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Episode 237

Alannah James

In this week's episode I chat to Alannah about her challenging pregnancies, NICU experiences and her sheer determination to breastfeed despite the hurdles. Her first pregnancy and birth was smooth sailing so when her waters broke at 19weeks with her second baby, she felt like her world had turned upside down. A long hospital stay ensued and she delivered baby Maisey at 29 weeks before enduring the rollercoaster of NICU for 60 days. A surprise pregnancy a year later came with concerns, including the increased risk of Preterm Premature Rupture of Membranes (PPROM) and early bleeding from a subchorionic hematoma, but it was vasa previa, where blood vessels extend from one lobe of the placenta to another and cover the opening of the cervix - that placed her in a high-risk category and prompted a caesarean birth at 33 weeks.

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Alannah fell pregnant easily with her first baby

“I went to one of my sister’s home births and just saw how beautiful it was and I felt so empowered watching her birth. I knew I wanted to home birth but not for my first baby so I decided to go apply for the midwifery group practice. I managed to get accepted and I was assigned a few of the midwives that assisted my sister at her homebirth.”

Before opting for the MGP program, Alannah looked into all the hospitals in Adelaide and discovered that the private hospitals had a higher rate of intervention and caesareans which she was hoping to avoid. She felt confident with her choice to be cared for by midwives in the public hospital system.

She lost her mucous plug at 36+6 and later that night her waters broke shortly after hopping into bed. She went to the hospital to confirm that it was amniotic fluid and returned home, got back into bed and had trouble sleeping due to the mild yet regular period-like pains and a brewing sense of anticipation.

“I didn’t realise that as soon as my waters had broken I was on the clock with the hospital. They wanted me to have the baby within 24hours of my water’s breaking but I think that time differs depending on the hospital.”

The next morning she was induced via the syntocinon drip at 10am. She laboured for most of the day and night; in the bath and the shower. By 10pm she requested fentanyl and it gave her just enough of a break to rest and refocus; 45minutes later she was fully dilated and started pushing shortly afterwards.

“The pushing part was the easiest part for me. I was on all fours on the bed and I was so excited to know that his head was right there and he was so close. I did have some issues getting my placenta out afterwards as my cervix was closing quickly so they gave me the syntocin injection which helped.

“I ended up bleeding for 11weeks and I passed a clot the size of my hand – I just didn’t realise that it wasn’t normal and that it was a sure sign of retained placenta. I was really tired and rundown and I looked really pale. I was so caught up in the baby phase and establishing breastfeeding that I wasn’t focussed on how I was feeling. I had an ultrasound and it showed a 4cmx2cm piece of placenta so I had to go under to have that removed.

“We started trying for another baby when Xavier was 18months old and after a positive test I experienced spotting which increased to bleeding and my HCG levels dropped. I couldn’t believe how much blood loss there was for a miscarriage at seven weeks and how painful it was to lose a baby that early. I was at home when the baby passed. I was on the couch and the cramping was so intense and I passed a clot which I think was the baby. I took it quite easy in the weeks that followed but then conceived Maisey a few weeks later.

“I had a lot of bleeding early in Masiey’s pregnancy but it stopped around 12 weeks. I had the perfect pregnancy between 12 and 19 weeks and then my waters broke and everything went downhill from there. My midwife downplayed it when I called her and so we didn’t do anything for a few days and I had another gush a few days later and we had our morphology scan booked that week. We still didn’t know that our waters had broken during the scan; in hindsight I knew something was wrong because the sonographer was taking a long time…because there was no fluid, no black, so it was really hard for her to see. We were told that we needed to come back so we went home and I got a phone call from the doctor who had reviewed the scan. He told me that I needed to go to the hospital immediately and that he thought my waters had broken. I felt like my whole world had been flipped upside down. I knew if I went into labour my baby wouldn’t survive because I was only 20weeks and my local hospital only care for babies after 23weeks gestation; that’s when they consider it a viable pregnancy.

