Sharing advice/stories about preterm labor

[Lousli]

Hi all,
I want to ask you about this. While I don't want to freak out pregnant women, and I realize that most pregnancies are normal and healthy, I do feel it is important for us preemie moms to share our stories and to make other people aware of the signs of preterm labor. I often see conflicting information, or even misinformation being given to women by other people that are well-meaning, but not fully informed. I don't by any means claim to be an expert in this area, but I just feel like if I can help anyone keep their baby inside longer that it would be a wonderful thing to do.

So here's the thing, a lot of women don't know the pregnancy resources forum or this one exists. They go to their due date clubs for advice because those are the women they are most comfortable with. I'd just like to see our experiences shared in a helpful, not frightening way. A long time ago in the resources area I started a thread about signs of preterm labor. Many of you chimed in. What I currenly plan on doing is starting a poll in the general "I'm pregnant" area to see where most women would turn for advice and maybe to get the word out about other areas of the board that are resources. I'd love it if we could then maybe get a thread or two going about what the signs of PTL are so that people would have good advice. Please join in! Your experiences are so valued!

[mama2karli]

That is a great idea. With DD my water broke in the middle of the night with no warning, so this time I don't really even know what I am looking for. I can't tell if something I am feeling is normal, or a PTL thing or what. Thanks.

[Lousli]

Thanks. I found out with my little poll that most women would visit the "I'm pregnant" forum if they thought they might be in PTL and a few would visit the midwives forum. So my idea is that maybe we can try to spread the word that other forums are there? Or try to go to the pregnancy forums to help people? I don't know, what do you all think?

[boscopup]

mama2karli - I'm in exactly your boat. Everything was fine, then water broke in the middle of the night. So I too am always looking for PTL signs and such. Ugh.

Lousli - I know the pregnancy resources forum is a great place to go, but most just don't go there. Even I barely check that forum, probably mostly because there aren't alot of new posts in there like there are the other forums. But yeah, the I'm Pregnant and the Midwives forums are where I'd probably go for something like that, even though I know about Pregnancy Resources. You just don't get QUICK answers in Pregnancy Resources, since it gets so little traffic, kwim?

[VikiL]

I tell a lot of people my story to make them aware of PTL.
I had no signs and felt nothing, yet I was in ACTIVE labor. 5CM and contractions 1.5min apart. There is a name for this type of labor, but I only heard it once and could not write it down. Also, the 2CM rule is a falicy, it should be 4 or more and if not you should be CLOSELY monitored. So many people are not told what to look for and it is a real shame. If my doctor had told me more of the bad things, or even focused on them a little I would have my twins here with me instead of just one.

[plantmama]

Ok, so what should we look for?
My water broke in the middle of a terrible coughing fit at about 29.3 weeks and I went into labor a few days later. I had lost my mucous plug earlier that day, or at least a lot of thin yellowy white mucous came out when I went to pee.
This time I have a feeling that the baby will be about a week early, but not more.... , let's hope!

So, what should I be aware of and what is the misinformation? I just sort of know from pregnancy books, you know?
Also what would you all do if your water broke early? I ran right to the hospital, and was glad to get the surfactant (sp?), and maybe the antibiotics. Though I am now miffed they did an internal exam as I've read that brings labor on faster...
I have thought about trying to stay home in bed if it happens again and try to ward off labor with remedies, but would most likely follow my midwife's advice whatever that would be, probably scoot to the hospital. I don't know yet. Anyway, I'm almost 31 weeks now, so farther along than I' was before and still feeling positive.
Also, what are any of you next time around mamas doing (if anything) differently, to try and carry to term?

[boscopup]

Originally Posted by plantmama

Also what would you all do if your water broke early? I ran right to the hospital, and was glad to get the surfactant (sp?), and maybe the antibiotics. Though I am now miffed they did an internal exam as I've read that brings labor on faster...

