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
Pregnancy Kick Counts:  What I Just Learned About Fetal Movement

Pregnancy Kick Counts: What I Just Learned About Fetal Movement

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I was not feeling the baby move as much for the last two days. So I did what I knew I was supposed to do: I laid down for an hour and started doing “kick counts.” After 1 hour of counting less then 10 fetal movements I was not reassured.

My husband drove me to the labor and delivery unit at our hospital. I called them first to explain the situation and they told me to come in and get checked out.  I am only in my 33rd week of pregnancy.

As I have written about before, I had a placental abruption when I was pregnant with my daughter at 33 weeks pregnant. We were able to have an emergency c – section and get her out safely in time (thank God!).

That is one of the reasons I am such a stickler about doing daily kick counts. They are the only way to determine fetal health in between doctor’s appointments.

(I have also been using an at-home fetal dopplar since I was 13 weeks with both my pregnancies. It definitely helped minimize my stress levels!  However, doing daily fetal kick counts is still the number one way to assess if the baby is in distress.)

I admit, I am probably getting a little paranoid considering the circumstances that happened during my first pregnancy. But I figured it was better to be safe then sorry, even if the staff at the hospital thought I was totally overreacting (which they didn’t).

My trip to the labor and delivery unit was relatively fast and saved me from many days of worry.

Fortunately, everything looked great! The trip calmed my nerves so that I could get through until my next appointment in 2 weeks (they were so booked I had to wait 5 weeks in between appointments this time, which I think is way too long at this point anyway).

Of course once the baby was placed on a fetal monitor he started kicking, turning and jabbing. He was bouncing around and showing off like a good, healthy baby should.

The midwife even told me our baby “had the strongest heartbeat of all the babies on the unit.” I’m not sure if she was just trying to reassure me or she really had some difficult pregnancies to deal with at the time, but I was so glad I went in.

Doing “kick counts” after 28 weeks is so important.

I thought I knew everything there was to know about doing “kick counts” because I had done a lot of research on it. I even wrote a blog post about it.

To do kick counts you lay down on your left side and count the number of kicks or fetal movements you get in one hour. Most providers says that once you get to ten counts then you can stop counting. Then quit for that day and start again the next day.

You are looking for a significant decrease in movement from a previously normal pattern.

The Midwife taught me a few new things about doing “kick counts” that are SO important.

#1. Babies in utero have 40 minute sleep cycles.

Which means that if you don’t feel any kicks for the first hour then the fetal movements should pick up in the second hour.

#2. Eat something while you are laying down to do the kick counts.

Eating will wake the baby up some you can feel more fetal movement. Don’t eat and then wait an hour, because it will put the baby to sleep and you will feel less movement during that time.

#3. If you are ever concerned about the health and safety of your unborn child, it is always the right thing to get checked out.

There is no benefit in sitting at home worrying that there may be something wrong. I was reassured many times that if at any time I felt a decrease in fetal movement or had any other concerns about the health of the baby that I should not hesitate to come back in. The staff reiterated that to me several times.

Oh, the joys of pregnancy!

I am getting large and even though I am pretty wiped out most of the time, I actually am enjoying this (when I’m not scaring myself to death, that is).

Even though the extra “nesting” energy I had a few weeks ago has dissipated.

And I’m also still experiencing foggy pregnancy brain symptoms.

But aside from all that, I am so grateful to be in the midst of such a healthy pregnancy. There really is nothing better. It feels awesome to know that our baby is doing so well and that he growing normally.

Baby boy is still measuring 2 weeks ahead! I’m shooting for a potential 9 pounder!

Thanks for reading!

Sarah, Mother Nurse Love

Fetal Kick Counts:  How To Do Them And Why They Are Critical

Fetal Kick Counts: How To Do Them And Why They Are Critical

Feeling your baby move can be one of the most exciting parts of a pregnancy. Its nice to have some confirmation that there is actually a tiny human in there!

But did you know that counting your baby’s kicks can help make sure they are healthy and possibly even prevent a tragedy?

There is strong evidence that counting fetal movements can reduce perinatal mortality in pregnancy.

Doing kick counts actually saved our baby girl’s life. If I hadn’t done them I wouldn’t have suspected that there was something terribly wrong and I wouldn’t have gone into the hospital.

When do moms start feeling fetal movements?

According to the American Pregnancy Organization you should start to feel some fetal movement between 18-25 weeks into pregnancy. For first-time moms, it may occur closer to 25 weeks, and for second or third-time moms, it may occur closer to 18 weeks or even a little earlier.

Why are fetal kick counts important?

Sarah and little Zoe

Our daughter was not moving as much while doing fetal kick counts during my first pregnancy. Intervention at that time was life saving.

Doctors only see moms every two to four weeks. According to Dr. Diep Nguyen, a Los Angeles OB/GYN “fetal movement is the best indicator of pregnancy health and is the best yardstick in between those times. If the baby is not growing well, it probably will slow down its activity way before it will stop moving all together.”

My own OB/GYN has expressed the same information to me. Especially ever since my placental abruption during my first pregnancy at 33 weeks.

Now that I am due in January with our baby boy, there is a part of me that is afraid that some sort of catastrophe could happen again. But I am doing daily kick counts and I am reassured that our baby boy is kicking quite frequently. If for some reason he slows down or stops I know to go right to the hospital to have things checked out.

When will I feel the most movement?

Moms generally find that the baby is most active between the hours of 9pm and 1am due to declining blood sugar levels. You my also feel more fetal movement after meals or eating sugary foods.

