Birth Story - Placental Abruption at 33+2 with positive outcome
Curiosity101
Regular
It's a long one! I've split it into different sections to hopefully make it easier to read.
I considered for a long time whether to post or not but as my pregnancy progressed I found myself looking to the internet for posts from people that had been through a similar experience to myself. If you're experiencing something similar, I hope you get some comfort from this and you're always welcome to contact me to chat.
I had a horrendous pregnancy, but I'm very happy to be able to say I'm now a mummy to a beautiful, healthy little boy. We are definitely a success story / positive outcome of placental abruption and premature birth. That said - I apologise if anyone finds this upsetting but posts like this really helped me when I was pregnant and having problems.
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The pregnancy
My pregnancy journey certainly wasn't a happy one. It started with horrendous extreme 24/7 nausea from week 7 until week 14. I had light spotting three times at week 8, 14 and 16. The second time it happened it was bad enough to scare me into going to the early assessment unit which really isn't somewhere you ever want to visit.
It took until week 18 for me to feel anything close to normal. I then had 2 weeks where I began to enjoy the pregnancy.
At 20 weeks we had a standard ultrasound scan. The US tech diagnosed me with a 'low placenta'. What she meant was that I had placenta previa grade 3. Technically you don't have placenta previa until you're closer to your due date as they almost always resolve themselves before delivery, but I remember walking home after that appointment utterly heartbroken. I was sure something would go wrong, my placenta wouldn't 'just move' like the majority of them did. She also confirmed that I was carrying a baby boy, which made it all the more real when I worried about the rest of the pregnancy.
Fast forward a few weeks and I was preparing for a housewarming party with my husband. Suddenly I felt a gush, at the time I felt like I'd wet myself. I was 24+3 when I went to the bathroom and saw what felt like a huge amount of blood coming out of me.
I tried to stay as calm as possible and called to my husband to let him know we needed to go to A&E quickly. The walk from the car park to the A&E department was the longest of my life. At that point I'd never been so scared in my whole life.
We went to the A&E department and I was asked what felt like really stupid questions 'How long does it take for you to fill a pad'. Firstly… I wasn't wearing one… why would I be, I'm 24 weeks pregnant. Secondly, when it comes it comes in what feels like huge gushes so we’re talking seconds to minutes. I just wanted to be examined and for someone to tell me my baby was ok. It felt like an eternity waiting to be seen. Soon I was up in the ABC unit being assessed. Fortunately the bleeding had slowed considerably and I was kept for observations. Their rule was 24 hours without a bleed and I would be allowed home.
I went home after a few days cause it took awhile for the bleeding to stop completely. It was a Saturday when I was discharged. The following Monday I went back to work as usual. At 9am I felt the familiar gush, my heart sank and I was terrified again. We rushed to the ABC unit this time as we knew the people and the procedures. I was still too early for the CTG so our little boy was checked with the doppler. Fortunately he seemed happy and healthy.
Shortly after this bleed I had another one while I was still in hospital. I remember how this third bleed started after I’d sneezed a couple of times, consequently I went on to avoid sneezing or coughing for the remainder of my pregnancy. Shortly after the third bleed I had a scan. At the scan they only planned to do a growth scan to check that the baby was still growing correctly despite the bleeds. After the scan I remember breaking down in tears at the consultant and begging him to do a TV(trans vaginal) ultrasound to check the position of my placenta and make sure I didn't have any additional complications like Vasa previa. He pointed out that it wouldn't change my care, they would continue to manage any future bleeds regardless of where the placenta was or anything else. I responded by saying that surely it would be good to know exactly what the state of play was, but also that for my own peace of mind I needed to know. He agreed and the US showed that my placenta had 'moved'. Feeling hopeful I decided this was the cause of the bleeds as my placenta shifted out of the way of my cervix. It was plenty far enough away that I would even be able to have a normal birth.
I tried to relax and remain positive during the following weeks, although by this point I was never without a sanitary pad. I also had a check up appointment with the consultant and he confirmed that the fact I'd been without a bleed for over 5 weeks was promising. Despite this I still was very nervous and wasn't comfortable being more than a mile or so from the hospital which made going to work very stressful. We had another growth scan shortly after my discharge. The baby was growing fine but I was sure on the scan that I could see areas of bleeding. The US tech assured me that US scans are not accurate for diagnosing bleeds but it definitely worried me. With a placental abruption, especially partial ones like I was having, there's nothing much you can do other than wait and see what happens. As well as staying close to the hospital I also increased my iron intake. I was lucky that my bloods had always been reasonably good with my HCG around 120 after the first couple of bleeds. However after a few weeks of eating iron fortified cereals and such I managed to get it to creep up to 127. Every time I was admitted I had a full blood workup and urine test, so this was something I was always keen to ask about to see how we were getting on. I also feel like this was the point at which I'd read basically every research paper and forum post on the internet to do with placenta previa and placental abruptions. I was 100% convinced that I was experiencing chronic minor placental abruptions, although I found it surprising and quite frustrating that no one labelled it as that any of the times I was admitted to hospital.
