Managing a Preterm Birth

After two back-to-back miscarriages, Maria and her husband felt “cautiously optimistic” about her latest pregnancy. A visit with a specialist at 27 weeks had revealed nothing of concern, says Maria, a 33-year-old postpartum doula and childbirth educator in Philadelphia.

But not quite 2 weeks later, her water broke – and the typical signs of labor didn’t follow. When labor doesn’t start after your water breaks, it’s called prelabor rupture of membranes (PROM). This can lead to infection of the uterus if labor doesn’t start soon enough. And because Maria was only 29 weeks pregnant, her birth would be preterm.

Maria, now a mom of five, shares her story in this edited interview.

ACOG: How were you feeling in the days leading up to your water breaking?

Maria: I suddenly felt very full, like my uterus had blown up overnight. And I felt kind of a sense of doom that I couldn’t really place. I just felt off.

ACOG: Tell us about your water breaking and what you did after it happened.

Maria: I was at home and we’d just finished dinner. I wasn’t feeling great, so I went to lie down. That’s when I ruptured [the water broke]. As soon as it happened, that feeling of fullness disappeared and I instantly felt like I could breathe again. My husband and I called our midwife to see if it was safe to drive to our chosen hospital, about 40 minutes away. She said it was, and we were out the door within 10 minutes.

All my previous births started with PROM, but this is my only preterm rupture. With my previous births, it was at least an hour from rupture to the first contraction, so I felt pretty confident we had time.

Within an hour I was being triaged at the hospital by my midwife, who met us there. There were no active signs of contraction, and I was admitted so I could be monitored until the birth.

ACOG: Who was taking care of you?

Maria: I had a care team led by ob-gyns and maternal–fetal medicine specialists, who are ob-gyns that work with high-risk pregnancies. But they kept my midwifery practice in the loop. There was a comfort level in having them involved. Because the hospital allowed that continuity of care, it didn’t feel like I was dumped on strangers.

ACOG: When did the birth happen and how did it go?

Maria: I stayed in the hospital for 12 days before I started having contractions. Then the birth happened pretty quickly. The ob-gyn was making all the major medical decisions, and two on-call midwives were doing the hands-on care. The midwife I had been seeing didn’t have time to get there, but it turned out that I knew both of the on-call midwives. That made a difference.

ACOG: How did it help?

Maria: One midwife knew that I like my space during labor. I don’t like being touched and I don’t like chatting. A nurse was talking to me, trying to take my blood pressure. The midwife could see that I was having a difficult time coping with her. The midwife took over and took that distraction away.

I couldn’t have an epidural because my daughter was in distress, and I was really struggling with pain. The midwife kept me calm and focused to get through it. She was very hands on, but in a way that I was comfortable with. Having continuity of care allowed me to feel like I had a positive experience, even though everything hadn’t gone as planned.

ACOG: How was your daughter’s health when she was born and how is she doing now?

Maria: After her birth, my daughter was resuscitated, which I knew was pretty normal after a preterm birth. Then they whisked her off to the NICU [neonatal intensive care unit], where she stayed for 46 days. Nothing major happened during that time. It just took her a while to outgrow some cardiac issues, and she came home on a heart monitor.

It also turned out that my daughter was born with a condition that caused her skull bones to fuse too soon. She had surgery for that at 4 months. And she was developmentally delayed at 1 year, but by 2 and a half was age-appropriate in almost every area. She has some very mild muscle weakness for which she gets physical therapy.

ACOG: What advice do you have for other women who experience preterm PROM?

Maria: Be prepared for things to take some time, whether it be a long stay in the hospital or a long NICU stay. And manage some of the expectations. You may not have the perfect bonding experience that you were hoping for in the beginning, but it’s never too late. You can still have that close bonding and newborn experience even if it’s a little delayed.

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This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.