Maternity Leave For Nurses:  How To Financially Prepare

Maternity Leave For Nurses: How To Financially Prepare

(This post about saving money for maternity leave as a nurse may contain affiliate links.  You can find my disclosure page here.)

As a new mother, it is your legal right to take a maternity leave.

Maternity leave is so important for a new mother for many reasons:

Unfortunately, many women in the US only get 6 weeks of maternity leave (8 weeks if you have a c-section).  And if you are a per diem employee like me, none of that time off is paid.  For that reason I worked right up until my 9th month of pregnancy while working as an emergency room nurse at a level 1 trauma center (thank God for pregnancy compression stockings!).

Nurses work extremely hard to care for patients like they would care for a family member, yet when they have a baby of their own they often have very little time to bond with their flesh and blood.  Add the financial strain into the mix and it can become very stressful and overwhelming.  So what is a nurse who is also a brand new mom to do?

Well, I have half-glass full mentality.  So for the sake of finding solutions to this conundrum that so many women find themselves in, I compiled a list of ways for mothers to plan financially far in advance of baby’s arrival.  You must take care of yourself first!

Pregnant nurse at work

The average paid maternity leave in the USA is only 6 weeks for a vaginal birth and 8 weeks for a c-section.  And if you are a per diem RN then chances are that you will not be paid at all while you are on maternity leave.

Saving for maternity leave is crucial for moms so they can spend more time baby bonding and less time worrying about money!

Unpaid maternity leave for nurses: you need to save up in advance!

After my daughter was born in 2015 I went back to work as a per diem nurse (higher hourly rate and more flexibility, but no benefits – including disability or paid maternity leave).   Therefore, eighteen months later when I went on maternity leave with my second baby I had a completely unpaid maternity leave.  It made the whole situation much more stressful for me.  Thankfully I planned well in advance to minimize the financial burden.

Here is how I managed to save up an additional 20K for my second maternity leave:

#1.  Open a new savings account dedicated to maternity leave.

One of the easiest ways to save money is to pay yourself first. When you set up direct deposit for each paycheck you make saving much easier. That way you don’t even see the money hitting your checking account. Liquid money is good so you can use it when you need it.

Suzie Orman (one of my all-time favorite financial gurus) says that you want to have as much money saved up for as many months as you plan to take off, as well as an 8 month emergency plan. You never know when an emergency can strike, for example, a medical emergency, a job loss or worse. The faster you can start saving into an account dedicated to maternity leave, the more prepared you will be when it comes.

#2.  Make a budget and stick to it.

I prefer more of a no budget, budget strategy. Basically, I decide how much I want to save each paycheck and immediately transfer it into an online savings account as soon as payday comes.

I am aware of everything I purchase and review it each month by using a program called Mint to track my expenses. If you aren’t using this, you should be. Since I have started using Mint I have watched my savings rate take off farther than ever. It is amazing how much you can save when you know exactly where your money is going!

I’m always surprised how many people I talk to who have no idea what they really spend in a month. Needless to say, this is a poor strategy for preparing for an unpaid maternity leave. You’ve got to have a plan.

#3.  Make more money now or take on extra work.

If you are currently pregnant or even just thinking about it, now is a good time to take on extra hours at work. Especially if you are able to get overtime pay.

As a nurse, anything over 40 hours of work a week is considered overtime at my hospital.  I don’t work overtime anymore now that I have small children, but I did it during my pregnancies just to add a little more to my savings.

In addition, some holidays pay time-and-a-half rates. Therefore, I have been known to pick up shifts on Memorial Day, Labor Day, Thanksgiving or even Christmas. It’s not my favorite thing to do, but my family handles it by celebrating these holidays on the day before or the day after the actual holiday. When children are young, they don’t know what day it is anyway, so this strategy has worked particularly well. It adds up quite a bit when you are saving to be out for a few months.

Maternity leave savings plan for nurses

Nurse maternity leave: how to save up in advance

#4.  Cut all recurring expenses that you aren’t really using or don’t need.

Look at your monthly expenses and see if there is anywhere that you can reasonably make a cut. Are you really using the 100$ a month gym membership? Or does it make more sense to take daily walks and do online yoga classes at home?

My husband and I talk about money often and try to be responsible about our spending. Saving money is all about establishing priorities and having set goals. This has kept us in good financial health and kept us on the same page with our spending habits.

#5.  Look at the easy ways to cut back.

Families dropping from a dual income to a single income usually need to trim expenses somewhere. Make a list of everything you are spending money on, and be honest with yourself about what is an actual need. Here are a few ideas to throw on the table:

  • Nix the coffee cart habit = save $4 a day
  • Pack your lunches = save $12 a day
  • Cancel the cable you are barely using anyway = save $80 a month
  • Cook your meals at home instead of ordering take out = potentially $100’s in savings per month (if you eat out a lot)
  • Go on a 3-6 month spending freeze on things that are not an actual “need” =  $$$

Do you see my point here? There is A LOT of money to be saved if you just pay more attention to what you are spending money on.

I do consider myself somewhat of an expert on “trimming the fat” on my own spending habits since paying off a large amount of student loan debt in a short amount of time.  Saving money for maternity leave as a nurse was a very similar experience.

#6.  Don’t fall for the baby registry trap.

