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.
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.
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.
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.
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.
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