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Tell me about 36 weekers please

3K views 18 replies 12 participants last post by  AllyRae 
#1 ·
Here's my situation......I was put on terbutaline for premature labor...can't take it anymore because I'm allergic...and here's the part i posted in my DDC

"okay, we're trying overnight without meds......if it doesn't go well they are considering Procardia....REALLY, Procardia???? for someone who will be, at that point, 1 day shy of 36 weeks?????? Someone that occasionally has a blood pressure reading as low as 90/60???? I'm not sure I'll agree to it. My normal BP ranges fro...m 90/60 to 110/70.....and Procardia is a medicine for hypertension!!!"

I'm trying to decide if the benefits of Procardia outweigh the risks here.
 
#2 ·
I'm sure you have tried hydration. If you are the least bit dehydrated, it can cause preterm labor in some moms, seeing how you already have a couple, the more labors, the earlier they can be and the quicker, or so I hear.

I would try magnesium first, if you haven't already.

You can always refuse medical advice/treatment. If you want to speak with someone about it, I'd call a local midwife, and ask her her opinion, and go from there. If you are uncomfortable with that, I'd get a second opinion. No good Dr. should be offended by a "patient" getting a second opinion.

Happy Birthing!
 
#3 ·
Quote:

Originally Posted by AustinMom View Post
I'm sure you have tried hydration. If you are the least bit dehydrated, it can cause preterm labor in some moms, seeing how you already have a couple, the more labors, the earlier they can be and the quicker, or so I hear.

I would try magnesium first, if you haven't already.

You can always refuse medical advice/treatment. If you want to speak with someone about it, I'd call a local midwife, and ask her her opinion, and go from there. If you are uncomfortable with that, I'd get a second opinion. No good Dr. should be offended by a "patient" getting a second opinion.

Happy Birthing!
Thank you
I actually have about 5 doctors, lol. I have to drive 2 1/2 hours to a high risk practice because I have 3 clotting disorders. I was hoping for a home birth until finding all of this out...but now I need to be with people that understand my condition. I will certainly ask about magnesium though. I'm not prepared to just blindly do what they say, I'm compiling a list of questions....and they'll have to convince me it's for the best. I'm supposed to call them in the morning to tell them how the night without meds went. Since I contract very regularly about an hour before my next dose of terb, I think I'll be going all night. I'm using my time before I have to call to assess the risks of a 36 weeker vs the benefits of taking a med that might be risky for me. UGH
 
#5 ·
OMG take the medicine.

I am a biased high risk L&D nurse so you probably will view me as the enemy. however, i see these babies and i see how they act at birth. very few kids are mature at 36 weeks. They don't do well. they have breathing problems, blood sugar problems, bilirubin problems, feeding problems.....

As a fellow preterm-laborer, I know you are miserable. I was on all the meds from 25 weeks on. Magnesium Sulfate IV is the worst of them all.
You said you are allergic? Why do you think that? An allergic reaction could either be mild (very severe hives) to severe (anaphylaxis or not breathing). I am guessing you are experiencing an adverse reaction to a med (which although annoying, in the short-term, if the benefits outweigh the risks, the dr would still recommend you take it). IF you are "allergic", you should be immediately off the med.
THe issues are this:
1. your life trumps the baby's life. meaning if your life is actually endanger, absolutely, you would be delivered immediately. however, if you are just "sick of being pregnant" and "sick of the terrible experience that preterm labor meds are", that is not enough to put your life ahead of your baby's life. See the difficult decisions doctors/midwives are faced with when the majority of women near the end of their pregnancy and say THEY ARE DONE!
2. your dates might be off...unless IVF was done. Your baby could really be 35 weeks.
3. there are potentially serious problems that a 36 weeker can face (just google Late Preterm infant) and I would hate for you to be faced with the regret and guilt if something did go wrong with your babe.

If I were you, if you really want to go off the meds b/c you can't stand them anymore.....I would talk with the dr about doing a amnio to test the baby's lung maturity. Therefore you will know if it is safe if you do go into actual labor and deliver.

Procardia is so much easier to tolerate than terbutaline. There is an extended release tab that your BP might tolerate better. Also, just be smart about it. Drink a ton of water. Take it the first time or two when someone else is there. Get up very slowly. See how you react to it. Maybe even take your BP at home before the next dose.