There are so many items that I was told I had to have for baby #1. Many of them are “nice to have items” that I barely even used (I’m looking at you grocery cart baby cover I only used 3 times!). Many of these supposed “must have items” from my baby registry are currently being stored away in my garage and will, at best, find a new home in our local Goodwill.

I remember looking through Pinterest at lists of “must haves” for the new mom. They are long and mostly unnecessary. Stay away from those lists!

For example, I was told that I “needed” the newborn insert for our stroller. But for the first few months I was using her car seat in her stroller. By the time I actually went to use the insert she has already grown out of it.   Same went for the ergo baby newborn insert- I didn’t even need it until she was too big to fit in it anyway.

If you actually need something, then go ahead and get it. These are just my thoughts as a second time mom with a lot of baby registry regret. With the exception of a double stroller and a crib, I can’t think of any other BIG items I will actually need for our new baby.

#7.  Consider the extra expenses that come with a new baby.

There will be some extra expenses after the baby is born. Some of the big ones for us are diapers, wipes, food, and additional childcare.  None of these things are cheap, so it’s good to be prepared for the expenses in advance.

You could always decide to go the cloth diaper route. I know people who have done this and it does save quite a bit of money. That, however, was not in our savings plan. There are some things of convenience that really are worth the money, and that was one for us.

Other big expenses include childcare enrichment classes (MyGym, recreation classes, music classes, etc.) if that is something you are interested in.

Childcare is our single biggest expense besides housing.  In fact, if I didn’t have the higher hourly rate that I get from being a per diem nurse, it might not even make financial sense for me to work as an RN.   We have a nanny that comes every Monday and Wednesday so those are the days that I work at the hospital (plus one day on the weekend when my husband is home to watch the kids).  If you have family that can help on days you work that would be a huge financial savings.

I have read that the average baby costs their parents $300,000 from the time they are born until the time they turn 18. And that doesn’t even include a college education! I don’t know about you, but that really makes me think about how we budget our money. (We have college funds set up for both of our kids which started the day they were born, but we are still going to encourage them to achieve scholarships!)

#8.  Think about the big picture.

Having a baby is one of the most amazing human experiences I have ever had. I absolutely love being a Mom. However, it can also be stressful at times, even with the most thoughtful preparation.

At the end of the day you can only do the best you can. Saving for unpaid maternity leave is just one of the things I did to try and ease the financial loss that comes with having a baby.  It is wise to try and eliminate as much stress as you can so you can joyfully relish in the awesomeness that comes with having a new baby.

Now, if only I could invent a healthy way to live on increments of 2 hours of sleep or less, I would be golden!  Best wishes to you and your growing family.

Are there any other tips on saving money for maternity leave as a nurse you would add to this list?  Leave a comment!

P.S.  HEY NURSES!  Remember to sign up to receive your FREE E-BOOK “The Nurse’s Guide To Health & Self Care”  in the sign up box below! (scroll down)

Additional Recommended Reading:


9 Tips for Working As A Nurse While Pregnant

9 Tips for Working As A Nurse While Pregnant

*This post may contain affiliate links.  You can find our disclosure page here. *Post updated on 11/20/19

Nursing is a challenging career, and working 12 hour shifts as a pregnant nurse is no exception.  In fact, most pregnant nurses are concerned about occupational precautions as well as the health of their unborn babies at some point during their pregnancies.

Some of the questions I asked when I was working as a pregnant nurse were:

Was I going to be able to tolerate being on my feet all day? 

What is the best way to prevent dehydration as a pregnant nurse working 12 hour shifts?

And most importantly, how am I going to keep my energy up for my entire shift?!

But by taking proper precautions and always putting safety first, working as a nurse while pregnant is possible. In fact, many nurses work all the way through their pregnancies until a few weeks or days before they give birth.   This information is intended to help you thrive while working as a nurse while pregnant.

Talk to you OBGYN about your concerns about working as a pregnant nurse

First off, it is always important that you talk to your doctor to discuss any occupational concerns you have during your pregnancy. Continue the dialog at your prenatal appointments as you move along your pregnancy.  If you have questions in between your appointments then contact your doctor.

It is also crucial that you communicate with hospital management and your charge nurse about your pregnancy.  They cannot help you avoid potential pregnancy hazards if they don’t know that you are expecting.

Physical challenges of working as a nurse while pregnant

The physicality of working as a pregnant nurse can be very difficult for some women, especially for those working on high acuity floors such as the Emergency Department and Intensive Care Unit.  However, many hospital units are able to offer modified duty for pregnant nurses who have instructions from their doctors to stay off their feet.

However, there are still a few physical challenges that pregnant nurses should consider during nursing shifts:

  • Stress
  • Working night shift or rotating schedules
  • Heavy lifting
  • Exhaustion
  • Standing and walking for long periods of time
  • Managing nausea during shifts

Additional pregnant nurse precautions and occupational hazards to consider

Nursing is unique to many other professions because there are a lot of additional occupational hazards to consider, especially for the pregnant nurse.  Working as a nurse while pregnant can be dangerous for both mom and fetus, therefore it is always important to wear the correct protective equipment or even possible refrain from working with some patients with highly infectious diseases.