I didn't go to the hospital until almost 12 hours later, but I was not having contractions yet. I did call my midwife right away, we discussed my options (she wasn't sure my water had broken from my description), and I decided to go see her first thing in the morning. Did that, and when I told her what happened again, she realized that it very likely WAS my water breaking (I mean, there was a big gush running down my legs!). So she called her unofficial backup OB and talked to him, then we went in to see him and get tested for AF and get an u/s. He verified that yes, my water had broken and fluid was low. He recommended that we go to a hospital with a level 3 NICU, and he called the hospital ahead of time to let them know we were on our way. We headed up there (an hour's drive) and got checked in. They started antibiotics. They WANTED to check my dilation, but my midwife had told us NOTHING IN THE VAGINA, and my DH was on the phone with her getting more explanation. He is skeptical of anything natural, including midwifery, but he said she made more scientific sense than the nurses. So he didn't allow them to check me (those nurses hated him!). I don't think it would affect your labor so much, but it is a HUGE infection risk. Dilation should not be checked in a PPROM mom. Period.

On the way to the hospital, some piddly contractions started, and they easily stopped once they put me on magnesium sulfate. I got 4 steroid shots over the next couple days, then they kept me pregnant another couple days to let them take effect. Took me off the mag, and let me deliver naturally. Knowing what I know now, they *should* have kept me pregnant longer. We got lucky that DS did so well, but normally you don't let PPROM babies come until 32-35 weeks unless there are signs of infection (had none) or other complication (cord compression, etc.). They instead let him come at 29w4d, and I think they just didn't believe me on my dates because he was big for his age. :

Originally Posted by plantmama

I have thought about trying to stay home in bed if it happens again and try to ward off labor with remedies, but would most likely follow my midwife's advice whatever that would be, probably scoot to the hospital. I don't know yet.

There is a mama on MDC (was it Spark?) who PPROM'd at 31 weeks and stayed home, took remedies recommended by a midwife who had PPROM experience, and she resealed and went very much full term. So it can happen. I don't have a midwife with that much PPROM experience, so I personally would feel more comfortable going to the hospital, but I've got a good OB lined up for such a situation, and I could always use natural remedies and just go home if I resealed like that. But I have done enough research about PPROM now that I know more about what's myth and what's reality when it comes to this issue.

Originally Posted by plantmama

Anyway, I'm almost 31 weeks now, so farther along than I' was before and still feeling positive.

Woohoo! Congrats! I'm 28.5 weeks. I PPROM'd at 29w0d last time, so I'm a bit nervous going into the next week!

Originally Posted by plantmama

Also, what are any of you next time around mamas doing (if anything) differently, to try and carry to term?

I've taken Vit. C this time around, but otherwise, haven't done anything special. We don't know why I PPROM'd. It was probably an infection of some sort, but they never found one. I was outside the window for IC, so I didn't do any monitoring of my cervix this pregnancy (some PPROM moms will get weekly transvaginal u/s to monitor the cervical length, but mostly that's the ones who PPROM around 16-20 weeks or so). My OB has treated me like a regular pregnant woman. I don't have any kind of "high risk" label or anything.

[BetsyNY]

My PTL "signs" were menstrual-like cramps that started around 23 weeks. I was prescribed Terbutaline and bedrest. I lost my plug at 26 weeks. Hindsight is 20/20, but at the time my doctor thought it was just discharge.


I didn't have a chance to get the steroid shot--when I got to the hospital, I was 8 cm dilated.

[plantmama]

Yeah, it doesn't seem like there are too many warning signs...just it's happening signs. I didn't go into labor for several days, but was also told they don't stop labor in PPROM women because of the risk of infection???
I was also in labor (strong contractions) for 7-8 hours and 8 cent. dilated when they finally admitted I was having this baby , kind of silly.

I've tried to do some research on PPROM but haven't found much. I'm also taking vit. C and really taking it easy. Like all my excercise consists of is lots of slow walks with ds and gentle prenatal yoga.
I guess one thing I've read which is good, is that with PPROM, if it happens again, it happens at a later gestational date than the first time, rather than preterm labor which usually happens earlier...this could be wrong though.

