questions for you professional ladies :) (sorry so long)

[~NewMa~]

OK, here's the story.
I'm 33 weeks 6 days today.
Last Monday, at 32 weeks, I started with preterm contractions. My cervix never showed any change though.
I was never in any pain or distress but the monitor at the midwifes office showed contractions 2 minutes apart lasting approx. 45 seconds.
I was sent to the hospital for a shot of Brethine to stop them and then went home.
I got a call from the midwife that night saying my fetal fibronectin swab came back positive so she was calling in a script for a med to keep contractions at bay. I was also instructed to restrict activity (meaning stay out of work also) and told to stay on pelvic rest.
Since then I've had NST's twice a week.
First one showed alot of "irritability".
Second one showed nothing
My third was yesterday. I had 1 big contraction and alot of small ones that were 3 minutes apart and only lasting about 20 seconds.
Again, no change in my cervix, no pain or distress. Babys heart rate looked great throughout these exams.
I've been taking the med as prescribed and following all restrictions.
I was told this last appointment to restrict my activity further and take the med 4x/day instead of 3x/day.
SO, my questions:
Why would this be happening in the first place?
How long can you painlessly contract so frequently without showing any changes in the cervix?
Should I be concerned about fetal distress at any point if this were to continue? I was told they're going to stop the med at 36 weeks and let whatever happens happen.
Is is possible I could contract rhythmically like that for a prolonged period before actually going into labor?
I'm confused as to why these contractions would be so close together but show no changes.
I don't know. Please help me understand! :

[Malga]

Here are some thoughts or opinions-- not to be taken as the gospel ;-):

Why would this be happening in the first place?

There are a lot of risk factors for preterm labor, but no one knows exactly what causes it. Some risk factors are (there are lots, but here are some interesting ones): low prepregnancy weight, obesity, stress, lack of social support, low socioeconomic status, peridontal disease, etc...

How long can you painlessly contract so frequently without showing any changes in the cervix?

I have seen people contract painlessly all the way until they are 40-some weeks.

Should I be concerned about fetal distress at any point if this were to continue? I was told they're going to stop the med at 36 weeks and let whatever happens happen.

I don't think so. It sounds good to let nature take its course after 36 weeks so you can get off the drugs as they have side-effects. Some people then continue to term, but your positive FFN may mean you won't.

Is is possible I could contract rhythmically like that for a prolonged period before actually going into labor?

Yes

I'm confused as to why these contractions would be so close together but show no changes.

It may be that not all of the uterine muscles are working together yet or you would make cervical change.

How is your diet and fluid intake? Are you gaining weight well?

[~NewMa~]

I'm at 34 weeks Monday and prepregnancy I weighed 124 lbs (5'7") and am now at 154lbs.
My diet has been really healthy.
I do have high stress job but haven't worked since the first incident of contractions.

[Alison Cole]

Okay, this is just my $.02, so take it as what you will...

I don't understand why contractions that don't change the cervix at all are considered to be PTL. My understanding of labor is that cervical change is involved. But you're not having that. Ergo, you're not in labor. If you showed up at your birthing location at term having these kinds of contractions, they'd likely send you home saying that you're not in labor. So, why all the fuss? I do think your body is could be trying to tell you something -- maybe that it was time to be done with the high-stress work environment for now, maybe that you need to drink more water -- but it's also possible that these contractions are simply your body's way of gearing up for the work of labor that is to come. Spring training, if you will. Your baby's been looking good, you sound pretty healthy. What is your sense about your health? If you feel well, and that your pregnancy is healthy, jump through the hoops, but please try not to worry. Your baby isn't coming yet, and that's a good thing. In a couple of weeks your baby can come without any concern, and you'll be well-rested and ready. Though, watch -- your baby will decide to stay in till 41 weeks just to keep everyone guessing.

The midwives I was apprenticing with last year often talked about how sometimes these bouts of early contractions were the uterus trying to help the baby get into a good birth position for birth. They would recommend forward-leaning (i.e. elbows resting on the counter, legs at a rightish angle to torso) or hands-and-knees, with a little hip-swaying action when the ctx come on, to help the contractions get the babe in a good place. Then, often, once the babe is well-positioned, the ctx peter out for a few weeks until it's time for the real deal. This could also be what's going on.

I wish you peace of mind and a beautiful birth at or around term.

[~NewMa~]

Originally Posted by Alison Cole

I don't understand why contractions that don't change the cervix at all are considered to be PTL. My understanding of labor is that cervical change is involved. But you're not having that. Ergo, you're not in labor. If you showed up at your birthing location at term having these kinds of contractions, they'd likely send you home saying that you're not in labor. So, why all the fuss?

I completely understand all that which is why I never used the word preterm labor to describe what was happening- just "preterm contractions".
I even felt silly going to have my midwife check them out but with all the literature you read they tell you that if you have contractions 10 minutes apart or closer, to have someone check. I'd been contracting from 6am to about 1030 am before I started timing them at 2 minutes apart.
My midwifes concern was that if it had continued this way, labor would start and at 32 weeks it wasn't safe to let them continue.
I do appreciate your info on this possibly being a way of the uterus trying to get the baby into a good position. That's a thought.
I guess I don't really see what all the hubbub is about either. I'm just really trying to figure out whether or not it would be all that harmful to let the contractions continue as long as they weren't causing change because right now I'm on a prescription med that there's not much literature about taking during pregnancy (procardia) and that scares me!
I haven't taken so much as a Tylenol this whole pregnancy and have been trying to do things more alternatively so taking a prescription med just bothers me.
I have another appointment on Tuesday and will discuss these concerns with my practioner then, I just wanted other opinions and points of view.
I think my midwife is just following her backup Dr.'s orders so maybe if I talk to her about this she'll just agree to monitor for cervical change without the use of the med. We'll see.
Thanks for the info.
(Any more thoughts or information are welcome of course!)

