Hospital wants to send me home after PPROM. I don’t want to go. Help.

[CatsEye99]

Posting for traffic. My waters broke at home and were bright red, and I was 26 weeks with DCDA twins. I called an ambulance and was rushed to hospital where I had a huge gush of red fluid. I was counselled about preterm birth and given steroid injections. I saw a neonatal doctor who stated the most important thing was to deliver at a hospital with NICU cots.

Despite severe agonising pain, a week has passed and I haven’t given birth. Twins aren’t distressed and my observations are fine.

However I feel incredibly unwell. I keep burning hot and turning red but my temp is not raised. I feel like I have the flu or another illness. I have no energy and can barely move due to pain. Codeine won’t touch it. A midwife told me to have a hot bath which I am sure is contraindicated.

The staff want to send me home. I have stated I do not want to go home due to me living an hour from the hospital and the risk of infection, cord compression, preterm delivery and stillbirth. I do not want to lose my babies. I want to remain in the unit with NICU like the doctor advised.

Can anyone give me any advice? I can’t find any info on this anywhere and feel like the staff are fobbing me off.

Contact PALS straight away

Huge sympathy to you. Do your blood tests indicate any infection? A CRP test is usually done.

I don’t know how you can force them to keep you in but certainly you can ask to see the consultant and stress your very valid concerns. Unfortunately if they are short of beds and you have no actual midwifery or medical needs they will really struggle to keep you for potentially weeks.

Best wishes.

What's their care plan post discharge? You can ask to see the head of midwifery or your consultant obstetrician to discuss your concerns. What are your water levels at now?

My bloods were okay but showed slightly raised white cell count, but nothing to indicate infection. I honestly do not know what to do. I’ve requested to speak to another doctor and I’m waiting for them.

I've had PPROM twice and with one of them I ended up with sepsis. In your position I would want to stay in hospital too.

Water levels are 4cm around one baby and 2.4cm around the other. His waters went to 1.7cm before but seem to have gone up.

They think twin 2 hasn’t lost her waters but twin 1 is the one which is leaking. Both twins are head down

Also when I had my son I was contracting but never dilated. I feel like that is happening here too but no one is listening to me.

Speak to PALS and get another medical opinion (insist on a doctor, not a midwife).

Unfortunately I have to agree with a previous post however, they have to manage their beds and if the bloods are showing no sign of infection and there's no immediate medical or midwifery needs then they would not be doing their jobs if they didn't offer those meds according to medical need as opposed to maternal anxieties.

Gosh yes they should keep you in, if you lived 5 minutes away that's one thing but an hour!!! The medical need surely is to ensure regular obs and CRP monitoring etc while you have ruptured membranes. I'd definitely be talking to the consultant in the first instance and asking questions that focus their mind on risk, like 'what happens if I have a cord prolapse an hour away from hospital?' People regularly get kept in hospital for weeks and weeks in this kind of situation. I was admitted with prolapsed membranes at 25 weeks and was told I'd be there until I went into labour, whether that was 24 hours or 10 weeks away. As it turns out it was 8 days until my DS was born, and in that time they didn't even move me from the delivery unit, let alone away from hospital!

Offer those beds

Ask them to check you for signs of Sepsis. Ask them now. If you ask, they have to check you. If nothing else, it could delay them discharging you.

That’s terrible that they want to send you home. I had placenta praevia and they kept me after a big bleed and I lived 15 minutes away. I was only in a week before DS arrived and he wasn’t as early as you are so was fine. I think you will have to be quite insistent. Speak to your consultant, then ask for PALS. You do have to be quite well informed as you have a fairly rare complication they don’t see every day. - I had to stop an SHO doing a vaginal exam to see if I was dilated when admitted through Labour ward with a bleed. (This is a no no with a praevia). I had to be quite stroppy and say go and check with your consultant and come back. Guess what- I was right.

I definitely feel because its rare that people dont know what they are doing.

I outright asked the midwife if survival rates are better if I give birth in a NICU after the doctor told me so, and she said yes they are. To which I asked why it was safe to discharge me and she said "well it's a balancing act"

Definitely check it out with a doctor and see what they say, but if they tell you you’re fine to go home will you trust them? You’re understandably very anxious, as anyone would be, but if the hospital have no clinical need to keep you in you will have to leave as they can’t just allow patients to stay when other people with urgent medical needs also require the bed and care.

Is there anyone nearby you can stay with so you will feel less anxious due to being nearer to the hospital? Can you afford a hotel there for a few nights once discharged so you’re near the hospital?

