28 weeks, 3 days. It’s incredible. No one, including Arthur or myself, thought we’d make it this far.
So far, baby shows good continued growth. For the last couple of weeks, I’ve had some pockets of amniotic fluid, even measuring 4.7 cm for my amniotic fluid index on my last official ultrasound. Baby hiccups and moves, and keeps rocking her heart monitoring sessions.
A few days ago, however, my white blood cell count showed a trend upwards. The reading, in and of itself, did not indicate infection, but the fact that the count was slowly and steadily starting to climb definitely bore watching.
Then I had my first round of recorded, mild contractions on the monitor two days ago. All the previous night, I’d been having a little bit of abdominal fullness and tightness, but it felt nothing like the “period cramps” feeling I’d been told to expect with the earliest stages of labor. I passed it off, especially when the monitor registered no contractions or uterine activity. That morning, however, the small, rounded hills were obvious on the monitor strip. The nurses tell me what I’m having is some uterine irritability rather than full-on contractions, but it’s new after weeks of no real measurable uterine activity.
It’s one of those things that could mean something or could mean nothing. By that afternoon, my uterine irritability had decreased markedly on the monitor and I’ve only had occasional, sporadic instances since. Plenty of normal pregnant women have periods of uterine irritability at this stage of pregnancy, so in and of itself, having those mild contractions on and off doesn’t mean labor is imminent. The white blood cell count went down, then back up to almost exactly where it had been the day before.
All of this is to say that the nurses and doctors are now watching very closely. For starters, pre-term labor isn’t like normal labor. It can progress far more quickly and come on far more suddenly than is usual for full-term labor. There is also the question of exactly what the white blood cell counts indicate and at what point the baby might be better off out than in due to the high risk of infection.
The good news, as I keep reminding myself, is that at 28+ weeks, we have a very decent shot. Even though it’s still horribly early, we are in a much, much better position than we were when my water broke at 21 weeks or at any point prior to this. If there is some sort of infection or other process starting, it is now better for the baby to come out than to try to buy more time and risk a septic baby or a baby that doesn’t make it to delivery. The baby’s heart looks strong. Or at least, these are the things I tell myself over and over again trying to stay as calm as possible.
The reality is: this is scary. I’d be extremely worried even if we were at the magical 34 weeks where I would be induced or C-sectioned automatically due to the PPROM. This is going to be a very premature baby. This is going to be a baby who had almost no fluid from week 21 on, and who could have serious lung issues. Emotionally, there is a part of me that feels that as long as I stay pregnant, the baby is okay. Intellectually, I know this isn’t true, because there’s any number of things from infection to cord compression to placental abruption that I’m at high risk to have happen as long as she’s in there. I think it stems from the fact that once that baby comes, we will get the ultimate answer to all our questions about her lung development and ability to survive.
I’m terrified that the answer won’t be the one I want to hear. It’s such an awful sense of powerlessness where the only thing I can do is keep doing what I’ve been doing: praying and hoping. We have been so, so grateful for so many people thinking about and/or praying for us and this little baby. Those words of encouragement really do make such a difference to us.
We’re walking on a very fine tightrope at this point. No one wants the baby born any earlier than she needs to be, but no one wants to mess around if there’s a chance of things going south. Obviously, if the baby’s heart monitor strip changes, my white blood cells go up dramatically, or I spike a fever, it’s go time. The issue is those less obvious signs that could mean problems or could mean nothing. It’s the dance we’re doing with my white blood cell count – not quite high enough to be a good indicator that infection has set in but high enough to cause concern – where the call to deliver or not deliver the baby is much trickier. Prior to this, the plan has always been to wait and see because the risks of prematurity outweighed the potential risk of leaving her in, but we’ve reached the tipping point where getting her out may become the better option.
That’s changed the balance. It reminds me of the first week or so after I ruptured when all of us were just waiting for me to go into labor at any second (statistically, most women go into labor within one week of rupture). After a while, we formed a routine and while there was still plenty of worry, the tension became weirdly manageable the vast majority of the time. Now, all of a sudden, we’ve jumped back into high alert waiting mode.