Even 1 more week would help SOOOOOOOOOOOOO much. You can do it.
 
#6 ·
My 36 weeker did pretty good considering she had IUGR. She weighted 4lb 14oz at birth.. when I brought her home a week later, she weighed 4lbs 8oz. She had some preemi problems (temp regulation, heart murmer, and feeding issues).. most resolved before even leaving the NICU. If your baby hasn't stopped growing, than the odds of even being in the NICU at all are low. Congrats, and happy birthing
 
#7 ·
Quote:

Originally Posted by elf View Post
OMG take the medicine.

I am a biased high risk L&D nurse so you probably will view me as the enemy. however, i see these babies and i see how they act at birth. very few kids are mature at 36 weeks. They don't do well. they have breathing problems, blood sugar problems, bilirubin problems, feeding problems.....

As a fellow preterm-laborer, I know you are miserable. I was on all the meds from 25 weeks on. Magnesium Sulfate IV is the worst of them all.
You said you are allergic? Why do you think that? An allergic reaction could either be mild (very severe hives) to severe (anaphylaxis or not breathing). I am guessing you are experiencing an adverse reaction to a med (which although annoying, in the short-term, if the benefits outweigh the risks, the dr would still recommend you take it). IF you are "allergic", you should be immediately off the med.
THe issues are this:
1. your life trumps the baby's life. meaning if your life is actually endanger, absolutely, you would be delivered immediately. however, if you are just "sick of being pregnant" and "sick of the terrible experience that preterm labor meds are", that is not enough to put your life ahead of your baby's life. See the difficult decisions doctors/midwives are faced with when the majority of women near the end of their pregnancy and say THEY ARE DONE!
2. your dates might be off...unless IVF was done. Your baby could really be 35 weeks.
3. there are potentially serious problems that a 36 weeker can face (just google Late Preterm infant) and I would hate for you to be faced with the regret and guilt if something did go wrong with your babe.

If I were you, if you really want to go off the meds b/c you can't stand them anymore.....I would talk with the dr about doing a amnio to test the baby's lung maturity. Therefore you will know if it is safe if you do go into actual labor and deliver.

Procardia is so much easier to tolerate than terbutaline. There is an extended release tab that your BP might tolerate better. Also, just be smart about it. Drink a ton of water. Take it the first time or two when someone else is there. Get up very slowly. See how you react to it. Maybe even take your BP at home before the next dose.

Even 1 more week would help SOOOOOOOOOOOOO much. You can do it.
My face started swelling up 10 min after taking the terb....and it was the only med I'd taken that time. Before it wasn't quite as bad (red cheeks and ears.....raised bumps, a bit of swelling and a lot of itching) and I wasn't sure which med it was because it was at a time of day when I was taking other things with it. The Peri took me off the terb and wants to see how I do overnight without it. I guess the Procardia just scares me because my normal blood pressure is a bit on the low side....and making it even lower means less blood flow to the baby. I'm dialated to 2cm on the outside, 1cm on the inside...and 2-3 cm thick still. I've been that way for a while now with no changes. I'm on bedrest....I'm well hydrated. Everyone in playgroup has been making soups for me and bringing them, so other than my breakfast all meals have been soup. I've been drinking plenty of water....adding a splash of juice to it so I don't have to gag it down (can only drink so much water plain before hating it).

Please tell me, how does it effect the baby if my blood pressure gets too low?

Oh, and I'm a bariatric patient....can't take time release medication.

I'm not miserable at all. I did complain about the terbutaline's side effects, but I think I have the right to be a little bit cranky in my last month of pregnancy, lol. I've been so good, following directions...doing all of my Lovenox injections, I've now been switched to heparin TID...I set the alarm to take my middle of the night dose without complaint. This isn't a discomfort issue for me. It's me really trully trying to decide what is best for both of us. I'm trying to weigh the risks on both sides.

Oh, wanted to add: My dates aren't off. I was charting and TTC and we only had sex when I was fertile...and I marked the times on my chart.
 