A week or two later I woke up with that familiar feeling. I rushed to the bathroom hoping that I wouldn't see what I expected to see. But as I looked down the pad was filled with blood so off we rushed to the labour suite. My husband went to park the car whilst I waddled into the labour suite as the bleeding continued. It was probably around 6-7am in the morning when I was settled into a bed. This time I was also given a cannula 'just in case'. The bleeding had slowed by now, although over the next couple of days it didn't quite stop completely. This was the point where I was offered steroids. The steroids weren't as bad as I'd anticipated and were 100% worth it. 24 hours after the first shot I did go very flushed though, apparently it's a common side effect. After a 3 night stay (and with the bleeding slowed but not stopped) I was offered discharge again. I was a complete bundle of nerves but at the same time knew I was only going to be monitored anyway, so why not at least have my own bed.
I only made it a few days at home before the stress and worry got too much that I took myself back to the hospital and asked to be admitted. The bleeding had never fully stopped this time so I couldn't help but think that the next bleed would be much worse. A couple of days after being admitted my fears were confirmed and I had my first major bleed. I remember that day my Braxton Hicks had been relentless and I'd had some lower back pain but I hadn't really given it much thought. The midwives had asked me if I was alright during the day as I’d spent a lot of it bent over and leant on a window ledge as I tried to get comfortable. I also remember I'd just laid down to try and sleep when I felt the gush start, at this point I was barely able to sleep and there is often a lot going on at an antenatal ward (the lady next to me had gone into spontaneous labour a few hours earlier). They estimated I'd lost roughly 300ml of blood in that bleed. The CTG trace also showed a deceleration in the baby's heart rate. Fortunately the midwife in charge was fantastic and kept me calm, also the doctor on call was the same one that admitted me a few days earlier so he was fully aware of my situation and history. He told me I was now 3cm dilated and he could feel the top of my baby’s head. I'd not been dilated at all when he'd examined me a few days before. He also said the baby had responded to being touched which was a very good sign. I'd also started having mild contractions. Off we went to labour suite (my first of 3 visits) and I called my husband as we didn't know if I was about to go into labor at 32+1. Considering my situation they would have let me labour naturally if things progressed that way. Eventually after several hours and passing some scary sized clots my contractions eased and so did the bleeding. This was the day I was asked if I'd like to speak to an anaesthetist about the procedure for an emergency c-section as it varies slightly from a planned one. I accepted as it felt like an absolute certainty that that's where I'd end up.
A few days passed and I was well and truly used to living in hospital now. However my stress levels had gotten to the point where I was waking up every hour of the night cause I didn't feel safe even in hospital. Not only that but I’d convinced myself that laying down to sleep would almost guarantee a bleed. The bleeding never stopped, just slowed down considerably. After a week had passed, at 33+1, I had another large bleed. In some ways this was worse than the others because the midwife left me on my own whilst they waited for the doctor to be available. Again I was wheeled around to the labour suite as I'd started having contractions. I remember that my Braxton Hicks had been relentless again, but then I was used to my Braxton Hicks starting up at around lunch time and not easing until I went to bed in the evening. One thing I did find surprising is that I never had any real pain or discomfort, yet when you research placental abruptions it says that it's accompanied with pain. After a lengthy number of hours in the labour suite everything settled and I was sent back to the antenatal ward for monitoring.
The birth
At 33+2 and around 7.20pm, just under 24 hours after my last big bleed, myself and my husband were settling down to watch a film. That was when the final bleed started. Coincidentally it was also shift change for the midwives which did cause a bit of trouble with respect to handover etc. This time they didn't hesitate in wheeling me round to the labour suite. However this time the bleed was so bad that I was wheeled around in the bed. I could tell instantly that they were treating this very differently as there were midwives and doctors swarming like bees. I had around 10 people in the room at one point. They also came to do an ultrasound scan to see if they could see the cause and extent of the bleeding. This was when they started running through all of the paper work with me. I'd done so much research in advance that I almost wanted to say to them 'yes to everything, just get my baby out of me I want him to be safe!'.
I was fortunate that I'd already met the doctor performing my section on one of the days where he'd done the ward rounds. I think he remembered how anxious I was as his bedside manner was absolutely impeccable. I felt very safe as he talked me through everything that was about to happen.
