Peeing pants & fetal heart monitors: Louisa’s pre-birth story

When I was just shy of 39 weeks with my first daughter, Louisa, I was laying in a lounge chair in my parent’s backyard. I had just taken my maternity photos with my family, eaten a big lunch and then… I felt a gush of fluid. It wasn’t a huge amount, but it was unusual sensation. I was paying special attention to anything happening in my body during that time, so I let my family know right away.

After chatting about it, we decided to call the triage line at Kaiser where I was planning to deliver. I had been instructed to call the hotline for any reason, including if I thought I might be leak amniotic fluid. After sharing what happened, I was instructed to come in immediately for evaluation. This involved driving almost 2 hours, and we did not have our hospital bag nor car seat installed in our car yet. Classic first time parents!

I was admitted to triage, where they sampled the fluid to determine if it was amniotic or not. The result came back negative: it turns out I had just peed myself. Anyone who has been in third trimester knows how much the bladder gets squished, and accidentally peeing is quite common. Because I was admitted into triage, it was recommended that I undergo fetal heart monitoring to assess how baby was doing.

Monitoring baby seemed harmless enough to me. I was certainly interested in making sure she was doing well, so we strapped on the monitors and started watching the screens and ticker tape that the monitors put out. A nurse and midwife were present for this, and after some time, they started to describe some concerns. They thought my baby was having heart decelerations—aka “decels”—a slowing of the heart rate that can mean the baby is in distress. An OB/GYN was called into the triage room, and told me that she recommended I be induced immediately.

I was surprised to hear that this was her recommendation. I did not want to be induced in general, and I especially did not want to be induced with zero notice, without my hospital bag, without any mental prep, not ready to bring my baby into the world. My hope had been to allow labor to start naturally, without the use of external medications. I had read about the natural chemical and physiological “symphony” of labor inception, how it initiates numerous overlapping processes including endogenous pain relief hormones, that it ultimately leads to better birth outcomes.

Starting a pitocin drip was, to me, stepping onto the “intervention escalator.” I’d soon have intense, painful contractions that my body and baby weren’t ready for, so then I would likely need an epidural. The epidural would mean I couldn’t walk, so baby would have difficulty descending in my pelvis. This would slow or even arrest my labor, and then another slew of interventions would be needed to coax baby out—including an increased risk of needing an “emergency” c-section.

To make the right decision in this situation, I needed more information. I needed certainty that my baby was genuinely in distress, and that the cascade of interventions that Kaiser offered most pregnant women who found themselves in triage were truly necessary for my body and my baby.

I began asking more questions about the heart rate data - how confident were they that my baby was actually in distress? I started to notice their lack of confidence and certainty in their responses. After a fair bit of back-and-forth, they admitted that they were not sure that my baby was actually having decels. They said that she was either having decels, or potentially having “acels”—heart rate accelerations due to being active.

Fetal heart monitors are a notoriously fickle method of assessing baby’s health and current wellbeing. Baby is a 3D object who is moving, kicking, floating, and the monitors are pucks that sit on a 3 inch section of a mama’s abdomen. Put them in the wrong place, baby moves too much, etc—and you’ve got an “erratic” heart monitor strip, when in reality baby is totally normal.

My baby had always been quite active as she got bigger, and I had been experiencing her regular dance parties roughly 90 minutes around the clock for weeks. It seemed reasonable to me that she was just being active like normal, so I asked the midwife if it was possible to monitor longer. I wanted to be more certain about the heart rate data, so we could make a decision based on good data.

The midwife agreed, but not before the OBGYN started to use scary language with me, saying “This is when we start to think about fetal demise.” That was her way of conveying that if I didn’t do what she was telling me to do, my baby would potentially die. Her language scared me, but because I felt we lacked a conclusive imperative to support her recommendation, I decided to undergo more fetal heart monitoring to get a clearer data picture. Professionally, I’m a quantitative growth marketer, and in my discipline, we don’t make decisions based on bad data. That instinct guided me here.

After 30 more minutes of monitoring, and then 30 minutes more, it became clear that my baby’s heart rate was completely normal. She was simply active: her heart would go up, and then drop after the acceleration (what goes up must come down), and then it would settle into her normal healthy baseline. It was such a relief to get this information, and for the “induction pressure campaign” of the hospital to stop.

After over 6 hours in triage, I was released and told I could go home. Exhausted and a little strung out, John and I drove home at 11pm that night.

Louisa stayed in for another two weeks, and was born healthy at 40 weeks + 5 days. I was able to go into labor spontaneously at home, after lots of bouncing on the yoga ball and other gentle DIY induction methods. I was able to have a fairly quick birth without medications and pain relief, which was what I had been hoping for. My immediate postpartum recovery was smooth too: I was up and walking 30 minutes after delivering, and went home after only one overnight in the hospital.

Had I been coerced into an induction, I most certainly would have had more complications: an epidural, a much longer labor, potentially a c-section, and a more challenging postpartum recovery.

Four years later in my Doula training, I had a realization: a Doula could have really helped me in this situation. Specifically, I could have texted my Doula when I felt the gush of fluid, and asked for their thoughts (instead of calling the triage line first). They would have told me to go get a maxi pad, and to put it in my underwear for the next hour. If the maxi pad filled with fluid over the hour, I should definitely go in, because it would be a clear sign I was leaking amniotic fluid. If it was dry after an hour, then we could basically surmise that I peed myself.

I wouldn’t have gone into triage, and I wouldn’t have been pushed and coerced into an induction I didn’t want. Even if I had gone into triage, I could’ve been texting my Doula during the process, and she could’ve been coaching me to push back, and to insist on strong data before taking on a major intervention. I truly came very close to accepting the induction, so having this extra advocacy in my corner would have been very welcome.

I didn’t hire a Doula for my first birth because I didn’t think a Doula could help me. But it’s very clear that they could’ve protected me during one of the most vulnerable moments of my pregnancy, even remotely.

I share this story because I want to highlight how powerful it is to be armed with information and support. When you know the risks of interventions, when you understand hospitals’ incentives to offer them, and when you have a real-time advocate in your corner, you can navigate a hospital birth more effectively. I aim to be the kind of Doula who will support my clients through every twist and turn of pregnancy and birth—helping you protect your autonomy and goals, no matter what your specific preferences are.