On a Tuesday night in January, one day shy of 28 weeks pregnant with our second daughter, as I sat at the table with my firstborn eating breakfast-for-dinner, my water broke. My first thought when I realized what had happened was relief that the warm gush I had felt was water and not blood. Then I quickly panicked when I realized the magnitude of the fact that my water broke on the eve of my third trimester. My husband, Nathanael, rushed home from work during one of the most inopportune weeks of the year for a family crisis (He’s an accountant. It was January. Bad timing.) and we rushed to the nearest hospital with a top notch NICU. Throughout the drive to the hospital I kept thinking to myself, “We’re on our way to either lose or have a baby. Which is it?” The unknown was torturous.
As Nathanael navigated our city’s streets and parked illegally, we talked about what we wanted to have happen depending on what we found out when we arrived. I wanted to be allowed to labor and deliver the baby if we had lost her. I wanted to hold her. If she was ok, I would rather be induced than have a cesarean if possible. Everything we said during that drive contained the assumption that this baby would be coming out that night. We had no idea what the next weeks would hold.
Because I wasn’t actually in labor, and because it was still so early in my pregnancy, we learned that night that the safer course of action for the baby was for me to stay pregnant and risk infection than to induce or operate and have a very underdeveloped baby outside the womb. Until the moment that a medical resident explained that to me, I had no idea that it’s possible to stay pregnant for an extended period of time after your water has broken. But it is, so that was our goal. Stay pregnant. And so, I moved into the hospital. It could be days or months, the doctors said. They had seen the full spectrum in cases like this. I was told that on average women with PPROM (Preterm Premature Rupture of Membranes) deliver within seven to ten days, but only time would tell.
Room 248 was my home away from home for the next seventeen days. And then, around 10pm on a Friday night, while I crocheted a baby blanket and watched the livestream of a Christian women’s conference taking place in Austin, TX, I started feeling crampy for the first time since this whole ordeal began. I tried changing positions a few times and began guzzling water, knowing that Braxton Hicks contractions can feel like cramps and can be caused by dehydration. The crampy feeling persisted, and I noticed it was coming and going in waves just like labor contractions do. I got into bed, hoping that lying down would make this feeling go away. We had only just passed the 30 week mark. My goal was at least 32 weeks to avoid the risk of bleeding in the baby’s brain.
I couldn’t tell for sure whether my uterus was definitely tightening or if maybe Hope was just moving in an uncomfortable way (sometimes that happened), so I decided to hook myself up to the fetal monitoring system (or non-stress test; NST) that had been in my room and used three times per day for the past seventeen days and see if it thought I was having contractions. I didn’t want to alert any nurses or doctors until I felt sure I was contracting. I was afraid of sounding a false alarm and ending up in Labor and Delivery unnecessarily, or even necessarily but too quickly and ending up with lots of interventions that I might not need. The waves on the line on the monitor’s print-out measuring my uterine activity were very small, but they were there. Every 3-4 minutes.
I had also started feeling lots of rectal pressure each time the crampy feeling came, and that’s what really convinced me that this was labor even before the next couple of hours convinced everybody else. I figured if these were just Braxton Hicks then they should just affect my abdomen or maybe my back, but that intense pressure coming quickly along with them alerted me that Hope’s head was pushing down and my body was definitely working on getting her out.
I called the nurse.
(Don’t worry, I won’t use the word “rectal” again).
The nurse came and looked at the NST strip, laughed that I had put myself on the monitor, tore off what had printed so far, and called the doctor in L&D. A doctor and med student came in to assess me. They had an IV started with a bag of fluids to try to do the same thing I had been trying: hydrate the mom and hope this is false labor that will then go away. The doctor asked me to stay lying on my side so that the baby was less likely to cause me to dilate. For the next hour or so the doctor would wander in every now and then to ask if I was still having contractions, how they felt, palpate my abdomen during a contraction, and then say “ok I’ll be back” without commenting on whether he thought this was labor or what the potential next steps may be.
Nathanael arrived at the hospital at some point during all that. He had been at home sleeping when my cramping started.
