Should my L&D nurse have known I was in labor?

kojex2

New member
Asking here because so many of us are part of the PPROM club.

Tl;dr - experienced PPROM at 32w5d and was admitted to the hospital. About eight hours after my water breaking I started getting low cramps that felt like really really bad period cramps. Turns out they were contractions. I didn't know because a) I was a FTM who was told that contractions would be through your whole belly and b) I assumed my nurse would tell me if I was in labor. She had no clue I was in labor, so we didn't do any interventions to try to keep baby in for a little longer. Baby was born 5 hours after "cramping" started (13 hours after water breaking) and ended up with a 22 day NICU stay. Should my nurse have known I was in labor?

More details:
Overall, my pregnancy was seemingly textbook, other than that I had brown bleeding from week 6 through week 11. So, very unexpectedly, my water broke at 32w5d while on vacation. I wasn't contracting or anything, so we made the four hour drive to our home hospital. It was very uneventful - we even stopped at Target for Depends and Jimmy John's to grab a sub for the road.

Triage tested and indeed found that my water had broken. I was admitted to L&D around 10PM on a Friday night. They did not do a cervical check to reduce the risk of infection.

I was hooked up to monitors and basically told to stay in bed. Up to this point I still was very asymptomatic. I'd have a very short, light cramp every now and then, but I thought nothing of it. They said they would try to keep baby in until 34 weeks (so 8 more days), but didn't mention anything about how they'd do that other than just keeping me there on bed rest.

Around 1 AM, I started getting stronger cramps every 15 minutes or so. I put the pain level at a four, and this was the last time the nurse asked me my pain or the frequency of the cramps.

Well, they kept getting more painful (up to a 7 or 8) and more frequent. I tried to sleep, but was unsuccessful because of the pain. I kept moving around, tossing and turning, and every bit of me wanted to just MOVE, but the nurse kept coming in to adjust the monitors that were falling off of my belly and she basically told me to sit still so they could get good reads. I asked for Tylenol once and she didn't ask me my pain level, she just brought Tylenol. She said I was having very light contractions but didn't seem to think I was laboring.

Later on she even said that cramps can be normal, but they usually go away after two to three days which almost sent me straight to an epidural after being extremely committed to an unmedicated birth because they were so bad by then. It turns out I was minutes away from TRANSITION and this nurse still had no idea I was laboring! Meanwhile, as a first time mom, I'm there thinking that it was just part of PPROM or the lead up to labor and that I was in for torture once labor actually came.

Not once did I even consider that I was laboring based on my nurse's words and actions. I even let me husband keep sleeping, thinking that we'd be in for a really rough few days and that one of us should get some sleep if possible.

I went to the bathroom around 5AM (my husband was awake for this), stood up, got back to my bed, then felt like I needed to poop. Perhaps the only helpful thing that nurse said all night to me was that I shouldn't need to strain to poop. Well, I got back to the toilet and felt like straining, so I went back to bed and had two (what still felt like low) "cramps" that had me bending over the bed in pain. I got back in bed, doctor arrived a minute later at 5:45, I pushed six times, and baby was born at 5:58. I did get to hold her for literally two minutes, but then she was taken to the NICU.

So, in less than an hour I went from not knowing I was laboring to my baby being taken away from me. (You guys understand - it was the best thing for her, but was traumatic for me.)

Should my nurse have known that I was in labor? If she had, do you think we would've gotten steroids and magnesium, etc?
 
@kojex2 I’m surprised that they didn’t start you on steroids when you came in ruptured.

Also cramps and contractions are parts of labor so I definitely think your nurse should have identified those as signs that baby could be coming, especially knowing your water had already broken.

Overall it sounds like the education they gave you was severely lacking!!
 
@kojex2 There should be way more going on behind the scenes that would have fed in to this decision. Contractions don't automatically mean labor, but also I don't think the nurse would have been making the decisions - the doctors are the ones who make decisions based on the information received.

I was having mild inconsistent contraction for literal weeks before I gave birth, but the determining factor (alongside the TOCO monitoring) was the fact that the contractions were inconsistent and irregular. I would assume that information is recorded in your record somewhere.
 
@lostandinsecure So I went back and read all of the notes and summaries available to me because of your comment; I'm not sure why I hadn't thought of that before. But anyway, the doctor's notes say that I "progressed rapidly" about eight hours after admittance (so about 5 AM). While technically the truth, I'd also been progressing for three hours before that, but especially after 3:30 AM. There were no notes after about 2 AM (until her after delivery notes), which isn't surprising since I was pretty much left alone from then until 5 AM.

I'm not sure what to think. I was blaming the nurse completely for never checking in with me, not even asking pain levels (which I don't think I'm misremembering since none are noted in their notes) but now I also blame the doctor. I just feel abandoned by the health care system (which I had little to no faith in before anyway). I didn't even get to do a followup with that OB (I was actually switched from midwife care to OB care upon admittance since I was earlier than 34 weeks) because she had a baby, too, right before my six week check up and hadn't returned yet last I checked.
 
