Birth story - Lee-Ann and baby Shalev

🤍Triggers: PPROM (preterm premature rupture of membranes), contractions (not negative to me), induction, death in the family, NICU stay, retained placenta.

Buckle up boys and girls, you’ve got a long read ahead of you (I know, we all say that!) It was really helpful reading the few stories that spoke of PPROM, so I really wanted to share a positive story for others to read. This story has a lot of pre-birth context - a story so mental I can’t even make it up.

Pregnancy:

Pregnancy itself was pretty smooth and uncomplicated (I now joke with my Gynae that my pregnancies are totally low risk, until they’re not). I had some really heightened anxiety at the beginning (lots of life difficulties - a car accident, not having a car or transport for 2 months with a toddler, covid, nanny hiring & childcare issues while juggling a fulltime job, moving house and more). My psychiatrist increased my anti depressant dosage, and all was well. A totally different ballgame to my first height of covid pregnancy - people now actually saw me pregnant, I needed to wear clothes because I was leaving the house... It sounds silly, but it was more to adjust to. I had some really unpleasant pelvic girdle pain, a few instances of incontinence, but most of the time I could forget I was pregnant.

My daughter came at 38w5d, so I was expecting this boy would come around then too, so my plan was to finish work at 38 weeks on 11 November (funny how the universe would have it that that was the day I’d bring my 4 week old preemie home).

Work was getting intense in September, and I felt I was approaching burnout. I knew if I didn't slow down, this baby would arrive purely from my own stress. So I took off the last week of September for Jewish Holidays, and to spend some time with my husband and daughter. I arrived back at work Mon 3 October, ready and raring to go. I had a new starter on my team, and a new nanny at home (4th hire for the year, in a crazy turn of events it was our original nanny who was planning on relocating earlier in the year), so lots of new starts but I was ready to tackle the next 6 weeks before maternity leave.

Tues 4 - Wed 5 October:

32w5d PPROM (Premature Preterm Rupture of Membranes)

I woke up and was in bed with my husband and daughter. We were playing and laughing in bed together. When I got up to get dressed I felt some leaky fluid. I wasn't sure if it was some incontinence, as I'd seen a pelvic floor physio for this a couple weeks prior. When I wiped, it was a little pink tinged, and a little later I definitely saw some of my mucous plug come out (which my 2yo witnessed 🤷‍♀️). I knew we'd be going straight to the hospital labour ward as soon as our nanny arrived.

In the labour ward I was promptly put on for monitoring, and would be throughout the day. I think they picked up some contractions which were probably braxton hicks, but the baby's heart rate was fine and i wasn't feeling a thing. They took a swab to confirm it was my waters (I told them that in my non-medical opinion, that I knew for sure it was), and so they confirmed it. I was told that my Gynae was on leave that week (which I then remembered, because my next appointment was the following week when she got back) and had a little (read: major) freak out. She knew my story, my history, the complications, the anxiety, and the birth that I was aiming for. She knew I was wanting to breathe this baby out, and I wasn't sure that a stand in Dr would support me in the same way. Her colleague that was caring for me is highly sought after, but a close friend had a terrible experience with her and changed Drs at 36 weeks. I had a bit of a cry, to get all the feelings out, and told Greg that we wouldn't be walked over by a different Dr.

She came in, was lovely, and explained the situation to us. That they would need to be monitoring my infection markers (CRP) daily so that we avoid infection, or worse, sepsis. There would be minimal, if any, vaginal examinations for the same reason. I had to have 2 doses of steroid injections, each 24hrs apart, to speed up the baby's lung development. I was told not to even use soap when I showered, at risk of infection. So I had steroids injected, blood drawn, and we'd wait and see. I was put on tablets (4 tablets, 4 times a day, plus a few more) to relax my uterus and keep it from contracting, to keep this baby inside. It wasn't doing enough at the start, so I was put on a drip that would do the same, but work even harder. I had that drip in for days, and was on those tablets daily until I eventually delivered.