Here are a few pregnant nurse precautions to consider:

  • Radiation from diagnostic imaging
  • Standing and walking for long periods of time
  • Working with chemo or other teratogenic medications
  • Risk of infections such as c-diff, tuberculosis, cytomegalovirus, and influenza
  • Physicality of working as a pregnant nurse (such as pulling patients up in bed)
  • Increased risk of varicose veins due to standing for long periods of time
  • Working with violent patient

pregnant nurse talking on phone during a 12 hour shift

Here are 9 helpful tips for pregnant nurses:

1.  Invest in compression stockings or socks

How compression socks help prevent varicose veins

Compression socks and stockings help pregnant nurses by preventing varicose veins due to standing for long periods of time.

During pregnancy, a mother’s blood volume increases by almost 50%!  That’s a lot of extra fluid to be circulating through your body when you are on your feet for 12 hour shifts.  This is also why many pregnant women develop varicose veins during pregnancy.  If you are a pregnant nurse and haven’t invested in compression socks yet, its time to get a couple of pairs ASAP.

Compression stockings are often overlooked as a proactive way to prevent some of the chronic issues that come from working in a profession where you are on your feet for such long hours.  Pregnant women especially benefit from wearing compression stockings or socks during a 12 hour shift for a few reasons:
  • Prevention of varicose veins
  • Improved blood flow and decreased risk of blood clots
  • Decreased swelling of ankles and feet

I was able to continue working as an emergency room nurse up until the beginning of my ninth month of pregnancy because I invested in a few quality pairs of toe to waist compression stockings.  I wouldn’t have made it past my 6th month without them!

2.  Wear good shoes

NIKE shoes for nurses

Pregnant nurses must make sure they have great shoes to support their growing belly’s.

Every nurse needs a great pair of shoes to get through a 12 hour shift.  But the benefits to wearing quality nursing shoes during pregnancy it is even more important.  You will be carrying an extra 25-35 pounds and your feet need support to carry that extra weight.  If you thought your feet hurt working as a nurse before pregnancy, wait until you are pregnant! Keep in mind that your feet will swell a little more during pregnancy.

Things to look for in a great pair of nursing shoes.

  • Comfort
  • Support and stability
  • Slip resistance
  • Work function
  • Price and warranty

You can read more about the best shoes for nurses here!


3.  Pack healthy and energizing snacks

Almonds: a healthy nurse snack!

Working as a nurse while pregnant requires that you fuel your body with healthy nutrients to keep your energy up!

During my first trimester I struggled quite a bit with nausea and an overwhelming feeling of hungover-ness (without any of the fun the night before).  I was also training to be an ER nurse, so it was more important than ever to be alert and focused.

By packing a lunch with nutritious snacks everyday I was able to keep myself energized as well as fend off nausea enough to get through each shift.  I just couldn’t go more than 2-3 hours without refueling myself with something healthy to eat.

Admittedly, when I forgot to bring food with me I would eat peanut butter and jelly sandwiches from the stash we gave our patients.  Although they were nothing special, for some reason they tasted amazing.  Never underestimate the hunger of a pregnant nurse!  I felt so much better and able to continue working afterwards.

Here are a few easy, fast, and high energy snacks to help your pregnant body stay energized through your 12 hour shifts:

  • Trail mix
  • Energy bars
  • Almond butter and apples
  • Peanut butter and jelly sandwiches
  • Greek yogurt
  • String cheese
  • Hard boiled eggs
  • Edamame
  • Veggies and hummus


4.  Go to bed as early as you can.

To be a healthy nurse you must get a good night's sleep.

Pregnant nurses need their sleep!

You simply cannot sleep too much when you are pregnant.  This is a fact.

Here is a sleep secret that got my through 12 hour shifts during my pregnancy.  I would go down to the hospital meditation room during my lunch break, find a comfortable chair and literally pass out for 45 minutes.  I set my phone alarm to make sure I was back to work on time.  When it when it went off I was so deep in REM sleep that sometimes I didn’t even know where I was when I woke up.

The only way you are going to have the energy to make it through your pregnancy while working 12 hour shifts is to make sure you get as much sleep as you possibly can every night.  8 hours would be ideal.

5.  Aim for 30 minutes of exercise everyday

women practicing yoga

Prenatal yoga can help pregnant nurses deal with stress throughout their pregnancies.

It seams counter intuitive, but exercising while pregnant will actually give you more energy to get through a 12 hour shift. In addition, exercise during pregnancy prevents gestational diabetes and hypertension.

(It is important to talk to your doctor about starting any exercise routine during pregnancy.  There are rare circumstances when your doctor may not want you to exercise while pregnant.)

Non-impact exercises for pregnant nurses include:

  • Walking
  • Swimming
  • Prenatal yoga
  • Hand weights
  • Low impact aerobics


6.  Reconsider working the night shift

Nurse playing with daughter and examining eyes

Working the night shift can be especially challenging for nurses during their pregnancies. Consider switching to day shift.

The rigorousness of working 12 hour shifts as a nurse is exhausting as it is.  Add pregnancy into the mix and you might find that you are even more tired than ever.

Some pregnant nurses who have already been working night shift continue with that schedule and do just  fine.  However, those who have rotating day and night schedules might find it especially hard to switch back to the night shift once they become pregnant.

Talk to your doctor about whether it is safe for you to continue working night shifts.  Communicate with your manager about your specific health needs during your pregnancy. You may want to switch to a day shift only schedule for the duration of your pregnancy.

7.  Talk to your manager about modified duty

Pregnant Nurse at work

Many facilities are able to offer modified duty for pregnant nurses who can’t be on their feet all day.

