Pre-term labor?

[Collinsky]

My sister is 29 weeks pregnant with her first and she had bleeding off and on all last week, with no dilation. She started having regular, painful contractions that prevented sleep, all night long (didn't happen during the day.) Still no dilation, turned out that she had a slight vaginal yeast infection, which she started treating and it began to clear up. The thought was that the cervical irritation (that caused the bleeding) was caused by the infection, and that the ctx were probably triggered by the cervical irritation.

However she is still having the ctx at night, and now she is 2 cm dilated. She wanted a homebirth and this is so far from what she expected that it breaks my heart.

Does anyone know about preterm labor? Why are her ctx only happening at night, and then subsiding during the day? They are going in to the hospital this afternoon and I know that she is feeling so discouraged. She hates hospitals and doesn't trust drs for anything, but she also doesn't know what else she can do. And honestly I don't either, I wish I had answers for her but I don't. I also don't know that what they do in the hospital for preterm birth is best, or if it isn't, or what her options might be... so any insight or advice or reassurance would be appreciated.

[Gena 22]

Hopefully your sister will be home soon. Rest and hydration are all I know about getting over BH ctx, if that's what your sister is experiencing. Sounds like it may be more serious.

Best wishes!

[JamieCatheryn]

She'll likely be put on bedrest and given minerals and salts or medications to stop the contractions when they start, and kept very hydrated. They'll want to offer steroids to mature baby's lungs faster I'll bet, in case this baby is coming preterm and at some point they can't stop it. I guess the tentative starting and stopping of labor is better than her body just rushing into it headlong, right? It can be stopped, and is trying to stop itself even. I'll bet the whole thing was set off by the yeast infection, perhaps curing that will shut this down and make the rest of pregnancy and birth go normally.

She's wary of hospitals and doctors, with good reasons I'm sure, but they are there to help her all they can. I would suggest she try and make the doctors communicate thoroughly with her and remember she's in charge of decisions, they are just there to advise and to perform the treatments. Remember "BRAIN" Benefits, Risks, Alteratives, what more Interventions might this make needed (or what's her Instinct), what if we do Nothing for now?

[riverscout]

I went into PTL at 24 weeks with my first. I was in the hospital for 2 weeks and was sent home on bed rest. I gave birth at 40w1d.

I think your sister is making the right decision by going to the hospital. It is very scary, but situations like this are what hospitals are there for. She will likely be given an IV and possibly medications to stop the contractions. She will also possibly get a fetal fibronectin test. At some point she may get steroid shots to mature the baby's lungs. Someone from the NICU might come talk to her to ask about her wishes for the baby and to talk to her about what to expect. If all goes well and the contractions stop, she will likely be advised to go on some type of bed rest (complete or modified) or at minimum pelvic rest. However, there is little data to prove bed rest is effective. That said, many women find activity increases contractions. It's really a judgement call for each women and something she should discuss with her doctor and consider carefully.

I hope all goes well.

[Collinsky]

Thanks so much all. I just got back from the hospital - she ws 4 cm dilated (approx, they mostly just eyeballed it so as not to disturb things) and her water isn't broken but the membranes were protruding. They've got her on mag and steroids, as well as IV fluids, and will know more in a couple days what the longer-term course of action will be. Someone from the NICU will be coming in to talk to them tomorrow.

At this point, all they know is that this baby almost certainly will be premature. Whether that's at 30 weeks or at 34 is the question. It is really good to hear your experience, riverscout. I hadn't even considered that she could still go to term... but I guess if they can get the ctx under control, the dilation reverses a bit, and the membranes recede, then there's no reason she couldn't. The next day or so really will be the deciding factor there, I guess.

Everyone at the hospital has been just so sweet and compassionate to her, she came in with her midwives so they know her original plans and they've been really sensitive.

[boscopup]

You might check over in the preemie forum for info on preemies and NICU stays and such.

