A couple of weeks ago, on Tuesday, February 25th I went in for a regular scheduled check up with a nurse practitioner at my regular OB's office. It took her three tries to get a read on Beau's location because every time she touched my belly it would trigger a contraction. In pregnancy it is common to have Braxton Hicks Contractions which are usually painless, usually short in duration, and don't produce cervical changes. They are like practice contractions. But since she pointed out the frequency of them I started to pay closer attention and the next day I noticed that I was having even more of them. By Thursday they were almost constant while I was on my feet, and Friday morning I woke up with painful cramping that felt very much like menstrual cramps. They were bad enough that I thought about trying to spend the day in bed, but Remy had an appointment and it wasn't practical, so I rested a little in the morning and then just toughed it out. Saturday the cramping was worse so Ross said I could stay in bed and he would look after Remy. I thought about calling Labor & Delivery about the cramps, but I was afraid they would do that thing where they tell you to come in and then when you get there act like you shouldn't be there. However Sunday, even after spending a second day in bed, the cramps were much worse and were beginning to include my back and make me feel kind of sick, so I finally called and they told me to come in.
We got there around 6pm and they hooked me up to the monitors, one for contractions and one for Beau's heartbeat, and left me for awhile to see what was happening. When they came back a little while later they told me that I was contractions every four minutes and they wanted to do some tests and check my cervix. The first test was for fetal fibronectin (fFN) which is a protein that helps "glue" the amniotic sac to the uterine lining. The presence of fetal fibronectin outside of the uterus may be a sign of impending labor. They sent that down to the lab for results. Then they checked for amniotic fluid, which was negative, meaning my water had not broken, thank goodness. And then they checked my cervix which was "long and closed", indicating that I had not gone into labor.
Their first objective was to slow down the contractions. They gave me a shot of Terbutaline and gradually I noticed the pain easing up. When they came back again it was with the fFN results. Positive. A negative is considered a more helpful result because if you get a negative your chances of delivering in the next two weeks are just 1/125. You are more than 99% likely not to go into labor, which can be hugely reassuring. Positive results however are more ambiguous. From what I have read, women presenting with painful contractions who test positive for fFN have a 1/6 chance of delivering in the next two weeks.
At this point the contractions had petered out so they gave me the first of two doses of a steroid to help Beau's lungs develop just in case labor was in my future and told me I could go home. They called later that night and told me the doctor had called in a prescription for a drug called Procardia that worked liked the Terbutaline to stop contractions. I was grateful for that because before we even got home the contractions had started up again. After a couple of hours of waiting for the procardia to work (and taking a second dose at the nurses urging) we went back into L&D where they said that the procardia was working by preventing the muscles of my uterus from organizing into real contractions but that my uterus was very irritated and was firing away and causing the pain so they gave me a shot of demerol and told me to go home and sleep and my uterus would probably give up and calm down by morning. The demerol also helped with the insane headache caused by the procardia. And the next morning I was feeling tons better.
Over the next couple of days we made two more visits to L&D, once for the second steroid shot and to check on Beau, who wasn't moving as much, and the second because my OB had checked my cervix and found that it was thinning and starting to dilate, and because Beau still wasn't moving much. That last visit was the hardest. We had to stay for about six hours and Beau's heart rate kept decelerating. Finally a Perinatolgist from my High Risk office came and did a biophysical on Beau and cleared us to go home but told me to come into the office the next day for another check. By the next day his heart was behaving normally and the doctor instructed me to go on bed rest and keep taking the procardia and we would take things one week at a time.
And that's what we are doing. The first week came and went. Contractions still start up from time to time so I'm sticking with the procardia. I'm going in three times a week, once to the regular OB and twice to the high risk OB. We are a little concerned about my blood pressure, which has gone up despite procardia being known for lowering blood pressure, but so far it is still in the safe zone.
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| he's feeling much better now! |
Yesterday I found this quote regarding bed rest that kind of resonates with me right now: “In many ways, medicine isn’t just about evidence, it’s evidence plus — it’s experience and skill and intuition — not to say those are replacements for evidence. But evidence isn’t all there is.” (Dr. Wolfberg) As for the dangers of bed rest - like blood clots and stress from lost income - I am on modified bed rest so I can get up and move my legs as needed and I don't have a job to worry about. The stress effects Mom, Dad and Ross much more than me but they have been encouraging and supportive. I am 33 weeks and 5 days pregnant. Every day we keep this bun in the oven makes a difference, so we are going to keep following doctor's orders and see if we can make it all the way!
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