Category: Procardia/Nifedipine

36 Weeks Pregnant!

Posted on by Becky

This post has been in my “drafts” for days now.

It’s obsolete, because tomorrow I will be 37 weeks pregnant–full-term! I guess I didn’t have a whole lot of motivation to post it, because my weekly ob appointments have become quite anticlimactic, even boring–and almost a joke between my close friends and me.

“Are you still a ‘loose one’?” they ask me. In fact, that was a text message I received today (you make me laugh, Melissa!)

Yes. I. Am. And I have been a “loose one” for almost two months now.

Despite having more contractions than I could attempt to calculate, all the medications, bedrest, and hospitalization seem to be doing the trick! I have to admit my lack of faith when the obs, perinatologist, and my insurance case managers were all talking about “shooting for 37 weeks.” I was skeptical! But here we are: with week 37 just around the corner.

Because we had 28+ inches of snow over the weekend, we couldn’t get the car down our street for my Monday morning appointment. We had to reschedule for Tuesday, because Wednesday we were forecast to receive another 12-20 inches of snow (we got 16 inches) . . . With that forecast in mind, my husband gave me very specific parameters for exactly when I am allowed to go into active labor. Ha ha!

Wednesday night, the night of the second big snowstorm, I had very very intense contractions along with severe diarrhea and nausea.

I guess it was providential that the roads were impassable, because I totally thought that might be “the” night! And with any other weather circumstance, I might have decided to go up to triage, just in case. But since I knew we absolutely could not make it to our hospital (and if we called an ambulance, I would be taken to a nearby hospital which was not my preference for several reasons), that was motivation enough to mentally ‘gut it out’ and think ‘there’s no way I can deliver tonight.’ We decided to increase the frequency of my procardia doses to 5 hours apart, instead of 6. (When I was hospitalized before Micah’s birth, this was one way they tried to hold off labor; my doses were every 4 hours the morning he was born. So we figured that was something small we could try from home to slow the contractions. Not that it worked with Micah!) Finally around 4:30 AM I was able to go to sleep. . . I am sooo ready to be done with these contractions!!!

Anyway, back to my appointment. As expected, Dr. C said I’m “between a one and a two,” the baby is still head-down (her kicking makes that obvious), and her station is -2. I asked about coming off bedrest and the meds early, since I am having so many contractions at night and really struggling to sleep at all (it feels like my body and the medications are fighting all the time and between the very-low blood pressure brought on by my meds, the lethargy from laying around for almost two months, and the lack of sleep while I fight contractions at night, I have very little energy at all),, but it was no great surprise to me that Dr. C insisted that I stay on everything until week 37. . . It was worth a shot. At this point, the baby will be okay whenever she comes (baring something unusual), and I’m sooo ready to stop fighting against my body’s contractions and just let myself go into labor.

We talked about going for a VBAC, and I asked what would prevent me from having one. He said, since I’ve delivered vaginally before, they know that my cervix is capable of delivering vaginally, so just the usual things would cause the doctors to recommend a c-section: if the baby were to change positions, if the baby’s heartrate would indicate distress during labor, if labor were to progress too slowly. . . and then he mentioned if I should have excruciating pain in my c-section incision area, that I should call right away and they would do a c-section immediately.

He told me that I’ll come off the meds and bedrest at the end of the week, and I’ll probably notice quite an increase in contraction activity. (Is that possible?) But he said that won’t necessarily indicate I’m in active labor. That said, he added, “I would like to see you wait to deliver until the first week of March, since that’s when you’re due, but my professional opinion is that you’re going to be delivering early.”

I had two thoughts: First, wow!  a professional opinion! So far, every time I asked the doctor’s to speculate on when I might deliver they would say ‘everyone is different: for some, right away, for others–you could even go past your due date.’ Which, I realize, doctors don’t have a crystal ball to consult on when anyone will actual go into active labor! but I really appreciated his offering a “professional opinion” after looking at my particular situation!

Second, I was struck by his comment wishing I could hold off till March! Ha ha ha! It’s just amazing–unbelievable!–that we’re even having this conversation!

So yes, I’m 36 weeks pregnant! By the end of the week, I will come off bedrest, quit taking procardia every 6 hours, and by Monday, the progesterone should largely be out of my system.

I’m sure it’s wishful thinking, but I’m hoping for a Valentines Day baby! And if she can’t come quite that soon, I’m hoping for some time before 38 weeks!

