Newborn beats the odds
Noelle Renee Ames was born in November 2012, eight weeks before her due date and 12 weeks after her mother's water first broke.
According to mom and dad, Alicia and Daniel Ames, having the birth wait until 32 weeks of pregnancy is something they consider to be "pretty miraculous."
Alicia’s pregnancy was at the half-way point, 20 weeks, when her water broke in the middle of the night. She and Daniel rushed from their Cambridge, Ill., home to a hospital in Bettendorf, Iowa, where they were given grim news: Alicia would most likely either develop an infection and create a need for an emergency induction within 48 hours, or would go into labor on her own in that same time frame. Neither option held promising results for the infant.
Baby and mom surprised doctors when neither event occurred. On Sept. 14, at just under 23 weeks into her pregnancy, Alicia came to UI Hospitals & Clinics, where she would remain as a patient until Noelle’s birth 11 weeks later.
"A lot of prayers have been said for this baby," Alicia says.
When Alicia Ames walked out of her doctor’s office following her 20-week ultrasound appointment on Aug. 31, she thought her pregnancy was finally heading in the right direction.
Despite the fact that her first trimester had been complicated by on-going hemorrhaging (an ominous sign for Alicia who had experienced two miscarriages following the birth of daughter Hannah in 2010) and the fact that Alicia was hospitalized with viral meningitis for a few days in mid-August, the scans suggested the pregnancy was progressing well. The baby’s heartbeat sounded strong, and Alicia felt better than she had in quite some time.
"We were walking out and I told my husband, Daniel, that I finally felt like I could enjoy this pregnancy, that I felt really good," she says.
That feeling of well-being lasted less than 18 hours. At 3 a.m. the next morning, Alicia’s water broke.
"I felt this huge gush and expected to find I was hemorrhaging again, but that’s not what it was," she recalls.
At the Bettendorf hospital, the couple learned that typically when a woman’s water breaks early she either develops an infection within 48 hours or the baby is born in the same time frame. At just 20 weeks, Alicia’s pregnancy wasn’t yet considered viable, and the infant’s chance of survival was slim.
"We were devastated," she says, adding that Daniel had made a call to a funeral home to discuss arrangements.
After two days passed, Alicia says, nothing happened. There was no infection and no sign of an early delivery. She says her doctor was stunned.
"The doctor told me she’d never seen this happen before," Alicia remembers.
During pregnancy, the amount of amniotic fluid around the baby on ultrasound, known as the amniotic fluid index, is one measure of the baby’s well-being. During a typical pregnancy the amniotic fluid index may be 20 cm. After her water broke, Alicia’s amniotic fluid index dropped to 3 cm. She was admitted to the hospital for monitoring, and by Sept. 4, the fluid level had climbed to 7 cm.
She remained on bed rest at the hospital for six days, and her doctor shared Alicia’s condition with members of the maternal-fetal medicine team at UI Hospitals & Clinics. Alicia was sent home and ordered to remain on bed rest; if they could sustain the pregnancy to a viable 23 weeks, she could be taken to UI Hospitals & Clinics in Iowa City.
In the morning of Sept. 14, when Alicia’s pregnancy had reached 22 weeks and 5 days, she felt a familiar gushing of fluid. She called her doctor, who directed her to go to UI Hospitals & Clinics.
A stay in Iowa City
They packed bags and left their home right away. When they were just a few minutes from Iowa City, Daniel called to let emergency department staff know they were on their way.
"We were greeted by three medical staff people at the door and were up in labor and delivery within minutes," Alicia says. "I’ve never seen a hospital move that fast."
They remained in labor and delivery for 24 hours, but eventually Alicia was admitted to the hospital’s mother/baby unit.
"There were no contractions, nothing to say I was in labor," she says. "It just wasn’t happening."
Alicia’s due date was Jan. 13, and doctors hoped she would maintain the pregnancy until she was at least 34 weeks along. They scheduled a C-section for Dec. 3, the 34-week mark.
When a woman’s water breaks before a pregnancy reaches full term there is an increased risk of infection for both mother and baby, says a maternal-fetal specialist with UI Women’s Health who helped care for Alicia.
"It’s a dangerous situation, but it wasn’t as dangerous as it might have been," she says. "Alicia’s was a chronic rupture, which meant there was just a small amount of bleeding. It could have been a severe rupture, which would have created much more bleeding and been a much more dangerous situation."
