PTL question

[jmwmommysings]

Hi there,

I am 28 weeks with my 4th and am looking for some more information regarding PTL. With each of my babies I've had some form of PTL and have tried to avoid as much medical intervention as possible. I have a wonderful midwife that I really like and trust though she tends towards more medical treatments than I would like for somethings. That was great earlier in the pregnancy with my struggle with Hyperemesis (which I still have just not as severe) but now I'm looking for more herbal/natural remedies for dealing with pre-term labor.

Quick history:
DD #1 I had an OB: PROM at 28 weeks, IUGR baby, made it to 42 weeks.
DD #2 I was told I had an irritable uterus but when checked I was dilating at 30 weeks, 36 weeks I was 7cm, and 37w, 1day she was born at home.
DD #3 terburtiline (sp?), wild yam root, etc. from 24 weeks on, baby born at 35w, 6days at home.

I don't want to take the terburtilin if I can help it since there is a lot of controversy about it's effectiveness. I've been having effective contractions since 16 weeks... well, I won't let them check me since then but at that point I was thinning and 2 or so cm. I lost my mucus plug last night (I know it can regrow so I'm not worried about it) after strong regular contractions off and on since Sunday. I took a bath, had a glass of wine, changed activity, rested, took wild yam root tincture, and Benadryl to sleep. The contractions stopped or I was able to sleep through them and I haven't had too many this morning. Last night they were getting to about 60-90 seconds long and 5 min. apart.

Is there anything else I can do? I don't want to have an early baby that can't breath and needs to be in a NICU and I really want a home birth again. A strong believer in intuition, I'm not real worried that she's coming just yet because I don't have that sense. Granted, not a for sure thing, but since I don't believe that she's coming yet do I even need to do anything or am I being naive and taking too much of a risk? Should I have my cervix checked (I REALLY don't want to) or can it wait?

Thanks for your help!

[mendomidwife]

PTL can be tricky because it is difficult to predict who will go on to deliver early and who is just having contractions. And you are right, PTL is very overtreated. It sounds like from your history that you had problems in with previous pregnancies, which may be a clue. It also sounds like you know what you will and will not do. I would want to check your cervix - it is the only way to know if the contractions you are having are causing cervical change...i.e. - increasing your risk of PTL/early delivery.
What about learning to check your cervix yourself as a way of monitoring.

Carla

[jmwmommysings]

Originally Posted by mendomidwife

PTL can be tricky because it is difficult to predict who will go on to deliver early and who is just having contractions. And you are right, PTL is very overtreated. It sounds like from your history that you had problems in with previous pregnancies, which may be a clue. It also sounds like you know what you will and will not do. I would want to check your cervix - it is the only way to know if the contractions you are having are causing cervical change...i.e. - increasing your risk of PTL/early delivery.
What about learning to check your cervix yourself as a way of monitoring.

Carla

I started learning how to do self checks with the last baby so I did check myself this morning... still hard for me to tell though. I'm about three fingers, the cervix is much more soft that I expected and lower too. Part of me feels this is just how I do it and I don't want the freaking out we've had before- that didn't do me any good. Thanks for the advice!

[olive&pimiento]

Three fingers side-by-side would be about 4 cm. If it were me, I would have my midwife check me. If I was having regular ctx and cervical dilation, I would consider the corticosteroid shot to help out the baby's lungs. I had PTL from 32 weeks on and was on Terbutaline for five weeks with strict bedrest. I really understand the desire for no medication. Terbutaline made me feel horrible. I did have two shots of betamethasone for lung surfactant development. Good Luck!

[jmwmommysings]

I see my midwife tomorrow and am starting to think I'll ask for an internal or maybe she'll just have be describe what's going on and go from there.

Are there any herbal or more natural options before the Terbutaline? I hated how that stuff made me feel and would like to exhaust all other options first. Back at 16 weeks they wanted me to do a cerclage but I opted out... was that stupid? My gut just told me to not go with sewing my cervix shut for some reason (risk of infection, risk of PROM, etc.) but now I'm wondering if that would have been better. I just hate that I try so hard for an umedicated pregnancy and birth and yet end up on Zofran and other stuff for hyperemesis and then Terbutaline... having a spinal for the cerclage just seemed like going against everything my instincts tell me for pregnancy.

I'm starting to have that very overwhelmed feeling, like damned if I do, damned if I don't. :

[mama2annabelle]

I would definitely get checked out by a midwife if I were in your shoes. You really need to know what you are dealing with before deciding on what course of action to take.

I had PTL with baby #2 starting ar 23 weeks. After 7 weeks on oral terbutaline, I saw a more natural-minded OB who my MW referred me to. He suggested I start on natural progesterone cream, which I did. I stopped the terb at 30 wks and continued on bedrest. DS was born at 38 wks.

[crsta33]

I'm not a birth professional, but my midwife just recommended some things to help calm my irritable uterus. I'm taking skullcap, passion flower tincture, and a liquid calcium/magnesium supplement before bed each night. The contractions have diminished and I'm sleeping better, which is a bonus. I wouldn't be able to take terb even if it was recommended as I have heart rate issues, although I will take the steriods if it looks like these ctx are going to head towards PTL.

Best wishes.

Christa