I was 25 weeks pregnant. For readers who are not currently pregnant — that’s second trimester, more than three months away from the due date. The baby weighs around a pound and a half and is definitely not ready to be born. The mom has just started bumping out into obvious pregnancy and has likely not bought baby stuff, chosen a name, or even toured the hospital yet, because she has more more than a third of the pregnancy yet to go!
I suddenly started leaking clear liquid down my leg. I was so confused — this couldn’t possible be my water breaking… but the liquid just kept gushing out, so I called my ObGyn’s pregnancy hotline and the nurse told me to rush to the hospital. I grabbed my wallet and my husband and son and I hopped in the car. Once at the hospital, they hooked me up to IVs, stuck a speculum in me, and put me in an ambulance to a different hospital.
Here’s what I wish I had known as I hopped in the car. If you’re water just broke and you are frantically googling and came across this article while someone drives you to the hospital, I hope this helps you.
On my way to the hospital, I cried. I thought it was basically over, that because my water broke, it was a sure thing that I was going to give birth within a day or two and my 25-week fetus would not survive outside the womb. Turns out I was wrong on both counts.
In fact, you can go for weeks or even months without giving birth after your water breaks! Who knew!?
Many women will go into labor within 48 hour of water breaking early (premature rupture of membranes). But antibiotics can help delay labor. About half of people make it to 12 days. And around one-quarter make it more than 6 weeks!
I initially thought that babies born in the second trimester were most likely to die or, if they survived, to have significant disabilities. That is true if you give birth at 22 weeks, but not true at 27. Every day you can keep that baby inside you is better for baby.
The studies all agree that survival and long-term health improve with each week of gestational age. For example, here is a study of babies born between 22–28 weeks gestation in the early 2000s showing that only 6% of the 22-weekers survived, whereas 92% of babies born at 28 weeks did. Here is a study looking at rates of major disabilities at five years old, again showing that things get better every week from 22 to 27 weeks gestation.
If you are less than 32 weeks pregnant, you need a Level III or Level IV NICU. Call the hospital you are headed towards and make sure that’s what they have. If they have only Level I or Level II, they will transfer you to another hospital after you arrive. Except that once you step foot in the hospital, you lose a lot of freedom . I learned this the hard way. Even though my husband had driven me to the hospital, once they told me I had to go elsewhere, they wouldn’t let us walk back out and drive there. Now I had to go in ambulance, which took more time and cost us thousands of dollars. We also wasted time with the first hospital running a bunch of tests that they just re-did at the new hospital.
Save yourself time, money and heartache by calling first and making sure you get to a hospital with the right NICU.
(Once your baby is born and is in the NICU, check out my list of things you’ll need.)
The hospital immediately gave me corticosteroid shots. The shots briefly hasten baby’s lung development and their effect peaks about 48 hours after they are given, and wears off in about a week. If you don’t give birth within a week, they will give you one more round of shots when they think you might go into labor. But they won’t give more than two rounds of shots because that could have negative effects. So it is a delicate game to try to anticipate labor and give the shots at least 2 days but not more than 7 days in advance.
After researching outcomes and seeing it was still likely the baby would either die or be severely disabled if born before 26 weeks, my partner and I decided it would be best to let nature take its course if the baby was born before 26 weeks (we didn’t think we should resuscitate). Because outcomes are a bit dicey before 26 weeks, the hospital will let parents decide whether to resuscitate. However, they didn’t tell us that and immediately administered corticosteroids without discussion. Had we understood the timing and our resuscitation decisions, we would have asked to hold off on the steroids until I reached 26 weeks. As it was, I got the shots at 25 weeks and he was born at 27 weeks, after the corticosteroids had lost their benefits.
ASAP, your family should ask yourselves: Could we, should we, must we resuscitate if this baby is born at X weeks? Then make a decision about corticosteroid shots accordingly.
Here were my hospital’s guidelines about resuscitation based on weeks of gestation.
- <22 weeks. Will not resuscitate.
- <23 weeks. Strongly discourage resuscitation.
- 23–24 weeks. Will not resuscitate unless parent requests.
- 25 weeks. Will resuscitate unless parent objects.
- ≥26 weeks. Will resuscitate even over parental objection.
If you are so early that you would not want to resuscitate and your hospital will let you make that call, then ask to hold off on the corticosteroids until you get to within 48 hours of the time when you would resuscitate.
The hospital is bustling with high-tech equipment and highly-trained staff and I was hooked to all manner of tubes and beeping machines. It seems like all of this diagnostic hubbub would be accompanied by a similarly dizzying array of nuanced treatment options. But for all the fancy equipment and sky-high medical bills, there is actually very little the medical profession can do when waters break early.
The main hammer the doctors have is to get the baby out faster, either by inducing labor or sending you for a c-section. They are continuously monitoring you and the baby to make one decision: do we need to get that baby out now? The doctors are gathering a lot of information, but ultimately, you can count on one hand the things they can actually do:
(Remember, I am just one person who experienced this and I have no medical training).
- Give you antibiotics through an IV ASAP after your water breaks. This is critical for preventing infection to both you and the baby, and can help delay labor.
- Give you corticosteroid shots, ideally 48 hours before baby is born. Two shots, 24 hours apart, can help the baby’s lungs develop a bit more before birth. My doctors told me the maximum benefit comes 48 hours after the first shot, and the benefits largely wear off a week after the first shot. If you don’t go into labor within two weeks, they will give you one more round (two shots) when they think you are getting close to labor.
- Give you magnesium sulfate through an IV to delay labor slightly and to improve health of baby.
- Induce labor or perform a c-section to prevent infection from impacting you or baby. The hospital will likely monitor your temperature, heart rate and blood pressure and the baby’s heartbeat either continuously or every few hours, and will likely press on your belly every day. All these things are attempting to detect infection. If they detect infection, the only thing they can do is get the baby out before the infection spreads. That means they will induce labor (if the baby is head down and the risk is not immediate) or perform a c-section (if the baby is not in position or they feel they can’t wait for you to go through labor).
About 1 in every 10 babies in the United States is born prematurely (before 37 weeks). That’s not nothing. Premature birth is the biggest reason for babies dying and premature rupture of membranes (water breaking early) is a major reason for premature births.
Yet doctors and researchers know very little about what causes water to break, or how to stop it. The two big theories my doctors explained to me were that something is just wrong with the sac from the outset so it was only a matter of time before it broke, or that infection early in the pregnancy weakens it.
Yet, when I had two UTIs early in my pregnancy, my doctors were totally blase about it. If infection could cause waters to break early, and waters breaking early is basically a catastrophe for the pregnancy, shouldn’t doctors inject some urgency into dealing with infections in their pregnant patients?
Or, I guess people carrying twins do, or with other risk factors. But I sure didn’t. I had no risk factors. My first son went way past his due date. I was in complete shock and denial at first. If it happens to you, I hope this article helps.