As a pregnant nurse it may be necessary to have a modified work assignment.  Especially for nurses who work in rigorous units such as the emergency department.  The physical demands of pregnancy might be too much for pregnant nurses already struggling with fatigue, nausea or having to carry so much extra weight.

Talk to your manager to see if there are alternative assignments you can have such as working at the monitor, organizing paperwork or auditing patient charts.  If these options are not available consider the possibility of working shorter shifts or working two days a week instead of three.

Remember, always ask for help if you need it!

8.  Communicate with management about your intended time to go on maternity leave

It is important to keep open communication with administration about when you intend to go on maternity leave.  As a pregnant nurse, you cannot predict the future.

When I was pregnant with my daughter, I had every intention of working up until my 38th week.  But when I had my appointment at 31 weeks my doctor thought it was best that I didn’t work on my feet for more 6 hours a day.  While 6 hours seems like a lot in most professions,  it’s not much for a hospital nurse.    Sometimes we are on our feet for 10-12 hours a shift!

Yet, I still didn’t want to go off work because for some reason I felt like I was taking advantage of the system.  I thought I had the grit to work all the way through.  So, I waited for two weeks before I finally presented my doctors note to my manager.  When I finally did, I gave it to him with tears in my eyes because I knew he would have to put me on disability at that time.  My maternity leave started at that moment.

It was a good thing in the long run because I suffered a placental abruption and had an emergency c-section 7 weeks before my due date.  It is wise to listen to your doctor’s advice!

9.  Enjoy your pregnancy

pregnant women's belly

Enjoy your pregnancy, nurse!

Pregnancy can and should be a beautiful experience, even when you are a nurse working 12 hour shifts.  Far too often many pregnant nurses focus on the inconveniences and difficulties they face at work during their pregnancies  But with proper precautions it can – and should – be a time filled with good health, gratitude, abundance and most of all, joy.

Recommended reading for the nurse mom:

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pregnant nurse at the doctors office

Pregnant nurse tips: Working as a nurse while pregnant

Pregnant Nurse Precautions To Consider At Work

Pregnant Nurse Precautions To Consider At Work

As an ER nurse who delivered my second baby in early 2018,  I have done a lot of research about pregnant nurse precautions to be aware of when you work in a hospital.  My goal was to make sure that it was safe for me to continue working in such a physically demanding environment with so many potential occupational hazards.

Fortunately, I was able to work safely right up until a few weeks before giving birth. As a per diem nurse, I did not have any maternity or disability benefits so I wanted to save up as much money as possible before I went out on leave.  Thankfully, I was able to do just that.  But safety was still my number one concern.  I hope this information can help other nurses stay safe during their pregnancies as well.  

Talk to your OBGYN

First off, it is always important that you talk to your doctor to discuss any occupational concerns you have during your pregnancy. Continue the dialog at your prenatal appointments as you move along your pregnancy.  If you have questions in between your appointments then contact your doctor.  

My goal in writing this is not to make pregnant nurses afraid to work in the hospital.  I am so glad that I was able to safely work as a pregnant nurse for as long as I did.  Still, there are no shortage of occupational hazards for the pregnant nurse within the hospital setting. Working safely is the number one goal.  

It is crucial that you communicate with management and your charge nurse about your pregnancy.  They cannot help you avoid potential pregnancy hazards if they don’t know that you are expecting. 

Pregnant nurse precautions to consider at work

Pregnant nurse precautions and hazards to consider:

Radiation from diagnostic imaging

In the ER and on most floor units within the hospital, patients often receive portable X-rays at the bedside.  So naturally I was concerned about radiation exposure and how it could impact the health of my unborn child.  I felt it was wise to air on the side of safety by not exposing myself to unnecessary radiation during pregnancy.  

If you are in an area where x-rays are being taken, you must wear a lead radiation apron to protect yourself, especially if you are within six feet of the machine.  If possible, it is also a good idea to step outside the room while the image is taken.

In my nursing experience, x-ray technicians usually notify anyone within the vicinity of where imaging is being taken.  I was able to leave the area for a few minutes, whether I was wearing a lead apron or not.  

Key takeaways:  

  • Notify management of pregnancy 
  • Wear lead radiation apron
  • Step outside of room when portable x-rays are taking place

Dangers from working with chemo or other teratogenic medications

There is evidence that handling some medications, such as chemotherapy drugs, can cause adverse reproductive outcomes including fetal loss, miscarriage, infertility and preterm births.  In addition, it may cause learning disabilities in babies exposed to some drugs if nurses are exposed during pregnancy. 

Wearing protective equipment, such as gowns, masks and gloves can minimize occupational risk to a pregnant nurse.  However, it does not completely eradicate it

Nurses working in oncology or other areas where antineoplastics are prescribed may want to speak with management about the safest way to continue working.  In addition, you can insist on getting help from co-workers or management to give teratogenic medications to patients.  Moving to another work area may be a consideration if safety for the fetus is still a concern. 

Key takeaways:

  • Wear protective equipment when giving medications
  • Ask for help from co-workers when working with teratogenic medications
  • Consider temporarily working in another area of the hospital during pregnancy as your management allows

Risk for infection

As a pregnant ER nurse I was very concerned with the risk of infection from patients such as c-diff, tuberculosis, cytomegalovirus, and influenza during my pregnancy.  Since the ER is often the first stop in the hospital for sick patients I often didn’t know that a patient had a contagious infection until after they had been admitted. By then it was too late to protect myself if I hadn’t already. 