I have always felt that it is easier to feel the baby move when I lay down and pay closer attention. It is also a nice time for baby bonding and just getting some well-deserved mommy rest. When I am busy and moving around a lot it is harder to pay attention to what is going on inside my uterus.

How should kick counts been done?

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. You will likely feel 10 movements in less time than that.

How to do kick counts:

1. Lay on your left side.

2. Count how many minutes it takes for you to feel 10 fetal movements (once you get to ten you can stop counting).

3. Do this once a day around the same time. I do it right before bedtime when my daughter is already asleep so I am not interrupted.

Charting fetal kick counts

Fetal kick count app

There are dozens of kick count apps to choose from, but this is the one I use.

You can use a calendar chart to document how many minutes it takes for you to feel 10 fetal movements. If your baby does not move at least 10 times in 2 hours or there is a sudden decrease in movement, you should contact your doctor right away.

There are dozens of fetal kick count apps available to make this even easier.

Having an app makes it so much easier. You can just set the time that you want to start doing kick counts and then tap on the phone each time you feel a kick. When you get to 10 kicks, the app tells you that you are done and records the total amount of time it took. The app also records the history of all your kick counting sessions so it is easy to review and see if there have been any decreases in activity.

Kick counting is an easy way to monitor baby’s well being in the womb.

Timely intervention after a mother complained of decreased fetal movements and the baby was found to be compromised on further evaluation has helped save many babies. I know from first hand experience that doing fetal kick counts can help divert a catastrophic event. It is always better to be safe then sorry!

Happy (and safe) pregnancy and thank you for reading!

Sarah, Mother Nurse Love

I Had A Placental Abruption At 33 Weeks: Our NICU Experience

I Had A Placental Abruption At 33 Weeks: Our NICU Experience

I had a spontaneous placental abruption when I was 33 weeks pregnant with my daughter.

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.

Luckily for us, I was able to have an early emergency c-section and we had a very happy outcome. After spending some time in the NICU our 33 week preemie daughter came home with us as a healthy 4 lb, 3 oz baby.

Sarah pregnant with Zoe

At my baby shower, one week before I had our daughter via emergency c-section at 33 weeks.

But it almost didn’t end up that way. Unfortunately, most mothers who have a placental abruption are not so lucky, according to our neonatologist. The reason, he said, is that babies end up being deprived of oxygen, sometimes within seconds. Mothers also end up losing a lot of blood, although they usually do better then the babies.

We still don’t know why it happened because I had no risk factors. Thankfully, I was able to have an emergency C-section in time and it was life-saving for the both of us.

I got the flu about 5 days before the placental abruption occurred.

As a nurse I already knew that just being sick doesn’t hurt the 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 was feeling so much worse.

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

After a 30 minute phone interview I was told NOT to come to the hospital as there was nothing they could do for me. I just had the flu, they said. I was told to stay home, rest and drink lots of fluids.

Two days after that I felt even worse! So again, I called the OB unit at the hospital to see what I should do.

I spoke with both the on-call OBGYN on the unit and another advise nurse. Both told me again NOT to come in. I explained that I was extremely weak and short of breath when walking more then 20 feet. I had no 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.”

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 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. My body was so sick and achy though 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 reminded that I was bringing my flu into the hospital.

I tried to explain again that I just didn’t feel right and 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 and was immediately concerned. She explained that:

A) I had almost no amniotic fluid.

B) The little amount of amniotic fluid that was there was the wrong color and she couldn’t explain why.

C) Our baby’s fetal heart rate was “not reassuring” which is another way of saying that our baby is alive but in distress.

D) It was likely I would have an emergency C-section imminently.

She didn’t know at that time I was actually having a 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 was swallowing blood the whole time. 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.

Preemie Baby Zoe

After finding out that a c-section was imminent, a team of preemie doctors came in to prepare us for what to expect after Zoe was born.

The preemie MDs 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). It the case that my baby didn’t 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.”

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 after a placental abruption usually don’t survive and the mothers don’t do that well either, although they do better then the babies.”

It was hard to have our baby in the NICU, but we were so grateful for the excellent care she received.

Preemie Baby Zoe

It was hard to have my baby in the NICU but we were so grateful for the excellent care she received.

The first time we saw her we were shocked. She was in an incubator hooked up to so many IV’s and tubes, and so tiny.

I wasn’t allowed to hold her yet. That part was so hard! But I could put my hands in the incubator and place one hand on the top of her head and one her feet. I remember telling her how proud we were of her. She was a tough baby right from the start.

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 the 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- preemies 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. Since she also was very jaundiced, she had to be under a bilirubin light for 5 days.

Zoe got a little stronger every day.

Mom and Zoe in the NICU

As a preemie Zoe earned the nickname “tiny but mighty” from her doctors.  This was taken during week two in the NICU.

Zoe 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…

A) Mothers need to trust their instincts. We know much more then we give ourselves credit for.
B) At 28 weeks gestation it is important to start doing fetal kick counts.
C) It is so important to be grateful for the miracle of having a child.

I can’t imagine what my life would be like now if I hadn’t gone into the hospital that evening, especially after being instructed not to. It is so important to trust your instincts!

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.

Zoe photo shoot

Zoe, 2 years old.  Spunky, hammy and giggling as usual.

Our daughter turned two today. And we are so grateful everyday for her presence in our lives.

Thank you for reading!

Sarah, Mother Nurse Love