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On Prematurity

Posted Feb 27 2013 11:17am
Recently I had a client, who I will call K, call me late one night. She was not the client I was expecting to hear from, just a few days earlier I had received her retainer for my services and I had another client who was 'overdue' and getting some labor action. I fully anticipated another woman on the other end of the line when I picked up the phone that evening.

Instead, I  heard K.

"Cole, I'm sitting on the toilet and I  have bloody water pouring out of me. What is this?"

I did a quick assessment by phone of the situation (what lead up to it, was there anything else coming out of her vagina, if there was any other sensations/physical things going on, and where was her partner/spouse) which took a total of 30 seconds.

"K, it sounds like your water has broken. Put a towel between your legs and go to the hospital; I will meet you there."

K was around 27 weeks.

There is a happy ending to the story - her baby was born healthy and strong, albeit via a truly emergency cesarean. If they had stayed home even minutes longer, K and her baby could very well not be with us today.

After this experience, I spoke to another online doula friend who offered to write a guest post on prematurity. Heidi Thaden-Pierce is an antepartum, birth, and postpartum doula, Happiest Baby on the Block instructor, and photographer.  She has a true heart to educate women on what to expect in a premature birth/baby, and warning signs. She, like myself, am wary of providers not sharing signs of premature labor early in pregnancy so that women can be on the look out for these symptoms.

I hope that you find something positive to take away from this post.
When we learned we were expecting for the first time we were overjoyed, and happily announced our news to everyone. We anticipated a smooth, full term birth and never imagined anything could go wrong. Unfortunately we miscarried early on, and suddenly pregnancy seemed much more fragile! When we became pregnant again we were already feeling anxious, so when I developed some concerning symptoms at 19 weeks we immediately called my OB. He was quite dismissive and encouraged me to just rest, but the symptoms didn't subside and we disregarded the doctor's advice and headed to the ER. I was contracting much too frequently but they explained it was so early in the pregnancy that if they could not stop the contractions there was nothing they could do to save our baby if he arrived. I spent the following month on medication and bed rest as we hoped and prayed for more time. We were thrilled to make it to 39 weeks and deliver a healthy baby boy.

Our next pregnancy went very smoothly until around 32 weeks, when once again I began to contract. Knowing the warning signs now of preterm labor we headed straight into the hospital. This time I had also begun dilating and again needed medication and bed rest to slow things down. We were grateful I made it to almost 38 weeks before our healthy baby girl arrived. Our fourth pregnancy ended in miscarriage, and we conceived again the following month. Because of our history we were understandably on edge! At 10 weeks gestation I developed some concerning symptoms and immediately called my new midwife. She saw me right away and then sent me for an ultrasound, which revealed the magnitude of the challenge we were about to face. The placenta was partially detaching and I was bleeding into my uterus. I spent the next 12 weeks on bed rest, moving into the hospital at 22 weeks gestation to be monitored more closely.

Throughout my three months on bed rest and then while living on the antepartum floor of the hospital I was given a list of symptoms I was to watch for and report immediately. We knew a premature arrival was inevitable, but we could not comprehend just how early our son would arrive! It was on a Saturday afternoon when I felt a strange pressure and cramping, along with an increase in contractions. I notified my nurse and I was quickly transported down to the labor & delivery unit where my perinatologist (a high risk specialist) caught up with us. It was apparent that we could no longer stall delivery and our son arrived at 23 weeks gestation weighing 22 ounces. Babies born this early are so fragile and tiny that survival is low and the chance of significant disability is high. This early in pregnancy most parents have just learned the gender of their child, and delivering is far from their mind! Unfortunately this also means they may not be aware of the early warning signs of premature birth, so they may delay receiving critical medical care.

It's now estimated that 1 out of 8 babies is born premature (prior to 37 weeks gestation) and many parents are not taught about the signs of preterm labor until their last month of pregnancy. Being aware of the potential signs can help ensure parents seek immediate medical care, as there are treatments which can sometimes help delay delivery. For a premature baby every single day in the womb can make a significant difference, so early education and intervention is crucial. While many people envision a premature baby arriving a few weeks early, not all parents realize preterm labor may begin in your second trimester! It is always better to call your care provider and ask about your symptoms, rather than ignoring them or waiting until your next appointment to ask. Better to call than to wish you had called!

What are some of the warning signs of preterm labor?

* Contractions every 10 minutes or more often in your third trimester. If in your second trimester then even 4 or more contractions an hour should be checked. When relaxed your uterus feels soft, like touching your cheek. When contracting your uterus will feel hard, like touching your forehead. In early pregnancy your body will be having practice contractions, but if they are coming more consistently, are causing you pain, or are lasting for more than 30 seconds it's cause for concern.
  • Change in vaginal discharge: a sudden increase in fluid, a bloody show, or a thick mucous plug. Some mothers have a problem with leaking urine while pregnant, but if you are unsure if it's urine or amniotic fluid it's better to be checked than not! And I promise, you will NOT be the first mother to come in for an exam to rule out leaking fluid. They would rather it be urine than amniotic fluid so please don't be embarrassed!
  • Pelvic pressure: especially in your third trimester you'll feel increasing pressure down low as the baby drops, but if you are concerned by the pressure or a sense of fullness, GET CHECKED.
  • Low, dull backache: this is often a first indicator of labor, preterm or full term!
  • Cramps that feel like your menstrual cycle.
  • Abdominal cramps with or without diarrhea.
If your care provider doesn't bring up warning signs of preterm labor it's important that you start that discussion! Ask them in your second trimester (or earlier) what signs you should look for and what you should do in each case. Sometimes calling the doctor during office hours is enough, but other times every moment counts and you will need to get immediate medical attention - either calling 911 or heading straight to your closest ER.

As a doula I am NOT a medical care provider, and you should speak with your midwife or obstetrician about what is best for you. You can read more about prematurity at The March of Dimes site . I hope you will not ever need to know this information, but from firsthand experience I can say it's better to be aware!

While in the NICU with our son we were told a lost day in the womb equals approximately three days in the NICU. Every day counts towards your baby's development, and the sooner the signs of preterm labor are count the greater the likelihood your birth can be delayed and your baby can continue safely growing inside of you. If at any point in your pregnancy you feel concerned by symptoms, call your doctor or seek immediate medical care.

We are grateful that we were warned well in advance that our preemie would be arriving, allowing us to be in the right place when the time came. Against the odds our 23 week little boy survived and is thriving, but we wish so much that parents and babies could be spared the pain and trauma of such an early arrival. I hope this information will help another parent and baby avoid a premature birth.
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