Wednesday, March 18, 2009

Preterm labor:

This is a subject that I am quite familiar with, unfortunately. Let me give you quick definition: Preterm labor is defined as the start of labor between 20 and 37 weeks of pregnancy. (Before 20 weeks it's considered a miscarriage, and after 37 weeks, it is normal labor).
It will cause your cervix to dilate and efface. So - nothing to mess around with. I’ll give a quick run down of my experience and then we’ll talk about what preterm labor is, and how it is managed.

With my first baby, I had contractions starting at about 18 weeks. Since preterm labor isn’t managed until about 20 weeks, I was told to only come in if I was bleeding. I laid down and tried to stay hydrated. I had contractions quite frequently from then on, but I figured it was just normal. At 22 weeks, I was visiting with my niece (who had preterm labor with her first baby), and I was telling her about the tightenings I kept getting. She put her hand on my belly, and started timing those ‘tightenings’. She said “that’s a contraction, and they are 3 minutes apart”! She made me go to the hospital, and sure enough, I was already dilated 1cm and 80% effaced. The next 15 weeks was a rollercoaster ride with full bedrest (bathroom privileges only and a shower every other day, and it had to be a quick one!). We had several visits to the hospital when contractions would kick in despite the oral terbutaline. Those visits usually entailed a nice big dose of IV magnesium sulfate, and lots of prayer.

Let me give you an explanation of the two drugs mentioned above.
Terbutaline (brand names are Brethine, Bricanyl, or Brethaire): This drug is actually a bronchodilator (often used as a short-term asthma treatment). It works for preterm labor because it has a derivative of a hormone called epinephrine - which is released when we are under stress. (You know - the “fight or flight” hormone). Stress causes many of our muscles to contract so we can flee danger, and at the same time, it causes the smooth muscles to stop working until we are ‘safe’ again. Since the uterus is made up of smooth muscle, it relaxes. Meanwhile, the rest of you is in “freak out” mode :-)
Terbutaline can be given orally, by injection under the skin (called subcutaneous or sub-Q for short), and in some cases it can be given by a pump.

The most common side effects are:
* jitteriness
* increased heart rate
* tremors

Magnesium Sulfate: I think this stuff is evil. However, it may have kept my my first baby and possibly my second from being born too early. (I refused this stuff after my 4th pregnancy, as the oral terbutaline worked well if I took it every two hours)..

Mag/sulfate works in mysterious ways. Nobody really knows exactly why it works, but the common theory is that magnesium lowers calcium levels in uterine muscle cells. Since calcium is necessary for muscle cells to contract, this is thought to relax the uterine muscle. Seeing as how they use calcium gluconate to reverse the effects of mag sulfate, it kinda makes sense.
It is also used for those who are having problems with pre-eclampsia because it lowers blood pressure and is an anticonvulsant as well.

It is evil because: First they start you off with a bolus. This can make you sweaty, nauseous, make you throw up and feel like you are going to die. Then they level off the dosage. You can’t see, (because you can’t get your eyes to focus), you can barely swallow, your blood pressure drops (so if you have low blood pressure like I do, that’s not fun). It can even make it hard to breathe. I won’t give you the ‘serious adverse’ side effects, just as I didn’t with the Terbutaline. I will tell you that they will take regular blood draws to make sure you don’t get toxic. Let me give you an example of toxic levels:

While pregnant with my first baby I was at the hospital during one of my many stays there, with my very enjoyable (heavy sarcasm) mag sulfate. I was talking a nap (what else to do when you can’t move, and focus your eyes to even watch tv). I woke up from my nap completely confused. I was *convinced* that we were being held prisoner and nobody could get in or out of the building. My husband was in the room with me, also taking a nap. I knew the hospital had changed our names. I started calling my husband by his new name (his name is Ron, but I was calling him Nori - which NOR is just Ron backwards lol). I called.“NORI”!.. NORI! ”, but he didn’t wake up. So than I decided to call him by his old name and I yelled “RON”!. I wanted to know if I was still pregnant, because they changed our names and whatever was wrong with me. I needed help to the bathroom to pee. He helped me in there, and I plopped down on the toilet. I became very upset, and started to cry because I didn’t know my name - old or new. I finally pulled the emergency cord because I needed answers. Two nurses came in running, probably quite frightened that I was giving birth on the toilet. I was crying and said “WHAT IS MY NAME”, “WHAT IS WRONG WITH ME?” The nurse turned my mag pump off. The helped in my bed and called lab up to draw my blood. Yeah, I was at toxic levels. I couldn’t have any more mag for the rest of the day and part of the night.