#8 ·
Quote:

Originally Posted by Kailey's mom View Post
My 36 weeker did pretty good considering she had IUGR. She weighted 4lb 14oz at birth.. when I brought her home a week later, she weighed 4lbs 8oz. She had some preemi problems (temp regulation, heart murmer, and feeding issues).. most resolved before even leaving the NICU. If your baby hasn't stopped growing, than the odds of even being in the NICU at all are low. Congrats, and happy birthing

They were estimating that she was 4lbs 7 ounces at my last level II ultrasound when I was 32 weeks. I know they aren't the most accurate, but I've also been measuring right on target, and she's stayed in the same percentile at every ultrasound.
 
#9 ·
That's a hard call to make and I won't give advice on it right now, but I will tell you that my first was 35+5 and the docs induced me rather than trying to stop my "supposed" labor (my forebag leaked at 35+3 and then resealed and I was having regular non-progressing contractions, the same as I had been having off and on for weeks, but was admitted and spent the next few days trying to be induced). Anyway, my son was 6lbs 8oz, was born the 23rd and went home the 25th of the month. Some problems with nursing, he was a sleepy baby and would drift off before full and then wake again within an hr or so to nurse. Other than the initial nursing problems, he was healthy and received no special care of any kind at birth or afterwards. Late term preemies certainly have a higher chance of complications, but in a lot of cases (such as mine) the baby does very well. Side note, unbelievably a few nurses actually told me "Look how big he is at these dates! Aren't you glad you had him early and didn't have to deal with a big baby and possible c-section?"
 
#10 ·
Ds1 was 36w0d weighed 6lbs 14 oz, came home with me after 1 day, no NICU. He was tired, had trouble waking to eat and did have to be hospitalized for jaundice but we found out later I have IGT and he was severely dehydrated and sick from not getting any food because I can't make more than 1 oz every 3 hours.

Ds2 was 36w3d, weighed 7lbs 3 oz and was in the NICU for a 2 days for aspiration because he swallowed fluid on the way out. He actually could have been released in a few hours because he was fine but they put him on some blood sugar glucose or something and had to wean him off. He did not have any issues eating or being awake or anything. He was hospitalized for jaundice too, but I still hadn't had my IGT diagnosed.

With this baby, who has a good chance of coming early too, I'm requesting a 2 day heel prick for jaundice and starting with formula from day 1 to ensure they get food and can poop and I'm also bringing home a bili blanket.

Both of my boys were totally right on par (even ahead in some) in meeting all milestones and are rarely ever sick and they're both giant happy strapping kids.
 
#11 ·
I, too, have had good outcomes with preterm babies. I would never recommend having a preterm baby if you can help it, but both of mine are fine. Home birth midwives used to deliver babies at home as early as 36 weeks, and they changed the standard to 37 weeks because they occasionally saw breathing or other problems. I believe that the risk is significantly lower at 36 weeks than at 35 weeks.

Dd was born at 34w6d (based on lmp) 5lb 20z, 19in. We brought her home after 24 hours, which she spent in my hospital room, co-sleeping. She was sleepy and a slow nurser, and had some jaundice, but we did fine at home with a bili-blanket. It was difficult and exhausting, and I wouldn't wish it on anyone, but now she is almost 3 years old, meeting and exceeding all milestones, and very active and healthy. No lasting problems.

Ds was born at 35w0d (based on lmp) 6lb 8oz, 18in. We brought him home after 48 hours, which he spent in my hospital room, co-sleeping. Hours after birth, his glucose dropped, and I supplemented with premee formula for 3 feedings. They should have sent us home after 24 hours, since he had no complications, but the doctor was worried about liability and refused to release him because my Group B Strep status was unknown and I had refused antibiotics. Ds was not too sleepy, was a great nurser, and had almost no jaundice. He is now 3.5 months old and is in the 50th percentile for height and head circumference and 25th percentile for weight without adjusting for prematurity. Healthy, happy, and meeting or exceeding all milestones.

I consider myself blessed, and will probably not risk another pregnancy because of my body and because of repeated preterm labor. Best wishes.
 
#12 ·
Thank you!!! Today marks 36 weeks and I'm keeping my fingers crossed that we can last another week.......now watch everything calm down by next friday and she'll be born late, lol.
 
#13 ·
I just did a little looking online, and it seems that most women who take Procardia end up stopping at 36 weeks.

