48 hours on the labour ward

I am a walking life support machine. For the moment, this is my only and most important function. It’s a really big responsibility, and, on Tuesday of last week, it looked like I might be breaking down. The diagnosis at 22 weeks of placenta praevia (PP) meant that any spotting whatsoever had to be taken very, very seriously indeed. The issue with PP is that, if you get a bleed, it is usually a precursor to future, more significant and serious bleeds. These are caused by weakening or tears in the placenta, which, if they become worse, can cause it to stop functioning. To manage the risk to both mother and baby in the case of increasingly catastrophic bleed scenarios a decision is usually made, once a bleed gets to about a pints’ worth of loss, to perform an emergency c-section and put the baby in an incubator. The very grave warning to take my diagnosis of PP very seriously indeed was written all over my notes, but no spotting had manifested, and things seemed to be going very ‘normally’.

Until Tuesday of last week, when at 26.6 weeks, with a lack of pain that would almost have convinced me that I had experienced a failure of bladder, I found myself soaked in blood. I was asked for descriptions of how much several times on Tuesday evening, and the best I can do is to say that my underwear was soaked, but it didn’t hit the floor. This equates to about 30ml, apparently. Enough to raise all kinds of alarms.

I was at work, fortunately not teaching (it was the end of lunchtime), and I had gone out of my office to find a student from my tutor group whose birthday it was as I had bought a cupcake for him (a little tradition we have in our class), but had forgotten to give to him in tutor time. Not an especially strenuous activity. Having delivered the cake and birthday greetings, I felt that something was ‘not right’ and went to the toilet next to the school matron’s office. There, I found that I was soaked in blood. I had already given matron the number of the labour ward so that it would be on hand should anything happen such as this, given the PP diagnosis, and I asked her to call it, and an ambulance. I felt surreally calm; I had been warned that this might happen, and now it was happening, and so I had to deal with it. I phoned my husband. There is no way of not sounding alarmist when you tell your husband that, at just under 27 weeks pregnant, you have experienced a significant bleed and are awaiting ambulance transportation to hospital. The same can be said for telling your mother, too.

By the time I had spoken to the midwife at the 999 call centre about the details, the ambulance had arrived and the bleeding had subsided. It was a paramedic and car, rather than a full-blown ambulance, and my blood pressure etc. was taken. Having decided that I could be taken in the car, and after the laying down of an absorbent sheet on the passenger side, I was transferred to Stoke Mandeville labour ward. I was feeling, as usual, some discomfort under my ribs (totally unrelated muscular issue which I have been experiencing for a few weeks), and I kept reassuring the driver that the associated wincing and facial contortions were down to that, and that I was not going into labour in the car.

My husband arrived about 10 minutes after I did, and, from the look of him, was in a much worse state of shock than I was. I was seen and assessed quickly by a midwife who kept calling my husband ‘Dad’ which I could see he found confusing as its not yet a term of address that he has associated with himself. Having been poked and prodded by doctors, we were visited by a team of consultants, the most senior of whom informed me that ‘my maternity leave had just started’ and that I could ‘expect more and heavier bleeds’. I wasn’t going anywhere tonight.

I was installed on the labour ward and my husband dispatched to fetch the overnight bag which we really should have packed when we were given the original PP diagnosis. I was cannulated, given a fish and chip supper, a raspberry pudding and an incredibly painful steroid injection in the backside. My assessment of these developments; if you are in hospital and they cannulate you, you are not going anywhere. If they feed you, they are not anticipating operating on you immanently. If they give you a massive injection, it still has the potential to all get a bit serious. Steroid injections are given when there is a chance that a baby might need to be delivered early. These injections are given, 2, 24 hours apart, to assist with the development of the baby’s lungs in order that respiratory complications after birth are minimised. Better to have them and not need them than need them and not have them. They chuffin’ hurt, though.

Throughout these proceedings the baby was monitored and was active, healthy and apparently completely unbothered by the medical emergency in which is was involved. This was obviously very reassuring.

