One in ten babies is born prematurely in the United States. Babies who are born earlier risk complications with breathing and development. I never expected it, but I gave birth at 33 weeks gestational age.
Our baby boy was my fourth child and spent time in the NICU due to my severe preeclampsia. I am a birth professional, blessed at the bedside (or tub-side, shower-side, floor side, and I think even a hallway or two) of hundreds, if not thousands of babies’ births. No two deliveries have ever been the same.
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My “Normal” Births
None of my births have been in the same realm. My first three were straightforward hospital deliveries attended by hospital midwives. They were each beautiful in their own right.
For my first two children, my water broke first, followed by inductions after. I set the bar pretty low- my first baby came after 6 hours of pushing. Thankfully, my second came quicker- but still required medication (oxytocin) to move things along.
An Introduction to Preeclampsia
When our third baby came, I did not expect it. My blood pressure crept up after a 24-hour call shift. Two days later, my blood work looked normal, but my blood pressure stayed up. I went home to do 24-hour urine to check for protein by peeing in a giant orange jug for 24 hours. Glamourous, huh?
Here I was, only 35 weeks pregnant, and I had too much protein in my urine. So, we scheduled induction at 37 weeks- and I pouted every step of the way. I wanted an unmedicated birth, complete with spontaneous contractions and water labor! However, I knew that the health of myself and babe was paramount. Yep, I sucked it up.
Then the headache came and with it, a pair of sparkle bunnies that danced across my line of vision when I entered elevators, looked towards bright lights, or tried to sleep. I knew what it meant- I was sick with preeclampsia and quickly getting sicker.
The baby needed to come sooner rather than later. Maternal-fetal medicine sent me to the hospital for an induction at 36 weeks. I was rather grumpy- I wanted my baby to be born at full term. Again– my life was in danger, and I am fully aware of the facts, but no one said I had to be rational.
I gave birth to my daughter in the spring of 2016, and she was perfect. My little preterm baby was well– 6 lbs 8 oz. She was strong, fierce, and other than breastfeeding issues- she excelled every step of the way. She is a vibrant, feisty little girl.
Fast forward to October of this year.
Why didn’t I expect birth at 33 weeks gestational age?
I am a midwife– I’ve immersed myself in pregnancy and labor for the last ten years of my life. Low-risk birth is my bread and butter. I expected to have a healthy pregnancy and delivery at the beautiful birthing center I worked at, into my midwife friend’s arms.
The human mind is a powerful thing. I knew I might get preeclampsia, but I believed I had worked hard to prevent it.
The toughest question I pondered was, “Am I sure I want a water birth, or should I stay flexible?”
As a midwife, I know the best-laid plans often change.
However, I tell my patients all the time– sometimes you can’t help these things. Sunday morning, in my 31st week, I woke up with a blazing headache. I felt metal etch into my skull, and nothing made the searing pain go away. I only had relief when I fell asleep in a pitch-black room. I would awaken to a lightning bolt of pain in my head, convinced I would die.
My blood pressure was 150s/90s continuously. One week after trying every medication, I received a prescription for betamethasone, a steroid designed to strengthen premature babies’ lungs. I gave myself two painful injections, 24-hours apart.
My induction occurred at precisely 33 weeks gestational age for severe preeclampsia. I had the most fantastic team of human beings: compassionate nurse-midwives, my favorite physicians, and the most incredibly supportive nurses.
Despite my high-caliber quality care, I have never been so scared in my whole life. I remember at 6 am that everything had a green cast. Later, I lost vision in half of the field of my left eye.
The pain became intense. My baby’s heart dropped, and there was the talk of a cesarean section. But, I knew birth wasn’t far off. I had the best nurse on the planet who listened to every word that I said and trusted me.
I flipped onto all fours because I felt sure that it was time to have this baby. They rapidly pushed my bed to the room closest to the NICU to give birth, since my baby was before 34 weeks. I rode the whole way with my rear end up in the air because, if there is anything you need to know about me, I like attention.
