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Stopping preterm labor

post #1 of 14
Thread Starter 
What are your thoughts on stopping preterm labor and the drugs that hospitals use to do it?
post #2 of 14
Not an OB nurse but our hospital gets a lot of PTL due to our NICU. We do successfully tocolyze lots of moms, which is a very good thing. It often buys enough time to get steriods to help speed up fetal lung maturity. And every day counts when you've got a preemie (unless there is something else going on like severe PIH and it's actually better for the baby to be delivered)

I know we use Terbutaline (also called Brethine) which can cause shakiness. DOn't know too much more about it. Also use magnesium sulfate which makes most moms feel like caca. They can also just try to hydrate mom, sometimes that helps. Most moms with a history of or who are at great risk for PTL are on bedrest though I think I remember reading that research doesn't show better outcomes.

Not sure if this is the kind of response you were looking for. I'm sure some here have personal experience with this.
post #3 of 14
I'd think it would depend on HOW early. If it's really early, it would probably be best to have the meds to stop labor if at all possible rather than deliver the baby - unless there are specific reasons why delivering immediately is necessary.
post #4 of 14
First and foremost for me is tuning into my body and my baby.

My water broke at 31/32 weeks my last pregnancy. Before it happened I always thought that if a situation like that would present itself I would head straight to the hospital (homebirth's usual for me). But, when it actually happened I really had such a strong sense that I should stay home and call a good MW. Thats' what I did and it was the right decision for my baby.

The MW was able to help us stop labor, seal my bags of water & refill them. If I'd have had an easy way to get a steriod shot for lung development, I would have done that, but I couldn't figure out how to do that without admitting myself to the hospital.

My baby Josephine was born at 41 1/2 weeks healthy and beautiful. I don't recommend the route I took to anyone unless they feel it's right for them.

I think preterm labor is a scary thing and we do the best we can with scary things. I would never fault a woman for going to the hospital if she were in the situation I was in. It must be right for her.

I don't always think that hospitals do a good job of presenting the whole story though.

There were a lot of things I did to stop preterm labor. These are just some that I can think of off the top of my head:
Homeopathics (I can't remember all of them though)
Incline (propped one end of the couch up 6 inches with books and then laid with my feet at the tall end)
Wine - not red (I drank 1 glass of wine every few hours until labor stopped)

There were some other things, too, but my son just woke up.
post #5 of 14
Having read many studies on the contraindications and side effects of common labor-stopping drugs such as terbutaline and mag sulfate, I'm very reluctant to use either. There is much coonflicting info as to whether or not these drugs actually help, and it's very certain that they can harm both mother and babe. They're currently the popular drugs of the moment for stopping labor and according to much of what I've read they're not proven to be much more effective than some methods that were used in the past such as morphine or alchohol etc.

Personally, because of past experiences with PTL when I had some issues with this pregnancy I've personally opted to have a drink of alchohol, take a bath and take a nap. This has happened several times when during my last pregnancy I may have opted to go to the hospital and accept drugs. I've noticed that I've had more positive effects with stopping contractions etc. than I did last time. Not being in a hospital environment helped immensely as well. Of course I knew to look out for other warning signs, but relaxation and IMO a bit of alchohol (Which is still being used in many places around the world to stop labor with similar success as the drugs used in North America.) helps IMMENSELY.
post #6 of 14
Without the drugs, my baby could have died, so I'm for 'em, although I know they are not for everyone. The magnesium sulfate was, as a PP mentioned, liquid evil, in all sense of the word. However, I have a beautiful baby girl as a result, and was able to get the steroid shots that enabled my DD3 to survive on room air from her first breath.

And FTR, alcohol and a nap was my first course of action, it just didn't help. Plus at 27wks, I wasn't willing to risk sitting around any longer, not knowing what was happening to my little one.

I wish it would have worked, as the magnesium sulfate was awful.
post #7 of 14
I had three episodes of full-blown preterm labor before DD was born, and I underwent most of the conventional treatment for halting preterm labor. I can't have terbutaline because of a cardiac arrhythmia, so I received magnesium sulfate, and then was sent home on oral nifedipine and prescribed bedrest. DD was born at term. I am not, however, a believer. In the meantime, I have done some fairly extensive research on the subject, becasue I am once again high-risk for preterm labor this time around, because I'm carrying twins, and I want to avoid anything that's unnecessary. Mag sulfate is horrible, horrible stuff, hell really, and I only want it if it's going to help.

Here's what I've learned. The research is pretty clear that despite its widespread use, complete bedrest does not prevent preterm birth in mothers at risk for preterm labor. It may actually increase the risk of preterm birth by raising mother's blood pressure, and just three days in bed substantially increases a woman's chance of developing blood clots. Neither does hydration or sedation bear up under research, despite many anecdotal reports of contractions stopping with hydration. Perhaps contractions that respond to hydration were not true labor to begine with? That's what the studies seem to suggest.

Tocolysis is not effective at preventing preterm labor when it hasn't begun yet, but it is often useful in halting regular contractions once they have begun, or at least breaking the labor pattern and slowing them down, as long as mama is less than 3 cm dilated with intact membranes. Their usefulness has only been demonstrated for delaying birth for about 48 hours however, so the common practice of sending mamas home on oral maintenance doses has not been shown to be effective. The primary reason for tocolysis, according to the research, is to provide enough time for the administration of steroids to hasten lung development. These steroids HAVE been shown to be effective in improving outcomes for babies born prematurely. Tocolytic drugs have significant side effects for both babies and mothers, and should only be used in mothers who are clearly experiencing LABOR and not just preterm contractions that aren't causing cervical change.