Krupp says doctors talked with Alicia and Daniel about the risks of delivering early and the benefits of trying to sustain the pregnancy, and the couple opted to sustain the pregnancy for as long as possible.
Alicia was put on antibiotics to ward off any infection, and remained in the hospital so she could be monitored for cramping or increased bleeding.
"Everything was going pretty well while she was here," Krupp says of Alicia’s pregnancy. "We continued to monitor her for signs of increased bleeding, but all seemed to be going well."
Though Alicia went through periods of discomfort during the pregnancy she was optimistic their daughter—named Noelle because Alicia and Daniel had long considered this infant a miracle—would be fine.
"To go from having a zero percent chance of having a baby to a 90 to 95 percent chance—it’s truly amazing," Alicia said in November.
Alicia’s pregnancy continued to progress well until Thanksgiving weekend. Alicia had had episodes of contractions that would come and go, but on Nov. 24, the contractions didn’t stop. Doctors monitoring her condition started to see an increase in bleeding, as well.
"They told me we were having this baby today," Alicia says.
Noelle’s early arrival
Alicia was able to reach Daniel and her mother, and both arrived in time for Noelle’s arrival by C-section. Daniel was in the operating room with Alicia when Noelle was born.
"I drove here as quickly as I possibly could," Daniel says. "I didn’t want to miss this."
As a patient at UI Hospitals & Clinics, Alicia was able to get high-risk prenatal care throughout the pregnancy, and Noelle was whisked to the neonatal intensive care unit (NICU), located within UI Stead Family Children’s Hospital. Neither mother nor baby had to leave the hospital for specialized care—it was all available on-site.
Noelle weighed 4 pounds, 13 ounces when she was born, and gained more than half of a pound in her first 10 days. At birth, Noelle had respiratory failure due to premature lungs and pulmonary hypoplasia, or underdeveloped lungs.
"Noelle grew well through Alicia’s pregnancy, which is a positive piece of her prenatal history from a developmental perspective," says Jane Brumbaugh, MD, one of the neonatologists who cared for Noelle at UI Stead Family Children’s Hospital.
After just 10 days, Noelle was removed from a ventilator and moved into a tiny crib. At two weeks, she started to breastfeed. Once Noelle started receiving regular feedings rather than through an IV, doctors began seeing improvement in her growth.
Noelle was able to go home in time for her first Christmas.
Thanks and praise
"To be where we were, to have little to no hope, and to be where we are now, is really nothing short of a miracle," Daniel says.
Both Daniel and Alicia credit the doctors and staff at UI Hospitals & Clinics and UI Stead Family Children’s Hospital for getting them—and Noelle—where they are today.
"When we were waiting for the 23-week mark we did some research on where the best place to go would be," Daniel says. "University of Iowa just kept coming back as the best every time."
"The doctors and nurses and everyone were so wonderful," Alicia says. During her 75 days in the mother/baby unit she met several perinatologists, residents, and nurses, as well as activities staff to help keep her busy. She also got to know several other mothers-to-be who were awaiting the arrivals of their newborns.
"It was nice to be able to meet people who knew what I was going through, what I was feeling," she says. "I made friends who I still talk to and keep in touch with."
Both Daniel and Alicia also credit their strong faith as helping them, and Noelle, get through the pregnancy.
"We are so grateful for all that Iowa City has done for us and for all the prayers from friends and family along the way," Alicia says.
For her first three months at home, Noelle received oxygen therapy to assure healthy lung development, and her parents and doctors are pleased with her steady gains. She will continue to see UI Stead Family Children’s Hospital specialists over the next two years to monitor her progress.
Though it may seem rare that a woman’s water breaks early, it really isn’t, Krupp says.
"We actually see quite a few women who have preterm rupture of membranes (water break) or some bleeding from the placental edge (abruption)," Krupp says. "It's fairly common. The abruption can often be the cause of the preterm rupture of membranes."
A buildup of blood along the membrane walls—as what may have occurred in Alicia’s first trimester with the hemorrhaging—can sometimes cause inflammation and preterm rupture of membranes, Krupp says. She says that may have been the case with Alicia’s pregnancy, though no one knows for sure.
Though fairly common, there are still precautions patients and families need to take when faced with an early abruption, she says.
"It’s very important to have a neonatal intensive care unit (NICU) close and available so if the baby does arrive early it can be cared for in the best possible environment," Krupp says. "Knowing the NICU is right there eases some of the pressure of who will best take care of the baby if it comes early."