By Kathie Robbins,I was in the 25th week of my first pregnancy and everything had been going fine until one night, after dinner, I went to stand up and felt a gush of liquid rush between my legs. I tried to squeeze my Kegel muscles, thinking I was peeing, but that did not stop the flow of liquid. It took me a few seconds to realize my water had broken. I yelled for my husband to call the doctor, "MY WATER BROKE", and I ran to the toilet, starting to cry as I knew something was terribly wrong.
PROM at 25 weeksDelivery at 28 weeks.
Story added: 1997-03
It was a twenty minute drive to the hospital. The only words spoken during that trip were when I said to my husband, "You know this means we've lost the baby". He just said "I know."
When we got to the hospital, I just knew my baby was dead. It wasn't until I was hooked up to a fetal monitor that I realized the baby was still alive. My eyes never left that monitor afterwards. Contractions started and were about 5 minutes apart. My OB arrived and found I had not dilated, which was a good sign. After an IV was hooked up, I started to receive terbutylene, a form of adrenaline, to stop the contractions. During one contraction, the baby's heart rate slowed to 40 bpm (typical rate was 130 bpm). The nurse immediately had me lay on my side (a position I would stay in for the next three and a half weeks)
I then got my first ambulance ride to a Level III hospital (Georgetown University Hosp. in Wash. DC) which could handle a premature baby. The poor paramedic, she was extremely worried that I was going to deliver in the back of the ambulance, so they were flying down the road. I was more worried about falling out of the gurney.
Once at G-town, I felt better because the perinatologist laid out the game plan. The terbutylene would hopefully stop my contractions and then I would just stay in bed, 15 weeks, until the baby was born. The contractions started to slow down, but my heart was racing and my body was trembling from the side effects of the terbutylene. Premature rupture of membranes (PROM-wow-finally a PROM queen, 15 years to late) is believed to be caused by an infection which causes a weakness in the amniotic sac. There is no way a situation like this could be predicted because it was probably an infection I never knew I had. My bed was placed in a trendelenburg position so that my head was about 1/2 foot below the rest of my body (the bed was slanted). This was to keep pressure off of my cervix and avoid dilation.
After a couple of days, my condition stabilized enough to move to the antepartum ward where I would spend the next three weeks. I was on complete bed rest, I could not get up for any reason, had to use a bed pan and everything (just imagine trying to pee when you're upside-down let alone into a bed pan). Luckily I had a private room. Between the terbutylene and the emotional strain, I found it hard to concentrate on anything, and I became a TV talk show junkie.
I started a diary only because I began to forget things, like if I took my pills, when I last went potty (just a note, when lying upside down, you tend to lose feeling in many parts of your body from lack of circulation, so I never knew when I had to go to the bathroom, I just forced myself to go every 3 or 4 hours) I had weekly shots of betamethasone. This is a steroid that supposedly helps the fetus to mature in utero. The shots were given twice a week in the buttocks and the serum was thicker than anyone's grandmammys molasses.
After 3.5 weeks of bedrest, I started developing bad gas pains which were really labor pains. Back to Labor and delivery and terbutylene by IV was started again. I called my husband (out on his bowling night) to tell him I'm in labor again but we are trying to stop it. I told him he didn't have to come to the hospital, but luckily he decided to come anyway. After 3 hours on the terb, and no slowing of labor, the Dr. wanted to do an internal exam.
Well Lo and Behold, I was dilated to 8 cm, there was no way we were stopping this thing now. So off goes the terb and on goes the pitocin (a drug to induce labor). My poor body didn't know if it was coming or going.
On April 16, 1994, after 2.5 hours of pushing, Alexandra was born at 28 weeks of gestation. I didn't want to watch her be born, but when she came out she made a small squeak and I had to look. She was a big baby (3 pounds, 2 oz.) for only 28 weeks. The neonatal unit immediately intubated her as she could not breath on her own. Her 1, 5 and 10 minute Apgars were 4, 6 and 7. She was fairly stable but on life support.
I saw her for the first time when she was about 6 hours old. My first sight of a NICU. I could not believe the amount of equipment hooked up to one little baby. She was lying on the warmer with the bili-lights on her and the jet ventilator tube stuck down her throat. Bert had had the task of signing all the medical release forms so I was unaware of her condition and how bad it was.
When I asked her nurse, she just said that right now things don't look good but wait for the conference with the Dr. The conference, about 6 hours later, left me in tears. I didn't understand a word the Dr. said. Only three things stuck out. Something about a hole in her heart, blood in her brain, and a bad lung infection. Her lungs were thought to have stopped developing at about 25/26 weeks (when my water broke-hence the betamethasone did not work for her lungs).
At this point we were told she had a 40 % chance of surviving, and the next three days would be critical.
Her first and second doses of surfactant on day 1 were a failure. She was on the jet ventilator at the highest pressures and 100 % oxygen. If her oxygen saturation levels (which were between 85 and 92 %) continued to decrease there was no possible way to pump more oxygen into her. Her body parts would begin to shut down in order to conserve oxygen for her brain. Her third dose of surfactant was luckily met with more success (alot of praying helped at this point). Her sats slowly began to go up to 95 %. The hole in her heart (actually PDA) closed on day 2 and her brain bleed (IVH-grade 1) had not changed in size by day 2. These were all good signs. By day 3, we were reaching the end of that critical 3 day period and beginning to feel some joy in the fact that our baby may live. The Drs. gave her up to a 70 % chance of surviving now.
To us this seemed like excellent odds. Her oxygen requirements decreased down to 40% yet pressures still remained high. The brain bleed was gone by day 3 but had been replaced by tiny holes near her ventricles (PVL). This was only the beginning of our roller coaster NICU ride of three steps forward, two steps back.
Alexandra remained on the ventilators for 6.5 weeks (jet 1 week, conventional the remainder). She suffered through pneumonia and a few lung collapses. We thought she would never breath on her own. She was finally able to wean from the ventilator when decadron, a steroid, was started. She was switched to CPAP for one week, then blow-by oxygen for a couple of days until she only needed oxygen during feeds. Finally, by week 8 we were giving the prognosis that Alexandra WOULD live and come home!
During her entire stay she had 3 lumbar punctures for suspected sepsis (2 of which occurred with middle of the night phone calls), and three blood transfusions (1 for high biliruben levels and 2 for anemia problems). There were also some hypertension problems that resolved themselves after investigating the kidneys by ultrasound. She spent a total of 10 weeks in the hospital and came home with an apnea monitor (until she was one 1 year old), oxygen (until she was 5 months old), and her meds included aldactazide (a diuretic), aminophylline (a bronchodilator), nystatin (for yeast infections), Zantac (for reflux) and 28 calorie per ounce formula (a limited fluids diet due to her BPD).
We were unfortunate to be rehospitalized her first week home, but that was none of Alex's doing. Her visiting night nurse overdosed her on her aminophylline. After that incident, all future nurses were not aloud to give her medication without ME! double checking the dosage.
Today at 2.5 she is a typical toddler, who is a bundle of joy, all kisses and hugs one minute then a screaming maniac in the midst of a temper tantrum the next. She has some minor delays in her fine motor skills, but all her other skills are on par with her peers. She has been very healthy with only the occasional minor cold. Unfortunately though, colds last for weeks on her and I think this may be because of her BPD. Her other long lasting effect from the BPD is a terrible snoring problem.
Some stats for Alexandra:
reached 10 pound mark at 7 months old
sat-up unassisted at 9 months
crawled at 12 months
walked at 13 months!!!! (couldn't believe that one)
and first tooth at 16 months