I don't think that I would take it if I were already at 36 weeks. JMHO.

Good luck.
 
#14 ·
Quote:

Originally Posted by Crunchy Frog View Post
I just did a little looking online, and it seems that most women who take Procardia end up stopping at 36 weeks.

I don't think that I would take it if I were already at 36 weeks. JMHO.

Good luck.
I can't have terbutaline because I have a heart arrhythmia. I took procardia for preterm labor with my last two pregnancies, because I delivered my first DS in the second trimester (he didn't survive birth) so we were taking the preterm contractions very seriously. Anyway, all of the docs told me that 36 weeks is when they generally recommend stopping all meds to stop labor, because at that point the risks of prematurity begin to outweigh the risks of the meds. I stopped the procardia at 36 weeks both times.

My twins were 36+ weeks. DS spent three hours in NICU because he had some trouble breathing for a few hours-- needed oxygen and watching. DD2 came straight to me, but went to NICU for 24 hours at 3 days old, because of some pretty severe jaundice, and there was no facilities in the regular nursery for putting her under lights. She actually spent one hours out of every three in my arms, in a bili blanket, in a rocking chair next to the bed. We did have some hiccups in the early days of nursing, with both twins, but a lot of that was them being twins and me being utterly overwhelmed. I had similar trouble with DD1, and she was 39 weeks.
 
#15 ·
Quote:

Originally Posted by moondiapers View Post
I'm dialated to 2cm on the outside, 1cm on the inside...and 2-3 cm thick still. I've been that way for a while now with no changes.
Those numbers are in the grey area for whether delivery is imminent or not, particularly as that's where you've been for a while.

I was 2.5cm and fully effaced and contracting at 35+6, doctor on call made no attempt to stop anything, though that in part was that I also had borderline high BP, not high enough to require delivery, but I guess high enough that he thought if I progressed he should just let my body get on with it.

It didn't progress to full blown labour.
 
#16 ·
I would go ahead and try the procardia if I were you. I took terbutaline in all three of my pregnancies and procardia in the last two. I have been on pretty much every drug for preterm labor. In general, the procardia works better than terb with fewer side effects.

Like you, I have naturally low blood pressure. I was on procardia in my last pregnancy from 18 through 26 weeks. By 26 weeks, my blood pressure was too low (under 75 over 45) and my heart rate was too high (over 130 resting). The doctors pulled me of the procardia at that point, but I do think it helped me get through those 2 months without going into preterm labor. At first, the procardia did not drop my blood pressure so far. It was only after 8 weeks being on procardia (and a half a dozen other meds) that my body couldn't cope. Actually, it worked great with my second pregnancy from 32-35 weeks.

And in your circumstance, you really just need another week or so and you can have a safe home birth. I would try the procardia and see. If your blood pressure drops too low (below 80/50, I think, but check with your doc) then stop. It can work really well.

But at 36 weeks, I wouldn't stress too much. Some 36 weekers do fine, breathe well and are able to breastfeed right away. Others need help for a few days or weeks, but the vast majority would be okay. Just not okay for homebirth!

Here are some more natural things to try:

1. Hydrate - make sure you are drinking lots of fluids
2. Pee frequently - a full bladder can make you contract
3. Treat any infections - inflamation anywhere in your body, especially a vaginal or bladder infection, can cause contractions
4. Avoid sex (actually, avoid anything in there including exams unless you think you're in labor)
5. Take baths with epsom salts - do this whenever you feel more contractions
6. Take a calcium-magnesium suppliment to relax muscles
7. Consider a small glass of wine to slow contractions
8. Rest and try to relax. Avoid anything that causes irritability.

You are ALMOST there. Not quite. After a long hard pregnancy, it's tempting to want to be done at 36 weeks, but you're not really done.
 
#17 ·
Quote:

Originally Posted by sbrinton View Post
I would go ahead and try the procardia if I were you. I took terbutaline in all three of my pregnancies and procardia in the last two. I have been on pretty much every drug for preterm labor. In general, the procardia works better than terb with fewer side effects.