That evening was Yom Kippur (Day of Atonement), the Holiest Day of the Jewish calendar, and a 25 hour fast. Greg was going to stay with me in hospital. His mom was already going to be coming over, so would be with our daughter, and we arranged for our nanny (who had started the day before) to stay over too as extra support. When my waters had broken that morning, I thought that I'd have to be pushed for a c-section, or that I'd be induced and deliver under another Dr that same day. I had no hospital bag (I had intended to do it the next week), no clothes for myself, nothing for if the baby arrived. I think that is what the rest of the afternoon entailed - shopping, packing, planning and logistics for the next 24hrs. All while I tried to stay calm and breathing (harder than it sounds, trust me!), to keep myself in a relaxed space in case I did have to deliver this baby later on.

The midwife caring for me that day was wonderful and arranged to keep us in labour ward overnight so that Greg could stay with me (if we were moved to maternity, he'd have to comply to visiting hours and because of the Fast Day, he couldn't come and go). In the morning the Dr did a scan for me - thankfully everything was fine and looking good. I was worried there wouldn't be enough amniotic fluid, and that would push me to an earlier delivery. I learned that amniotic fluid is essentially just baby pee, and they keep drinking and peeing inutero - so I figured if I could keep drinking and lying horizontal so the baby can pee... it should help. The goal was at this point to get to 34 weeks, so a week and a bit longer, and we should be fine.

Thur 6 Oct onwards:

The days became a blur. Greg would bring Or-Tal to see me in the morning, we'd have breakfast together. It was lovely and chaotic. He'd take her home and then come back. Then he'd leave to try get some work done. I had a roomie, who had her baby at 34 weeks by c-section, and she was lovely company until she was discharged. I had friends visit. There was a lot of shabbat (Sabbath) and chaggim (Festivals), while I was in hospital for an 11ish day stay.

Fri 7 Oct:

My husband gets a call in the morning from the home that his dad has been living in for dementia, that they think the end is on its way. He left in a hurry, with no words, and I heard nothing else until later in the day. His brother and SIL flew in from London, his uncle flew in from Australia and from there everyone waited. It was a lot of shabbat and chag ahead for me over the next few days. And while that was really hard, being alone, on my back, without a phone or laptop for distraction, it really did give me time for compulsory rest. There is no way I would have slept or read that much over these days under "normal" circumstances. So a part of me was grateful, and tried to embrace it and recharge.

Mon 10 Oct:

My Gynae was back from leave! I had never been so happy to see anyone at 7am on a Monday morning. I went to her rooms a little later to discuss what had been happening, and have another scan (her machines are way fancier than her colleague's). She confirmed baby was head down (which I was grateful for, I was wanting to confirm this in my appointment with her later this week, as I was getting a bit worried about it), she said the level of fluid was good and nothing to be concerned of. Again she said the goal is to get to 34 weeks, protocol would be to let me go to 36 weeks (providing all CRPs were low) and at that point she would not rush to induce me either. But I wouldn't be going to term - understandably. In the week that had passed my infection markers (CRP) had gone from 17 (it needed to be below 5) down to 13, 11, 6 and ultimately 3. So things were looking good and I felt positive to get to 36 weeks. She even mentioned that I could possibly go home and come back for monitoring and blood tests twice a week, if I would prefer that. Because it was Jewish Holidays (Sukkot) at the time, I would only get to discuss it with Greg on Wednesday. I was uncertain of going home, because I wouldn't be able to get as much rest, but I wouldn't need to be bedridden like I was in hospital.

Wed 12 Oct:

Greg spends the morning with his family at his dad. He later comes to see me, as I hadn't seen him since Sunday and we were both looking forward to catching up on the last few days. My gynae comes in and explains about me possibly going home - we all decide it is better to stay here, rest and be monitored, and I can get day passes to come and go whenever I want. Which made the biggest difference. I must be honest, that after a week in a hospital bed, I was starting to lose morale around the birth I had been working really hard toward. The thought of being there still a few more weeks, and having to still go through (possible induction) labour, birth and recovery was an exhausting thought. It was starting to wear me down. The thought of opting for a c-section crossed my mind many times. It wouldn't be the easier way out, but it would certainly be quicker. After my gynae left, we decided to go out for lunch, so he ran after her to get permission for us to get a pass and out we went.

