Nicky’s Fast Pre-Term Birth

Nicky had a plan and knew what she wanted her birth to be like. She is the perfect example of why making a plan is not about getting exactly what you wish for, but knowing how to advocate for yourself and make the right choices for yourself when things don't go to plan.

I was blessed with an easy-going pregnancy, no morning sickness, everything was going particularly well. Our biggest challenge was trying to come up with both and girls and boys name as our babies gender was a surprise! I was considered a low risk pregnancy and couldn’t be more excited to be accepted by the Family Birth Centre out of Fiona Stanley, an active labour and birth was exactly what I wanted and I loved the sound of the continuity of care I would be receiving from my midwife. We were in the third trimester and I was getting a little anxious about having not seen baby in a scan since week 20, all previous scans were tricky as she was always in some ridiculous position (we called her pretzel while pregnant for that reason and they always had trouble checking everything), at our 34 week check up and I asked how or where I could go for a scan, just to see how the baby was growing, perhaps I was just being inpatient to meet them! As with every appt with my midwife she measured my fundal height to see how baby was growing, she turned and said, careful what you wish for, but your fundal height is less than what we expect at this stage and you will need to go and have a growth scan.

That week we had a scan, there was concerns of baby’s size measuring in the 2nd and 3rd percentiles. I was contacted immediately following the scan that I would need to present to the fetal assessment unit the next day to have CTG to check babies heart rate. It was likely I would need these a minimum of twice a week until baby was born. Although all this was going on, baby’s movements continued to be very strong and I her heart rate was always good, I felt assured that perhaps we were just going to be the parents of a little baby.

On the Friday at the scan (week 36) everything looked normal (they assessed the flows from the placenta, heart rate and amount of amniotic fluid). I asked the sonographer if she could tell me which direction baby was facing as it had always been head down. She advised the baby was facing my spine, I knew this was the preferred position for birth. Interestingly enough our baby had been facing the opposite direction in the scan the week before. This is when I started to think maybe our baby would be coming early as it was in the right position. I was also a premmie baby, 8 weeks early so I always kind of expected that maybe I would too have an early bub.

The following Monday we saw an obstetrician at FSH and my midwife attended with us. They needed results from the next growth scan to compare to determine if our baby was small for gestational age or if she was actually intrauterine growth restricted (IUG).  The OB regardless of which, our baby was most likely to thrive on the outside rather than stay in the womb and we would be scheduling a date for induction to start at 39 weeks. If there were any concerns earlier, they could act sooner to deliver my baby. I spoke to my midwife in the corridor after the appointment, I wanted to avoid induction if it was at all possible. We boked an appt for the Thursday with my midwife so we could review the results of the next scan together with the OB over the phone. My midwife got the approval from the OB that we could start stretch and sweeps (on the Thursday) and I asked if we could go through together any other options/ suggestions I could try to attempt to bring labour on myself. I was also keen to be shown how to start collecting colostrum at that appointment too. I thought it would be a good option to store colostrum early in case my milk took a while to come in and having a small baby, her weight would be closely monitored. I could get a head start on a stash and also I hoped it might help to bring on labour.

The following day, started as a typical day of maternity leave for me. I had a nice catch up with a friend that morning then I ran some errands of the way home. My father-in-law popped in to pick something up and then as I getting ready to meet a friend at the dog park, my water broke. I had a slight trickle of fluid so I was unsure exactly if it was my waters, I called my midwife who told me to put a pad in my undies and monitor for the next hour. I called her back in 30 minutes to advise that I has soaked through 4 maternity pads in that time and was advised to come into the hospital. I called my husband who started organising to leave work. My lovely friend clued in on my call about being unable to meet and offered to drive to the hospital so we only had one car there.

I met my midwife at the hospital and my husband arrived soon after. She confirmed my waters had broken, however I was showing no signs of labour as no contractions had started. My midwife briefed me on my options and advised that it is generally recommended practice for spontaneous rupture of membranes before 36 weeks to usually wait to see for 24 hours if labour commences naturally or attempt to prevent labour from progressing. For those after 37 weeks, induction is typically recommended. I was in the grey area being between 36 and 37 weeks and I had to think about what I would like.

The obstetrician working for the night came in and suggested that we proceed straight away with the induction. He prepared us that our baby was likely to be taken to NICU immediately, require a respirator to breathe, it would be unlikely that I would be able to hold the baby immediately and they would remain in the NICU till full term. They wanted me to be prepared for what could happen associated with a pre-term and low birth weight baby. I said I understood about the potential requirements for baby to be supported medically however I wanted to advocate for what I wanted since my body had come this far already and see if my body would go into labour naturally. I asked if the induction could be held off until the morning if nothing happened itself over night and I was happy to have all recommended monitoring and take oral anti-biotics to reduce risk of infection. At this decision, my midwife went home for the day and my husband left once the visiting hours were over at 8pm to get some sleep, after we did a quick final decision on the boy and girls name’s we picked.