[jengacnm]

The fetal fibronectin being positive indicates that the contractions ARE enough to cause cervical change, albeit microscopically at this point. If you were contracting every two minutes but the fetal fibronectin was negative, you wouldn't have to be on bedrest.

Fetal fibronectin is a by product of cervical dilation.

Ask your midwife about the specifics of the fetal fibronectin-something like and I'm guessing here-a negative test indicates that preterm labor and birth is NOT likely to occur in the next 72 hours. Ask her what a positive test is supposed to mean.

As to the procardia-it's a smooth muscle relaxant, and you're right, it hasn't been well studied. Neither has Brethine or magnesium sulfate. All are used to prevent preterm birth. It's a question of balancing the unknown risks of a medication against the KNOWN risks of preterm birth.

HTH!!!

[Malga]

We do these tests at my work-- here is some info. from the manufacturer on what the results mean:

What a Negative Test Result Means
A negative test result means you have a less than 1% chance of giving birth in the next two weeks, which can give you peace of mind and can help you avoid unnecessary drug treatment, bed rest, and hospitalization. This knowledge can provide reassurance so you can get on with your current activities without worry and you don't need to cancel plans unnecessarily.

The vast majority of women will get a negative test result, indicating that no fetal fibronectin is "leaking" into the vagina
A negative test result gives you 99.2% assurance that you will not deliver in the next two weeks1

What a Positive Test Result Means
A positive test result means your body is leaking fetal fibronectin, a sign that your body may be getting ready to deliver.

There is an increased chance that your baby is going to arrive early — but not everyone with a positive test result delivers early. The test can be repeated as often as every two weeks to monitor your ongoing risk.

I've seen different stats for actually having a pre-term birth after a positive FFN test from 30-60% increased risk (cervical length also plays a role). The FFN can detect a chemical marker of cervical change before any cervical change can be palpated.

[~NewMa~]

Thanks for explaining the fFN swab. I only had limited information on it based on what I got from the march of dimes website, I think this helped me more though!

[annanicole]

From a been there done that perspective. I first entered the hospital at 26 weeks. I was contracting a lot. not very painful. I had a short cervix but not scary. At 27 weeks i was hospitalized again for contractions that wouldn't stop. I was put on procardia at that time. I was not having any significant change until 32 weeks where I dilated to 1cm and was 50% effaced. My contractions were causing the baby distress that is why my midwife opted to keep me medicated. This went on until 37wks when i had my son.

Later after a lot of testing It was determined I have a heart shaped uterus which is prone to irritability. So I ran very little risk of preterm labor, but had painful contractions off and on from 32 weeks until I delivered.

good luck Mama, it's scary. I was freaking out. Possible early baby, possible side effects from the medicine. You'll get through it!!! Pray a lot

[~NewMa~]

I'm not scared.
I'm tryin to stay really positive and just keep my sights on at least 37 weeks.
I'm talking to the baby and asking him to please start listening to his mama and stay put for just a little bit longer!
I talked to my midwife about coming off the procardia since the contractions weren't causing stress to either of us, but she said because of the +fFN, and the fact that I was contracting again every 3 minutes during an appointment last week, it's a better idea to keep me on it until at least 36 weeks.
So, a little less than 2 weeks to go. I'm sure it'll fly by.
I still have no cervical change. I almost wish I did have some so that I had a head start when I actually go in to labor
I don't know if that's really smart or not, but it seems like it would help, no?
Thank you for your info and support!

[DoulaAlicia]

My Story

Hello -

I'm also from the viewpoint that the definition of contraction is dilation. The only other factor here is your positive ffn test. Hmm. I wonder. But I will tell you this about myself:

My first child I started getting bh contractions at 6 months pregnant and they continued in frequency and duration until the end with a full term 37 week delivery.

My second child these bh contractions (practice contractions) started at 16 weeks along. As you I entered the hospital with contrax 2 minutes apart. Staff was perplexed - no cervical dilation. Sent me home. Contrax continued until a full term 39 week delivery.

My third child I GOT MY FIRST CONTRAX AT 6 WEEKS ALONG. I couldn't believe it!! MY uterus just balled right up tiny as it was. And they continued on until birth at 38 weeks 4 days. Some days they were mild, others they were a couple minutes apart for hours at a time.

That is just the way my body works. And while I was nervous about it for the first two pregnancies I was content with the third.

I've heard others with similar stories some of them who have been content and others who have stayed super medicated because they are too nervous. But none of these people I refer to ever experienced any dilation.

It is possible you are like me and this is just the way your body births (slowly...haha). I am a VERY quick laborer though once the day comes. My last two children were born in a bit over 2 hours from first contrax to birth. Maybe this is in your future too! My first was about 7 hours.

Anyway you did infact get a positive ffn so special precaution is needed. As far as damage to baby from so many contrax from my research and probing questions I've been told that "no, these contrax are natural and normal and will not hurt the baby"

[SublimeBirthGirl]

I had ctx starting at 19 weeks with my 2nd. Regular and often towards the end. I had a UC so there was nobody to give me any drugs or check my cervix, but I went to 40+6 despite contracting for so long. I'm not saying you don't have anything to worry about, I have no idea. If your cervix isn't changing I'm not sure it's PTL though. Are you taking RRL? I think that can cause irritability in the uterus (I hate that phrase).