Pregnant women need to be especially proactive with protective equipment and hand hygiene. It is ideal for all hospital employees to have their measles, mumps, and varicella zoster vaccinations before pregnancy (most facilities require these vaccinations to work anyway). Hep B and influenza vaccination can also safely be administered during pregnancy.

As an added precaution, I made sure to change my clothes and shoes before leaving the hospital to minimize the risk of work-to-home contamination.  The first thing I did upon getting home was take a shower to rid myself of any other possible bugs I could have inadvertently carried home with me.

Key takeaways:

  • Stay up to date in all vaccines including the yearly flu vaccine
  • Adhere to strict universal precautions and hand hygiene
  • Request job modification to minimize exposure to certain patient populations
  • Minimize work-to-home contamination by changing work clothes and shoes before going home
  • Shower as soon as you get home from work

Physicality of nursing while pregnant

Being a nurse while pregnant is especially hard work.  Not only are we on our feet for up to 12 hours a day, but pregnant nurses are also carrying an extra 25-plus pounds towards the latter part of pregnancy.  Additionally, the extra girth makes it significantly more difficult to fit into tight spaces.  

Movement becomes even more awkward for pregnant nurses due to having an altered center of gravity.  In addition, high serum levels of progesterone and relaxin loosen muscles, ligaments, and connective tissues.  For nurses who do a lot of heavy, repetitive work requiring lifting, pulling or pushing their risk of musculoskeletal injury is increased.   

It is wise for pregnant nurses to use patient transfer equipment and to ask co-workers for help with moving patients.  However, if your work situation is still too physical for you to manage safely during pregnancy, you may want to consider a modified duty in a lower risk setting with a less physical patient load.  

On another note, pregnant nurses also have a higher risk of developing varicose veins due to an increase in total blood volume caused by pregnancy.  The added blood volume combined with being on one’s feet all day leads to poor circulation, puffy legs and swollen ankles.  Compression socks or stockings can help reduce the risk of blood clots and varicose veins as well as prevent swelling.

Key takeaways:

  • Pregnant nurses may want to inquire about modified duty
  • Understand how the altered center of gravity and hormonal changes in pregnancy predispose a nurse to injury (despite using best lifting practices)
  • Use patient transfer equipment when available
  • Ask for additional staff help with transfers
  • Wear compression socks or stockings

Violent patients

I worked in our ER psychiatric hold area several times throughout my pregnancy.  There were a few incidences where I had patients verbally threaten me and/or begin to escalate towards violence.  I always had a security guard with me and I stayed a good distance away from patients when I felt that my safety could be at risk.  It is likely that I was overly cautious at times, but it is better to be safe than sorry.

Violence against nurses is not uncommon, especially in the ER setting.  Stay vigilant and keep away from any potentially threatening situations.  If a patient is escalating towards violence then leave and call for help immediately.

Working during flu season

The CDC recommends that pregnant women get a flu shot.   Not only do hormone changes during pregnancy often make pregnant women more susceptible to getting the flu, but a common flu symptom is fever, which may be associated with neural tube defects and other adverse outcomes for a developing baby.  Getting vaccinated can also help protect a baby after birth from flu through passive immunity.

My experience:  The flu season in December 2017 was unusually bad.   Many patients came to our ER for flu symptoms.  Unfortunately, almost every nurse was infected with the flu or a cold at least once during the season.  Myself, included.  

At the time I was over 8 months pregnant and I was really struggling with a how horrible I felt.  I always get a flu shot to reduce my chances of getting sick during flu season.  However, if I ever got pregnant again, I might consider starting my maternity leave towards the beginning of flu season.  Especially, if I was that close to my due date.

An unexpected benefit of working as a nurse during pregnancy

One of the best gifts that pregnancy gave me was that it forced me to not be sedentary on days that I felt really tired. (Although while you are carrying an extra 25-35 pounds of extra weight, you may not consider it a benefit).

Many studies show that not moving enough during pregnancy is bad for both mom and baby.  If fact, exercise during pregnancy can actually boost your baby’s brain development and make them smarter.  Who knew that working a 12 hour shift might actually promote health for both you and your unborn baby?

Good luck to you during your pregnancy and take care of yourself mama!

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Silent Placental Abruption: Our Premature Birth Story

Silent Placental Abruption: Our Premature Birth Story

I experienced a silent placental abruption when I was 33 weeks pregnant with my daughter.

In case you are wondering what that is, I’ll explain: a placental abruption occurs when the placenta (the lifeline delivering blood, oxygen and nutrients to our baby) peels away from the uterus. It deprives the fetus of oxygen and causes the mother to hemorrhage internally.  

Sarah pregnant with Zoe

One week before I had our daughter via emergency c-section at 33 weeks.

The most common symptoms of placental abruption are bleeding and abdominal pain.  Because I had neither symptom it was considered a silent placental abruption.  It was especially unusual in my situation because I had no risk factors.  

I got the flu about 5 days before my silent placental abruption was discovered.

As a nurse I knew that just having a cold or flu generally doesn’t hurt an unborn baby and may even give her a few extra antibodies. I decided the best thing to do was rest and drink lots of fluids.

