On Tuesday, January 17th, one day shy of 28 weeks pregnant with our second daughter, my water broke. I was admitted to a local hospital with a top notch NICU that evening but wasn’t actually in labor, so I will be staying here either until I have the baby or until my amniotic sac heals itself, which is rare but does happen. It could be days or months here in the hospital; they’ve seen the full spectrum. I’ve been told that the average for women in my situation is delivery within about two weeks, but only time will tell. We’re praying for the miracle of the sac sealing up again and them letting me go home! If that does happen I would still have to come back frequently for close monitoring.
Night 1/Day 1: After about two hours of mostly sitting and waiting in triage, they confirmed that my water broke (thanks… lol). The resident who came in to see me explained that they would start antibiotics once they admitted me to prevent infection (a big risk with ruptured membranes, and dangerous at this stage of gestation). They will also give me two shots of a steroid 24 hours apart to help the baby’s lungs develop. This steroid tells the baby’s cells that make something called surfactant to start making it now and release it into her body. Surfactant coats the inside of the lungs to keep them from collapsing, and babies normally create enough of it on their own to survive outside the womb by 35 weeks. Now that this steroid has been created, doctors are able to administer it when they foresee a risk of premature delivery so that the baby’s lungs develop earlier.
During the first night they kept me in Labor and Delivery in case I did go into labor. This meant I wasn’t allowed to eat. That was torturous. Not feeding pregnant women is so cruel. Yes I know it’s a potentially lifesaving precaution in case they have to do an emergency surgery using general anesthesia; nobody wants someone to aspirate under anesthesia. But when you’re a hungry pregnant woman it just feels cruel. My nurse that night was wonderful, though, and one of the wonderful things she did was let me eat popsicles :o)
Early that morning/still during the night I had another sonogram to estimate the baby’s size and measure the amniotic fluid around her. She’s about 2lbs 4oz right now which I was told is around the 60th percentile. The fluid is low, as expected, but there’s enough for her to be safe inside, and I’ll continue to make more so the fact that it’s still leaking isn’t their biggest concern. Infection seems to be the biggest concern, followed by going into labor anytime soon.
A little later on a resident came in to explain in more detail about the average lengths of time they see moms continue to carry after premature rupture of membranes (PROM) and also shared some exceptions they’ve seen to the typical two weeks. She said they had a mom last year whose water broke at 18 weeks with twins and she stayed in the hospital and carried them until 30 something weeks. They’ve also seen the rupture heal and sent moms home like I mentioned above. So she seemed pretty optomistic and answered lots of my questions. I was grateful to have an actual conversation with somebody on the staff and not just be told again and again that we were waiting for something or other before they could tell us much. One scary thing (scary to me) that she told me is that if the baby happened to be breech and had to be delivered while she’s still so small they would have to do a vertical incision because horizontal isn’t safe for her size (I’m not totally clear why but ok). That felt like a big blow because labor and birth were such a meaningful experience to me with Ella, and as I’ve read and learned even more since then birth has become very important to me. The kind of births I will have matter deeply to me, I value natural birth so much; obviously the safety of the baby is more important than having my way, but to have a vertical incision for a c-section would automatically mean no chance of natural birth in the future. I would always have to have c-sections with future babies. That would be a huge loss to me. So far the baby is head down, so hopefully this never becomes a real possibility, but it was definitely tough to swallow.
Late Wednesday morning I was moved upstairs to the mom and baby AKA antenatal unit which was a welcome relief in several ways. I can eat here! Also the beds are much more comfortable because they’re made for sleeping in and not just delivering babies on. The nurses have all been great so far.