Other preemie moms share this same sentiment during subsequent pregnancies: The conflict of how very exciting and yet how difficult the last trimester is, particularly with meds and bedrest (especially since we entirely missed out on most of the last trimester with the preemie pregnancies), and how we feel a twinge of guilt saying it, but admitting, “It was nice missing the last two months of pregnancy last time!”

That was nice. I don’t want to repeat the scenario. But that was nice.

For now, I am just thankful that we’ve made it this far. It really is incredible!

“I Mean, It’s not Crack . .”

Posted on by Becky

That was the nurse practitioner describing the tocolytic I was about to receive.

So, yes, I ended up back in L&D triage this afternoon. After strong contractions four minutes apart through the early (sleepless) morning hours, and then waking up with contractions (not as strong but still four minutes apart), I spent most of my day “contracting.”

Daniel was working from home today, and he decided I really should call the doctor (and we knew the doctor would say to go to triage). So there we were. Again.

We asked our friend Bill, who is working on his dissertation, to come over and sit in the living room during the kids’ naps, which he most graciously did. . .

I know I’m emotional with pregnancy and all, but I really had a hard time putting the kids down for their naps and saying good-by. I was afraid they were going to increase my procardia (like they did with Micah), and it would do nothing for my contractions, but I would have blood pressure issues, and they would have to keep me on the Mom Unit (like they did with Micah).

Once my now-19-month-old Micah was in bed, I sang to him “Great is Thy Faithfulness” (more for me than for him) and then he held up one finger like he does everytime I put him to bed these days, and said, “Muh mo’.” [one more] So I sang one more. He did it again, and I had to say ‘That’s all, buddy. I know you’d have me sing all day long if you could.’

When we got to the hospital, Daniel insisted on pushing me up to Labor and Delivery in a wheelchair, despite the fact that I felt like a total wimp. I said I was pretty sure I could walk, and if I walked, the nurses would have adequate proof that I really was having a lot of contractions. He said we weren’t trying to impress the nurses with how many contractions I was having. I knew he was right–if I had walked, I’m sure my contractions would have just multiplied. He’s a good husband–he’s just what I need.

There were no beds available in triage when I arrived, so we were sent to the waiting room with a huge crowd of people awaiting news on a set of triplets that was to be born that day. Apparently the mom had chosen not to find out whether the babies were boys or girls! (Can you imagine? They had picked out three boys’ names and three girls’ names and were waiting to see what she delivered! Daniel said to me, “With all the logistical challenges in having triplets, why would you add one more by not finding out what they were?” So if we ever have triplets, you know we’ll be finding out whether they are boys or girls or a combination.)

When I did get a bed in “LD,” it was the same old routine: urine sample, hospital gown, cervical exam, various swabs/samples, blood drawn, IV fluids, monitoring the baby’s heart rate, my heart rate, and my contractions. My contractions were steady, 2-3 minutes apart, but varied in intensity. I think they felt worse because I hadn’t slept much last night–I felt nauseous and yucky–and I didn’t know if that was just fatigue or the ever-illusive “something different.”

The nurse practitioner checked my cervix and said, “It’s a loose one.” But it’s still a one, which means after all these contractions, I’ve had basically no cervical change! That was just not the case with Micah. But with Micah they had also waited to put me on any tocolytics until I was already 3 cm and 70% effaced. I’m sure it helps that I’ve been on progesterone for 12 weeks now and procardia for about 2-1/2 weeks.

While they monitored me and waited for results of the fetal fibronectin test, Daniel and I discussed baby names. Unfortunately, I can’t discuss what we discussed, but it was really one of the first opportunities we’ve had to sit and go through names together. I was glad I had made a list, glad Daniel brought his laptop (with my list on it). And surprised by the names he liked and didn’t like. There was one name–a beautiful name–from my list that Daniel contemplated for about half an hour. I was beginning to think it would be Little Boo’s name! While Googling the names’ meaning/ trendiness/ etc, Daniel learned something that completely ruled the name out for him. For one reason or another, every name was scratched off my list. And when Daniel began suggesting new names, there were none that really “grabbed” both of us.

