Terbutaline? Pre-term labor or Irritable Uterus?

[radicalmama]

Yesterday, I was having contractions intermittantlly at school all day, came home and went on way too long hike w/ DP (6 or 7 miles) and by the end was having contractions on top of one another and a lot of pain. Went home and took a hot bath, relaxed on the couch, and drank a lot of water, but still kept contracting. Checked my own cervix and it felt about 1 centimeter and really soft, although still long. Decided not to even wake up my midwives, (it was 1 am) and went to the local hospital. They couldn't really pick up the contractions on the monitor, but said it didn't mean that I wasn't contracting (hard to detect because I'm only 24 weeks). The nurse did an internal exam and said she could see why I thought I was dilated, because my cervix was like a funnel and the front felt open and stretchy, but the back was closed and probobaly couldn't reach that far back. Cervix is really soft though, although still thick. They called my back up doctor and he ordered a shot of terbutaline. It seemed to help some and they sent me home. Still having some contractions today since waking...the doctor called in a prescription for terbutaline. I was on it in my other pregnancies (although I didn't remember it in the last one...but my midwives found it on my records), and I hate the way it feels. Plus, I've read that there is evidence that it can be harmful and not helpful... I watched the baby's heartrate go up from 140 to 154 after the shot... I've never delivered before 37 weeks (had PROM in first pregnancy at around 35)...but I certainly don't want a preterm baby. I am in school full time and have three other kids...

Suggestions, ideas, articles, etc? Thank you.

[nighten]

Well -- sorry to sound like a pooper -- but maybe lay off the hiking?

When contracting pre-term, we're all told you're to drink buttloads of water and lie down. Or at least sit. And do it right then. But don't go for a 6 mile hike! :wink

So my vote is to up your water intake daily, check your mineral intake, and stop pushing your body so much. You already are in school and have three kids so you've got TONS on your plate already. I'm just gonna assume you're a very active person from those facts alone. So honestly, hiking or ANY extra time on your feet with your difficult pregnancy history is just asking for contractions. I'm sorry but it is. (I say difficult because I assume the doctors wouldn't have put you on the meds if you weren't in danger of pre-term.)

I had a dear friend who jogged all through her first pregnancy -- up to the last few days before she went into labor. With her second baby she had to stop because she started contracting early in the 3rd trimester.

And thankfully, she did. I strongly urge you to do the same. Your body was trying to tell you to slow down -- please listen to it!

The bath and water was a good thing -- I have no experience with Terbutaline and will let others advise you on medicinal alternatives.

My advice is listen to your body more and slow down.

Good luck! :)

[etoilech]

A one time shot of terbutaline? That's a pretty weird thing to give you. You're either in pre-term labour or your not.

Protocol would be if you were contracting and producing cervical changes they would admit you and put you on a tocolyctic. If you are in PTL, usually the risk of the tocolyctic is less than the risk of having a a pre-term baby. They can usually put off labout long enough to administer cortisone shots and give the babe a bit longer to grow.

FYI, there are better more effective (read more expensive) tocolyctics than terbutaline. They are hormone based and do not have the same bad side effects of terbutaline. Just so you have that information. Search for "hormone and tocolyctics" in google and it should be able to come of with drug trade names and studies.

Very strange, I've never heard of getting a one off shot of it, but then again you learn something new everyday. :wink It sounds like a CYA thing. They use terbutaline b/c it's cheap and easy.

Try to take it easy mama. Warm bath, glass of wine. Lots of water. I have a very irritable uterus and delivered my son at 29 weeks, I know it's stressful. I hope that you're little one stays a bit longer.

Olivia

[Brinda]

If the terbutaline bothers you, you could try Procardia. It's used for PTL, but doesn't have the rough side-effects of terbutaline. Procardia will actually lower blood pressure. I opt for Procardia first, and add terbutaline only if I end up really needing to. I have to watch the Procardia, though, because I have naturally low blood pressure, and being on strict bedrest makes my blood pressure even lower.

When I have irritable uterus, my contractions are VERY frequent, but only last 15-20 seconds, and I can have up to 10 in a couple minutes. My PTL contractions last a lot longer, more like 30-45 seconds spaced 3-10 minutes apart.

I also agree that perhaps you should shorten your walks/hikes.

[Lousli]

I was given the one-time shot of terb, 3 or 4 times in my last pregnancy, as well as a prescription for oral terb. I think it is because it is tough to determine whether you're in PTL or having irritable uterus in many cases. I was told to take the terb. on an "as needed" basis, but the thing about it is that it gets less effective the longer you are on it, so at first I was taking it only once a week or less, and later every 2-3 days.

I would agree with PP's that there are other drugs that they can put you on if you truly need them, but also that if you are having an irritable uterus with no cervical changes that you may not need them. Check with your midewife and see what she suggests. My guess is that she will say hydrate, rest, lay off the hiking, and if you start contracting to lay down for an hour. Hopefully that will be enough to take care of the contractions without meds. The pregnancy resources section has more information on preterm labor, if you'd like to check it out. best of luck to you and your baby!

[KoalaMommy]

Well -- sorry to sound like a pooper -- but maybe lay off the hiking?

:yeah:

Whatever is going on, you shouldn't be hiking when you're having contractions (especially so early in pregnancy). I'm having lots of contractions (since about 33 weeks) and my midwives tell me to drink a quart of water, take a warm bath and go to bed when they start to get too strong or too close. One time when they didn't stop they told me to take 2 extra strength tylenol with something caffinated, a warm bath and go to bed. I've been known to sip a glass of red wine now and again to slow them down too. But it is always followed by warm bath and go to bed, not long hike!!!!

