21 + 2
10/7/24
After a long sleepless night of research and stressing over the possibility of going into labor, a long morning of doctors visits started. I had called my mom the night before to fill her in on what was happening, and she had gotten in the car and started her trek from NC to NY early that morning. Anthony arrived at the hospital as soon as visiting hours started at 8:00am and we had our first ultrasound right around that time. Baby was looking good, I had not had any labor symptoms, and ultrasound showed an acceptable amount of fluid still around baby. The average amount of fluid during pregnancy is 5cm - 25cm. My fluid was right at 5cm so although it was on the low end, it was still considered acceptable and baby was not in any danger due to no amniotic fluid, so that was good!
We met with the MFM team of high risk doctors to go over our options. They explained that the typical move when your water breaks so early is to be admitted to the hospital. When there is a rupture somewhere in your membrane it means that the protection layer has been compromised and infection is a major concern. They explained that is fluid is able to escape, that means bacteria is able to get in and that carries a risk of sepsis for myself and baby. Additionally, a prolapsed cord would be an immediate emergency that has a better chance of survival when caught immediately at the hospital, and becomes a major risk when at home waiting for an ambulance or needing to drive to emergency. Because of these two situations where every second counts, they recommend admittance for the duration of pregnancy.
One hiccup for our situation, however, was that our baby was not of viability age. We were still 21 weeks and 2 days, so if I were to be admitted to the hospital this day, and any of these emergencies did happen, they could not do anything to help our baby. The MFM team described that if baby were to come this early they would need to do a classical c-section, which is where they make their horizontal incision as usual, but then cut the uterus vertically because baby is too small to be removed via usual incision. They explained that if I were to have another baby after this type of operation then we would have to have another c-section as the uterus will never be strong enough for birth after the classical. They also explained all of the concerns of having baby so early, and that was when we were introduced to the NICU team.
The NICU explained the risks and survival rate of having a baby at 22 weeks. Survival rates are near 0% and the level of deficiencies in life are over 80%, so the odds weren’t great. This conversation was now the third time that termination had been offered to us in the past week, and the doctors went over our “plans for intervention.” There were levels of intervention where you may want resuscitation for a certain amount of time, or you may only want a few chest compressions due to the risk of increasing brain bleeding with compressions. The worst part was that there were so many different scenarios and situations to consider, and every one of them was a hypothetical. We had no idea if baby was going to come on Wednesday, if they would make it to the 22 weeks, or maybe we are an anomaly and we can make it all the way to 30 or 32 weeks. With every single day, babies odds increased, so we focused on what would happen if baby came in the next couple weeks, and if we make it past that, we will have this conversation again, and again. After learning about all of the risks and options and concerns for myself and baby, we had made the decision that we would like full intervention immediately. That meant that if baby were to come soon, after we hit the 22 weeks mark, we wanted them to do everything possible to give our baby their best chance.
After a long morning of difficult conversations we had made the decision to go home and monitor from home. Since there was not anything they would do for our baby for 5 more days, there wasn’t really any reason for me to be in the hospital. At this point our pregnancy was considered high risk and we left the hospital with a whole new team of doctors for myself, and a whole new team of doctors for baby. The plan was to start on steroids right before we hit 22 weeks, that way baby has a little boost if they decide to come sooner than later. We scheduled an appointment with our new high risk doctors at an office close to our house, and I planned to stay on bed rest at home and monitor at the local doctors. So we went home and planned for a long boring couple months in the house, or so we thought.
