Preparing for a 3rd preemie?

[Lousli]

This could get long, so I'll try to reign myself in.  I've tried to stay away from this forum during my pregnancy so far because I'm really, really trying to be positive about this pregnancy and protect myself emotionally.  I definitely suffered from PPD after the traumatic/premature birth of my younger daughter 6 years ago, and it took a long time for my husband and I do decide if we were going to have a 3rd child or not. 

So here I am, almost 30 weeks pregnant, and the birth is starting to get much more real and immediate to me.  I am starting to think about the likelihood of having a another preemie and trying to prepare myself (both physically prepare with some preemie clothes and diapers, and emotionally prepare.)  but I'm not sure preparing is something I can really do.  I'm struggling a lot with decisions about what/how much preemie stuff to buy, when to take off from work, etc. 

The problem is that with my first, I had zero warning, no signs/symptoms/contractions, my water broke at 36 weeks and there she was.  She was early for sure, just 5 pounds 4 ounces at birth, sleepy and jaundiced and difficult to nurse. 

With my second, I had tons and tons of BH contractions that in retrospect I think were irritable uterus, but no dilation or any other real signs of PTL.  I had negative fetal fibronectin tests.  At 32 1/2 weeks, I got a stomach virus and was vomiting and dehydrated and contracting every 3 minutes.  I went into the hospital and was there 4 days with contractions that they could space out but not stop, still negative FFN and no dilation, but complications from the meds and hydration they gave me (pulmonary edema.)  On the 4th day there my water broke and then I was in active labor and my daughter was born 5 hours later at 33 weeks (or 32w 5d, according to the docs.)  She spent 23 days in the NICU/SCN.

I have been seeing both a regular OB and a perinatologist and the peri bascally told me I don't need to return unless something comes up since my ultrasounds, bloodwork, weight, blood pressure, etc have all been great.  I am having the weekly progesterone shots (since 16 weeks.)  My cervix (after U/S exam at 19w and 25w) is long and closed, no funneling.  My regular OB said to keep alert for signs of PTL and asked me if I wanted to in for FFN tests every 2 weeks, which I think is somewhat pointless, given that my FFN was negative the day before my daughter was born.  I've had some BH contractions, mostly when I don't keep up on my fluids or if I get really tired and stressed.  But as long as I rest and hydrate, they go away and I've never had enough to get worried.

So given all this, I'm feeling pretty positive, but the thing is, I think there is a very real possibility that my water could just break and I could go into active labor.  No one has ever given me any statistics about this and I think that there is really nothing they can do to tell me if it is going to happen or to prevent it from happening.  I plan to ask my OB next time I go in about steroid shots for the baby's lungs just in case. 

I guess what I am asking is what is the likelihood of pPROM again?  How early should I prepare myself vs. am I unnecessarily stressing myself out to start getting ready this early?  Should I consider taking off of work early even if I am not having signs of PTL?  Should I purchase preemie clothing and diapers with the assumption that I will need them and/or that my baby will likely be small anyway (I'm only 5'' tall and small-framed and my dh and I were both pretty small babies at birth?)

If you got this far, thanks for reading. 

[MeepyCat]

Oh wow.  I can imagine the stress you're feeling.  And honestly, with your history, if I were in your shoes, I wouldn't feel reassured until the baby was definitely NOT premature. 

In regards to when to take off work - oh gosh, how can you know?  How specific do you have to be?  If your job is not physically demanding (the sit and stare office classic, for example) and there are no indications of PTL, then I see no reason why you particularly have to stop - although if you feel that you should, you should.  My plan with my pregnancies was to work until I went into labor, which meant that I never gave an employer a specific date, just a general range, and we were able to use that range to prepare.  I would encourage you not to plan to take off early just on the off-chance that the baby comes early:  reasonable people understand that emergencies happen, and can change your plans.  A premature baby is an unexpected emergency.  So if it were me, I would make sure that my co-workers were trained on all my job functions, and then carry on with the expectation that I'd be going out around my due date. 

I would not buy preemie stuff.  In the event that you have another preemie, you already have at least some preemie stuff.  I had no preemie stuff when my daughter was born - absolutely freakin' nothing - and between the day she was born and the first day that we thought she might come home (about a week and a half before she actually did come home), we had time to acquire these things.  It was actually quite a handy errand to have to send people on when they wanted to help.  They felt involved and useful, and yet did not cut into our private time with DD in the NICU.  (I wasn't fond of most NICU visitors - germs, and they wanted to hold the baby when *I* wanted to hold the baby, and so on.  You may feel differently.)

[windymama]

Both my babies were in NICU, but for different reasons (one preterm and the other due to birth defect) so I can somewhat understand where you're coming from.  We're pregnant with our 3rd and so far everything is looking fine, but like you, in the back of my mind I'm waiting for my world to fall apart again.

I'm packing my labour bags to be ready sometime between 30-35 weeks (DS was a 35 weeker).  I did this with DD too.  Part of me figures that if I'm prepared then bad things won't happen.

I wouldn't purchase preemie clothes or diapers, but I would make a mental note of which stores carry them.  IME NICU supplies preemie diapers and both NICUs my kids were in had a large wardrobe full of preemie clothing for those babies able to wear it while there (plus they did that laundry).  Someone can always get the clothing/diapers later (and let's face it, people love to buy baby clothes and preemie clothes are even cuter because they're so much smaller).

Unless your job is super stressful I'd keep working.  You'll have more time with your baby later.

[Lousli]

So a small update.  Yesterday I went in and had the fetal fibronectin.  It was negative, woohoo!  In 2 weeks I have to have the test again.  I also got the first steroid shot and go back for the second one tonight.  They monitored me for a little while and the baby looked great and I didn't have any contractions or uterine irritability.  Now I just wait and hope that I don't PROM again.

[liberal_chick]

Another pPROM mom here.  With ds1, I pPROMed at 20 weeks, so way early.  Terrifyingly early.  And with absolutely no warning signs.  We are so, so lucky that nothing happened after that and I was able to carry him for 10 more weeks (with varying amounts of fluid, but the area of rupture never sealed).

I went and saw the OB that delivered ds1 and she said (and the research I've done pretty much backed her up) that pPROM recurrence rates hover at about 30%.

I totally understand your worry.  I was so scared when I was pregnant with ds2, terrified, all the time.  The week that I was 20 weeks pregnant with him I basically was in this frenzied state of anxiety the whole time.  I had decided to plan for a HBAC w/a midwife but saw an OB for shadow care, just in case.  I never saw a peri.

I'll be honest, until I was beyond the point in which I delivered ds1, I was a tense mess.  After that, I was able to relax a bit more with every passing week.  Carrying ds3 still wasn't easy, mentally, but it was better.  Both my last two were full term w/ds3 actually coming 5 days "late."  And I'll tell you, I don't think anyone appreciates going "overdue" except a mom that's previously had a preemie!

I can't answer your questions, but I'll certainly hold out hope and send good thoughts and prayers out that you go term this time.  We all deserve it.

[Lousli]

Thanks so much!  I can't imagine how scary it would be to rupture at 20 weeks!  I feel so lucky sometimes that if I did have to go early, at least it was when I knew my babies would most likely be okay.  I'm almost 31 weeks now, so I'm starting to get the relief of knowing we're not talking about a micropreemie now, which is hugely comforting to me.  Still, I'd like to avoid any NICU time at all, if I can.