What will you do if you do speak with a doctor and they back the staff up who’ve already said you’re ready for discharge? I get the sense you’re hoping the doctor will go against the staff advice, but perhaps it’ll put your mind at rest about being discharged to just have that second opinion.

Do you have anyone with you right now for emotional support?

I will struggle to trust them, because I don't see how being an hour away with no medical equipment can possibly be safe.

My mum and partner are alternating staying with me at the moment.

I saw a neonatal doctor who stated the most important thing was to deliver at a hospital with NICU cots.

a week has passed and I haven’t given birth. Twins aren’t distressed and my observations are fine.

I want to remain in the unit with NICU like the doctor advised.

Either I’m missing something or you’ve confused something, but your statement about wanting to remain at NICU like the doctor advised doesn’t sound like that’s what they actually advised, they advised you give birth in a unit with NICU cots. That’s very different to the doctor advising that you remain in hospital until you give birth, which could be weeks from now. I didn’t realise from my initial post you’d already been there being monitored for a week. If what you say is correct that the twins aren’t distressed and your obs are fine you really can’t expect them to let you stay until whenever it is that you give birth.

Am I confused here or did the doctor actually state you should stay in hospital now until birth? Or did they say what you’ve put here, that you should birth in a hospital with NICU cots? I think it’d be good to get that straight before speaking to the new doctor you’re waiting for so there aren’t any crosses wires.

It’s a fine balancing act, you’re clearly so anxious which anyone would be, but anxiety alone isn’t a valid clinical justification for allowing someone to remain in a hospital bed when there are other people needing it too. I’m sorry that sounds harsh, I don’t know how else to phrase it.

Have you spoken to a consultant or is it a more junior doctor who is discharging you? When were the blood tests last done, I would want sepsis ruling out with how you feel, some people don’t get a temp until they are really unwell with it so would want repeat bloods to see if they have changed. If they still insist on discharging I would probably tell the dr I hold them liable if I go into labour an hour away from home when I’ve been told I need to be by a nicu. Might not make any difference but I would still be saying it!

I have no specific advice but appreciate your anxiety. Can you stay nearer a hospital or that not feasible at all?

Sepsis seems less likely with normal CRP but obviously you’ll need medical observation. What’s the plan if they do send you hom?

The doctor stated it was important to be here as I could give birth at any time.

The thing is, my waters have broken. My babies are at a much higher risk than a normal pregnancy. I dont feel safe going home with that at all.

So you’re basically only wanting this second opinion in the hope that they’ll go against the advice you’ve had most recently to be discharged?

You definitely need to think about what to ask the doctor if they say you’re fine to leave to alleviate your anxiety because they won’t let you just stay if multiple clinicians have said you’re ready for discharge, so maybe start thinking about what it is you need reassurance around so that when you leave hospital you feel as confident and secure as possible. I know you want to just stay but i doubt they’ll allow it so you don’t want to be leaving in a fit of anxiety/anger when you could get your questions answered now. Maybe ask if there’s any chance of a daily community midwife visit? Or like I say, you might have to consider staying nearby if you’re unhappy being at home.

I agree with getting a consultant review. I had midwives and even registrars who didn't have a fucking clue, excuse my french. One registrar wanted to do an internal exam when I'd been told by the consultant when I was first blue-lighted in that under absolutely no circumstances did they ever do an internal exam when there were prolapsed membranes! Another midwife tried to get me out of bed ('we need to mobilise you') when I'd be put on total bedrest (they even fitted a catheter so I wouldn't need to get up to go to the loo). You have to be very, very firm in advocating for yourself, which is so so hard when you are feeling hugely vulnerable already. There may be justifiable reasons why it's ok for you to be sent home, but I'd want to hear them from the senior consultant in charge, definitely not from a midwife. Sending courage xx

Is there a hotel near by you can stay at?

They did my bloods two days ago.

The plan is twice weekly scans. The other thing worrying me is I'm in agonising pain and they can't find out why.

The thing is, my waters have broken. My babies are at a much higher risk than a normal pregnancy. I dont feel safe going home with that at all.

So why are the staff saying you are fine to go home for now? They must know all of this and have taken it into account and still believe that clinically you don’t need to be hospitalised?

Can you speak with the original doctor who first said you should stay a week ago? His advice might have changed now it’s been a week with no birth, but I think you’ll feel better knowing that it’s coming from someone who knows your situation from the start.

If the doctor wants you to remain, who is attempting discharge?