I had only been eating meat, chicken and fish while in hospital (kosher food options were limited and odd) and was desperate for something dairy. We got pizza, pasta and a luxurious milkshake. I got to eat in a sukkah. I got to breathe fresh air. I shook the lulav & etrog. I got to experience a little of the holiday that I had been missing. It felt a little normal. It was like a daytime date, that we never ever got to enjoy normally. It was wonderful. We discussed names - and I was surprised to be on the same page (previously 85% of my suggested names were vetoed), and that we'd decided on a name that we really liked (ironically - it was not the final name we chose). After lunch at around 3pm he dropped me back at the hospital, and went to the mall to take some time to himself and buy some things he needed. 4pm he got the call to say his dad had passed. I was about to get on to my online therapy call. He said he was ok, that he didnt need me now, he wouldn't be going back to the home and he'll come later with Or-Tal to see me.

He came through later, and was on family calls with the Rabbi working out logistics and details of the funeral that would happen the next day. I was planning on going, knowing that I could get the day pass. It was really a crazy day with lots of up and down thoughts and feelings.

Thur 13 Oct:

I woke up feeling like I had a bit of a cold brewing. I'd felt it a few days before. A little bit of a sore throat, snotty nose etc. I whatsapped my gynae (at this point, we’ll call her by name, Cath) to ask her opinion re the funeral, and she came in and said it is ultimately up to me, as long as I won't be standing for too long. I decided I will go, Greg came to drop off clothes for me and suggested I get a wheelchair, I said I'll be ok. He leaves to go, my parents come to visit and they'll be giving me a lift. But before they arrive I decide I dont think its the best idea - lots of people, they know I've been in hospital, I'm not feeling well, the weather is bad, I've been working so hard to keep this kid inside and infection at bay... I wanted to get to 34 weeks and beyond for this baby. So I decide not to go. Greg is ok with it, he understands, and I watch the funeral online.

I get a call from Cath after the funeral - my CRP had gone up this morning, so she wanted me to do bloods again to see if anything had changed in the past 6hrs. Postpartum she told me she was starting to stress a little, and a colleague reminded her they can retake the bloods. She told me she really was trying to take the entire family unit into account that day, she cares for Greg as much as she cares for me. It sounds like it was a stressful day for her. She’s proof that not all obstetricians should get a bad rap.

So they took more bloods. At 9pm I get another phone call from her. "Do I need to worry about you calling me at this hour?" "Well...". Essentially, my CRP had steadily been going up all week and the trend didn't seem to show it going down. She was going to come in in a bit to discuss with Greg and I a bit more, but essentially she was recommending an induction. The benefit was us beating possible rising infection, the risk was that at 34 weeks, an induction might not work (greeeeat, just what you want when you know induction is meant to be more intense than labour that starts naturally). She assured me she has never regretted this sort of decision before, and I trust her with my life (considering past postpartum complications). In the essence of time (that I could safely be induced before time turns against us and infection possibly increases), and from my side to avoid the need for an emergency c-section, I chose the induction. We could possibly have waited until morning, but Greg was already stressing about shabbat (and our daughter, while being with family, being without us, and how she would cope), and I felt this was the right choice.

Induction:

She did a scan, confirmed my amniotic fluid had decreased and that baby was head down. I was induced around midnight with the Prandin gel, and I was already about 2cm dilated. She wasn't sure the gel would work, so she said she thinks we would get some sleep. I was hooked to a drip too with antibiotics (from what I remember), had quite a bit of monitoring, but as soon as that was done I was determined to get as much rest as possible if labour was going to progress the next day. Luckily the room we were in had another plinth/bed thing, so Greg got to rest too. How restful it was after the day he had, I have no idea.

