When our water broke with Baby B at 12 weeks, we had a crash course in pProm or Preterm Premature Rupture of Membranes. I didn't even know that could happen - I thought that your water broke and that you went into labor. Little did I know that it happens to many women, and that there are things you can do to help the situation.
Here's how we survived pProm:
1. Get determined - your state of mind matters. I read this quote every day, several times a day if needed. I did not leave our fates in anyone else's hands - I took full responsibility for our outcome whenever possible. Your baby can feel your emotions and state of mind, especially stress and panic - so it is critical to manage these.
"When our determination changes, everything will begin to move in the direction we desire. The moment we resolve to be victorious, every nerve and fiber in our being will immediately orient itself toward our success. On the other hand, if we think, 'This is never going to work out,' then at that instant, every cell in our being will be deflated and give up the fight." - Daisaku Ikeda
2. Fluids: Drink 6-7 liters of water a day. Tea, juice, and other beverages should be on top of this amount. Gatorade is helpful also. Get a bottle to help you measure. **I was very thirsty when I was leaking more.**
3. Bed Rest: Don't fake it. Have your friends and family help you, and make sure you have some bedrest "Wardens" who enforce your bedrest, keep you company, and assist around the house. When you get restrictions from the doctor, take them to the next level and take them SERIOUSLY. My mom was stricter than the hospital.
4. Vitamins: I took 2 grams estercized vitamin C with bioflavanoids, 800 IU of vitamin E, 250 mg of magnesium, Prenatal with DHA, and Isopure Protein drink. The doctor did not recommend all of these (or approve them) but I truly believe they helped to prolong our pregnancy.
5. Leaking: Lay so you leak / bleed the least. It may be difficult, but for the last several weeks at home I was propped up 24 hours a day on the couch on my right side to prevent an abruption.
6. Know your new "normal". Everything you read about as signs to call 911 or go to the ER during pregnancy will happen during pProm, including bleeding, gushing, you name it! So how do you know what's an emergency and what isn't? First, find your baseline (temperature, energy level, etc). Be your own advocate and when a new symptom is above your baseline, it's time to involve your doctor. (That's why they have 24 hour lines - and Jimmy had to make me call 99% of the time). When a new symptom pops up, consider it your new normal. For example, docs will tell you to call when your temperature gets to 100.4; I know that if I'm seeing temps of 99 something is brewing and to call the nurse line. I never got an infection, and you don't want to either. If you get to 100.4, it's too late in my opinion.
7. Disinfection: here's what I was concerned about: hand washing, no baths, following doctor's orders. Some ladies went crazy about disinfection and ended up getting infections. It's not entirely worth it - stick to your routine. Worry about hospitals, not your home (as long as you can stick to your routine or have someone else help you on the cleanliness side). Hospitals have superbugs - chances are, your home does not.
8. Get support: There are a couple of groups on Facebook and a great one on BabyCenter that are solely pProm people. They can provide great resources for you, as women who have been through pProm first hand. Also, there's a good website called INKAN that has pProm stories that you can search by week and see the outcomes.
We also have our non-profit, American Alliance for pProm Support, which is a fabulous place to start. http://aapprom.org
9. Get a perinatologist or Maternal-Fetal Medicine Specialist. They should be well versed and absolutely back you up on your situation whatever you decide. *PS, telling you that termination or miscarriage is the only option is not being supportive*. Optimism is a plus, but support is a must. If you have pProm you should not be seeing a regular OB/GYN - you need a perinatologist. They will align you with a level 3C or 4 NICU, which is crucial for when the baby/babies arrive (see below). Find an MFM here: Society for Maternal-Fetal Medicine
10. Medical Intervention: anytime we had bleeding I went on antibiotics just to be on the safe side. I did two rounds of betamethasone at 24 and 26 weeks respectively. When delivery was imminent we received magnesium sulfate and IV antibiotics. The babies received surfactant for their lungs upon delivery. James's life was saved by the administration of 40% nitric oxide and high frequency jet ventilation, for which he had to be transported to another hospital within hours of birth to receive.
***In a nutshell: if you have ruptured your membranes prior to term, stay determined for a positive outcome, make sure you are registered at a hospital with a level 3C/4 NICU, and check to be sure high frequency ventilation with nitric oxide up to 40% is available. Take your vitamins, stay hydrated, and stress free. Talk to your baby and remember: today you are pregnant, and give your little one the courage to fight on the other side. Get support from the pProm groups and your medical professionals. Hang in there, because it is a wild ride.