In the end, we arrived back at the name we’ve been contemplating–but got hung up on the spelling. (And no, it doesn’t begin with an ‘M.’ But that’s the only hint I’m giving!) It is still not set in stone, because both of us have a pretty strong opinion on how we’ve “always envisioned” spelling it. We may have to scrap the name altogether and start over. 😉

But I was encouraged that we had the chance to discuss names. Probably we will settle on something soon, and she won’t spend her first three days nameless as Micah did!

My favorite news of the day was that the fetal fibronectin test came back negative again. That means there’s a 99% chance I will not deliver before two weeks from today (almost 35 weeks!). I was so excited that I told Daniel I was going to take myself off bedrest to celebrate! A 35-weeker sounds great to me! At that point, most of the lung development issues are resolved, and many babies can suck well enough at that point that they wouldn’t need tube feeds.

Of course, I was kidding about taking myself off bedrest. But comments like that always scare Daniel. (Sorry dear! Didn’t mean to–I’m just excited!) He started asking me questions like ‘What are the characteristics of the 1% that does deliver within two weeks? Do they have all your symptoms? It seems like you’re in the 1% on everything else–why should this be different?’

The question remained: What to do with all these contractions? Supposedly I’m on–not one, but two–drugs that should be keeping me from contracting.

Marianne, the nurse practitioner, asked about my progesterone and procardia dosage, then went to consult with Dr. C. We overheard the entire conversation.

“She’s contracting like crazy,” we heard her say. “But she’s still only a one.” Marianne recommended terbutaline, which I had read is the tocolytic most commonly given to stop preterm labor. I remembered one of my favorite preemie-mom-bloggers, Heather Spohr from The Spohrs Are Multiplying, being given terbutaline for preterm contractions.

I always wondered why I was given the procardia (nifedipine) instead during both pregnancies. Dr. C approved the terbutaline, so Marianne came to tell me more. It’s a drug that is commonly given orally to treat asthma, by dilating air passages in the lungs. In pregnant patients, terbutaline is injected into the arm and apparently reduces contractions by relaxing the muscles in the uterus. She told us side effects include: tremors, nausea, nervousness, dizziness, headache, drowsiness, heartburn, heart palpitations, fast heart rate, and elevated blood pressure. [Oooo, elevated blood pressure! So between procardia lowering my blood pressure and terbutaline elevating it, my blood pressure should be completely normal, right?] She said the primary feelings patients describe are heart palpitations, shakiness/the “jitters,” and headaches.

Honestly, as she described it to me, I was skeptical. I’m on bedrest. Progesterone. And procardia. They’re not working. Sure, add some terbutaline. It can’t hurt, right?

I think she could read me.

She insisted that it works really fast–within 20 minutes–and added, “It’s really good stuff! . . . I mean, it’s not crack. . .”

Oh, good.

I wish I had taken a picture of the contraction monitor! The graph displayed a constant stream of “hills” and “valleys” with each contraction 2-3 minutes apart. Then suddenly I was given my shot of terbutaline, and the graph literally flat-lined.

I was in awe. I did not know that a drug like this existed! (Although I have to say, my heart racing and jitters felt a lot like the side effects of an epi pen administration. And I came home with a headache–but very few contractions.)

Marianne told us it isn’t a “permanent” fix, but at least, we were able to stop my contractions one more time and buy our Little Boo a few more days, or maybe even weeks. She said we did the right thing coming in and she promised Dr. C that I was “very reliable, and she was sure I would come right back if there was anything unusual.”

I nodded heartily in agreement, while Daniel made some comment about having to twist my arm to get me up here. (Shhh! I want to go home tonight and see our kids!!)

So the combination of the negative result on my fetal fibronectin test and my very positive response to the terbutaline, was enough for Dr. C, who said I could go home.

Personally I think they needed my bed there in triage. There were more pregnant women in the waiting room.

And I was most willing to give it up!

When we got home, Mara greeted me with the most enthusiastic tears of joy imaginable from a three-year-old. Daniel’s mom said she had a hard time when she woke up, dealing with the fact that I was in the hospital again. I guess Micah handled it much better. While Mara hugged me (and wouldn’t let go), Micah hugged Daddy’s legs saying “Dadda!” I guess he knew he should be hugging somebody at that moment.

I’m still pinching myself. I really expected them to try increasing my procardia, and then (when that didn’t work) to keep me, at least overnight. I really didn’t expect a single shot to knock out my contractions. And I really expected to go to bed without my dear family tonight.

“It’s not crack,” but it’s pretty amazing, that terbutaline!