Winter PROM

Yesterday morning at 12:30 AM I returned home from a 36 hour stint at the birth center. During that time, I was "managing" the labor of a primip who had premature rupture of membranes (PROM) at 38 weeks. By managing, I mean I was assessing wellbeing of mother/baby and progress of labor as well as making decisions based on those assessments that would affect the outcome of the mother/baby/labor. This is an continuous, ongoing responsibility that isn't finished until a few hours after the birth occurs. I had a cold. I was discouraged to hear the mom's news that her water had broken and no contractions yet. (this is the definition of PROM) A primip with PROM spells "LOOOOOONG, labor intensive hours ahead". This mom delivered fine 22 hours after the PROM. There was a severe winter weather advisory outside and I was eager to get home. But it was not to be. 1 hour before mom delivered, I got a call from ANOTHER primip with PROM, this one at 37 weeks! Unbelievable! Must be the weather system. Mom #1 decided to spend the night, so we moved her to another room and got the "water" room cleaned so mom #2 could use the tub for her labor.

This mom came to the birth center at 8pm, loaded down with every imaginable comfort from home, since she was not yet contracting and none of us knew how long we would be at the birth center, since freezing rain was now falling. Thankfully, she and her husband (who also had a miserable cold) had brought pizza, Dr. Pepper, Moutain Dew, and 2 bottles of wine. And all I had requested was the pizza! At 9pm, I checked her and she was 1cm dilated. I encouraged her to try to sleep as tomorrow would be a long day. I went to the midwive's office, opened the window (radiator cranks out WAY too much heat) and went to sleep. Sometime during the night, I dreamed of a baby being born and a full neonatal resuscitation being done. Actually, that's a nightmare, isn't it? Around 6 am, I woke and realized the power was off. I shut the window as it was now plenty cool in there. I could hear my mama outside the door in the hall talking and knew she must be up laboring. Well, at least labor had started.

At 8am, power was back on, mama was settled in the labor tub, I had eaten some pizza for breakfast and called my friend Beth to tell her what I was up against and ask her if she wanted to come in to pray. (She's an amazing prayer warrior) Beth told me she would get around and come in. By 10:30, she and my nurse arrived. Mom was already 8 cms so we thought things were going great! Alas, mom didn't deliver until 7 pm. What an amazing blessing it was to have Beth there, walking the halls in intercessory prayer for that mama/baby and me, the midwife. I have no doubt that it was due to her fervent, whispered prayers all afternoon that I had complete peace and confidence that this baby would be born at the birth center when the time was right. I usually really start to question the situation and my judgement, but I just felt the grace of God falling all over me, enabling me to be at peace and have no fear. There were a few moments of frustration but never anxiety.


28 hours after her water broke, and after 4 hours of off and on pushing, she victoriously delivered her 7lb, 6oz son , straight OP, (face up) over an intact perineum. Perfectly normal transition, with no resuscitation needed, apgars 8/9/9. The baby nursed like a champ and I was off to the midwive's office to chart the events of the day. (I had been unable to chart all day as our computerized medical software program was unavailable due to server problems). An hour after the birth, my nurse informed me that baby was grunting - a sign of respiratory distress. We carefully watched and monitored the baby for the next hour and 1/2 for signs of either improvement or deterioration. He required continuous oxygen during this time, and would resume the grunting every time we tried to wean him off of it. At 2 1/2 hours after his birth, I made the decision to send him in and was on the phone making the call, when he stopped breathing and turned blue, as the nurse was watching him! Artificial respirations were provided while awaiting EMS, who arrived within 3 minutes of the 911 call and whisked him off, with mom and dad following in their car. Hmm, about that dream.

Oh, my gosh, what a sad ending to such a victorious birth. I was really worried that baby might be septic. In my 10 years of midwifing, I've only heard about, never seen, the rapid respiratory failure that can occur with sepsis. Although mom was GBS negative, this was my suspected diagnosis due to the PROM at 37 weeks and the prolonged ROM. But happily, baby didn't have anymore apenic episodes and so far negative blood cultures. What a blessing. Hospital staff is not concerned about anything today except for a bilirubin of 10. Which concerns me, since he definitely had respiratory arrest. I don't like it. I hope he goes home with an apnea monitor.

Anyway, it's so wild how this birthin babies thing goes: nothin for 2 months and then 2 in 1 day. happens all the time. But why during an ice storm and when I have a cold??? At least it was warm at the birth center during a 12 hour power outage back at my home, so glad I missed that!