HOW IT STARTED
It was Sunday morning, Sept 20th, I was 33 weeks 3 days. We were staying with my parents, in town for a shower I'd enjoyed the day before. I woke up with heartburn a little after 4 AM and got up to go to the bathroom. This was all very routine at this point but after I went to the bathroom several times I realized something was wrong and I was leaking fluid. I've heard stories of moms thinking their water broke but it was just a weak bladder, but my bladder was empty and fluid was still coming. I was hoping there was some other explanation as to what was happening but when it didn't stop, in my heart, I knew it could only be one thing.
I sat on the edge of the bed and just cried to myself for a few minutes as the reality of what was likely happening went though my mind. I silently sobbed as I processed all the changes that I should expect. If this was really amniotic fluid leaking this meant so many changes. It meant I was saying goodbye to my home birth plans. Most likely goodbye to having a full term baby. Goodbye to being able to protect him from the world by having him in the comfort and familiarity of our home and having him with me at every moment. It meant saying goodbye to him joining our family with just us for a few days, quiet, intimate. It meant saying hello to him sooner but in an environment full of strangers and strange germs. It most likely meant saying hello to the NICU and needles and tubes. He would need more than just me, which is all he's supposed to need. Medications, plastic, disposable diapers, all those things that I wanted to avoid because I'm me. I knew I was going from minimalist to full-on medical. A total 180 was going on in my head. I prayed through this for a few minutes and surrendered my hopes and plans. God knew this was going to happen, He wasn't surprised and I trust that He will take care of us. He is bigger than all of these unknown things that are coming at us.
I pulled myself together and woke Blake up. Told him what I thought was going on. We agreed we needed to go to the hospital and have the fluid checked. I woke my mom up and told her what we were doing and she went to sleep in our room so someone would be there when Emerson woke up.
As we drove to hospital we nervously talked, hoping we were overreacting, praying everything was going to be okay. Discussing the irony that we were far from home, in a loaner car while ours was being worked on. So much going on in our lives and yet it was all possibly coming to a halt.
We arrived and the ER sent us up to OB triage. They did their usual bit (tons) of paperwork and did a swab test to see if the fluid was amniotic fluid.
It was.
So then we began the conversations, what to expect, what the progression might be and what the outcomes would be if Monkey was born that day, the next etc. It was all so hypothetical. I wasn't in labor. I had no contractions. They did an ultrasound to estimate his size and check to see if I was effaced. I wasn't. My body wasn't preparing for labor in any way. I just had an unexplaned rupture in the amniotic membranes. Preterm premature rupture of membranes (pPROM it's called).
I was admitted, given a room and we waited to see some specialists to get some more answers before we made decisions about medications and interventions. We talked to the neonatologist and got more information about the likely status of Monkey's lungs if was born now, in a few days or in a week etc. We discussed the standard protocol for a premature birth and the risks vs benefits of keeping him in vs letting him be born if that's what happens. We were specifically looking for information about the use of betamethasone to mature his lungs. Our admitting dr said that at 34 weeks they consider the lungs developed and that steroids would no longer be a benefit. We were very close to 34 weeks so we were considering waiting the time out without it. However, the neonatologist said that more recent studies show a benefit from the steroids through 35 weeks. It would reduce his risk of lung disease by 30% or more to have the steroids. There are no statistically significant side effects for the short term. It would likely suppress our immune systems some, which is what I wanted to avoid, but lung disease can be a life long issue. The research does say that more studies need to be done on the long term effects but currently no side effects are known. Lung disease might mean a longer NICU stay, a difficult time feeding due to breathing interventions and possibly life long effects. We felt like it was probably in the best interest to give the steroids and hopefully he wouldn't need as much NICU time.
Our next issue was the protocol for preventative antibiotics. Two through IV and one orally. I am not a fan of antibiotics. I am a fan of having a healthy immune system through healthy good gut bacteria and have worked very hard to have a good microbiome so that when Monkey is born he gets a good dose of good bacteria to colonize his digestive system. It's a big deal to me and antibiotics would ruin this completely. If I had any sign of infection I would understand but at this time there are no signs of infection and although I'm at risk for infection the longer I have ruptured membranes, there are ways to limit the risk. And of course if I begin to show sigs then I'd take the medication.This is kind of a big deal to them that I am refusing this, but they agree to it. I've also clearly been labeled as a protocol breaker at this point ;).
Next we see the weekend on-call perinatologist (high risk preterm OB specialist). Up to this point everyone has been very understanding of our questioning their protocols. Very patient in my needing more information vs taking their word for it and very respectful of our desire to feel like we are making informed decisions. Our first perinatologist was not really any of these things. She is a specialist and expected us to purely respect her opinion and take it as law. She said I needed to take the antibiotics, needed to have a manual exam and needed to be induced at 34 weeks. The benefit of keeping baby in longer than that was not any greater while the risk for infection just continued to increase. I asked if we could discuss the induction at 34 weeks and she essentially said it wasn't a discussion point, it needed to happen. There was no reason to wait longer. As such, I asked if antibiotics were really necessary. To her, their purpose is really to prevent labor starting, since an infection could cause labor to start. Since I was so close to 34 weeks I didn't see the point in it. She agreed to this (shockingly) and I didn't ask to discuss any of her other recommendations. We did ask her if there was any way to find out why/how this happened or if we'd ever find out. She said we probably wont ever know why it happened. I didn't have any of the risk factors for pPROM, I was healthy and had experienced an uneventful pregnancy up to this point. It's just one of those things they can't explain. We also discussed the details of her plan to induce me.