I too was planning an out-of-hospital birth with a CPM with my first, and my water broke at 29 weeks. He was 29w4d when he was born (they used mag to stop contractions and gave me steroids, then took me off the mag once the steroids had time to kick in). I still had a vaginal birth without pain medication, and the hospital birth experience was not as horrible as I had expected it to be. Yes, I still birthed the next one out-of-hospital and will be doing so again with this one if I make it full term, but I at least feel *better* about birthing in a hospital if I *have* to. Having knowledge from planning an out-of-hospital birth helps a LOT!

NICU stay is no fun, obviously. My son was there for 4 weeks (short time for a 29 weeker), and he came home with no monitors or anything, nursed a tad over 2 years (with help from a nipple shield in the beginning, but he came home with NO bottles ), and he's now a normal 4.5 year old with no problems due to prematurity. Long term outlook is usually very good for 28+ weeks. You just have to go through more issues in the beginning when they come that early, as they learn how to coordinate suck/swallow/breathe. Of course, every week baby stays in, the better things go and the shorter the NICU stay. So hopefully she'll keep cooking a couple more weeks, but I don't know what the chances are of that since she is dilating.

Good luck! And feel free to PM me with any preemie/NICU questions.

[Collinsky]

Originally Posted by boscopup

You might check over in the preemie forum for info on preemies and NICU stays and such.

I too was planning an out-of-hospital birth with a CPM with my first, and my water broke at 29 weeks. He was 29w4d when he was born (they used mag to stop contractions and gave me steroids, then took me off the mag once the steroids had time to kick in). I still had a vaginal birth without pain medication, and the hospital birth experience was not as horrible as I had expected it to be. Yes, I still birthed the next one out-of-hospital and will be doing so again with this one if I make it full term, but I at least feel *better* about birthing in a hospital if I *have* to. Having knowledge from planning an out-of-hospital birth helps a LOT!

NICU stay is no fun, obviously. My son was there for 4 weeks (short time for a 29 weeker), and he came home with no monitors or anything, nursed a tad over 2 years (with help from a nipple shield in the beginning, but he came home with NO bottles ), and he's now a normal 4.5 year old with no problems due to prematurity. Long term outlook is usually very good for 28+ weeks. You just have to go through more issues in the beginning when they come that early, as they learn how to coordinate suck/swallow/breathe. Of course, every week baby stays in, the better things go and the shorter the NICU stay. So hopefully she'll keep cooking a couple more weeks, but I don't know what the chances are of that since she is dilating.

Good luck! And feel free to PM me with any preemie/NICU questions.

Thanks for sharing! The hospital she's at is the best one around for preterm labor/NICU, which is why they went straight there - if they had gone to any other hospital they probably would have just sent them there anyway! They seem really confident about a 30 weeker doing fine, and the OB told my sister that there wasn't any reason she couldn't give birth vaginally, and was adamant about not doing a c-section. They did seem to be indicating that she would be having the baby sooner rather than later, so we're preparing for that, but time will tell. How she does today will be key.

I didn't even know there was a preemie forum. I will SO be checking that out.

I'm back to the hospital now and I'm so grateful for the positive things you've all shared.

[Collinsky]

Just an update, the membranes have receded back up and her dilation is down from 4 cm to 1 or 2... she is off the IV magnesium and on an oral med (I think it's nifedipine) and they're going to see how that goes tonight. She experienced some fluid leakage tonight after I left, and the nurse was concerned that it was amniotic, but the OB didn't think so. She was feeling really confident this afternoon, and is now worried again.

[emaye_to_2]

Saying a prayer now for your sister and her little bean. I understand her fear of hospitals but I'm so glad that she went in with her support system in tow and that the doctors/nurses have been sympathetic and competent so far.

I went into pre-term labor with my first at 32 weeks. They sent me to the hospital to receive tocolytics and the steroid shot and I was dilated to 2-3 cm there. I went home on bedrest until 35 weeks and then return to work. Ironically, my son was born six days late! It happens.