@kojex2 Just here to say I could have written this myself, basically same scenario and I replay it in my head everyday. Also a FTM and wish I would have known that what felt like period cramps was actually contractions — I was also told I’d feel it in my whole belly. I told them multiple times I was cramping since my water broke and it was dismissed as “you don’t have anymore fluid left”. 45 mins after my contractions kicked up baby girl was born via emergency C-section under general anesthesia as she was breech and by the time they checked me her feed were coming out. I didn’t get to meet her until the next day.

I’m with you on questioning these things and wishing things went differently. I’m sorry this happened to you and I hope your LO is doing okay ❤️
 
@raviathon Wow, yes! I just wish they told me that’s what my contractions could feel like (I was one day away from that portion of my birthing class, of course!) so I would have known to call them in sooner. I knew it’d be a c section either way since we knew she was breech but maybe I could have had the epidural instead and my husband could have at least been in the room.
 
@kojex2 I ended up recently having my baby at 32+2 from pre eclampsia. The Monday before I had her I was in being monitored and felt very intermittent contractions. The midwife said she didn’t think they were contractions. That Thursday, I was in again being monitored and felt like I was having more contractions but their monitors weren’t picking up anything except for variable decels on baby. The transfer me to a bigger hospital (was the plan before the decels were noted) and when I get to the bigger hospital, I’m having regular contractions anyway. Ended up getting a c section due to the pre eclampsia and baby being breach. But yeah, they missed my contractions and all I could think was, I knew it.
 
@kojex2 I started having cramping exactly like that at 30w0d…then had heavy bleeding so my doctor said go to the hospital asap. The whole way there, the cramps got worse and worse and closer together until it was just constant pain. Couldn’t even make the walk up to L&D - had to get a wheelchair attendant to take me and he RAN once my husband said I was in labor. Meanwhile I’m standing there hunched over in pain still thinking “no I’m not!”

Changed my mind once we got up to L&D and I got on the table and they said there was a foot out, less than 2 hours after the first cramp 🫠 Little man was in the NICU/SCN for 49 days but is now a thriving 5mo old. Just goes to show, labor doesn’t always just feel like the books say!
 
@kojex2 This happened to be at 35 weeks. Came in because my water broke by myself because my husband was out of town. They said he would most likely make it (was driving at 1am) because of my previous labor. Nurses left me alone and by the time they returned they immediately called for the doctor because I was at a 10. I was in too much pain to realize what was going on, so I don’t necessarily blame nurses. Giving birth is wild and unpredictable. Still left a sour taste in my mouth tho.
 
@kojex2 I don't know. I had a 34 weeker then went in at 25.5 with extremely close together contractions and they all said I wasn't in labor because my cervix wasn't changing which is what always happens in my labors. Because of it I didn't get any meds (including steroids and stuff) until shortly before he was born a day later and it caused a lot of pain and trauma and I'm angry about it still.

So, as much as I'd like to say they know what they're doing, I also don't believe that anymore.
 
@kojex2 My experience resonates with yours! I had a more complicated pregnancy (AMA, placenta previa that then resolved, took lithium through pregnancy so had extra monitoring, had mild preeclampsia). At 32 and 6 I was in a maternal fetal medicine ultrasound appt in the morning and the Dr said everything looked great, the cord flow was still elevated but that was okay. I experienced some mild cramping (this was my second kid, but my first pregnancy was an induction so I never experienced spontaneous labor) and different feelings than usual in my pelvis and was worried about premature labor, but when I asked him he said I’d know I was in labor. That was around 10am. The cramping increased, and I noticed it came every 5 minutes but still felt mild. At 3 I decided to go to the hospital, and at 4 he was born (and taken to NICU). My water didn’t break until transition. But I also felt… shouldn’t this doc have checked my cervix?

It does seem your nurse should have known.
 
@kojex2 I am not a nurse, so can't comment on what they should/shouldn't know, however I can say my experience was very similar, except I was in hospital at the time my waters broke at 9.30pm at 35 weeks. The first nurse gave me some panadols and told me babies aren't born in bed (when you are sleeping) and to sleep, and the second nurse got me to download a contraction app and measure my contractions in the app and she'd "come back in 30 minutes." By that time "they could see the head," so they got me to call my partner, who was a 2 hour drive away, called my midwife, who was also that far away, said it was too late for any pain relief apart from gas and it was at the L&D room so I had to walk there. I got there and within about 20 minutes, at 1.24am, I had given birth to my son, with none of my support people there, having gone through most of the labour alone in the hospital room. I still am not quite sure what anything except active labour feels like, as a FTM.

It is my opinion that the nurse in your/my situation should spend more time with the woman to determine what stage of labour they are in if the woman is reporting stomach pains or is having any kind of symptom that would indicate labour. I am not a worker in the health sector so cannot comment what their education on this would be, nor whether this is a problem due to labour shortage. However, as I first hand understand the emotional impact of feeling fobbed off during labour can have, I'd say that alone (the emotional impact/trauma) should mean your care should have been more attentive and no woman should need to ask this question.

I do hope it helps slightly knowing you are not alone in your experience.
 
@kojex2 From what I’ve experienced, nurses do what doctors tell them to do. They “know” as much as the doctor wants you to know. My nurse was also surprised when i went into labor spontaneously. I think they are more used to the women there being induced.
 
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