Boscopup, did you do the progesterone shots?
Good luck getting through this next week, the third trimester feels pretty good doesn't it?

[Lousli]

It happened earlier with my second than my first.

I know a lot of people don't have any warning signs at all, I didn't with my first. But I also want to encourage people to go with their gut if they feel something is wrong. To be aware that REAL contractions might not hurt any more than BH at first, and the sooner that they are stopped (if possible) the better. That if you lose your mucous plug, it can regenerate, but it might be something to keep an eye on (my friend lost hers 1.5 weeks before she PROM'ed at 33.5 weeks). That kind of thing.

As far as misinformation, I see people say all the time that 6 contractions in an hour is nothing to freak out about, it is probably just an irritable uterus. Or "drink a glass of wine and lie down for an hour." I realize people want intervention free pregnancies and births, and I support that. On the other hand, drinking plenty of water is far more important than drinking wine, and wine isn't going to stop true PTL. That's the kind of thing I'd like to gently debunk and give advice on.

Of course, those people that are pregnant again, or plan to be will want to share stories here as well and get support and information. I just try to be aware of the pregnant moms that are getting the information they need from people in their DDC's or elsewhere.

[plantmama]

I know what you mean. Because sometimes people in the Pregnancy forum ask there instead of going to their mw/ ob and everyone is usually like "Your fine, don't stress out..."
My midwife didn't think I was PPROM when I called her and I basically had to be like "this is NOT pee!"
So, I'm wondering if I lost my mucous plug several hours before my water broke, could that have been something I could have prevented with lying down etc...no stress on my cervix?

[Lousli]

I don't know about prevention of PROM. It is a good question. I believe Vera has a really good link about it. My friend that lost her mucous plug told me that her midwife basically brushed her off and told her she was fine She didn't even have her come in to check her in any way. Unfortunately she ended up with a hospital birth instead of her planned homebirth, and she wasn't able to get steroid shots in time to help her son's lungs. Even though he was nearly 34 weeks and 6 pounds (!) he was on a vent for a while and oxygen for about 3 weeks. She's expecting again and went with a birth center birth this time because she lost her faith in that midwife.

[boscopup]

Here's the good PPROM site, with an e-mail list and everything. Very helpful. After going there, I realized how LUCKY I was that my PPROM was at 29 weeks and not something much earlier like 12 or 16 weeks. Often, for earlier PPROM like that, doctors will recommend termination, and many women have taken that option, not realizing that there was a (small) chance that baby could make it. If they'd had all the information, they wouldn't have made that choice, but their doctors just didn't believe or know that a baby *can* make it. The list has had several live births after such early PPROMs, although there have been several deaths too (if the lungs don't develop between 18-22 weeks, baby won't make it on the outside, no matter how long you keep it in... and you don't know if lungs are developed until baby comes out).

There's also some good study links on the gentlebirth.org site, but currently when I click on a search result, it's asking for an admin username/password. Maybe later I'll try to dig that up when it's working correctly.

Originally Posted by plantmama

I didn't go into labor for several days, but was also told they don't stop labor in PPROM women because of the risk of infection???

This usually depends on how far along you are. If you're in the 32+ week range, yeah, they will probably let you deliver. Better to have a 32 weeker in the NICU than to have an infected baby at birth later on. You PPROM'd around 29 weeks, as I did, and that's sort of a gray area. My OB says *he* would have kept me going until 32 weeks at least, but it would have been hospital bedrest, of course. The OBs I was assigned to let me deliver after getting steroid shots and giving them time to kick in, but I think part of that is because they may not have believed me on my dates. I grow big boys, so my 29 weeker was measuring 31 weeks on u/s (and I know alot of 32 weekers that were smaller than him). The u/s was accurate for size estimation, but developmentally, he was a 29 weeker.

Originally Posted by plantmama

I was also in labor (strong contractions) for 7-8 hours and 8 cent. dilated when they finally admitted I was having this baby , kind of silly.