Sometime that day an incredibly kind and patient neonatologist came in to tell me about what their patterns of care in the NICU are for preterm babies, and he told me lots of stats. The summary is that the prognosis is good with a 90% survival rate at 27 weeks, 95% at 28, and “approaching 100%” at 32 weeks. His words were “nothing is ever 100% in medicine, so we have to say it approaches 100%.” He was really nice and quite reassuring. I like that they always have one of his veteran colleagues on 24 hours per day. Apparently the other hospital in the area with the same level NICU doesn’t have that coverage and because they’re a teaching unit they tend to medicate more liberally there. Not that medicine is bad, obviously it saves lives when needed, but as he said all procedures and drugs also have side effects so they weigh decisions carefully. He’s very pro breastfeeding which was a relief to me after being pressured to give Ella formula during her brief NICU stay. He said as soon as I deliver to start pumping and as soon as she develops the ability to coordinate sucking swallowing and breathing they’ll give her my milk by mouth instead of feeding via IV or tube. If she’s born before 29 weeks they will give her a synthetic form of surfactant just in case the steroid I got hasn’t done enough yet.
Also, fun fact (slash, crazy-to-wrap-your-mind-around fact), he told me that at the baby’s current size she only has about 3oz of blood in her entire body. Every time I drink one of these little juices they give me I think “Whoa… my baby has less blood than this container in her whole tiny body…”
The rest of the day was mostly tests and antibiotics and monitoring and tears. I was very emotional on and off all day, mostly due to missing Ella and just feeling very lonely. I’m sure it didn’t help that I had barely slept the night before. And the first full day of everything settling in was just a lot to absorb.
Day 2: I slept as well as I think I ever could in a hospital given all the interruptions of hallway noise and checking vitals and starting antibiotics and getting a steroid shot and having blood drawn and the paper towel dispenser randomly dispensing paper towels in sync with the light above my bed turning on of its own accord during the night. I actually slept quite deeply between all of that, which is unusual for me. I’m a very light sleeper. So yay for rest! Better sleep seems to have had a wonderful impact on my ability to deal emotionally today. I’ve been in a surprisingly good mood all day. It also helped that I had several visitors and was on the phone with friends and family a lot of the day and did FaceTime with Ella a couple of times. I really want to be able to FaceTime at night and read and sing to her and say goodnight before she goes to bed, but we tried that last time and then she was a disaster after we hung up. So I think I have to forego bidding my sweet girl goodnight while I’m here. That seemed like such a small moment in our routine before this, but now I miss it so much.
There were no changes today in terms of how the baby and I are doing. Still leaking fluid a little here and there, but no contractions or bleeding or signs of infection. Her heart rate has continued to be perfect every time they’ve monitored. She slept through the whole thing of our first Biophysical Profile (BPP) which is a sonogram in which they check her measurements and heart and brain and such but primarily they’re looking at four things: Movement: full body movement for 10 seconds; they want to see three occasions of this. Tone: Flexion of an arm or leg or hand; one occurrence of this. Fluid: They want to see a 2cm by 2cm square of amniotic fluid; if there’s more than that great, but they don’t actually measure beyond that minimum. Practice breathing: They want to see thirty seconds of sustained practice breathing, which is when she inhales amniotic fluid and then her diaphragm moves to pump it back out (I think… I’m a little unclear on this one). I guess technically she failed that BPP since she was asleep… They’re supposed to come do it again today, but it’s getting late and I don’t know if the fetal testing unit operates overnight. They’ll do this test every day until I leave or have the baby. One reason for observing her behavior through this test is to watch for what the doctor called a “silent infection.” That means the baby has gotten an infection but it’s not manifesting in my body as a fever or high white blood cell count. That would be an indication for inducing labor or delivering via cesarean. He said they would induce first, but with a premature baby the cesarean rate is higher just because the uterus isn’t necessarily ready to contract effectively for labor. So, hopefully her BPPs go better going forward, as in, she’s awake! He didn’t seem concerned about it today because it was the first one and we likely just caught her in a typical resting period. The way they have them scheduled going forward are somewhat scattered throughout the day but tending to favor late morning, so hopefully having breakfast and coffee in me will help give her some energy!
We’ve now made it 48 hours with PROM and so far there are no additional scary things happening. We are thankful to our Lord for this provision! Thank you all for your continued prayers and support. I’m praying for total healing of the amniotic sac and going home to carry to term!