That night on the ward, I hardly slept and kept imagining that I would find myself covered in blood at any moment. That didn’t happen, though, and I was relieved to be fed again in the morning (so surgery still not immanent). I was told I would be scanned at lunchtime and my husband was going to return in time to accompany me to that. However, a slot became available at about 11am, so I went on my own. The news was good. The PP has resolved, the placenta iss now a good 2cm away from the cervix; a ‘safe’ distance. Even better, it showed no signs of damage or bleeding. In fact, where the bleed had come from was a mystery, with no obvious bleed site anywhere to be seen. The baby, meanwhile, continues to grow well, and seems active and healthy. In the absence of evidence of anything more sinister, the bleed has been attributed to a burst varicose vein. However, the sonographer noted that my cervix has become shortened (thankfully still closed), but this gives us something new to worry about. It seems that we have exchanged the PP diagnosis for the possibility of early labour. It’s less dramatic, but not the ‘normal’ prognosis that I was hoping for.

Back on the ward for a second night, I was fed again (yay!) and the cannula was removed. Red alert had officially been stood down. I still had to endure round two of the pain-tastic butt jabs, but, better done than not done. The consultant has said that the shortened cervix presents ‘no significant clinical concerns at this time’, and I have been released to laze about in my own bed. We have to go in and see another consultant on Tuesday afternoon to find out what the plan will be for the rest of this pregnancy – house rest, bed rest, carry on as normal etc. and I am, of course, on constant vigil for anything else untoward, which would require immediate return to hospital.

The only one who has been seemingly unaffected by all of this has been the baby, which, on Thursday morning gave myself and the duty midwife the proper run around (at 27 weeks, it still has plenty of room to change position) when they were trying to do its obs. It was being very uncooperative; it wouldn’t stay still and kept kicking the doppler probe. I had to literally chase it round my tummy with the machine for an hour and still we couldn’t get a good reading, although it was obvious to all that baby was alive and well in there. I guess that’s the price you pay for giving your baby steroids!

So now its just a case of waiting to see what happens next and hoping that its all normal and non-emergency in nature. Stay in there, baby, not too much longer to go!

If necessary use the emergency exit

I am happy to report that baby’s re-scan went well today. Spine and kidneys all present and correct. Baby was asleep when the scan started, but awake by the time it was over (well, so would you be if you were being prodded and poked and blasted with sound waves). Growth is on track, and he or she (we haven’t found out) seems perfect – and looks like a real baby (there is no reason for me to be surprised by this, but somehow I still am).

The less good news is that the placenta is really very low, and, although many low placentas do move up in later pregnancy, it seems that mine has quite a long way to go – 7 centimeters. We saw the consultant and he has officially given me the diagnosis of placenta praevia (http://www.nhs.uk/ipgmedia/National/Royal%20College%20of%20Obstetricians%20and%20Gynaecologists/assets/Alow-lyingplacentaafter20weeksknwonasplacentapraevia.pdf). He is already talking about a planned c-section at 36 weeks or so, which brings the EDD forward to the week of the 27th May. That’s almost a whole month! (!!!!!) I’m not too worried about that, per se, because it’s pretty much term, and they can give me injections to help accelerate the development of the lungs etc., so the baby will be able to manage. To be honest, I just want it to be OK, so I’ll take whatever advice I need to take to achieve that. I don’t think I’ll feel any ‘less of a woman’ if it ends up coming out through the sun roof. It’s not about me, it’s about getting this baby healthily into the world, whatever it takes. I’d rather avoid hospital scares along the way, but I’ll do what I need to do to achieve that objective.

We’ll be scanned again at 32 weeks to see what’s happening and I expect the final decision will be made then. Assuming, that is, that nothing untoward happens in the mean time; we are on alert to go straight to the Labour Ward if there is any spotting of any kind, where I’ll me monitored for 48 hours to check it isn’t a more serious bleed. But hopefully nothing like that will happen. (Please don’t let anything like that happen!).

Apparently, the risk factors (that could possibly affect me – given that I am not a smoker or a cocaine user, I can rule those out as possible causes!) are age (a factor at 38) and previous c-sections (no) and ERPCs (4 + 2 hysteroscopies, including the surgical removal of a septum). Has my surgical history caused this placenta to mis-grow? Even if it has, there’s nothing I can do about it now.

Wish us luck for an incident free path through the next 3-4 months, and getting baby safely into the world in either June or May. Whatever it takes.