At 11:00pm I started to feel some strong cramps like period pain. They kept coming, fairly frequently. I pressed the call bell for the nurse, who suggested I try sleep through it best I can and call if it was keeping me awake. 30mins later I called the nurse again, the cramps were getting stronger and were 6 minutes apart. The nurse put the CTG machine on which confirmed I was having contractions, however they were showing up as very irregular. The monitors appeared to be having difficulty picking up contractions and it was challenging to get the measurements as baby was so small and down, engaged in my pelvis. This wasn’t how I had imagined my labour, being in a small assessment room with nothing but a bed, I asked if I could get a fit ball so I could still aim for the active labour I had been planning for. I asked if I should call my husband in, they said the decision was up to me but perhaps I’d like him to get some sleep as being a FTM I would likely be in labour for a long time. To me it felt like things were ramping up quite quickly, however I didn’t know what to expect, but at the end of the day, if I was going through it I’d like my husband to be there to support me so at 11:50pm I called him to come in.

Unfortunately, the fit ball didn’t allow the monitor to work so I instead I just stood and leaned on the bed during contractions. I laboured away in my room until 2am, where things were getting increasingly intense; it just felt like waves of strong period pain cramps. I asked when I would be given the IV antibiotics as I was pre-term and my results from my GBS screen was yet to be received. They came back and asked for my consent to complete a speculum exam, I consented and was told that they couldn’t see the baby’s head, however after a vaginal exam I was told I was between 5 and 6 cm’s and my labour was progressing quickly. They called my midwife to come in and started the process for getting an IV line in, it was about 3am by the time all of this happened and my midwife arrived. She came in, reviewed everything and we started to make our way down the corridor to the labour suites (I was no longer able to give birth at the family birth centre).

One of the rooms was set up with some of the similar equipment in the room as the birth centre and there were no other births at that time we had the pick of rooms. My midwife set up the flicking candles and the salt lamp. My IV bag was connected and as I walked to the labour room, I had to stop and hold onto the rails for my contractions. We got into the room and my midwife asked where I wanted to be and in what position. I wasn’t sure; I was planning a water birth so I hadn’t really thought about it but I knew I wanted gravity to assist me. My midwife suggested on my knees leaning up on the bed head placed in an L shape, I was happy to try that.

I told my midwife that I was feeling the need to push, like my body was doing it and I wasn’t trying too. She asked my consent to re-examine me; I was fully dilated and ready to go. In some ways all I could think was “this is happening so quickly, I can do this!” A monitor was placed on baby’s head as they couldn’t measure her in any other way. The pain during the contractions was very strong but as soon as the contractions finished I was laughing, cracking jokes and attempting to sync my Bluetooth to put a play list on (you know, the essentials). From where I was, I could watch baby’s heart rate stats, I could see it drop slightly with every contraction but come straight back up after the contraction finished, the baby might be small but I felt comforted that I could see she was managing labour really well. After what felt not very long at all, my midwife could see the baby’s head. The paediatrician arrived and within moments, our baby was born, it was 3:30am.

Now was the part I was most worried about, would our baby be ok? Before I could even ask I heard a big cry. I asked my midwife if it was a boy or girl, she said to reach down, hold my baby and tell everyone… what!? I was prepared I wasn’t going to get this opportunity. I held my baby in my arms. I looked down, and told everyone “it’s a girl!”, she was absolutely perfect. My husband cut the cord. I looked at her all over and held her close, then the paediatrician took her to complete tests. I was helped to turn around and sit down, baby got an APGAR score of 9, weighed 2080g and was 42 cm long. She was healthy, she was ok and she was 80g over the requirement to go straight to the NICU, she was allowed to stay.

I was then given the injection to pass my placenta. I vividly remember saying “ouch” very loudly about the injection and then laughing how I couldn’t believe I was saying how much that hurt when I had just birthed a baby! As my placenta was being passed, my husband got to have his special time with our daughter, she was having trouble regulating her body temperature so placed in a foil wrap and numerous swaddles.

We had our skin to skin time and attempted our first breastfeed together before I was assisted to shower and then taught how to express colostrum. My midwife showed us the placenta which was only as big as my palm, but looked healthy. It was sent off for testing to see if they could get any indication as to why she was so small and why she potentially came early. My labour was considered a precipitous labour and birth I was in early labour for 1 hour and 58 minutes, established labour for 45 mins and pushing for 15 minutes.   

I was discharged the following day but Piper was admitted to the paediatric ward so I boarded with her for another 4 nights. We had to achieve a stable body temperature and gain 20g for 2 continuous days before we could be discharged as well as monitoring for infection as she did not receive the recommended dosage of antibiotic IV before birth.

Although I did not get to birth in the birth centre or have the water birth I had planned or the opportunity to play around with all the positioning equipment available I felt like I was empowered in my birth to make the best decisions for me and my baby. Everything was presented to me as an option or recommendation and I was able to consent or decline I wanted. It felt like it was truly my own unique and personal experience and although it was nothing like I expected it to be, I never felt that I was uninformed or worried. I loved my birth and I’m so unbelievably impressed by what my body was able to do!

* Please remember these birth stories are shared in their own voice; from the point of view of the writer. Please remember that every birth, woman and baby are different so different choices have been made in individual circumstances. They are not intended to be used as medical advice, but to share the amazing stories of these mums

Nicky’s Fast Pre-Term Birth
Sam Ziegelaar 26 February 2024
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