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Preterm Labor & Contractions
Hi, I'm currently 19 weeks pregnant and for the last week have been experiencing moderate to severe contractions and a lot of upeer left quadrant pain. I've gone to the doctor, the emergency room and I have been told that fluids and staying off my feet (bed rest) should hopefully help but that there is nothing they can really do to help. They have seen, monitored the contractions, done multiple pelvic exams and given me IV fluids. I have been pregnant before, have miscarried twice and have one wonderful 6 year old daughter. This whole pregnancy has been very difficult, I used clomid to concieve, had severe hyper emesis until about 15 weeks and horrible migraine headaches throughout my whole pregnancy. I just feel like I should not be having this much pain, that something HAS to be wrong and hate that I cant get a ''real'' answer from any of the doctors. ''It's normal to sometimes feel contractions'' (I feel up to 20 a day) they all say and since I'm not bleeding or thinning out/ dilating there is nothing other than fluids that they can do to help. I am already drinking 6+ bottled waters a day, I'm not dehydrated and they still say the same thing over and over. Am I worrying too much? Have any of you felt this way and it has been fine? I feel like I'm going crazy...telling myself and thinking this is not right and then having several doctors brush it off. I don't feel like I should be having such strong and painful contrations that I have to use breathing techniques and even cry through some of them. I even woke throughout the night to a contraction. Am I being foolish? Can any of you please give me some advice. I feel somewhat lost in this situation. Thanks.
Terbutaline is a bronchial dilator, and the assumption is that it also relaxes the muscles of the uterus. It is not something I took while pregnant (and asthmatic) but I did take albuterol and theophyllin in huge quantities. My kids are now 12 and 8 and aside from weird senses of humor (genetic predisposition) they suffered no ill effects. Because I moved to Europe during the second pregnancy, the prescriptions were written by the OB there -- and he was allowed because in Switzerland (where he was) preterm labor would have been an on-label use for those asthma drugs among others.
Again, punch Terbutaline into a net search -- and relax. Stress is NOT a muscle relaxer! Heather
The hardest part for me was monitoring my heartbeats with a stethoscope to determine whether I could take a dose. This is very important. Because I had to take the terbutaline every "X" number of hours (can't remember--maybe 3 or 4 times a day), there was always a 2 a.m. wakeup to do this. The reason is, if the heartbeats were too fast ("X" number of beats in 15 seconds of monitoring), then the terbutaline had to be postponed until the heartbeats calmed down. This happened to me once or twice, and the advice was to elevate my feet and relax!
After a few weeks, my Dr. did allow me to go to evening birth-prep classes, but she told me I could not do certain things, like "pretending to push." There was a woman in there who had pre-term labor and was on the same medication, but she did not follow the instructions for strict bed rest, etc. and as a result, she went into labor early.
By the time I was 2 weeks from my due date, the Dr. took me off the terbutaline. As I recall, I was able to go for longer and longer stretches without feeling any contractions and took the medicine less and less (with Dr. permission). So, for the last couple of weeks I could do things like go to the movies or have lunch and a short walk with a friend.
I am convinced the terbutaline helped me keep my baby to term and quite possibly saved her life. My daughter is 13 now and I can see no ill side effects (nor can her pediatrician). My OB/GYN told me that Terbutaline is an asthma medicine that they discovered works for pre-term labor, although she agreed with me that the side-effects of the "shakes" and shortness of breath would seem to be just the opposite effects one would want either for asthma or for stopping contractions! (Those symptoms went away over a period of about 2 weeks.)
By the way, the common cure for pre-term labor prior to Terbutaline was to put the woman on an alcohol IV drip or make her drink vodka all day long! Seriously! I have a friend who roomed with a woman while they were having their babies, and her roommate was instructed to drink a bottle of vodka a day in order to keep her baby to term. This poor woman was a teetotaler and started each day with a Screwdriver!! (This was in a era prior to the discovery of fetal- alcohol syndrome, although there is a certain "duh" factor here, isn't there? Actually, when I asked my Dr. about this, she said that a baby with 2 or 3 months to go wouldn't have the kind of damage that a fetus in the earlier stages would, but it still is not a good thing. . . My Mom drank wine and martinis and smoked when she was pregnant with me in the early 50's and I guess I'm normal. . . but what a risk we now all know that is.) Becky
Regarding terbutaline to reduce contractions: Has your doctor advised you to use a "Tokos" type monitor? These devices can detect uterine contractions through a sensor on a belt that you put around your belly. You lay down with the belt on for a period of 15 minutes or so. Then you remove it and place the sensor into a base-set that sends the information via telephone line (modem) to a facility where they read the results. This helps to establish how many contractions you are experiencing. This information is valuable since a continuous, regular pattern can indicate labor.
