Pregnancy update #2349871
Baby’s now 33 weeks old (or young)…and you guys won’t believe what has happened in the past week!
Had a very very minor spotting incident last Saturday evening, and decided to drop by the maternity ward at DSH just to check if everything’s ok as the blood was bright red. When the nurses monitored baby’s heartbeat using an electronic fetal monitor/CTG, they found that I was experiencing regular contractions (which was extremely strange because I didn’t feel anything before I went to the hospital!). They called my doctor, and after doing an internal exam, he found that my cervix was already 1cm dilated. Yes, I’ve apparently gone into preterm labour. Definitely not good news at 32 weeks!
I was immediately admitted and spent a night in the labour ward on an IV drip containing tocolytics…it’s a kind of medication used to suppress the contractions, and also given 2 shots of steroids 12 hours apart as well as antibiotics.
The steroids were given to mature baby’s lungs in case I do go into labour. It promotes the production of surfactant, a substance that prevents the collapse of the alveoli (small sacs in the lungs where air is exchanged), and also helps to decrease the possibility of other complications affecting the bowels and circulatory system.
Steroid Injection for Fetal Lung Development
Injections of corticosteroids for fetal lung development has been praised as one of the best advances in fetal medicine in the 90s. Since 1994 the National Institutes for Health and other professional organizations have encouraged their use in promoting the development of fetal lung development in moms who were at risk for preterm labor or birth.
Betamethasone and dexamethasone are the two most commonly used steroids. The average protocol was to give to intramuscular injections (IM) 24 hours apart. Some practitioners also choose to continually repeat the dosages every week until the birth. The injections had to be given 24-48 hours prior to the birth for maximum effect. They were also best used between weeks 24 and 34 gestation.
The use of the steroids provided benefits for the lung development in the premature infants to reduce the risk of respiratory distress syndrome (RDS) as well as to reduce the risk of intracranial hemorrhaging and some other potential benefits.
However, recent studies say that the benefits of multiple doses is questionable, particularly in light of potential risks. Citing the “limited quality” of the studies of multiple doses and the potential disadvantages the National Institute of Health issued a statement of August 18th that a single dose was sufficient in achieving the benefits desired.
Potential down sides to multiple doses can include: psychomotor delays, behavioral problems and the fact that the effects on neonatal mortality aren’t known between the single and multiple dose courses. In separate findings by an Israeli study it was also noted that there is an increase in maternal infection with the use of steroids, so limiting doses may help with this side effect as well.
The antibiotics were administered to prevent any infection that may crop up due to the 1cm dilation of the cervix, and to treat any existing infection that may have caused me to go into preterm labor. Both the steroid and antibiotics were administered through injections…the former in my butt…ouch, and the latter through the IV tube…also not very pleasant as there’s a horrible icy sensation when it enters the bloodstream.
Needless to say, the past few days has been mentally very stressful. I was taken off the drip on Sunday evening and allowed to go back to the maternity ward and given oral tablets (Terbutaline) instead, but the dosage of the oral tablets were not sufficient as the contractions still came back despite taking the tablets for a whole day. I was taken back to the labour ward and put on the drip again on Monday night till Tuesday afternoon.
The side effects of the drip are heart palpitations and hand tremors, both of which I’ve experienced…not very pleasant. I couldn’t get much sleep during the nights when I was in the labour ward as the nurses had to continuously monitor my blood pressure as well as baby’s heart beat and the uterine contractions…add the heart palpitations and the constant tick-tocking of the wall clock, I was one extremely cranky patient by Tuesday morning!
The doctor finally allowed me to go back to the maternity ward on Tuesday afternoon as the CTG showed no major uterine contractions, but he still kept me on the IV drip till Wednesday morning. Was finally discharged on Wednesday afternoon and given the oral tablets to take at home.
I’m now staying at my parent’s place so that there’ll be someone around all the time in case anything happens. The oral tablets still aren’t as effective as the drip, but at least the heart palpitations and hand tremors are reduced greatly. I still feel contractions during the tail-end of the dose…ie. I’m suppose to take one tablet every 8 hours, but after about 6 hours, I start feeling the contractions again.
We went back to see the doctor on Friday morning, and after doing the ultrasound, we were told that baby’s estimated weight is now 2.1kg…that’s a big relief as 2kg was the so-called ‘target weight’ we were aiming for in case she does come out early. The other good news is that the top of my cervix is still closed, and even though baby has ‘dropped’, her head is not engaged yet. The doctor said that my condition is what they call an irritable uterus…this is certainly something new to me!