The birth at 33 weeks gestational age was much better than I expected. My calm, kind doctor caught our baby and left the cord attached for several minutes. The NICU physician encouraged me to hold him in skin-to-skin for several minutes before taking him to the anteroom for his assessment.
And even though I risked out of midwifery care, my midwife was at my bedside, physically supporting me. The nurses were terrific, and I am grateful for the experience.
In a nutshell- I cannot overstate that my nurses, doctor, midwife, and neonatology team were mind-blowingly incredible. Baby J came in quite the hurry at 5 pounds 7 oz, 18.5 inches. He only needed a bit of assistance to breathe for the first 12 hours, but otherwise did very well.
I cried tears of joy after the birth. My son came out perfectly healthy and pink, but the labor was frightening. While I labored, I feared that one of us was going to die. I know that it sounds surreal and dramatic, but it was a persistent thought throughout the hospital stay.
Even with all my knowledge and training, perpetual dread consumed me, and it took months to shake. Because I had rolled directly from my ectopic pregnancy into this one, I fought a lot of demons. So it’s not shocking that I had risk factors for depression and anxiety.
The NICU Stay
I knew that my baby would be checked out by the NICU team and most likely stay in an isolette. While I’ve seen lots of babies with IVs, it’s different when you’re looking at your child.
As you can see, his skin tone was quite red. In his first few days of life, he was put under bilirubin lights to prevent any issues. He was only under lights for 48 hours and never needed them again.
At first, he was only receiving IV fluid with added nutrients. I was pumping regularly and brought all colostrum to the NICU. He would get fed everything through his nasogastric tube in his nose.
After the lights, his skin lost its reddish tone, and he became much more interested in breastfeeding. When babies have high bilirubin levels, it can cause them to be lazy and disinterested at the breast.
Breastfeeding a preterm NICU baby is hard work even with experience! J was my fourth baby, and I have helped moms breastfeed for ten years, but being in the thick of it is entirely different.
At 33 weeks, our baby was in the window of “moderate preterm.” They are very sleepy and have trouble regulating their temperature. Feeding on a breast is a lot of work for little mouths, so I mostly breast pumped.
The first few days were challenging because breastmilk takes a few days to come in. Early breast milk is known as colostrum and is chock full of antibodies, nutrients, and substance that is ideal for your little nursing. However, pumping twenty minutes 10 times a day and only collecting a few drops is frustrating.
Once a day, my baby would nurse for 15 minutes. It was my favorite part of the day. The rest of the time, I was pumping like crazy on my hospital grade pump.
And to put this into perspective, I was lucky. I had experience breastfeeding. All of my children nursed, and I was lucky enough to be pumping 25 ounces a day by the end of the first week. Plus, my little guy latched occasionally.
It was one of the hardest things that I have ever done, and I had it easier than many women. If you know a breastfeeding NICU mom, hug them and bake them a lasagna. They’re seriously on a different level– that is HARD.
After three weeks of struggling to drive between my children at home and visiting the NICU to stay overnight with baby J as much as possible, I decided that I would instead give him a bottle and bring him home. I could either work on breastfeeding at home or make peace with exclusively pumping and bottle feeding.
If you’re interested in learning about my breastfeeding journey with our NICU baby, check it out.
My husband fed our baby his first bottle around three weeks of age (36 weeks adjusted). I would try to nurse him, give him a bottle of fresh breast milk from my last pump, and then pump again. Timing everything was tight, but we made it work.
Regardless of how challenging it was, we brought baby J home after four weeks in the NICU. He is a cuddly baby who doesn’t like to leave my side. And who can blame him? He was in an isolette for quite a while– I don’t want to put him down either. Good thing that I firmly believe that you can’t spoil a baby!
The Experience of Birth at 33 Weeks Gestational Age
It is tough to share this story, as I am still quite emotional in the postpartum period. Please, be gentle and leave love in the comments!
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Caitlin Goodwin MSN, CNM, RN is a professional nurse copywriter with 12 years of experience in the nursing profession. She works as a nursing consultant and health content strategist. If you are looking for a professional content writer, please message below!