Home uterine monitoring has not been shown to improve outcomes, and there is some evidence that frequency of irregular contractions does not seem to predict preterm birth.

Several tests have been shown to have good predictive value in determining which mamas are not likely to deliver early. The most commonly mentioned ones are the fetal fibronectin test and measurement of cervical length by ultrasound in the second trimester. These tests have good value in helping to determine which mothers are good candidates for tocolysis, and which mothers can safely be sent home.

There is another test too, something to do with salivary estriol, but I don't have much knowledge of that one because it's never been offered to me.
post #8 of 14
I used terbutaline with my last pregnancy and would do it again. As far as stopping labor in my case, it was fairly unclear whether I was in true PTL or just having tons of contractions, but with a previous preterm birth and being just over 32 weeks, I wasn't going to chance it. The meds gave me time to get steroids, and slowed my contractions from 3 min to 8-9 min apart. When my water broke, after 4 days of contractions, I had not been experiencing any cervical change up to that point, but after PPROMing, my daughter was born less than 5 hours later. I'm glad that I went to the hospital and slowed the contractions enough for those 2 shots, she needed oxygen for only about 10-12 hours, and then was on room air.
post #9 of 14
I had mag sulfate with my DD at 34 weeks, and probably would not do it again. If I had known more then, I might not have done it then, either. We were "transfers", after planning a birth center birth (one staffed by cnms, where you get whatever cnm happens to be around). As it turned out, the cnm that showed up was the ONE we'd met and didn't like, and between her and the back-up OB, they were basically useless. According to the OB, at 34 weeks, you're right on the line of trying to decide do they or don't they try to stop the labor. Since I was 34 wks exactly, we decided to try. However, I'm pretty convinced that I had placental abruption, and I think they should have known, based on the amount of bleeding I had, and in retrospect, trying to stop labor could have been very risky to both my DD and I. The OB claims he couldn't see one on the u/s, but I don't believe he knew at all what he was doing with the thing, since he kept messing around with it trying to get measurements of DD, and then eventually gave up, and said she'd be around 3.5lbs (She was 5lbs, 10 oz). And a small abruption might not have been able to be seen, but IMO, given the amount of bleeding, they shouldn't have dismissed it as quickly as they did. In the end, when DD was born, her placenta came out immediately behind her feet. Luckily for both of us, the mag didn't work (though it did make me feel like crap), and we were still able to have a relatively natural birth. This time we're doing a lot of things differently.
post #10 of 14
This is interesting how many 32 week preterm labor reports we have. Did you know that in old medical texts it used say that the at 32 weeks is when a lot of babies want to be born. At the time they thought it was a carry over from our ancestors who they presumed had gestastion of 32 weeks instead of 40.
post #11 of 14
Quote:
Originally Posted by Spark View Post
This is interesting how many 32 week preterm labor reports we have. Did you know that in old medical texts it used say that the at 32 weeks is when a lot of babies want to be born. At the time they thought it was a carry over from our ancestors who they presumed had gestastion of 32 weeks instead of 40.
That's really interesting. My two episodes with DD were at 31 and 33 weeks, and then again at 35 (we didn't do anything to try and stop it then; it stopped on its own.)
post #12 of 14
I just wanted to share my experience. I had an irritable uterus with both pregnancies. The first one went to term no problems. I was put on some bedrest for a few days here and there when the cx got too strong but that was it.

For the second pg I had some bloody show and dilation along with the cx starting at 23 weeks. That was really scary. I ended up on full bedrest and terbutaline for the rest of the pg. I had a couple of other episodes where I started to dilate because the cx were breaking through the terb. The terb never stopped my cx. It just weakened them.

I think I did the right thing by taking the terb and doing the bedrest. My OB at the time said that he wasn't sure if the terb really helped prevent labor. He had seen mixed results in his practice. However it was best to take it in case it helped me. Better to try it since at 23 weeks I didn't have much to lose except my baby. (He didn't say it in those words but that's what he basically told me.) If I had started to dilate more rapidly they would have put me on the mag.

So, as it turned out, I got off the terb at 35 weeks when it was deemed safe for my baby to be born. I expected to go at any time. I dilated all the way to four cm and was walking around like that. The cx were really strong for weeks and I was getting no sleep, was exhausted and stressed out. Finally did some things to start labor on my own when I got to 38 weeks. It was the types of things that would not work unless the body was ready to have the baby anyway. I had her at exactly 38 weeks. I had a very strong bag of waters and I wonder if that helped to prevent her from being born early. No PROM.

Looking back I am not sure if the terb really did much to truly prevent a premature birth. If I had to do it all over again I would do the same thing, though. My baby's life was at stake. I would also have probably researched and done everything to change my diet and supplements to support a healthy pregnancy and relax the uterus.
post #13 of 14
Well i've had the mag sulfate with both my pregnancies. If I had to do it over again, i'd probably do it. Yes it was hell but it did work. It bought my first baby 5 more weeks and she was fine. My second gave me enough time to give her the steroid shots. Although I did refuse a second treatment of mag with my 2nd. She was going to come no matter what and i didn't want her to have any more medications.
post #14 of 14
I am new here, but I have just been released from the hospital on bedrest and Terb to prevent PTL, since my DS decided he wanted to come at 32 weeks. So far I have not taken my maintenance terb doses, simply because I don't feel the side effects are worth it. Does anyone have any experience with the long term side effects of Terb on a baby? I took it, plus Mag sulfate and phenergan and steroids in the hospital, and now I am really regretting it. However I was just trying to do what I thought was best at the time. I think it is horrible that my OB never mentioned to me that Terb is not even FDA approved for use in stopping PTL!
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