But to my surprise, two days later I wasn’t feeling better and had worsening fatigue, dizziness, a horrible sore throat, and a headache.

I called the OB floor at our hospital and was directed to an advice nurse.

After a 30 minute phone interview and a detailed discussion about my symptoms I was instructed to stay home. I just had the flu, she said. I should rest and drink lots of fluids. So I took the advice and tried to rest as much as I could.

Fast forward two more days and my dizziness and symptoms were only getting worse. I was even having difficulty walking from one side of the house to the other. So again, I called the OB unit at my hospital because I thought for sure they would want me to come in.

I spoke with both the on-call OBGYN on the unit and another advice nurse. After another detailed discussion about my symptoms I was again instructed to stay home. “Please do not come to the hospital,” the doctor stated clearly.  “There is nothing we can do for you.”

I tried to explain the best I could that I was extremely weak and short of breath when walking more then 20 feet. I didn’t have a fever, but I had never felt more sick in my life. They told me I just had the flu and needed to “ride it out.”

So I laid in my bed and cried for 30 minutes because every inch of my body was hurting so much that I could barely stand it anymore. I had a hard time catching my breath.

(Later we found out that the reason I felt so horrible was that my hemoglobin was extraordinarily low due to the silent placental abruption already having started. My hemoglobin (the oxygen carrying component of a blood cell) at that time was 6 grams per deciliter. The normal level is 12.0 to 15.5 grams.)

I laid down for an hour and started doing “kick counts.”

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that you time how long it takes you to feel 10 kicks, flutters, swishes, or rolls. Ideally, you want to feel at least 10 movements within 2 hours. Usually a mom can feel 10 movements in less time than that.

But I only felt 4 or 5 movements in that hour period. But my body was so sick and achy that I wasn’t sure exactly what I was feeling, so I drank two large glasses of orange juice and ate a small bag of gummy Lifesavers. I was determined to sugar-shock my baby into giving me more fetal movements.

I began counting kicks for a second hour.  But after about 40 minutes I still only counted about 3-4 pretty weak kicks. At that point I decided I wanted to see a doctor, even if they thought I was overreacting.

I called my husband and asked him to come home and drive me to the hospital.

When we arrived at the labor and delivery unit I was immediately given a mask and asked why I came to the hospital after I was specifically told not to. I was once again reminded that I was bringing my flu into the hospital and putting patients at risk for infection.  They were clearly frustrated with me by the tone of their voices.  I kept thinking “am I not a patient too?”

I explained my symptoms once again and told them that I thought the baby should be kicking more. They put me in a room and we waited for the on-call OBGYN.

When she arrived she did an ultrasound.  I could tell by the look on her face that something was very wrong.  She stated very clearly that she was extremely concerned about our baby’s safety.  This is what she told us:

  • I had almost no amniotic fluid.
  • The little amount of amniotic fluid that was there was the wrong color and she couldn’t explain why.
  • Our baby’s fetal heart rate was “not reassuring” which is another way of saying that our baby was alive but in distress.
  • It was likely I would have an emergency C-section imminently.

She didn’t know at that time I was actually having a silent placental abruption. Apparently it is very hard to diagnose on ultrasound.

(We later found out that the amniotic fluid was showing as the wrong color because it was actually blood, not amniotic fluid.  I had already been bleeding into my uterus and our daughter had been swallowing blood. After the C-section they pumped 15 cc’s of blood out of our daughter’s stomach and she pooped blood for the next few days.)

A team of preemie doctors came in to prepare us.

The preemie doctors explained in detail what would most likely happen to our daughter since she was coming out 7 weeks early. They said it was likely that our daughter would not be able to breathe on her own and that she would need to be intubated (using a machine that breathes for her). In the case that I didn’t hear her cry after delivery, they wanted to make sure I was prepared for that possibility.

We were also told to prepare for 30 days in the NICU, which was the average length of stay for a “33 weeker.”  They initially wanted to try delaying a c-section for 48 hours so they could give me steroids to help develop our baby’s lungs develop faster.  But we weren’t able to wait that long.

Within a few hours things got much worse.

Soon, I started hemorrhaging and was having what felt like one long contraction that wouldn’t stop.

Our OB determined that I was not actually in labor as my cervix was completely closed. She thought it was best to take the baby out right then because something was very wrong, but she didn’t know exactly what yet. I was wheeled across the hall for the emergency C-section.

Our daughter, Zoe Grace, was born.

Zoe came out at 4 pounds, 3 ounces. After being suctioned, she let out a tiny little cry that I will never forget. It was the best and most beautiful sound I had ever heard in my life.

The doctor was able to confirm during the c-section that I had a placental abruption. My placenta was 30% detached from my uterus.

The next day our neonatologist told us that Zoe had no signs of brain damage and we had a “very healthy baby considering the circumstances.”  He then let me know bluntly, and in no censored way that “babies born under my circumstances usually don’t survive and the mothers often don’t do that well either.”  He basically told me he couldn’t believe that she had no brain damage.

We were so grateful for the excellent care she received in the NICU.

Our silent placental abruption story

We were so grateful for the excellent care Zoe got in the NICU.

Admittedly, I was shocked when I saw her for the first time. She was in an incubator hooked up to so many IV’s and tubes.  And she was so very tiny.