“With Preterm Premature Rupture of Membranes (PPROM) 50% of women go into labour the first week afterwards. I was admitted and given antibiotics. Our life became obsessed with not getting an infection. Because I wasn’t yet viable yet they discharged me and told me to take it very easy. It was a horrible couple of weeks trying to get through every day although we had a lot of help from our friends and family and church community. At 23 weeks I was admitted to hospital because I had reached viability and I stayed there for five weeks. I was leaking constantly – changing pads every hour or two – it was clear fluid until 25 weeks when it turned to a blood colour. They think my placenta was starting to detach.

“I would talk to Maisey and sing to her and tell her that everything was going to be ok. I was staying strong for her…I honestly think it helped because I was staying calm and I think it kept her calm too.”

“I’d been bleeding for a couple of weeks but I went home at 27weeks because my mental health was deteriorating and she had turned head down so they were happy for me to come in every few days for blood tests (to check infection markers) and CTG monitoring. The first sign that she would be born was that my fluid started to look a bit green and when I showed the midwife…I’ll never forget the look on her face, she got the doctors straight away and they were convinced I had developed an infection. My white markers in blood tests had also started to increase so it was decided that I would be induced. Twelve hours after I was induced I had a big breakdown…I realised that I had done the best job I could of growing her even though I wanted to keep her in for longer. My sister just encouraged me and my body then started to relax and let go. When I felt her head drop my sister ran to get the midwives and a whole team of specialists came in. I was trying to hold her in to slow her down; it was a beautiful moment putting my hand on her head, that I was the first one to touch her. She made a few squeaky noises and they took her onto the resus table. Her apgar scores were 6 and 8 which were really good for a preemie. She was intubated right there in the room and I didn’t get to hold her; they wheeled the bed over to me and then she was taken to the NICU.

“It was a tough 60 days in NICU; commuting to the hospital every day, expressing without having Macy in her arms. It’s really hard sharing the care of your baby with someone else.

She has chronic lung disease and she gets sick quite often but aside from that she doesn’t have any other health concerns.

“There is a 15% chance of PPROM happening again so we were going to wait a few years…I was still feeding Maisey at 13months when I felt the sudden urge to take a pregnancy test. I didn’t have any pregnancy symptoms though. I did the test but didn’t even look at it…I just went to bed and saw the two lines the next morning.

“I started bleeding from 5 weeks and it continued till 20 weeks and that’s because of a subchorionic hematoma . They didn’t diagnose it until 13 weeks so until then I didn’t know what was causing the bleeding so that was tough. At the morphology scan at 19 weeks I had complete placenta previa and I wasn’t worried because I knew it could move but they had found vessels that had grown abnormally out of the placenta; I had a bi-lobed placenta which means it’s split in two halves and the vessels were connecting the two lobes.

“It’s called vasa-previa where the placenta and vessels have grown abnormally and are blocking the way for the baby to get out. There were two vessels – one was an artery and one was a vein – if my waters broke or I went into labour and one of the vessels broke, I had 15minutes till the baby was drained of blood and would have brain damage due to lack of oxygen. I had regular scans and was hoping it would resolve..at the 29 week scan the placenta had moved but the vessels hadn’t. At the 32 week scan there was a large artery still in the way…they told me that they wanted to admit me to hospital that day. We asked for two days at home and it was even harder this time because Maisey was still so reliant on me…in hindsight it was just a short period of time and it was so worth it to have a healthy baby on the other side.

“I was in the hospital for 10 days before she was born. We had been chatting to the team and they were pushing for a caesarean date in the 34th week. I started having contractions so they put me on the CTG monitors and I was having two every ten minutes. Three hours later they moved me to the labour ward and a few hours later I was taken to theatre, given the spinal block and when it kicked in it felt like a lightning bolt in my leg. I didn’t feel nauseous but I was shaking a lot. Meadow was born soon after…she was 2.6kg which is huge for a 33 week baby. I was able to have her on my chest which was really lovely but she was cold so she was wrapped up in lots of layers.”

 

Topics Discussed

Vasa previa, Subchorionic hematoma, Premature labour, Three babies, Retained placenta, PPROM, Caesarean birth, Vaginal birth, Miscarriage, NICU

Connect

You can connect with Alannah over at Alannah James

Episode Sponsor

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