I had a fast labor, so really took the nurses by surprise! First, the contractions weren't even picking up on the monitor. The nurse moved the monitor, and there they were! But then she said "Oh, you'll be a while". HA. She didn't believe me when I said my family has fast labors - both mom and sister had 4-5 hour first labors, and mom's subsequent labors were 2.5 and 1.5 hours (that last one being me, almost born in the parking lot). So since my water had broken 4 days earlier and my baby was small and in perfect birthing position, it just makes sense that I might go faster than is typical even for my family. Sure enough... But hey, it kept the nurses out of my hair during labor!

Originally Posted by plantmama

I guess one thing I've read which is good, is that with PPROM, if it happens again, it happens at a later gestational date than the first time, rather than preterm labor which usually happens earlier...this could be wrong though.

Don't tell me that! Actually, I have not read that, and on the PROM list, it looks like most went earlier the 2nd time around, but who knows. I think it's one of those things that can happen at any time, unfortunately. I know I've seen some that made it just a week past their previous PPROM date.

Originally Posted by plantmama

Boscopup, did you do the progesterone shots?

No, I didn't. Since I've only PPROM'd once, I didn't feel there was good reason for me to do anything special. If I PPROM this pregnancy, then yes, I'd definitely consider progesterone shots for a 3rd pregnancy.

[plantmama]

I have seen that site before...whew, are you taking all those precautions boscopup? I'm not really doing any of them except reduced activities level. But I still have to lift my almost 30 lb 2.5 y/o- and no, it doesn't feel good.
Maybe I can show the list to dh and get out of doing all my least favorite chores .
I have taken no medical precautions either. I left a practice that basically was forcing me to do the progesterone shots.
This is helpful though and hopeful that most have gone before not after their previous pregnancy's gestation.
Thanks for the link!

[boscopup]

Oh, I'm definitely not doing all those precautions!!! I even still have sex... well, ok, twice a few weeks ago... haven't been in the mood since then (partly because my chiro was out on maternity leave and I didn't want to mess anything up and be in pain for weeks before she came back!). But I'm basically treating myself as a normal pregnant woman until proven otherwise, and I'm taking the Vit. C specifically to help prevent PPROM, since I know my diet is deficient anyway (I'm *such* a picky eater).

If I'd had multiple PPROMs, I might take more precautions that are on that list. But since the chance of having a normal, full term pregnancy is 80-85% for me, I didn't feel a need to go overboard.

[jule924]

I had PROM with my first, but it was only 9 days early so there was no question of whether or not he would be OK, etc.

With my second (who is only a week and a half now) I had some bleeding 2 weeks before I had him along with contractions - some painful and most not. I was in the hospital for 2 weeks and was doing great so I convinced my MW to let me go home (I was on magnesium sulfate most of the time and it was working to slow the contractions). Then the next morning at 2:30 I awoke with painful contractions that never stopped even after going to the hospital and begin on magnesium sulfate for about 5 hours. So would I still have gone into real PTL if I had stayed in the hospital? Who knows???? He was born almost 6 weeks early and is home now after only a week in NICU (for low blood sugar and was on antibiotics). I was able to get the steroid shots and he never had any breathing issues.

[plantmama]

I can't imagine taking all those precautions!
I actually feel way more active now that I'm past 30 weeks and I'm starting to really feel like the baby is doing well in there.
You know, my mom knew she was in labor with me only after waking up in the middle of the night when her water broke. Is it PROM when your water breaks before labor really starts, or is it always early?
I was born on my due date, but was actually probably a week early.

It's weird, boscopup, we have similiar pregnancy histories and now we are only a few weeks different in these pregnancies. Hope you're doing well!

[sweetpeasmom]

Both my ptl took me on by complete surprise. First one I had to go for an 2nd level u/s for polyhydrominos at 31 wks. She did a cervical check and I guess saw something and called my OB. Of course she didn't lead me to believe anything was up, so I went shopping after my test and got home to 5 messages on my machine from my ob saying to get to the hospital asap! I was like freaked. Turned out I was 3 cm when I got to the hospital and contractions where showing up, although I didn't feel anything. Luckily i had that test that day and was able to get to hospital in time to stop the labor.