After about an hour of the medical staff monitoring my contractions, I was confident this was labor and felt ready to go downstairs to L&D. I asked Nathanael to make sure the doctor was aware my contractions with our first child—the full term one, as opposed to this itty bitty baby—started at six minutes apart and labor only took 8.5 hours. Actually, I demanded Nathanael run after the doctor who had just left my room and “make sure he knows that! This is going to go fast!” He found the doctor, passed along my message and told him “Just so you know, we’re expecting to go downstairs.” He said the doctor seemed relieved to hear that, as if now he could stop trying to pretend this might go away. As if pretending would make us feel better.
At this point I was feeling like I was in pretty active labor, or at least that my body was trying to be, and I kept thinking “If they just get me downstairs so I can let my body labor, this is going to go really fast.” All the lying in bed waiting was starting to make me anxious that they wouldn’t get me down there in time to start the magnesium sulfate for neuroprotection for Hope (to protect against bleeding in her brain). The contractions were also really starting to get painful, and I wanted to be able to move around. I remembered that with Ella lying down made the contractions feel worse, so I was convinced that being upright would be better.
Sometime between 1 and 1:30am, they brought a gurney to my door and we moved down to L&D. Oddly, the motion of the gurney was actually soothing and helped me deal with the contractions a little better. Maybe I should have asked to just be pushed around on that for a while! There were three or four nurses in the room when we got there, and they all hurried to get me situated and hooked up to their monitors while also being incredibly enthusiastic and supportive. They were also so patient about getting the wireless monitors to work so that I could move freely and labor in the shower.
The doctor I was assigned to once we moved was one I saw during the first night and couple of days in the hospital, so I was relieved to see a familiar and friendly face. I really liked her when we first came in, but I hadn’t seen her in a couple of weeks. She did a quick sonogram to assess my fluid level and see the baby’s position. She could only find one small pocket of fluid, and I told her I had lost a large amount during dinner. She said that may be why the contractions started, or I could have started developing an infection that caused both the fluid loss and the contractions. Hope was still head down. Next the doctor did a “visual cervical exam” with a sterile speculum; they wanted to avoid doing an internal exam until they felt it was necessary because that would increase the risk of infection by potentially introducing bacteria into the uterus. She said a visual exam is not that reliable but that my cervix looked closed between contractions and maybe 2cm dilated during a contraction. I was totally baffled by this. My contractions were already practically on top of each other, felt like really active labor, and were already way more painful than almost anything I remembered from Ella’s labor (which at that point I was still attributing to being forced to lie down the whole time). Being told I was only maybe a 2 made me really determined to get permission to move around and find ways to relax. I was sure my contractions were more advanced than what would produce 2cm dilation, and I just needed to be able to relax in order for the tangible progress to occur.
By this point we were down to one nurse; the extras were just there to help us get situated. Our nurse who was with us throughout the process was the BEST and we loved her. I was finally allowed to move a little, but because Hope’s heart rate was dipping pretty low during contractions the doctors were cautious about what they would let me do. I really wanted to get in the shower because heat and water are known to be relaxing and because the shower was like a miracle drug to me during Ella’s labor, but the doctors weren’t comfortable with that yet. I tried sitting on the edge of the bed and leaning into Nathanael, who was standing in front of me, and that helped a little, but I was experiencing so much pain in my hips and pressure from Hope’s head that being stationary was pretty awful.
Our nurse got a birthing ball for me to sit on, and rocking on that while leaning on Nathanael through contractions was helpful (Nathanael automatically took a wrestler’s stance that he calls “neutral”and leaned into me as well during each contraction. This made me laugh because it’s been years since he’s wrestled but the stance was still his natural preference). Unfortunately I only got to enjoy the birthing ball for a couple of contractions before the doctor came back into the room (she can see all the patients’ monitors on a big screen out in the hall) and said the baby was really not liking my position, and I needed to get back on the bed. Apparently Hope’s heart rate decelerations were even worse during those few contractions. The doctor suggested a few ways we could adjust the bed to accommodate different positions for me to try, and then she left again.