I remember waking up early, went to the bathroom (determined to empty everything ahead of birth as often as I needed, lol), so I sat on my ball, listened to some music to try get oxytocin flowing. Cath came in at around 8am-ish and checked my dilation - still only 2cm, instead of a second dose of gel, she suggested the drip. I was induced with my previous birth (waters broke and labour did not start), so it didn’t worry me - though I was a little anxious at the thought of the pitocin drip. To this day I wonder if it really does bring on stronger contractions than natural labour, as I wouldnt know - and she confirmed at my 6 week appointment postpartum, that yes - it definitely is. Eeeeek! I kept reiterating that they only start on the lowest dose 😂 steadily the midwife came and kept needing to increase to a higher dosage, and in good spirits I kept telling her off. Postpartum I was told they actually reduced to the dosage at a point!

While this was going on Greg and I tried to get some oxytocin flowing... we started watching some Disneyland parades and then moved on to some comedy on Netflix. Poor guy was mostly falling asleep at this hour. I was feeling pressured that I didn't feel any contractions yet, after the gel and being on the drip and that I needed to get oxytocin going to get labour to start, and it was a bit of work to release that anxiety. I really wanted the induction to work - I didn't want a c-section. Greg wasn't in the best place either, with lots of calls and messages from people regarding the passing of his dad, meals to be delivered, care for our daughter etc. At that point he wasn’t (couldnt) mentally be in the room. It made me more stressed, as I felt my birth partner was not present in my time of need. Thankfully we were still in early stages trying to get labour going.

I had to be hooked up to monitors as well as the drip, and the way the room was set up I had the bed in the middle with the monitoring on my right and the drip on my left. It was far from ideal, and at times I felt chained and strapped to the bed. We did what we could, and got the drip mobile so that I could walk around when needed, go to the bathroom etc. Greg had fallen asleep while I was standing and swaying watching Netflix. But then my waters broke properly. I went to the bathroom and lost some more mucous plug and saw some bloody show. It was show time. I knew things were about to start ramping up, and this is when the details start to get a little hazy.

I remember the contractions were definitely on and getting more intense, probably around 10am (the prandin gel was inserted midnight the night before, and the drip started around 8ish), maybe it was closer to 12 (time was hazy!). I remember being in the bathroom and Cath came in to check on me, and I was talking to her through contractions (well, pausing and deep breathing as the wave came). We agreed everything was moving along so no need to do an internal exam right now, but we agreed to check around 2pm, as I hadn't been checked since the morning (minimal exams when your waters had broken, because of increased chance of infection, and yknow, those broke almost 2 weeks prior).

I needed to be hooked up to the monitors again (I was pretty over it by that point, having been monitored two-three times a day since my initial admission, and now during these crucial times!) and I remember struggling to find a comfortable position. The midwife was happy to accommodate any position I wanted to be in, so she helped hook me up while I kneeled on the floor leaning over the ball. After a while, I didn't find this comfortable anymore so I got onto the bed on my side, and I landed up there until I delivered. I really wanted to be upright, forward and open, knees in calves out, but this was most comfortable and what my body needed.

Contractions were intensifying, and my husband was timing them for me on the Freya app - he was in full on doula dad mode by now. I was clutching hard into the combs in the palms of my hands (what a brilliant counter irritant for labour!) I had gotten very vocal for each contraction, and I really think it helped. He kept the midwife informed with how frequent and how long they were. As well as the combs, I had Greg squeezing/pushing down on my hips with each contraction, which also really helped and felt so good. The midwife started asking if I was needing to push yet, and I said I think almost… With my first birth I felt the urge to push even though I knew it was too early, so I was worried the same was happening, but the urge was increasing. It was 1:30 and she asked if I could wait until 2 when Cath was coming in, I said no lets do it now.

With my pjs and undies around my ankles (I just couldn't get them all the way off between contractions - ha!) to my absolute heartbreak, she said I was only 5-6cm, and I was GUTTED. Absolutely gutted. I almost burst out crying - if things were feeling this intense, how TF was I going to do this for lord knows how many more hours, for this birth I had worked so hard towards?! In hindsight, I think this was my moment of transition (or shortly thereafter anyway). I started asking about pain relief - could I get pethadine, should I consider the epidural...The answer was no, and so I asked for the gas and air (which for my last labour I was told I'd feel too nauseous, so didn't give it a shot). It took a few tries for me to get it and the timing right and it definitely worked in taking the edge off. If anything, it gave me another distraction and thing to do.