[Llyra]

I delivered my son extremely prematurely, so when I started contracting a lot at 31 weeks we took it extremely seriously. Now, looking back, I can say that I'm pretty sure all the stress and aggravation was unwarranted, and that I just had irritable uterus, or maybe it was just what was normal for me.

I'd say lay off the exercise and take it easy, stay hydrated, and really try and relax.

As for the terbutaline, I never had it because I have a heart condition and it's contraindicted for me. I do know from my research, though, that the maintenance doses of it have never really been shown to be effective.

I had mag sulfate, which I wouldn't wish on my worst enemy. I also took Procardia for 6 weeks, and while the side effects are nothing like mag sulfate (which made me feel like I was going to explode) or terbutaline, there were definitely effects-- dizziness and headache. Also, Procardia carries its own risks-- the risk of intrauterine growth retardation-- and isn't really approved for use as a tocolytic. Nothing I've seen has convinced me that any of these drugs are effective for more than a day or two-- they can buy you some time to transfer somewhere that has an NICU, and that's pretty much it.

There's a test that can be done, called a fetal fibronectin test. It has a very high rate of negative prediction-- that is, if you get a negative result from the test, it means you will likely NOT go into labor within the next two weeks. It's a 99% accurate result. A positive result is less reliable-- you might go into full-blown labor, and you might not-- but I can say that the negative result is very reassuring. Most insurance carriers will pay for the test before 34 weeks, and it's easy-- just a quick cervical swab, like a Pap. It might be something to ask about.

[radicalmama]

Llyra-thanks for the info!

I'm going to ask about the test.

[cymbeline]

FWIW, I hate that term, "irritable uterus." As usual, women's bodies are blamed for being troublesome when they don't adhere strictly to medical expectations. </rant over>

Anyway, I started having ctn's about 5-10 min apart starting at 24 wks with my first. My cervix was soft but thick and low. The dr. didn't want to take any chances, hospitalized me, and gave me morphine to stop the contractions. What she didn't know was that I was allergic to morphine and I went into anaphylactic shock. In case I was dehydrated, they gave me an IV of saline, and that helped a lot.

I went back to the hospital twice, "just in case," and got the saline both times. It was then that I had a serious pow-wow with my body and my baby and decided that I was a-ok and just needed more water and rest.

Everyone told me, including the dr., that I would go early, but I gave birth on my due date (at home with a midwife, I dumped the distrustful doc)!

Same thing with my 2nd, ctn's started at 24 wks, but this time I just rested and drank water. My 2nd was born 11 days before his due date, technically on time.

I figure this time I am in for "irritable uterus" symptoms again, but I know now that they are not harmful. That is not to say that you should ignore your symptoms by any means. But I do recommend to any woman who has a dr. recommending drastic measures to follow your maternal instincts.

Good luck, and I hope things smooth out for you asap!!

[nfbmom]

The reason "irratable uterus" can be harmful is that there isn't really any way to tell if it is just that or actual ptl, unless your cervix gets checked. I will have ctx for 5, 6 even 7 hours that don't do a thing or I can have ctx for an hour and have my cervix be changing. There really isn't any way to tell just from the ctx and that is why they can be dangerous.

FWIW, every time I start ctx I do the same thing. Drink a ton of water, change what I'm doing, take a bath, lay on my side, etc. If, after 4 hours of ctx, I am still contracting then I get checked. If it was ptl, it continues after I get to the hospital. If it's irritable uterus, it always stopped when I get to the hospital. I always felt so dumb! It happened so many times that I have started teaching dh how to check me so he knows what it would feel like if there are changes. I figure if I go to the hospital I will end up with at least 4 people checking me so why not save the trip and get someone who I know and who has mostly the same germs that I do, check me first.

Also, I never can go "by the books" They say to get checked if you are having more than 4 an hour. I'm used to ctx every 7-10 minutes so the books are useless in my case. I go more by my mood. If I'm feeling nervous about them, I go. One more thing, one shot of terbutaline has helped me many times. It's not unheard of.

[kerikadi]

I had some contractions when I was about 33 weeks with #4 after a day at the beach and a long car ride.

Have you tried calcium with magnesium? All good calcium supplements have magnesium in them - I tripple dosed on a good cal/mag supplement, took a long hot bath and they subsided - I carried to 40w 4d :)

Cal/Mag is great for menstral cramps because it calms the uterus.

Good luck!
Keri

[Daphnes_mama]

I am so glad I found this thread. I am 27 weeks pregnant, and I am having contractions! They are irregular, B-H contractions, but they still take my breath away. I also panicked when I looked in my pregnancy books and it said to call a doctor if you have more than 4 an hour. Well, last night I had 7 in one hour and this morning I have had 6 in one hour. I have only had a few during the last few hours, however, so they are irregular like I said. They also don't last long (30 seconds tops). However, I am starting to notice that my activity level might be causing it. Yesterday, I took a mile walk, came home, cleaned the bathroom, cooked dinner, and vacummed. Of course, I am sure all of it aggrevated my body and made me contract more.

Anyway, you are not alone. I guess this is why we are supposed to rest, huh? I go to my midwife tomorrow and I plan to ask all about this. I had to spend a few weeks on bedrest when I was pregnant with my daughter, but it was not until I was 34 weeks. I don't want to spend the next 3 months on bed rest, but I guess I will if I have to. The baby is worth it. Of course, I HATED terbutiline. That stuff is nasty! It made me jittery and shaky I remember.