Why do the worst medical concerns happen at night?
I think I had mentioned we were expecting a baby at the end of January (this month!) November was a normal month up until Thanksgiving. We had a great day here and had a few family members in for dinner, nothing major or taxing by any means! But during the night, for no apparent reason, my water broke. I was 30 weeks and 6 days.
I wasn't actually positive that it was amniotic fluid I was sensing, but the entire night, it kept leaking. I changed clothing multiple times and couldn't sleep as I was worried about what this could be. I did not want to wake my husband--he was getting up early anyway to go to the gym and I wasn't sure I wanted to call the doctor in the middle of the night or my parents to come stay with our older boys.
At 5:30 when my husband's alarm went off, I told him what was going on and what I had suspected since around midnight. He was surprised when I said I had not yet called the doctor and made me call them. Of course, the doctor on call said to come into the hospital. I called my mom around 6 am and felt I was overreacting, but yet something in my head just knew this was amniotic fluid and we'd better get to the hospital. My mom rushed over and we left around 6:15 am.
We drove to the not-so-local hospital where my doctor delivers babies. The nursing staff checked for amniotic fluid and the first test was positive. I cried, not knowing what could be done for this baby. My doctor came in, they did another test and it was also positive. He explained that I would need to decide on another hospital in Pittsburgh with a NICU to transfer to; this hospital could not care for a baby of this gestation. They had been watching me for labor, I had no signs so it was safe to transfer. My doctor called our selected hospital, talked with the Maternal-Fetal Medicine doc there and then the staff administered a steroid shot to help mature the baby's lungs, began two courses of antibiotics in case of infection, and started an additional IV for fluids since I hadn't eaten for awhile and wouldn't be allowed to eat until they saw me at the hospital in Pgh. They made sure I had two IV sites so I could possibly get more medications at the hospital I was transferring to. The doctor said they might give magnesium sulfate to mature the baby's brain. If I was the lucky recipient of that drug, I would be on bed rest in the hospital. He said they would probably try and get me to 34 weeks before delivering the baby but wasn't sure of exactly what they would do.
They had me go as quickly as they could in an ambulance; I wanted to go with my husband in our car but I was hooked up to so many drugs and also was at risk for labor to begin so they would not permit him to drive me to the hospital in Pittsburgh. I was so tired as I'd been awake all night but was so worried I couldn't sleep at all. I was not in any pain, so it seemed odd to be on a stretcher. The paramedics asked me if I'd had prenatal care (of course I had), but apparently this happens more often in women who haven't had prenatal care.
When I arrived at the hospital, the first room I saw from the stretcher read "Bereavement Room". I was so worried after seeing that! They delivered me to a tiny labor and delivery triage room without windows. A nursing aide hooked me up to a non-stress test and I waited. And waited. And waited.
Finally, a resident came in and examined me, saying that my doctor had collected most of the information they needed, but she would be re-doing some of it. They also did an ultrasound to check the baby's position, breathing patterns, and movement. Then the doctor came in--he was great, told us what to expect. I was surprised when he told me I would not be leaving the hospital while still pregnant. And that they hoped they could keep me pregnant for three weeks! I was surprised they would require me to stay in the hospital. They told me if there was an infection, antibiotics could "calm it down" and possibly keep labor away. However, he did tell me that 50+% of women go into labor in 7-10 after membrane rupture.
Since we were now at a hospital with a Level III NICU, he said that the baby would be expected to stay in the NICU for several weeks; if born now, at 31 weeks the stay could be until 37 weeks gestation and likely discharged by the baby's due date. I was concerned about cerebral palsy and other disabilities. The maternal fetal medicine doctor was not concerned about those things at this stage but estimated that for every day we could keep the baby inside, that would be about two days less the baby would spend in the NICU. He answered all of our questions and told us kindly that even though this seemed like a dismal situation, we could have a very good outcome and there were many that have experienced great outcomes with the protocol they suggest.