Silent Placental Abruption: Our Premature Birth Story

Silent Placental Abruption: Our Premature Birth Story

I experienced a silent placental abruption when I was 33 weeks pregnant with my daughter.

In case you are wondering what that is, I’ll explain: a placental abruption occurs when the placenta (the lifeline delivering blood, oxygen and nutrients to our baby) peels away from the uterus. It deprives the fetus of oxygen and causes the mother to hemorrhage internally.  

Sarah pregnant with Zoe

One week before I had our daughter via emergency c-section at 33 weeks.

The most common symptoms of placental abruption are bleeding and abdominal pain.  Because I had neither symptom it was considered a silent placental abruption.  It was especially unusual in my situation because I had no risk factors.  

I got the flu about 5 days before my silent placental abruption was discovered.

As a nurse I knew that just having a cold or flu generally doesn’t hurt an unborn baby and may even give her a few extra antibodies. I decided the best thing to do was rest and drink lots of fluids.

But to my surprise, two days later I wasn’t feeling better and had worsening fatigue, dizziness, a horrible sore throat, and a headache.

I called the OB floor at our hospital and was directed to an advice nurse.

After a 30 minute phone interview and a detailed discussion about my symptoms I was instructed to stay home. I just had the flu, she said. I should rest and drink lots of fluids. So I took the advice and tried to rest as much as I could.

Fast forward two more days and my dizziness and symptoms were only getting worse. I was even having difficulty walking from one side of the house to the other. So again, I called the OB unit at my hospital because I thought for sure they would want me to come in.

I spoke with both the on-call OBGYN on the unit and another advice nurse. After another detailed discussion about my symptoms I was again instructed to stay home. “Please do not come to the hospital,” the doctor stated clearly.  “There is nothing we can do for you.”

I tried to explain the best I could that I was extremely weak and short of breath when walking more then 20 feet. I didn’t have a fever, but I had never felt more sick in my life. They told me I just had the flu and needed to “ride it out.”

So I laid in my bed and cried for 30 minutes because every inch of my body was hurting so much that I could barely stand it anymore. I had a hard time catching my breath.

(Later we found out that the reason I felt so horrible was that my hemoglobin was extraordinarily low due to the silent placental abruption already having started. My hemoglobin (the oxygen carrying component of a blood cell) at that time was 6 grams per deciliter. The normal level is 12.0 to 15.5 grams.)

I laid down for an hour and started doing “kick counts.”

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that you time how long it takes you to feel 10 kicks, flutters, swishes, or rolls. Ideally, you want to feel at least 10 movements within 2 hours. Usually a mom can feel 10 movements in less time than that.

But I only felt 4 or 5 movements in that hour period. But my body was so sick and achy that I wasn’t sure exactly what I was feeling, so I drank two large glasses of orange juice and ate a small bag of gummy Lifesavers. I was determined to sugar-shock my baby into giving me more fetal movements.

I began counting kicks for a second hour.  But after about 40 minutes I still only counted about 3-4 pretty weak kicks. At that point I decided I wanted to see a doctor, even if they thought I was overreacting.

I called my husband and asked him to come home and drive me to the hospital.

When we arrived at the labor and delivery unit I was immediately given a mask and asked why I came to the hospital after I was specifically told not to. I was once again reminded that I was bringing my flu into the hospital and putting patients at risk for infection.  They were clearly frustrated with me by the tone of their voices.  I kept thinking “am I not a patient too?”

I explained my symptoms once again and told them that I thought the baby should be kicking more. They put me in a room and we waited for the on-call OBGYN.

When she arrived she did an ultrasound.  I could tell by the look on her face that something was very wrong.  She stated very clearly that she was extremely concerned about our baby’s safety.  This is what she told us:

  • I had almost no amniotic fluid.
  • The little amount of amniotic fluid that was there was the wrong color and she couldn’t explain why.
  • Our baby’s fetal heart rate was “not reassuring” which is another way of saying that our baby was alive but in distress.
  • It was likely I would have an emergency C-section imminently.

She didn’t know at that time I was actually having a silent placental abruption. Apparently it is very hard to diagnose on ultrasound.

(We later found out that the amniotic fluid was showing as the wrong color because it was actually blood, not amniotic fluid.  I had already been bleeding into my uterus and our daughter had been swallowing blood. After the C-section they pumped 15 cc’s of blood out of our daughter’s stomach and she pooped blood for the next few days.)