I used the Tokos monitor and Terbutaline with bed rest when I was expecting twins, who are now 9 years old. The Terbutaline does seem to help to reduce the strength of the BH/contractions. Unfortunately for me, the Terb. alone was insufficient and I was hospitalized for more than 11 weeks on a therapy of Terbutaline and intravenous Magnesium Sulfate. These two meds saved the lives of my daughters and they were born at 31 weeks. They never experienced a single detrimental effect and are healthy and wonderful in every way. They were premature, technically, but twins can tolerate early births quite well. The birth process itself helps to "mature" the infants. My girls were born vaginally and I had no anesthesia or pain med at all. I wanted to be fully aware and awake to see them! The several extra Amniocentesis procedures I had in the weeks before birth had me worried about their lung development. When I heard them cry in the operating room everyone laughed at the volume! One girl was in the NICU for several days because she wasn't breathing well; it had more to do with her being born second, rather than prematurity.
Terbutaline is kind of a mystery. It is a medication approved by the ADA for helping with breathing difficulties. No one ever did completely explain to me why it worked to help stop uterine contractions. I have known many women who have used it, while no one likes the side affects (nervousness or shakiness), they would do it again. The important objective is having those babies, strong and healthy.
Please fee free to Email me privately if you would like any more info or would like to talk about parenting twins. You have a wonderful adventure ahead of you! (Are you the person I helped find a MacLaren twin stroller?) Sharon
For my second pregnancy, I had premature labor at 28 weeks and this time I took a different drug, the name of which I can't remember. But it is a drug for lowering blood pressure that came into use for stopping contractions between 7 & 5 years ago. I bet you doctor would know about it if you asked him for this alternative, unless it has fallen out of use. I did not have a particularly good experience with it and did not think it was so effective at stopping contractions as the terbutaline, but it did not cause me to have so much nervous energy. It did cause me to feel dizzy and nauseous. What eventually happened with it was that, as it did not stop my contractions, the doctor kept upping my dose until I became convinced that the baby had greatly reduced motion as a result (and I didn't feel too great either) and stopped taking it on my own recognizance. The midwife was upset and wanted me to start taking it again immediately (which I didn't do), but when the doctor was reached she said that if the baby was moving less then there was something wrong and I should do what I felt was right and let the chips fall where they may. (I should add that by the time all this happened we were well past the dangerouse 28 week mark, although we were still several weeks away from the wonderful 37 week mark.) She said if the uterus was not a good place for the baby, the baby might as well come out. But the baby stayed in and was born full-term, despite thousands of contractions that I had all day and MOSTLY from 1:00 - 5:30 every morning. I took warm baths and drank lots, glasses and glasses, of water during that time and my baby stayed in! He is now 3 1/2 and is also beautiful, intelligent, active, healthy, normal. A real sweetie,...a much more physical, active, wiggly person than his older sister. I always find that kind of interesting...with her I took a physically stimulating drug and she is not a very athletic person, but is very cerebral, very imaginative, and can read for hours and hours. With my son, I took a drug that physically made me (and him) less active, but he is a very physical, athletic little person on the go. And there's no way to ever know if the drugs played a role in this, but they are wonderful kids. Good luck with your twins and the terbutaline! Laurel
If you do end up having to be on Terbutalin for the rest of the time I'm sure it will be okay too. My sister in law was on it for 7 weeks and her son is now 10 yrs. old and healthy as can be. There is a good bulletin board with people's experiences on bed rest/meds. on Babycenter.com which you might want to check out. Good Luck! Royce
I developed gestational diabetes from taking Terbutaline, which I believe is quite a common side-effect. As a result of my high blood sugar, my daughter was born with low blood sugar -- not dangerously so, but in order to keep her blood sugar up, we did need to give her a bit of formula the first two days of her life until my milk came in.