I have to go back to the hospital on alternate days to do the CTG, and see the doctor once a week. Other than that, I’m to rest at home…no physical exertion, nothing that will cause any strain on the uterus…no straining my bowels, not even coughing! I was also told not to rub or stroke my tummy…it apparently induces contractions as well!*
Baby is still as active as ever, though. It’s as if she’s saying…I’m bored, someone get me out of here already! Whenever the nurses strapped the sensors of the CTG machine to my tummy, baby would squirm and move as if she was trying to kick it off….I think she really dislikes the feeling of something pressing down on her ‘home’. Even the nurses commented that she’s such an active baby. My tummy felt like she was doing a constant series of Mexican waves inside or something! 
Anyways, the goal now is to keep baby in my tummy till she reaches 36 weeks. I will have to continue with the oral tablets for another 2 weeks at the current dosage, ie. 3 times a day, and at 35 weeks, the doctor said he will reduce it to twice a day. Once we’ve hit the magical number of 36 weeks, he’ll stop the oral tablets and let labour come naturally, which, according to the doctor, usually takes around 1 to 3 days. In the meantime, I’m to watch out for further bleeding episodes and possible membrane rupture as that would necessitate an emergency c-sec straightaway.
I’m praying really hard that everything will be alright. I feel mentally, physically and emotionally exhausted. The initial worry that baby may come out too early and what would happen if she did had me crying on and off whenever I thought about it. The inactivity, the medication…yes, even the uncomfortable hospital bed…all of it just added to the stress.
And even though I’m now back home, the constant worry of any long term effects of taking the oral medication for another 3 weeks is still weighing heavily on my mind despite the doctor’s reassurance that there will be no side effects on the baby (or me). Me, being me, went on the net as soon as I knew the name of the medication I was given to check if there are any side effects, and of course, ended up worrying myself by reading all the different articles and opinions! However, the dosage I’ve been given is very low, and the doctor said that if there are side effects (on me), it would’ve manifested within a couple of hours of me being on the drip. In the end, it’s a balance between the real risk of baby coming out too early, vs. the possible risk of any long-term effects…and at this point, the real risk is…well, more real.
Needless to say, hubby and my parents have been absolutely wonderful during the past week. Hubby has spent every night at the hospital with me, packing clothes and toiletries from the apartment to bring over to the hospital, buying food, magazines, etc. to keep me occupied. My parents have been dropping by daily too with home-cooked food. The day I was discharged, I went back to our apartment to stay till Friday afternoon before moving over to my parent’s place…and I was so touched to see how hubby tried to ensure I moved around as little as possible. Now that I’m at my parent’s place, hubby has been coming by every day to keep me company, and sms-ing me when he’s back home to remind me to take my medication. These little gestures have truly touched me to the core.
Well, all this just goes to show that even the best laid plans can go awry. It’s a lucky thing we did all the baby shopping early…there’s not much left to buy so at least I’m not too stressed over any last minute shopping. I still need to pack my hospital bag, though! Oh, and my birth plan has also flown out of the window as a c-sec is also more likely to happen should baby decided to pop out before 36 weeks. I’ve also been told not to do anymore Kegel exercises, and not to start on perineal massages.
With this unexpected development, (I know it’s ridiculous, but) I can’t help feeling kinda cheated that my pregnancy has been shortened…I think those of you who have been reading my pregnancy updates would’ve guessed how much I’ve enjoyed my pregnancy.
Looking on the bright side though…at least we went to the hospital for a check-up that Saturday evening. God knows what would’ve happened if we didn’t. So mummies-to-be…do trust your instincts!
****************************************************************
* Other stuff that I’ve learnt:
1. Constipation apparently aggravates the uterine contractions, according to the nurses.
2. When the labour ward is quiet, it’s really quiet. When it’s busy, it’s REALLY busy! I think I sat through at least 10 births during the time I was at the labour ward…and about 4 of the ladies ended up with emergency c-secs, and one lady’s baby went into distress as I could hear the nurses frantically calling the paed to rush to the labour ward. And one lady came in groaning in pain, and about 10 minutes later, she’d delivered (I heard the baby cry!)…the nurse told me later that it’s a lucky thing they got to the labour ward in time else she would’ve probably delivered in the car!
3. My own observation - stress seems to aggravate the uterine contractions as well. I experienced less contractions when I’m lying down and when I sleep, and also less contractions when I’m back home vs. in the hospital.
4. Drink lots of water if you happen to end up in the same condition as me. Dehydration can cause contractions as it causes your blood volume to decrease, which means the concentration of oxytocin (hormone that causes uterine contractions) will rise. And water also helps with the constipation…
5. The contractions are actually ‘good’ for the baby as it induces some stress which will help her to mature faster. But again, there’s also a balance between what’s just right vs. too much…and if baby decides to take her time to come out after the doctor has stopped the oral medication, then we might have to induce the labor! Now, that would be truly ironic, wouldn’t it??
6. Disposable underwear are a godsend! 