Within 30 minutes I was in the theatre having a spinal block done ready for the surgery. My husband was in the side room getting ready in his scrubs. Our baby boy was born at 8.20pm, he screamed like a banshee and I was so happy to hear it. The section was very straight forward and despite the number of people in the room it felt very organised and calm. One thing to be prepared for is how many people could be around your baby (even if they're perfectly healthy). We had around 8 or so people around our baby and he was instantly taken to the NICU. We got to see him for about 30seconds in total.
The rest of the section went normally, although it was a very odd feeling knowing my baby was out but I didn't have him with me. Fortunately he was my first baby so I didn't know any better, but I'd imagine if he'd been my second or more that I'd have been utterly heartbroken. During the section apparently both mine and the baby's heartbeats dropped to dangerous levels, mine got down to 52bpm. I reckon I was probably very lucky not to end up with a general anaesthetic.
After being in the recovery area for 20minutes or so I was wheeled up to the postnatal ward with my husband. It was probably about 10pm by this point and despite having had next to no sleep and reasonable blood loss I probably felt the best I'd felt in a long long time. I knew I was safe, and more importantly my baby was safe. I remember someone describing me as ecstatic, and I genuinely was. That night my husband went down to the NICU to see our baby and then went home to get some sleep. It would take quite some time for the spinal block to wear off so it seemed silly for him to stay with me, especially as it would have been in one of those horrible hospital chairs (anyone who's been on the antenatal or postnatal wards knows the ones). Plus we’d both probably only had a couple of hours sleep over the previous 48 hours - due to the worry and time spent in the labour suite.
After the birth
This was probably the first night I slept in a very long time. I didn't feel like a mum, but then I hadn't been a mum before either, but I finally felt safe. It probably helped that I couldn't feel the post natal bleeding cause of the spinal block, in all honesty once the feeling did come back it took me a long time to get used to that feeling without having huge panic attacks.
In the morning the midwives came onto the ward to let me know my baby would be coming up to join me at 8am. You could have scooped my jaw up off the ground when they told me. I was so confused… 'But does that mean I need to look after him?' was all I could think to say. It sounds like a silly question of course, but both me and my husband had prepared ourselves for a premature baby and we didn't expect him to be leaving the unit for at least 2 weeks. However the midwives explained that he hadn't needed any assistance except for a feeding tube. The feeding tube was purely required cause of his gestation, at 33+2 a baby wont have the ability to suck and breath at the same time so they have to be fed via a nasal gastro tube.
So at 8am on the 31st of August I finally met my baby. I had sent my husband roughly 100 messages to tell him what was happening as I just couldn't believe it. I was also really scared because I could barely move so I couldn't work out how I was going to care for a baby. Fortunately it wasn't long until my husband arrived at the hospital, but for the hour or so that I was alone with our baby I felt incredibly overwhelmed. I didn't feel like I could do anything because I was so restricted in my movement, in hindsight this will all have been because of how weak I was after the blood loss. It was estimated I lost almost 3 pints in the 10 days prior to delivery, but by some miracle my bloods were coming back as just good enough that I wasn't anemic. I think it must have been quite a big shock overall to me both physically and mentally so I really did find the whole morning very overwhelming.
The next few days passed in a blur, we were moved into a side room because we weren't likely to be leaving anytime soon. I'd also started expressing milk with a breast pump as I'd wanted to breastfeed once he was old enough. In hindsight I didn't pump enough in the first few days so I never built up a good enough supply to exclusively breast feed. If I'd known you had to pump at every feed to create an adequate supply then I would have done 😔, but we did what we could given the circumstances. Our baby went from strength to strength, we focused on trying to get him onto the bottle as soon as possible. He took to the bottle really well and at 9 days PP (at what would have been 34+4) we were allowed home.
Things I've learnt:
- Make sure you know the details of your local ABC unit or labour unit
- Trust your instincts
- Maternity pads hold between 30-50ml of liquid
- Midwives prefer you to be wearing a maternity pad over a sanitary pad as it allows them to estimate volumes
- Toilet bowls make the amount of blood look like 100x more than you expect
- Don't delay your whooping cough vaccine, I struggled to get mine with being in and out of hospital
- If you have a premature baby make sure you pump at every feed if you're wanting to breastfeed, your body needs to be asked for that much milk in the first couple of weeks if you want to stand any chance of producing enough to breastfeed once your LO is big enough
- This type of experience can be incredibly tough on you mentally, don't hesitate to set up counselling or support before the birth to help you handle everything
- Don't be surprised if you struggle with the initial weeks of motherhood. It took me a long time to get past the trauma, and it took me to get past the trauma before I could truly enjoy my son.
- You're the only constant of your care, ask all the questions you need to make sure you understand what is happening and what that means
I took a little longer to recover and needed therapy to get past it but I am now loving being a mum. I've never experienced anything that comes close and we've even started discussing TTC number 2. Hoping for an unremarkable/uneventful pregnancy next time round though if we do have another!