy, a soft bedside lamp illuminating the space as I pulled off my sweatpants and underwear and climbed onto the gurney. The nurse pressed gently on my belly with a sensor, looking for a heartbeat.

“Uh-oh,” I gasped as I felt another gush at the pressure. “It’s happening again,” I informed the nurse, pulling back the sheet, a large splotch of the dirty brown fluid on the heavy cloth soaker pad underneath my hips.

The nurse handed me a fresh cloth soaker and examined the wet one. “No fresh blood,” she noted. “It doesn’t look like amniotic fluid, that’s usually more clear. And it doesn’t smell like amniotic fluid either.”

“Is there some way you can check if it’s amniotic fluid? Like with the nitrazine paper or something?”

“We don’t use the paper anymore,” she informed me.

“So how do you know if it’s amniotic fluid?” I demanded. “I just need to know if it’s amniotic fluid, because then I can go home if it isn’t.”

She shook her head. “We don’t have a definitive way to test for that here,” she said. “You’re really early anyway, I don’t know if anything we did would answer that question for sure.”

I stared at her, feeling more fluid leaking out underneath me. “So what am I supposed to do?”

“Well, the doctor doesn’t want you to go home right now. He says he wants you to stay until he makes rounds in the morning, probably around 6:30 or 7 am – unless something else happens. Then he can see if things have stopped or changed.”

“I just need to know if I’ve ruptured!” I said shrilly. My mind raced, wondering if there was anywhere in town Arthur could go to get nitrazine paper so we could just check on our own. “I mean, I am gushing a lot of fluid here. I have no idea what it is, and I need to know. Can’t you understand? I’ve had so many issues with this pregnancy and the high-risk doctor told me that an infection related to the SCH could cause my water to break. I just need to know,” I repeated, trying not to cry, begging her internally to do something, anything to stop what was now a near constant trickle, the wet spot growing larger and larger.

The nurse finally told me that she’d call the doctor and see if there was anything else she could do for me. I closed my eyes, trying to rest and calm myself. It couldn’t possibly be good for the baby to be this worked up. Arthur slumped in the hard chair next to me. We waited.

“Doctor has ordered an ultrasound,” the nurse informed us when she came back in. “They can check your fluid levels and see if there’s anything obvious going on. After that, we’ll move you over to a room where you can get some sleep until the doctor comes in to see you.”

It was only about fifteen or twenty minutes until the ultrasound tech showed up, but it felt far longer.   The gushes and trickles were getting worse. “Can you grab me a new soaker pad from the cabinet over there?” I asked Arthur. “This one is really wet.” We switched the pads, putting the old one on the counter for the nurse to check whenever she came back. I felt panicked when I stared at the spread of fluid on it.

The ultrasound tech had seen us several times in ER and was familiar with our situation. I watched the screen as she scanned, the baby kicking and moving. She carefully measured the pockets of amniotic fluid, once, twice. “The only thing I can’t seem to get,” she noted, moving the probe over my belly, “is the head circumference. The baby’s head is really, really low. Right against your cervix.”

I barely even registered this comment. I was just relieved to see plenty of fluid pockets. I’d seen the numbers as she’d measured and with a quick calculation in my head, knew they had to be fairly normal or close to it. Even so, the fluid continued to pour out of me. By the end of the ultrasound, the soaker pad, the sheet under it, and the sheet covering the bottom half of my body all had ugly brown stains spreading over them. Arthur called for the nurse to come in and take a look.

The nurse shook her head as she stared at the mess. “I don’t know,” she said. “It doesn’t look like amniotic fluid, but…” she trailed off. She helped change the linens, and decided to go ahead and put a fetal monitoring transducer on me. “I don’t know if this will pick up. You’re so early yet, but I think it would be better if we kept an eye on things if possible.”

The transducer did pick up for quite a while. The baby’s heartbeat was strong, beautiful. The nurse came back briefly to tell us that it was taking a bit longer to get the ultrasound read by radiology than she’d expected, but as soon as she had results, she’d call them to the doctor and then let us know the plan. “That’s okay,” I said. “I mean, I think the people with urgent chest x-rays and traumas obviously need to get read first. I’m alright, I could tell my amniotic fluid was still there and the baby still has a good heartbeat. That’s what I needed to know.” The nurse looked at the strip printing out with the baby’s heartbeat, then told us it looked excellent, more like a term baby than a 21 week baby.

Reassured, I closed my eyes. Every time I nearly nodded off though, I felt the trickling or gushing sensation of fluid flowing out. Everything looked normal. Everything is okay. It’s just another weird thing with this pregnancy, I told myself over and over.

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