What to expect - in hospital
If the hospital establishes PPROM and depending on your medical condition, you will be offered one of two fundamental choices:
1. To continue the pregnancy
2. To induce the pregnancy
If you choose to continue the pregnancy you will be expected to either stay in hospital or go home.
You will be expected to return to hospital two to three times a week to check bloods and for signs of infections.
As you approach 34 weeks gestation you will be offered steroids for your baby, if you PPROM before 24 weeks the first set of steroids are recommended at 24 weeks.
If you go into labour prior to 34 weeks you may be offered a drug to try and stop you from going into labour.
If you are based in the UK some hospitals will not help baby if born alive before 24 weeks gestation.
On the other hand depending on which hospital you attend, some will offer to help baby dependent on weight and size, as you will notice some 23 weeker stories.
The youngest surviving PPROM baby was born at 21weeks in the USA. However sadly not all our hospitals can accomodate this service.
If you have bulging mebranes without PPROM you maybe able to have an emergency stitch to help progress the pregnancy.
If you choose to continue with your pregnancy we strongly advise you to follow a strict routine of bed rest where possible.
Also avoid baths, long showers, soaps and where possible, lifting of any kind.
We provide information PPROM packs to all our pregnant PPROM mums
What to expect - special care baby unit
The Special Care Baby Unit (SCBU) consists of an Intensive Care Unit (ICU), alongside High Dependancy, Special Care and Transitional Care units. The level of sickness will determine where your baby is placed; with the most sick being placed in the ICU and the least sick in special care. No matter where your baby is placed within this unit it is imperative to minimize the risk of infection. Therefore visitor hygeine should be a prerequisite. On entering the unit wash your hands with the antibacterial soap and hand sanitizer provided. As an added precaution, you may also be asked to wear a gown, mask and gloves. Also clean mobile phones/cameras etc with antibacterial wipes. Mobile phones can harbour more germs than a toilet seat. To re-emphasise, always ensure that your hands are scrupulously clean at all times. Particularly before touching your baby.
When you first visit, you will find your baby either in an incubator or a heated cot. Not only does this afford an environment where your baby's temperature can be monitored and stablized, but also where the risk of germs and noise are minimized. It can be a bewildering and scary moment when first seeing your child covered in tubes and wires and attached to machines and alarms. And often not knowing what the purposes of these machines are can add to the anxiety. Simply ask a doctor or nurse to explain all this to you. This will help you gauge the seriousness of the situation.
Do not be alarmed to see many people surrounding your baby. As a matter of procedure, once in SCBU your baby will be assigned a whole team of specialists; neonatologist, paediatrician, doctors, nurses and support staff. They are all there to do the best for your baby. Other staff in the unit include a psychologist and a chaplain who are available if you feel the need to talk about your thoughts. It can be very helpful speaking to someone who is not emotionally involved.
Having a baby in the SCBU can leave you feeling like you are missing out on precious bonding time. However there are actually lots of bonding opportunities. Ask if you are able to help with your baby's daily care ie nappy change, face washing, moisten mouth (if tube fed), move blood oxygen monitor and feed. Ask when your baby can have a bath. You too can help with this. Skin to skin contact can work wonders too. If your baby is well enough to be held, try to do this at least once a day. However if you are unable to hold your baby, remember you can always touch and talk to them. Place one hand on the top of the head and the other around the legs/bottom or lightly over their stomach. This can be very soothing for both parties.
Ask about the visiting policy. Generally you will be able to visit whenever you would like but there will be times where you may be asked to sit in the waiting room for a while ie during shift changes and doctors rounds etc. If you would like to be present during the doctors round ask if someone can inform you when they reach your child. For other visitors there will be set visiting times, normally limited to one visitor at a time accompanying a parent. Children are not allowed to visit unless they are a sibling.
Only parents and hospital staff are allowed to touch your baby.
If you are breastfeeding ask about the hospital's policy for storing milk. You will need to know this for when you return home and also if your baby is being tube fed. Normally you can borrow a pump from the unit if necessary. If you are unable to produce enough milk some hospitals have donor breast milk which can be used as a substitute if you wish. If not, a formula top up is another suggestion. If your baby is tube fed they will be given a dummy to help establish the natural sucking response. This helps your baby to reinforce the association of sucking with being fed. Once feeding has been established, whether breast or bottle, a feeding pattern will be introduced. At first this normally involves alternating tube feeds with breast/bottle feeds. This is to ensure the baby does not become too tired. Only when they are considered strong enough will the tube feeds be withdrawn.
Going home and leaving your baby in hospital will be one of the hardest things you will ever have to do. But remember your baby is in the best place with all their aunties (nurses) looking after them. Should any concerns arise the hospital will contact you immediately. Of course you may call at any time for an update.
As your little one starts to improve, the machines and wires will begin to disappear. On occasion however, certain pieces of equipment may be re-introduced having previously been removed. Try not to let this dishearten you too much. In these situations it can simply be a case of your baby not being quite ready. Once a constant body temperature is established your baby will be transfered to an open cot. And as they improve they will work their way through each care unit until they arrive in Special Care.
Once your little one has gained enough weight, is feeding properly and is strong enough to go home they will need to pass a car seat test. This involves sitting your baby in a car seat for an hour attached to the necessary monitoring equipment.
The nurses will pay close attention for any heart or breathing issues. If your baby displays three episodes of desaturation (a lack of oxygen levels in the blood) lasting 20 seconds or longer this is deemed a failure and the test will need to be performed again. Ask when this might be as hospital procedure differs.
To help you prepare for bringing your baby home you will be offered to share a room for a day or two in Transitional Care. There you can handle all your baby's needs with the medical staff on hand should you need them. If you feel confident enough to take your baby straight home you can opt out of Transitional Care and go home from Special Care.
Before you go home a plan will be made for your baby's care and follow up appointments will be made. If your baby still requires any machine you will be shown how to use them. You may also be taught how to administer CPR (cardiopulmonary resuscitation).
Throughout all of this remember that you need to look after yourself and make sure you get enough rest.
You need to be strong for both of you.