A team of preemie doctors came in to prepare us.

The preemie doctors explained in detail what would most likely happen to our daughter since she was coming out 7 weeks early. They said it was likely that our daughter would not be able to breathe on her own and that she would need to be intubated (using a machine that breathes for her). In the case that I didn’t hear her cry after delivery, they wanted to make sure I was prepared for that possibility.

We were also told to prepare for 30 days in the NICU, which was the average length of stay for a “33 weeker.”  They initially wanted to try delaying a c-section for 48 hours so they could give me steroids to help develop our baby’s lungs develop faster.  But we weren’t able to wait that long.

Within a few hours things got much worse.

Soon, I started hemorrhaging and was having what felt like one long contraction that wouldn’t stop.

Our OB determined that I was not actually in labor as my cervix was completely closed. She thought it was best to take the baby out right then because something was very wrong, but she didn’t know exactly what yet. I was wheeled across the hall for the emergency C-section.

Our daughter, Zoe Grace, was born.

Zoe came out at 4 pounds, 3 ounces. After being suctioned, she let out a tiny little cry that I will never forget. It was the best and most beautiful sound I had ever heard in my life.

The doctor was able to confirm during the c-section that I had a placental abruption. My placenta was 30% detached from my uterus.

The next day our neonatologist told us that Zoe had no signs of brain damage and we had a “very healthy baby considering the circumstances.”  He then let me know bluntly, and in no censored way that “babies born under my circumstances usually don’t survive and the mothers often don’t do that well either.”  He basically told me he couldn’t believe that she had no brain damage.

We were so grateful for the excellent care she received in the NICU.

Our silent placental abruption story

We were so grateful for the excellent care Zoe got in the NICU.

Admittedly, I was shocked when I saw her for the first time. She was in an incubator hooked up to so many IV’s and tubes.  And she was so very tiny.

For the first 48 hours I was not allowed to hold her. That was so hard for me!  But, I could put my hands in the incubator and place one hand on the top of her head and one on her feet.  I remember telling her how proud we were of her.  She was a tough little gal right from the start.  “Tiny but mighty” was what the doctor said. What a wonderful feeling it was to finally be able to finally hold her on her third day of life.

Zoe had an oral-gastric feeding tube for nutrition since she was unable to eat for the first 7 days on her own. I would pump breast milk and give it to the nurses so they could feed her through her OG tube.

She was also receiving TPN (IV nutrition) and lipids (fats) through 2 IV lines. That was probably the most difficult part to watch.  Preemie veins are so tiny that it would often take an hour of poking to get the IV in. And they didn’t last very long so she was constantly being stuck with needles.

She was on oxygen and a cpap machine for the first week to help her continue breathing on her own. She was also kept under a bilirubin light for 5 days to treat her jaundice.  

Mom and Zoe in the NICU

2nd week in the NICU. Zoe earned the nickname “tiny but mighty.”

Zoe got a little stronger every day.

Our “tiny but mighty” preemie started doing more on her own, like eating through a preemie nipple and no longer needing the IV nutrition.

We were shocked on our 9th day in the NICU when we were informed that Zoe would be discharged the next day. I knew she was doing well, but we were told that due to her stage of prematurity that she would stay for at least a month. She was so tiny I couldn’t believe they were letting us take her home.

My experience taught me a few things…

  • Mothers need to trust their instincts. We know much more then we give ourselves credit for.
  • Kick counts are very important after 28 weeks gestation.  If you feel less than the normal amount of kicks then you should see your OBGYN immediately.
  • Having a healthy baby is a gift.  Not everyone gets to have that.   

I can’t imagine what my life would be like now if I hadn’t gone into the hospital that evening, especially after being told not to by the staff. My life would have been turned up-side-down.  I am so glad that I trusted my instincts that night!

I am so blessed that I get to be a mom.

Not everyone gets to have healthy baby, or a baby at all for that matter. Whenever I find myself getting frustrated with the difficulties that come with parenthood, I think about how close we were to not getting to have Zoe at all. That puts it all into perspective for me.