The gas and I soon became best friends, and I was relying on it for every contraction, though my timing felt way off and I was just taking drags every other moment. More and more I felt the urge to push. My voice sounded heavy (to me, anyway) and I did feel that lightheadedness effect too. I was on my side, eyes closed, moaning through contractions, clutching my comb in one hand, breathing in the gas using the other. I was far from calm and zen at this point, I was feeling pretty panicked and couldn't breathe in the gas fast enough. I never felt a ring of fire, just a LOT of pressure, literally like needing to make a big poo. Suddenly, I knew this baby was coming out "Terri, you don't have much time!" I called out to the midwife, sounding and feeling high as a kite. Next thing I know I hear them frantically saying "call Dr Elliott, we need Dr Elliott here now" as I felt a slimy sensation come out of me. Of course I think I am bleeding out considering I lost so much blood at my first birth. But no, it was a baby! Terri didnt even have time to get gloves on, and Dr Elliott walked in to hear me proudly exclaiming "I f*&$ing did it!" and her simultaneously saying "man, I really wanted to be here to see you breathe the baby out!"

The best way I can describe my labour and birth is totally primal. I felt like I was an animal out in the wild, moving into a dark private place to birth my baby. I probably sounded like an animal out in the wild too. But I let my body take over, and I’m really proud that it did its thing, especially with the Pitocin drip. If my body would just go into labour naturally without complications, I feel I’d nail it no problem!

The cord was wrapped around his neck 3 times, which could be why it took him some time to get out, and why his body was so cold when he came out (I later saw they wrote he had hyperthermia when he was born). They placed him on my chest (truthfully I wasn’t even expecting that with a preemie) for a few moments before he was whisked to the back of the room to be inspected. My husband got to cut the chord, and then the NICU staff had to take him off.

The most unpleasant part of the whole ordeal for me was definitely birthing the placenta and the stitches (ok, it was only 1 stitch). After all the blood tests, injections and canulas I'd had inserted over the previous few weeks you'd think I was a pro, but this was the worst part for me (it probably would have been less unpleasant if I'd thought to ask for the gas or if I’d been in an oxytocin bubble with my newborn). The placenta took some time, and Cath was careful to inspect it due to my history of retained placental tissue (despite her checking and it being whole, I still had tissue remaining and had it removed in theatre 4 weeks postpartum).

And from there our 4 week NICU journey began. Thankfully another positive experience - he was healthy and well, not on oxygen, and not even on a feeding tube for too long - he was just a preemie who needed more time to bake. That was the hard part, the neonatologist said, having a healthy baby in the NICU. I'm grateful to have had a positive experience there with kind and caring nurses. They actually kept him an extra week while we determined if I would need to go into theatre for retained placenta or not. Yes it was weird leaving hospital without my baby, but I got an extra 4 weeks of sleep, I got to spend extra quality time with my daughter, extra time to get our home ready. So there really were pros and cons.

To this day (and I had my final post partum check up a week ago) we don’t know why my waters broke - usually it is due to infection, but I tested negative for everything. It could have been something like bacterial vaginosis thar my body cleared by itself, but we won’t know. She also has no idea why my body keeps retaining placental tissue after birth. Cath has some tactics up her sleeve for my care next time (you know, if we do this again and all).

This period really tested us in more ways that I could have ever imagined. I get emotional thinking how strong we had to be - for me to keep this baby inside, my daughter to have her mom suddenly disappear, my husband dealing with single parenting while losing a parent, going through the uncertainty leading to this birth, and how strong our little guy was in staying inside, coming earthside so early, and fighting to be strong and healthy in the NICU.

So it was fitting that we wanted a name relating to strength, and felt it a bit ironic being so drawn to the name Shalev, in Hebrew meaning calm and tranquil. Though honestly, without the skills I learned from the PBC (from my daughters birth in 2020 to now); to breathe, to remain in green, to use our BRAIN, all to keep ourselves calm - I have no idea how I would have gotten through the crazy whirlwind of October 2022 and beyond. Our hope is that being calm and serene will ultimately be this little guy’s super power, and his biggest strength.