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.

I read the opposite, Jessie, that she'd been told initially that she needed to stay put but now was being told she'd need to leave. I can well believe this with pressure on beds, but that's not the OPs problem. If some registrar or midwife is under pressure to clear a bed then maybe OP is an easy win for them; I certainly wouldn't presume that they've made the decision in full knowledge of either the clinical picture or earlier recommendations. Communication can be atrocious in some of these units.

Another midwife tried to get me out of bed ('we need to mobilise you') when I'd be put on total bedrest

One today told me to go for a walk to make myself feel better when I'd been told not to move much and was doubled over in agony. I don't have confidence in them to be frank.

This seems madness. I’m another one who has had PROM and ended up with sepsis from infection in my womb. I don’t want to scare you but It came on within a few minutes whilst I was in labour and I wasn’t showing any signs of infection prior, didn’t feel poorly (but it may have been masked by the fact that I was in labour so was feeling prety shit anyway) Have you seen a consulant? Are they just hoping you’ll go into labour sooner or later and be readmitted? I thought they could give you drugs to halt labour and put you on bed rest as it’s so early ? For context they offered me that option when I had PPROM at 35 weeks but they said at that stage risk of infection was higher than risk of preterm birth, but that wouldn’t be the case at 26 weeks. I would say you are totally correct to want to stay in, maybe if you were closer to hospital it wouldn’t be such an issue. That said I’m pretty sure I picked up my infection from the hospital as I was there about 70 hours before the sceptic shock. Are they thinking you’ll be at less risk of infection at home maybe?

Can you speak with the original doctor who first said you should stay a week ago?

That doctor is a neonatal doctor so focusing on the babies not an obstetrician so I haven't seen her since sadly.

Insist they repeat bloods before you are discharged.

How can you be discharged if the doctor said you need to stay in?

Because I see different doctors every day and the plan seems to change every day

Spamfrittersforeveryone I read it as the doctor’s advice a week ago was to remain in hospital as OP could give birth any time, but now that an imminent birth hasn’t happened and it’s a week later with no sign of birth imminently the advice has changed and OP can go home and then return when necessary. The original doctor could only advise based on the info she had at the time, but a lot can change in a week and the original advice clearly no longer stands if the hospital are now saying OP is fit for discharge.

I guess the ins and outs don’t really matter, what matters is how you’re doing OP and who is there to support you, as I really can’t see them agreeing to let you stay if there’s no clinical need in their opinion, so you might not have any choice in the matter :(

You need to be ensure they are very clear with you as to why they are discharging you and what the plan is. Sorry you’re going through this.

Oh I see, sorry.

Hospitals can seem uncaring but there are so many patients reluctant to or unwilling to go home when they’re medically fit to, for many reasons (they don’t want to go back to an awful situation, they’re really anxious something might go wrong, they’re returning to a cold dark house and no food, loneliness) that they do sometimes have to make difficult decisions based on medical need as they’re having to think not only about the patient in the bed right now but the ten acutely sick people in the corridors in A&E and the acute assessment unit waiting for a bed to free up. I know this isn’t OP’s concern but it is reality.

OP what do you think to the suggestion of finding a place near the hospital to go and stay for a few days so you’re not too far away? Can you afford that, is it logistically feasible? If so, get planning it now as you don’t want a situation where they’re discharging you and you have to go straight home if you don’t want to.

I can't afford to stay anywhere and I have a three year old so wouldn't be able to anyway.

OP, I think it is very reasonable for you to ask to speak with an obstetric consultant, in order to fully understand what the ongoing plan for you should be.

It doesn't have to be from the point of view of "I'm not going home unless the consultant tells me to", but more, "I need the consultant to explain what might happen and what I should do, and go over how I should be monitored until then". I hope you can get clear explanations and a practical plan that you can feel confident in and that works in terms of distance if you go home for part of the time.

Very best wishes for your babies, in time (hopefully a fair bit more time, fingers crossed!).

Whereabouts are you in pain?
It seems to me as though that hasn’t been properly investigated. I’d be pushing for that and making it clear that you don’t feel it would be safe for you to go home with such high pain levels.

If they insist, I would contact PALS and sit tight until you’ve had more thorough investigations

Your action plan seems to be:

1. contact PALS immediately
2. ask for a sepsis check immediately
3. ask for a consultant to speak with you ASAP about prognosis, what they think the pain could be etc

They can’t discharge you if you’re in pain that can’t be relieved.

I suppose in truth you are less at risk of infection at home, and the risk is small anyway. They will surely tell you to monitor your temp if there’s any sign of a raise to go straight back in.

No way on earth would I let them discharge me. I had a cord prolapse in prem labour and very very nearly lost my baby. Luckily I was already in hospital and had a crash emcs. Is there anyone who can come and advocate for you?

OP, every hospital has its own discharge policy.

www.nhs.uk/using-the-nhs/nhs-services/hospitals/being-discharged-from-hospital/

If you google the hospital you’re in and discharge policy you will find it. You might find some stuff in there that backs up your case to stay which could come in handy when talking with the doctor ?

You need to push to stay close by - maybe in hospital emergency accommodation. Ask PALS and push to stay.

But given the pain and other symptoms I think you’d still need to be checked over by a consultant!

This is a very different scenario than someone in A&E with a cold, I had a rupture of membranes at 19 weeks and was allowed to go home but with very strict instructions that if I felt unwell at all I was to go straight back to hospital. The op already feels very unwell and her babies are able to survive I would not leave hospital under any circumstances

Sorry I’m way out of my depth here but I was just really worried they’re not concerned about unexplained pain?! Are they doing anything about that? Do you have a possible diagnosis?

I’m so sorry. This sounds awful and I really wish I could help but this strikes me as really strange that they’re not following up/listening to you. Definitely speak to Pals and mention this

Op I would ask to speak to the neonatal dr again and arrange for them to speak to obstetrics. I would refuse to leave hospital in your condition

Don't let them discharge you. This happened to me and my sister but we were both further on at 36 weeks. The day after my waters started leaking they burst them completely which put me in labour and I had her an hour later.

My sister was sent home. She ended up getting a serious infection and my niece ended up with meningitis because the infection spread to her. She was rushed for emergency c section and they were both really really ill.

Both our waters went because of strep b which wasn't discovered until after when swab results came back. Have you been checked if you are carrying it?