Another time, I had a much smaller reaction - when my mom came into the hospital to visit me. She woke me up and started talking to me. I couldn’t understand what she was saying. I kept saying “what?” and she would repeat it.. I would ask again to repeat what she was saying, but I couldn’t make sense of any of it. It was like the words were coming in randomly, and then lost the second they came to my ears. I don’t know how long this went on until either someone went and got a nurse, or somebody went to get her. I was in tears because I couldn’t understand the very simple sentence my mom was saying. The nurse thought my mom just made me cry, and put a ‘no visitor sign on the door’, but not long after, somebody realized I was not ‘with it’, and turned the mag off again. I’m just not a big fan of mag sulfate.

In case you are wondering about my other pregnancies the short version is this:
With baby #2, I started dilating and effacing at 28 weeks.. I spent the last 4 weeks dilated to 4cm and 100% effaced. Gave birth at 36 weeks (on the dot) (the day I went off bedrest and meds)
#3- I started dilating at 28 weeks (3cm 80%) - I was 4cm and 100% effaced from at least 34 weeks. gave birth at 35 weeks (zero days) (went to ‘partial bedrest that day, and stayed on meds, but had him anyway).
#4 - I started dilating at 28 weeks 6 days -(1cm 90% and stayed there) gave birth at 36w1day. (The day I went off meds and bedrest)
#5 - I started progesterone cream at 14 weeks (the kind you get at the health food store), my doctor laughed, but told me I could continue it anyway. I started dilating at 33 weeks 2 and 80% effaced). Was 5cm and 90-95% from 36 weeks on. This was my first child that I didn’t go into labor the day I went off bedrest or meds. I delivered him at 38 weeks and 2 days. (I used the progesterone cream until I was 34 weeks).
With #6 - At 33 weeks was 4cm and 80% - at 34 weeks I was 5cm and 90%. Went of bedrest and meds, on Friday, went to hospital Friday night at 11pm.. Gave birth @7am Saturday..the day I turned 37 weeks.

Signs of preterm labor: (Keep in mind you don't have to feel all of these symptoms!)

*Contractions (tightening of the uterus) at a rate of about 6 in an hour.
*Cramping and lower back pain - especially if it comes and goes every few minutes.
*Leaking amniotic fluid from your vagina.
*A feeling like something isn't right. It can be a burp that comes every 5 minutes, or just waves of nausea that come and go.. or pressure that feels like you have to have a bowel movement..

If you have been having contractions, your doctor will give a vaginal exam to see if those contractions have been causing you to dilate or efface. If you have been dilating and/or effacing - your doctor might do one of the following things:

1) The doctor may ask you if you have had any contractions in the last hour. If no - you might be sent home, even if you have begun to dilate and or/ efface. Your doctor might also do a fFn Test (Fetal Fibronectin) to see there is a chance your body will go into labor in the next two weeks. (Note:: Not 100% accurate - is not to be given AFTER a vaginal exam or recent sexual intercourse as it can cause wrong results)

2) Your doctor may hook you up to a monitor in the office, to see if you are having contractions. This usually takes about 20 minutes. If you are having contractions, you will be sent to labor and delivery at the hospital. If you have not had contractions in this time, the doctor may send you home. Perhaps with medication to stop contractions.

3) Your doctor may send up up to the hospital's labor and delivery and have you monitored there, and give you some IV fluids as well. If you are having contractions they will give you medications to stop the contractions. They may give you an antibiotic in case there is an infection somewhere causing the labor. They might give you a steroid shot to help mature the babies lungs. When labor has stopped, and the doc is comfortable with your status, you will be sent home with instructions to come back in if symptoms return.

If you think you are experiencing preterm labor, denial will not make it go away. The sooner you find out what is happening, the better the chances of it getting stopped. Yes, it is scary, but watching a baby fight to stay alive is *much* scarier.
To all of you mothers out there going through what I have been through: You are in my prayers. I wish you all the best!


Curdie said...

So informative. Thank you!

~The~Birth~Teacher said...

Your Welcome :-)

**~Beautiful~Lette~** said...

I went into labor at 25 weeks, was 1cm and 40% effaced! I've been on modified bed rest since and am on a medication called Procardia and another called Vistaril. I am now 33 weeks along and am scared I'm going to have another preterm baby. My second was born at 35 weeks. This is my 3rd baby... Thank you for giving me hope!

Cynthia Mercado said...

I'm 18 weeks and 1 day along. I haven't really felt the baby move. I have however felt a pressure in my lower abdomen that comes and goes. When the pressure is present my stomach tightens and I sometimes get a bulge that i can feel in different places. Is that the baby or something i should be worried about?

Cynthia Mercado said...
This comment has been removed by the author.
Mollie Greene said...

This blog is seem to very nice keep sharing information about Brethine.

Janine Fernandez said...

Im 14 weeks pain for over 36 hours the e.r sent me home with tylenol and said its just early in sooo much pain!!!! Nothing helps