All three of the anti-tocolytic drugs that are used (Magnesium Sulfate, Terbutaline, and Nyphetapine (sp?)) are "off-label" i.e. none of them are approved for controlling contractions, but are regularly used for that purpose. I think Nyphetapine may be the least risky of the three, but I'm not sure about that -- and it wasn't effective for me at all. But you might want to ask your doctor about it.
I got acupunture treatment as well as taking conventional drugs. I found the acupuncture to be very effective. I also did a lot of visualizations, talking to my daughter and asking her to stay inside, etc.
I followed the bed rest protocol very, very strictly until I was 32 weeks along, at which point I did get up to sit out in the backyard every once in a while, or to move to the living room.
Best wishes to you and your twins -- and congratulations, you are already passed the 28 week point, after which most preemies do just fine. (But of course you want them inside as long as possible...) Alysson
I started having contractions at 23 weeks and was admitted to the hosptial at 24 weeks because I was 70% effaced (no dilation). I was on magnesium sulfate for a week (which made me violently ill), and then terbutaline for the rest of my pregnancy. I continued to have very mild and increasingly infrequent contractions until my water broke at 35 weeks (3 days after I stopped taking terbutaline).
Does anyone else have an experience of their water breaking seemingly coincident with going off terbutaline?
What are people's experiences with subsequent pregnancies following pre-term labor? I'm trying to understand how likely it is that I would have pre-term labor again if I were to get pregnant again. I am extremely reluctant to risk having a very premature baby -- the really little ones in the NICU were heartbreaking.
For the first pregnancy, I was on bedrest for about 3 weeks (Weeks 34-37) due to really strong contractions. I avoided meds and the hospital, but I was pretty much in bed all day and night, only getting up to go to to bathroom. It was torture, but I made it through with the support of my husband who then worked from home.
For my second pregnancy, Kaiser put me in a special program right from the start because of this history of preterm labor. At first it was a little annoying because I was feeling really strong and happy and healthly with Baby #2. A specific nurse called me every week to find out how I was doing, and documented my progress by putting the main points of our conversation in the computer after each discussion. This was a bother when all was going well, but, at 24 weeks, I started to spot. I was out of the country visiting family at the time (no less, argh!), but they since had insisted I take my medical file with me, and provided a number I could call if I had any troubles, I had a method of action. (Was I EVER glad to have all that information with me!) They told me to go get monitored at a local hospital, and they were really wonderful about reimbursing me the costs. (imagine that!)
Once home, and back to the routine of taking care of my then 3.5 year old while my husband worked out of the house, I really needed support. So I spoke a lot to my np and the ladies at the preterm labor line. They told me to rest one hour every morning and afternoon. Ya, right - with a preschooler?? They said do whatever it takes. Does your child like videos? Sweets? Juice boxes? USE THEM, they said, for baby #2 needs you to put his/her needs before any mother-guilt of having baby #2 watch too much tv. That gave me 'permission' to do whatever I needed to do to take care of my pregnant self. (And of course we did try to balance all this out by reading books on the couch/bed. I also minimized snack-getting by putting stuff in the fridge at my daughter's height. Things like glasses of milk, cheese sticks, bowls of grapes, even bags of crackers.)
My husband was still supportive - he took over making dinners and doing laundry (the lifting - I could still fold!) and even getting the groceries at night. He never once complained, although I was once again miserable for feeling so hopeless/useless. But I NEEDED to stay down; I continued to spot right up until delivery, with many a trip to L&D. They never found out what caused this problem, but I actually delivered three days late and the baby was over 10 lb, so I guess the rest was good for him!
So I guess my advice is this: stream line as much as possible, for you may suffer preterm labor again, and it is important to take care of yourself just as much this time as the the last pregnancy. (Forgive my being so obvious; I just needed to hear these words myself at that time, and it was a hard reality to face while I had a preschooler to take care of.) And get SUPPORT! Tap those friends/family that say they will help you, put your child in more care (although this may be hard and expensive....), have your partner take really good care of you and the home, and try to get the best medical care you can. Also, I read a number of books on the subject, so I tried my best to educate myself/be prepared. There are also a number of cyber communities that could help, or at least be a support of others in the same spot. ParentsPlace.com has a number of pregnancy boards, and I am sure they have one for preterm labor/bedrest pregnancy.
Good luck with your pregnancy.
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