For the first 48 hours I was not allowed to hold her. That was so hard for me!  But, I could put my hands in the incubator and place one hand on the top of her head and one on her feet.  I remember telling her how proud we were of her.  She was a tough little gal right from the start.  “Tiny but mighty” was what the doctor said. What a wonderful feeling it was to finally be able to finally hold her on her third day of life.

Zoe had an oral-gastric feeding tube for nutrition since she was unable to eat for the first 7 days on her own. I would pump breast milk and give it to the nurses so they could feed her through her OG tube.

She was also receiving TPN (IV nutrition) and lipids (fats) through 2 IV lines. That was probably the most difficult part to watch.  Preemie veins are so tiny that it would often take an hour of poking to get the IV in. And they didn’t last very long so she was constantly being stuck with needles.

She was on oxygen and a cpap machine for the first week to help her continue breathing on her own. She was also kept under a bilirubin light for 5 days to treat her jaundice.  

Mom and Zoe in the NICU

2nd week in the NICU. Zoe earned the nickname “tiny but mighty.”

Zoe got a little stronger every day.

Our “tiny but mighty” preemie started doing more on her own, like eating through a preemie nipple and no longer needing the IV nutrition.

We were shocked on our 9th day in the NICU when we were informed that Zoe would be discharged the next day. I knew she was doing well, but we were told that due to her stage of prematurity that she would stay for at least a month. She was so tiny I couldn’t believe they were letting us take her home.

My experience taught me a few things…

  • Mothers need to trust their instincts. We know much more then we give ourselves credit for.
  • Kick counts are very important after 28 weeks gestation.  If you feel less than the normal amount of kicks then you should see your OBGYN immediately.
  • Having a healthy baby is a gift.  Not everyone gets to have that.   

I can’t imagine what my life would be like now if I hadn’t gone into the hospital that evening, especially after being told not to by the staff. My life would have been turned up-side-down.  I am so glad that I trusted my instincts that night!

I am so blessed that I get to be a mom.

Not everyone gets to have healthy baby, or a baby at all for that matter. Whenever I find myself getting frustrated with the difficulties that come with parenthood, I think about how close we were to not getting to have Zoe at all. That puts it all into perspective for me.

Our baby Zoe is turned 3 years old on Halloween.  She loves Elmo so she decided to choose Elmo as her Halloween costume.  In honor of her birthday our family dressed up as the whole Sesame Street gang.  My husband was Cookie Monster, I was Big Bird, and our 9-month-old son, Oliver, was Ernie. It was a wonderful celebration that I especially treasured because I know just how lucky I am to have two “tiny but mighty” kiddos.

Thank you for reading our story.

Sarah, @ Mother Nurse Love

Zoe Grace, 4 weeks old
Zoe Grace, 3 years old.  
Silent placental abruption: Our premature birth story
Reasons Why I Am Lucky To Be Full Term

Reasons Why I Am Lucky To Be Full Term

As uncomfortable and large as I am right now, I am so lucky to be full term.

I’m actually even grateful for my current state of enormity and girth. Wow, I can’t believe I wrote that! That sounds so odd coming out of my head, but I’ve had a lot of time to think about it lately. And there are a lot of reasons to be so joyous and excited about it (besides the obvious excitement that comes with having a baby).

Some moms don’t get the opportunity to go full term.

lucky to be full term

It may not seem so lucky at the time but moms are lucky to be full term when they are pregnant.ome moms don’t get the opportunity to go full term.

Some moms don’t get the opportunity to carry a child for the full nine months. As the mother of a premature baby born at 33 weeks, I had a few moms mention that I was actually lucky to not have to deal with the hugeness that comes with carrying full term.

But the alternative is having an infant with potentially significant medical issues and spending weeks or even months in the NICU.  Or even worse.  The safest option for the baby is always the best one.  From experience I can tell you that it sucks to be discharged from the hospital without your baby.

We are very lucky that our sweet little preemie was born so healthy and has no obvious residual effects from being born early. Not every mom is so lucky.

I get to have the whole experience of a full term pregnancy.

As I just mentioned, our daughter was born early (due to a spontaneous placental abruption at 33 weeks). After she was born I remember feeling like I wasn’t ready to not be pregnant anymore.  I felt like i had somehow “missed out” on the full pregnancy experience.   I thought other moms were so lucky to be full term and I still wanted to be pregnant.

Because of my past experience, I have been relishing In these last few weeks of my full term pregnancy.  I am enjoying both the good and uncomfortable parts because this experience is so temporary.

Some women don’t get the opportunity to have children.

There was a time almost a decade ago when my husband and I discussed the possibility of not wanting to have children. We were much younger and our interests included our social life, travel, and pretty much anything that didn’t have to do with caring for anyone but ourselves.

lucky to be full term

I am lucky to be full term.

Fast forward many years and our priorities have completely changed. When we decided to start trying to have children we are very lucky that we were able to.

I know parents who wanted to have their own children but couldn’t, and it was devastating for them. I also know several women who have had to go through in vitro fertilization, which is not only extraordinarily expensive but requires months of doctors appointments, medications, and often repeated disappointments. Sadly, even after all that it doesn’t always work.

There is something really fun about being super pregnant.

Don’t get me wrong. I miss my wine.  But I know that there is a light at the end of the tunnel.

I love it when people ask me questions about being pregnant. It is fun for me to talk about.  The more I talk about the joys of pregnancy the more I realize how I am so lucky to be full term right now.