The 2nd time I noticed a bit of bloody mucous at 24 wks. Didn't really think much of it since I had polyps on my cervix which cause some spotting at times. But for some reason thought I'd call my ob just in case and good thing I did because I was 2 cm and water bag bulging when I got there. I had a hard time for a few months thinking, what if I never called? I almost brushed it off as nothing. My dd may have died but since I did play it safe and called, we were able to hold off delivering her for 6 days, got some steroids in her and some crucial extra time. So i'm always like to give advice to play it safe than sorry.

[boscopup]

Originally Posted by plantmama

Is it PROM when your water breaks before labor really starts, or is it always early?

PROM is when your water breaks prior to labor, regardless of your gestation. PPROM is when PROM happens preterm (prior to 37 weeks). Some women have PROM full term and then go on to have PPROM in subsequent pregnancies.

Originally Posted by plantmama

It's weird, boscopup, we have similiar pregnancy histories and now we are only a few weeks different in these pregnancies. Hope you're doing well!

Yeah, that is neat! I'll be 30 weeks on Thursday (or today if you go by u/s date ). I'm just past the point when Joshua was born. I do still feel a little nervous everytime I stand up, wondering if my water will break suddenly. Once I get to 36 weeks, I'll be more at ease, since at that point, even if I have PROM, my midwife can still deliver me out-of-hospital.

[sehbub]

My PTL was brought on for no apparent reason whatsoever. I went in to labor at 27w6d and was having a lot of bloody show. Contractions every 4 minutes. When I got to my OBs office, he checked me and I was 2-3cm with bulging membranes. I went to the hospital, was hooked to the magnesium sulfate and sent by ambulance to the university hospital 90 miles away because our NICU can't handle babies smaller than 32wks. I received all the steroid shots in the first 48 hours in the hospital.

Three days later I was sent home on bedrest with nifedipine to keep contractions at bay. After a week at home, I went in for a routine visit and was found to be stretchy to 4 with ballooning membranes. Back to the hospital, back on the mag, and this time helicoptered to the university hospital, where I was going to stay until DD was delivered.

Five days after I got to the hospital for the second time, they decided they had to do the gestational diabetes test (I'm refusing it this time) and it sent me in to hard, active labor, contracting every 3-4 minutes. They put me on the mag for a third and final time. After 18 hours they realized not only was I still contracting, but I was dilating as well. They turned off the magnesium and sent the neonatologists to talk to us. 15 hours after they stopped the mag, DD was delivered at 30w2d, weighing 3lb5oz. So, that's 33 hours of labor. :

I had no signs that anything was wrong. Quite the contrary. Everything was as it should be from day 1 of my pregnancy. I knew before I got a positive test that I was pregnant, and had all the "normal" signs (incredibly sore boobs, nausea) and DD had really strong heartrates the entire length of my pregnancy, even through labor. Her heartrate actually accelerated through contractions instead of decelerating like is normal. Apparently the kid liked the rush.

Even though my membranes were "ballooning" they never ruptured. They finally broke my water after I had been fully effaced and dialted for about 15 minutes, and within five minutes of rupture, DD was crowning. The docs were screaming at me not to push because they weren't gloved and gowned yet.

And now we're pregnant again. We got pregnant 4 weeks post partum and are expecting our first son, and last baby, in February. I will start receiving the progesterone shots at 18 weeks, and receive one shot every week until I reach 36 weeks, at which point I'm going to stay pregnant by sheer stubbornness and will until at least 38 weeks. I want a big, healthy baby, and I want to leave the hospital with my son, and not without him.

I just wish I'd had some kind of indication as to what was going to happen. This time, I'm terrified, because everything is perfect, and so much easier than it was with DD. I haven't been sick at all. The only indication I have that I'm even still pregnant is that my boobs hurt like crazy and I can feel my uterus expanding. Other than that, I got nothin.