Like you, I have naturally low blood pressure. I was on procardia in my last pregnancy from 18 through 26 weeks. By 26 weeks, my blood pressure was too low (under 75 over 45) and my heart rate was too high (over 130 resting). The doctors pulled me of the procardia at that point, but I do think it helped me get through those 2 months without going into preterm labor. At first, the procardia did not drop my blood pressure so far. It was only after 8 weeks being on procardia (and a half a dozen other meds) that my body couldn't cope. Actually, it worked great with my second pregnancy from 32-35 weeks.

And in your circumstance, you really just need another week or so and you can have a safe home birth. I would try the procardia and see. If your blood pressure drops too low (below 80/50, I think, but check with your doc) then stop. It can work really well.

But at 36 weeks, I wouldn't stress too much. Some 36 weekers do fine, breathe well and are able to breastfeed right away. Others need help for a few days or weeks, but the vast majority would be okay. Just not okay for homebirth!

Here are some more natural things to try:

1. Hydrate - make sure you are drinking lots of fluids
2. Pee frequently - a full bladder can make you contract
3. Treat any infections - inflamation anywhere in your body, especially a vaginal or bladder infection, can cause contractions
4. Avoid sex (actually, avoid anything in there including exams unless you think you're in labor)
5. Take baths with epsom salts - do this whenever you feel more contractions
6. Take a calcium-magnesium suppliment to relax muscles
7. Consider a small glass of wine to slow contractions
8. Rest and try to relax. Avoid anything that causes irritability.

You are ALMOST there. Not quite. After a long hard pregnancy, it's tempting to want to be done at 36 weeks, but you're not really done.
There is no homebirth for me.....my birth has to be planned and managed because of anticoagulant therapy. I'll be 37 weeks tomorrow. I just wasn't comfortable with the risks of procardia after 36 weeks. IN someone with low blood pressure it's more likely to slow blood flow to the baby. That's not an acceptable risk to me at that point. If it was earlier, I'd chance it...but only in a hospital setting.

Anyway....I was checked yesterday...still only 2cm, no changes. I'll be checked again on this coming tuesday, we're watching for an inducable cervix so that I can stop the heparin for 12 hours, then be induced. If this hasn't happened by 39 weeks I'll be given prostoglactin (sp) gel overnight, then checked again for changes....
 
#19 ·
Amelia was born at 36w0d (exactly 1 year ago today...
)

I had steroid shots at 28 weeks, so keep this in mind as I go on...

She was born (via c-section) with apgars of 8 and 9. She was good to stay with us in the operating room for about 10 minutes. Then they took her to the nursery where she had to receive oxygen because she begun to have a lot of trouble breathing. The nursery's cutoff for going to the nicu is 4 hours and 15 minutes on oxygen...Amelia was on oxygen for exactly 4 hours, so she missed the cut-off for the nicu.

When she got to my room, she had very wet lungs and grunted a lot. She had absolutely *no* suck reflex. She couldn't nurse, couldn't take a bottle, couldn't suck on a finger, nothing. They ended up having to tube feed her for a couple days. After each feeding (which occured after each time she tried to nurse), they brought her back. She had a lot of trouble maintaining body weight, so she stayed in naked chest to chest kangaroo care almost the entire time.

Another issue she had was that her blood sugars were really low. After a couple days, it was fine.

She had to stay in the hospital a few extra days because of her breathing. When they discharged us, she developed very bad jaundice, which stuck around for a month. That first month, all she did was sleep (23 hours a day), had a LOT of trouble nursing and couldn't latch on--we had LCs come to our house several times a week trying to get her to nurse right, and she still had problems breathing.

Right when she turned a month old, everything seemed to change. She stopped being jaundiced, she started being able to suck better, and she started the typical sleep-wake pattern (I'd say she was still a very sleepy baby for about 3ish months).

At a year old, she is pretty much on target for most milestones--she has 2 words, she takes several steps by herself, points, eats like a champ, and looks to have no delays. Her ped says she needs to use a corrected age for 2 years, but really, she's on target for her actual age. The only long term effects we see is that she still gags on anything but breastfeeding and solids (but she gags on spoons, sippy cups, bottles, binkies...so pretty much she nurses and finger feeds herself), and she has selective immunoglobulin a deficiency. I'm not sure if the S-IgA-D is related to her being early though....

Most of her issues are very mild in comparison to what could have happened. She, for the most part, did quite well with just a couple minor issues.
 
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