Even strangers stop me on the street to ask questions and the questions never get old. I happily tell people how far along I am, that I am having a boy, that it is my second child, and I couldn’t be more excited!

It’s better than being in the first trimester again.

I felt horrible during the first trimester. I was nauseous and felt hung over for at least two months. Work was difficult, especially since I as working and training as an emergency room nurse. Worst of all, it was early in the pregnancy so I couldn’t tell anyone that I was pregnant.  I’m sure my co-workers thought it was weird that I was constantly snaking on a saltine.

At least when you are double your size with a huge baby bump people automatically know that you are most likely pretty uncomfortable. I often had people offer up their chairs so I could sit or ask if they could help me with anything. While it was usually unnecessary, their gestures are very kind and appreciated.

Being full term (and huge) is something I can bond with other moms about.

At nine months pregnant, it’s difficult to explain how enormous one feels to someone who has not experienced it. But other moms who have been in the same situation totally get it.  Especially my need to continue nesting even 3 days before I have this baby!

I have even made friends with people whom I I’ve worked with for several years but never had a conversation with. It gives me an automatic connection with a lot of other women who I never may have spoken with.

Full-term babies have less complications and are generally healthier at birth.

This one is that obvious best reason that I am so lucky to have a full term pregnancy.  I can feel our son moving around so much. It’s mostly because he is so big, and that makes me feel relieved since our daughter was born at 4 lbs. 3 oz.   I am really excited to have a baby who will be at least in the 7 pound range. He will be born at the right time with the least amount of potential complications due to the fact that I am full term.

I have 3 more days until our son is here!

I am so excited to count all his fingers and toes and cuddle him silly. However, having a newborn in the house is going to be an adjustment and I know I won’t be getting any sleep for a while.  So for the next three days I am going to just enjoy every minute of my full term largeness. This will be the only time in my life where I can be proud to be almost 30 pounds heavier and not feel guilty about it.

I am so lucky to be full term!

Sarah, Mother Nurse Love

My Last Week Of Pregnancy

My Last Week Of Pregnancy

I am in my last week of pregnancy and I am ready for this baby to get here.

Physically, I’m feeling OK under the circumstances.  I’m huge and tired.  I also have a baby foot constantly kicking into my right rib cage most of the day.   But I’m still able to take care of our daughter and all of the things I need to at home, despite some of the physical discomfort.

This is the last week for my daughter to be an only child.

I am relishing in spending quality time with our daughter as I know that things will be a little different for her with a new infant in the house.  It makes me a little sad for a second but then I remind myself of what a great big sister she is going to be and how our son will be so lucky to be able to learn from her.  They will be good for each other and I am excited to watch them grow and play with one another.

For the last week I have been spending a little extra snuggle time with her before nap and bedtime.   We have a ritual of things we do before I put her down:  she gets all of her blankets out of the drawer, one by one, and lays them on me.  Then she climbs up on my lap and we read a few books, followed by about ten minutes of snuggle time with the lights off.  That might seem like a lot but I don’t know how long I will be able to spend with her after the baby is born, so I am taking advantage of it now.

Feeling slightly foggier then normal has become my new normal.

Over the last several weeks I have not been feeling as sharp as I normally do.  This is partly due to the fact that I have  “pregnancy brain” and my brain is restructuring in preparation to care for a new infant.  But if I am being honest, I am really looking forward to eventually getting my old self back (and finally having our new baby boy at home).

I’m ready to stop talking about being pregnant on my blog.

My last 6 blog posts have been all about pregnancy, or preparing for a new baby, or pregnancy health related things like doing fetal kick counts.  I’m ready to stop talking about being pregnant and start talking more about other mom and registered nurse stuff.

But pregnancy is on the forefront of my brain at this time, especially since I am in my last week of pregnancy.  And I’m having a hard time thinking about much else at this time.  So for now I guess I just have to go with it.  Eventually I will have the time and mental ability to write about a few other things.

My last week of pregnancy has started off on a productive foot.

Yesterday my husband and I finally bit the bullet and bought a new car.  We decided on the Subaru Forester due to the excellent safety ratings.  I love my Prius, but having two baby seats plus all the gear in the back was just not going to fit.  This afternoon we installed our toddler and newborn car seats into the forester.  Its still pretty tight but it works and I love the car.  I feel a lot safer since it is a lot bigger too.

We also went through the garage and brought all the 1st year baby stuff that we needed for our daughter back into the house:  bottles, breast pumps, newborn sleepers, floor mat, bassinet.  I washed, cleaned and organized for most of the day.

I have not packed a hospital bag yet.

This may sound surprising coming from a registered nurse during her official last week of pregnancy.  However, my first pregnancy I had no hospital bag and everything went just fine In fact, I realized that there was very little I actually needed from home.

Therefore my list of things to bring is pretty short:  picture ID, clothes to wear home from the hospital (for me and baby), a few toiletries, cell phone and charger, earplugs and eye mask (to help with the little bit of sleeping I will actually get).

This was the most productive New Years Day I have ever had.

Normally, New Years Day has always consisted of some sort of recovery from an event from the night before.  My husband and I are normally much more social especially for big holidays.   But as we are expecting to have a baby pretty much at any time we decided to stay in.  We were in bed by 10:30pm and I am happy we were since we accomplished a lot today.

2018 is going to start off big for us, that is for sure!

Thank you for reading!

Sarah, Mother Nurse Love