With the head of the bed completely upright, I tried kneeling and draping my arms over the back of the bed. As soon as a contraction hit I started yelling “No, that’s terrible! Put the bed back down!” and went back to lying on my side. It’s funny that all I had wanted this whole time was to stop lying down because I was convinced that, like Ella’s labor, lying down was making the contractions worse, but I ended up finding that everything I expected to make me feel better actually made everything more painful, and lying down was the best option. And after all the trouble those sweet nurses went to to make sure I had the wireless monitors!
During those few minutes of trying to find a more comfortable position the doctor spoke briefly about the possibility of a c-section. The details of the conversation are a blur, but I know that next contraction was one of the worst because just hearing the words “c-section” made me so afraid and anxious. The decelerations in Hope’s heart rate were concerning the doctors that the baby might not be coping well enough with the stress of contractions for us to safely keep this up for very long. I think whether a c-section was really on the table right then came down to whether I had made progress dilating or not, and she said that when she had just called their chief resident to tell her how things were going, the chief resident wanted her to do a cervical exam. She did the exam and said I had dilated to 6cm. Our nurse told us later that from then to Hope being delivered was only about 10-15 minutes. Everything that night felt like it took so much longer than it did; I was shocked when she told me that from the initial sonogram when we were brought down to L&D to birth was only 63 minutes.
After reaching 6cm, I asked again to get in the shower. The doctor said no because she felt confident we would have the baby within the next hour or two, and she didn’t want to risk delivering a baby in the shower (Good call. See above. 10 minutes). Really soon after that I distinctly felt Hope start to descend into and through the birth canal, and I said so to everyone in the room, loudly. The doctor said, “Ok, let’s break the bed,” and on the next contraction I announced “Urge to push!” to which the doctor said “Never mind breaking the bed!” (Breaking the bed means they take the bottom third of the bed away so that I deliver right at the edge of it and the doctor has room to get really close to guide the baby out. There’s also a big bucket lined with a thick plastic bag to catch all the yuck that comes out along with the baby).
My favorite part of the whole labor was the last few minutes as Hope was crowning. When I had Ella, I just pushed as hard as I could at the very end because of the intense burning that comes with the baby’s head emerging. That left me with lots of stitches and a tough recovery. This time I had read about how to get through those moments slowly by lifting my chin and blowing out rapidly and not actually pushing. The reflex to push is strong enough that a woman’s body will push anyway, and her body will do so just strongly enough to let the baby emerge slowly. I had asked one of the doctors the week before if a smaller baby means I’d be less likely to tear, and she actually said the opposite. Because preemies are so little they tend to come out too quickly, but they’re still big enough that moms tear. With Nathanael and our awesome nurse coaching me and cheering me on every second of what probably only took about a minute, I managed to avoid that long recovery this time! I’m so thankful! All these trips to the NICU would seem an impossible feat if I were as physically run down as I was after delivering Ella.
A funny moment right at the end of Hope’s birth was as she was coming out, and I asked if I could touch her. Background story: the midwife during Ella’s delivery suggested I do this, and feeling her head while she was still inside of me is one of my favorite memories of that experience. So I wanted to do that again. The doctor said “Yeah go for it she’s right there!” I reached down to feel her head and before I could even get my hand there she was out! I said “Oh, whoops! I missed!” and then laughed out loud at myself.
Hope cried right away, and the doctor held her up over my chest so I could get a good look at her, touch her, and give her a kiss, and then she was whisked across the room for the NICU team to take care of her. She weighed 3lbs 1.4oz. A neonatologist used a manual pump to help her breathe while the rest of the NICU team examined her from head to toe. I’m not sure if she wasn’t breathing after her initial cry or if that’s just a precaution to make sure she breathes consistently in those early moments. They intubated her and took her up to the NICU to get her settled. We went up to see her a couple of hours later.
There was one resident who saw me on rounds every morning during my hospital stay, and she told me later that she has never seen a PPROM case last as long as mine and then NOT end with an infection. I’m so thankful that we didn’t get an infection, that labor was spontaneous, and that I didn’t have to worry about an induction after all! The Lord has been so kind to us through all of this!
Your very brave, what a tiny baby.