PPROM

Emily Dickinson said it best...

Success is counted sweetest
By those who ne'er succeed.
To comprehend a nectar
Requires sorest need.

Not one of all the purple host
Who took the flag to-day
Can tell the definition,
So clear, of victory!

As he, defeated, dying,
On whose forbidden ear
The distant strains of triumph
Burst agonized and clear!

Tis the season for babies. Many of my friends are pregnant or at home with newborns. I wonder if any of them truly understand how miraculous it is to carry a baby to term and to deliver a healthy child? It's easy to take for granted. I know we did with our son John.

Our son John was born prematurely. Five weeks to be exact. He spent 11 days in the level 2 nursery yet we never really questioned why he arrived early. I figured I was working too much and under too much stress and that I should probably take it easier with the next pregnancy. The doctors concluded I was probably right. We know now his premature birth was caused by the same events that happened with Charlie, Cal and Harry.

Both of my pregnancies resulted in delivering premature children due to a complication called PPROM (preterm premature rupture of membranes). Here are the basics. Normally, the cells in a woman's body trigger labor to start between 38-42 weeks. Once labor starts the sac around the baby that holds amniotic fluid will eventually rupture. We typically know of this natural process as "water breaking." When this happens as part of a normal sequence of labor it is called rupture of membranes or spontaneous rupture of membranes. When the membranes rupture prior to labor starting that is called PROM, premature rupture of membranes. When this happens prior to 37 weeks it is called PPROM (premature preterm rupture of membranes).

Many times when women experience PPROM they have a small leak in the sac. That leak can close up or it could continue to leak and not induce labor. The placenta will keep making new fluid. This can happen to some women early on in the pregnancy, say 17 week, and they can go on to carry the babies close to full term. They will likely spend their pregnancy in the hospital or on bed rest at home.

The danger when the sac actually ruptures (instead of just having a leak) is that the fluid levels are really low - that can lead to a prolapsed cord or various other complications that could be very dangerous to the baby. That did not happen with either pregnancy - all my babies had plenty of fluid around them and the sac did not actually rupture until I was delivering them. (Medically they really don't differentiate between leaking and rupturing when discussing PPROM).

The biggest danger in PROM or PPROM is the risk of infection. Once there is a leak it is feared there could be an infection already present (that caused the leak) or that an infection could now enter the amniotic sac carrying the baby. The agreed upon protocol after 34 weeks of pregnancy is to deliver the baby within 24 hours of noticing the leak because the risk of infection to the mother and babies is more dangerous than the babies being born early. The protocol is less clear prior to 34 weeks and certainly prior to 25 weeks.

In both pregnancies I was leaking a very small amount of fluid. With John I only leaked a quarter sized amount of fluid - once. In fact when I discovered it at 2am I went back to bed and only called the midwives in the morning after Aaron insisted. I walked down to the hospital not thinking for a second that I was going to be having a baby that day. With the boys I leaked a quarter sized amount three or four times in two days. It's not much at all and could easily be missed or overlooked. I did however first notice a small amount of fluid at 19 weeks; I went in to be tested and it was determined it was not amniotic fluid. I am now about 99% sure it was - I think perhaps the leak was tiny, on one of the top babies or healed up before I went in the next morning. I would not mistake it. It's clear, odorless, and watery. I never leaked again until 23 weeks.

So why does PPROM happen? Good question. Nobody really knows for sure. It occurs in less than 2% of pregnancies. There could be a genetic component (my sister delivered all three of her girls early because of the same thing - yet no studies have proven the genetic link). It could be biological - my body's cells are just messed up and trigger the wrong series of events to happen. It could be (and most studies suggest) caused by infection. Pathology on the placenta could reveal an infection, however, it's hard to determine whether the infection caused the membranes to rupture or if infection presented itself once the membranes were compromised.

If PPROM happens once it could be a fluke and not happen again in other pregnancies. Once it happens twice the odds of it happening again are higher. It's unfortunate that to discover a pattern it needs to happen more than once. Those at highest risk for PROM are smokers, drinkers, those with STD's, low BMI, drug users (all the things I am not) as well as those who have had previous PROM and pregnant with multiples (check on both of those).

It's frustrating that the human body is so amazing (our other proof there is a God) yet sometimes works against itself. I cannot imagine the frustration of those with arthritis or cancer or other conditions in which the body is trying to fight or kill itself. My body was growing healthy babies and doing everything right and then out of nowhere something goes wrong. It's hard to fathom. It's harder when there are no answers and no clear way of knowing if and when it will happen again.

I asked my doctor if it happened so early because my uterus was measuring full term. He said no, my uterus may have been full term but the sac surrounding each baby was the same size as a singleton of the same age, 23 weeks. Not comforting. We have not talked to our doctor since the morning after delivery but will have a regular postpartum six week appointment with him.

I've read a lot of journal articles regarding PPROM and there is not a lot of data that is conclusive. They are studying a lot of possible causes and also what causes labor to start after the membranes leak/rupture. The March of Dimes has a Prematurity Research Initiative (PRI) in which they give grants for researching different areas of premature birth and premature babies. Their web site lists the topics and grantees. I will be contacting those researching PPROM to see if my experience could help them in any way. The March of Dimes has been instrumental in funding research that has lead to important discoveries regarding premature birth and also the care of premature babies. I have also used their web site frequently for dealing with the grief of losing Charlie, Cal and Harry.

It's amazing to me that although we live in such a highly technologically advanced society, the best place for babies to grow is still in the womb of their mother. No matter how many advances in medicine we have made we still do not fully understand a process that has been occurring since the beginning of time. I was listening to a program on MPR the other day in which they were talking about extending the average life span due to medical advances etc. Selfishly I wish we were less concerned about a 90 year old living until they are 100 and would instead focus on giving the littlest of our society a fighting chance to experience life. I guess they are not mutually exclusive but still you get the point.

So, there it is. PPROM. I can tell you we plan on trying to have more children but it will not be with the same excitement as our last two pregnancies. We've been burned now. Big time. If we do have a successful pregnancy it will come with 30 weeks of terror...We are optimistic and know not being pregnant with multiples will help our chances. For now, we continue to enjoy John and grieve over not having Charlie, Cal and Harry home with us.