Our baby Zoe is turned 3 years old on Halloween.  She loves Elmo so she decided to choose Elmo as her Halloween costume.  In honor of her birthday our family dressed up as the whole Sesame Street gang.  My husband was Cookie Monster, I was Big Bird, and our 9-month-old son, Oliver, was Ernie. It was a wonderful celebration that I especially treasured because I know just how lucky I am to have two “tiny but mighty” kiddos.

Thank you for reading our story.

Sarah, @ Mother Nurse Love

Zoe Grace, 4 weeks old
Zoe Grace, 3 years old.  
Silent placental abruption: Our premature birth story
Our Baby Boy Arrived!

Our Baby Boy Arrived!

I am excited to announce that our baby boy arrived!

On January 8, 2018 at 10:59am Oliver made his way into the world weighing in at a sturdy 8 lbs. 1 oz.

He is chubby and extraordinarily cute, nursing like a champ and has the most adorable baby babble. I had forgotten how incredibly sweet baby sounds are. Oliver’s snuggles and baby noises are the best!

My (very brief) birth story:

We arrived at the hospital at 7:30 for our scheduled c-section.  I was full term and 39 weeks.  After getting checked in and set up we finally headed over to the surgical suite around 10 am.

I had a scheduled c-section (unlike my first, an emergency c-section at 33 weeks due to a placental abruption).  It was a much more relaxed environment with fewer nurses and other staff in the room.

I was given a spinal block which numbs the entire lower half of the body from just below the diaphragm.  It is the weirdest feeling to not be able to feel or move your entire lower half!

The doctors had a difficult time getting Oliver out.  After the surgery I was told that he was wedged in at a difficult angle to grasp.  After several minutes of effort to get him out they had to use suction just to get a grip on him.

Our baby boy arrived with a great set of lungs!

Our baby boy arrived with a great set of lungs!

Our sweet boy finally arrived.

Oliver came out kicking and screaming, which is the most reassuring sound for a new baby to make.  He was much bigger then the doctors had expected him to be.  In fact, they told me that it was a good thing I was set up for a c-section because there was very little chance I would have been able to get him out on my own.  They said I would have ended up having another emergency c-section anyway!

Oliver was exactly 2 times bigger then our daughter was when she was born so he felt like a huge baby!  Looking at him I couldn’t believe that he had actually fit inside my stomach.

Fortunately, Oliver took very well to breastfeeding, which was a welcome relief (it had been difficult with our preemie).  He seems to be able to self sooth with his fingers and has been relatively easy (knock on wood!) to care for thus far.  As long as he is fed every 2-3 hours, changed frequently, gets his sleep and is held frequently he is a happy camper!

There were a few surgical complications that I was not anticipating.

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I lost 2 liters of blood during the procedure.  According to my doctors I had a few large vessels that they were trying to bypass but still ended up causing a large amount of bleeding.  As a result I had even more post postpartum bleeding over the next 24 hours.   This resulted in me needing to have a total 4 blood transfusions and multiple different anti-hemorrhage medications.

It was a bit scary and uncomfortable for another day and a half after my c-section.  Luckily we were able to get the bleeding under control and I was able to be discharged on day 3 to go home.  What a relief!

Zoe is doing great in her new role as big sister.

Our daughter can’t stop giving Oliver hugs and kisses every chance she gets.  We do need to keep as eye on her though because she does try to squeeze him hard and force his pacifier into his mouth (out of love and her desire to help).

So far she has not expressed any jealousy towards sharing her time with a new tiny human (hopefully we can keep it this way!).

Zoe tries to help by letting me know when Oliver needs things like toys, a blanket, or his pacifier.  It is so sweet and melts my heart every time.

My mom friends are so helpful.

Some very sweet friends brought over some of their old baby items that have really helped us out with Oliver.  I am so glad they did because I never would have even known to get them myself.  (FYI- the BEST invention ever is the Doc-A-Tot Grand.  It has been a game changer!)

Life is good.

I am so relieved that our baby boy arrived safely and is a healthy baby boy.  There is no greater gift then that!

My husband has been able to be home with us for the last week but he will be heading back to work tomorrow. It’s going to be a bit of a challenge caring for a very energetic two-year-old and a newborn for nine hours a day by myself.

I haven’t figured out how I’m going to manage that yet but lots of women do it so I’ll just have to figure it out day by day.

Wish me luck!

Sarah