The rest of the day went by with a few more test results coming back, constant monitoring for contractions and heart rate, and just settling into this new situation we found ourselves in. We didn't get a lot of sleep that night. There were moments of disbelieving laughter, moments of weeping and surrender in prayer and there was hope.
Blake and I had talked about getting away for a few nights, just the two of us before baby was born.. this wasn't exactly what we had in mind and was certainly more money than we were planning on spending. ;)
DAY TWO
Monday morning came and as the day progressed we saw that I was stable and even more important, Monkey was stable. His heart rate was great, still no contractions, no signs of infection etc. I felt the same as I did a few days ago and Monkey was behaving the same as he always did. I don't think he even knows that something is going on!
We spoke to a new perinatologist and voiced our concerns about induction at 34 weeks. Primarily, I'd like to see Monkey cook as long as we can let him. I understand that statistically his chances for thriving are no different between 34 and 37 weeks, but common sense would indicate nature and God had intended him to stay in the womb longer. The average outcome might be the same when you look at a large group of babies but this isn't the average this is our son. It's my job to nourish and protect him as long as I can. Additionally, being induced isn't ideal and can be unpleasant. It's not that I'm afraid of the discomfort, it's that it sounds so hard on our bodies. So unnatural. Here my body is closed up (save for a little leak) and not preparing for labor. Closed for business. Being induced when you're closer to full term and your body has begun opening the cervix but not dilated yet is one thing but to try to take me from zero to sixty purely by drugs just sounds hard on me and hard on Monkey. I feel like it might put him in more distress to have my body jack hammered open like that. I digress.
So the new perinatologist said that if we were uncomfortable with induction at 34 weeks he would be willing to discuss waiting until 35 weeks. He said that more recent studies are showing that there is more benefit in waiting until 35 weeks. So now the benefit of longer gestation does outweigh the risks of infection. We were really glad to hear this. So currently the plan is to wait until Thursday, October 1st for induction. I will (of course assuming things continue to go on as stable as they are now, and assuming I don't go into labor naturally) ask to extend that more once it gets closer because again, I want to keep this little guy where nature intended him as long as I can, and again, I'd really prefer for both of us that labor happen spontaneously. But I'm glad we've bought another week, even if it means sitting in this hospital room on bedrest for nine more days. We can take things as they come and reassess next week hopefully.
So for now we are praying that no infection creeps in, that Monkey stays stable and safe and that I don't lose too much amniotic fluid (or rather that I don't lose it faster than he can make it up), as there are some complications that could happen if there isn't enough amniotic fluid. Complications that could lead to an emergency surgical delivery, which of course we very much want to avoid. So far, they haven't seen any distressing signs of low amniotic fluid.
DAYS THREE & FOUR
Tuesday and Wednesday were pretty routine days. I'd settled into being here. I'd gotten some snacks and better food, figured out how to get a few extras from the kitchen, got some changes of clothes and permission to take a shower. I had some great visitors, including some time with Emerson. Things have been very steady and stable. I had time to kill but felt like I was being productive by filling it with continuing ed and some compliance training I'd been putting off. I also got a little Netflix time in. My nurses have been great and best of all, I got a new bed on Wednesday. I'd been on a delivery bed, which splits in funny places for specific purposes and is pretty hard but my nurse Weds morning came in and immediately asked for a postpartum bed, which is more like your standard hospital bed. I'm guessing I'll sleep better tonight!
I had the same perinatalogist Monday through Wednesday, which was wonderful. He was very supportive and I found out on Weds, he was going out on a limb a little in supporting my 35 week plans, since it was going against protocol of the hospital. He had good information and data to support this decision though and I really appreciated him. All of my vital checks and non-stress tests on Monkey were coming back great. Everyone comments on what a happy little guy we have in there. I still feel great. I feel the same as I did last week despite all that is going on.
On Monday night, we had decided that Blake should go back home and work Tues, Weds, and part of Thursday. Things were probably as stable as they were going to be and we would rather save the vacation time for when Monkey was here with us. It was a hard decision but in the end a good one since things have remained steady and uneventful. It's been hard having him gone but again, I'm trying to make the best of the quiet time. It's the most time I've had to myself in years! I'm ready for him to be back though. I know he worries more when he's not here to see what's going on and of course there's the worry that if something happens, will he make it back in time. And of course, he's my partner in this journey and it's better when he's here to cry on his shoulder, vent about something and process the decisions. He's such a support to me and always makes things easier by just being here.
SO.. We'll see what the next week brings! Tomorrow I'm 34 weeks, so it's a relief to have easily made it to this point and there's hope that things will go smoothly through next Thursday. If all goes well, we'll have an October baby!
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