The long and the short of it (no pun intended) is that my cervix is still short (around 2.4cm), but it’s stable, which is great news. Babies all look fine, good heart rates and good amount of amniotic fluid. Dr. P. was working today, which was a relief (he was the doctor on call this past weekend, so I’d been hoping to speak with him directly today, and I got my wish).
He spent a lot of time talking to me about the changes he’d made to my protocol and why and how he hoped things would progress over the next several weeks. We’re on the same page with the whole, “even though the survival rates for 28 weekers are very high, it would be very bad to deliver right now.” He still wants to get me to 34 weeks before delivering, and I’m all for it.
Two babies are head down and the placenta previa has finally completely resolved itself, so I told him I don’t need no stinkin’ c-section. He reiterated that vaginal triplet deliveries are tricky at best and not always advisable, and I said, “well, I can dream, can’t I?” “Oh yes, you can can dream. And I always wanted to be 6’4″…” Anyway, he didn’t say no, but did emphasize that I shouldn’t get my heart set on it. He has done vaginal triplet deliveries and he’s not dead set against it (for that matter, he’s done a vaginal quad delivery), so it’s not like he can’t do it, but he wants to make sure I realize that it’s a very rare occurrence that things really line up in such a way that it’s remotely advisable. I understand that, but I really want to keep the door open for as long as possible, even though I know it’s probably not going to happen.
He explained that I can’t stay on the Indocin long term, as it tends to result in a lower amniotic fluid level, but that if we need to repeat the Indocin regimen of 48-hour treatment on a weekly basis, we can do that until about 33 weeks… after that, there are bigger problems, but then things get a little less problemmatic if I go into labor anyway. He also explained why he didn’t want to do steroids yet… although steroids are good for about 4-6 weeks after they give them, they are problemmatic for a couple reasons: 1. they’ll definitely raise my blood sugar (which isn’t the end of the world for me, since my blood sugar is stable and normal right now, but why tempt fate if we don’t have to yet?) and 2. steroids have a tendency to increase contractions both in frequency and intensity for several days to a week after administering them. I love irony. So he said steroids aren’t quite as magical as everyone thinks they are. Still, he’ll definitely give me steroid shots at or around 30-32 weeks to give the babies the added edge in lung development that they need, but his preference is to put it off until as late as possible.
He said one of the problems I’m facing is that my uterus is distended further than it would be if I were full-term with a singleton right now and it really does think it’s done, and that’s likely a huge contributing factor to the contractions. He said this is definitely aggravated by the fact that I’ve got a very small pelvis to rib size (read: I’m SHORT), so there isn’t even much more room for things to expand, even if it wanted to. With all that pressure on my uterus and, in turn, all that pressure on my cervix, it’s no surprise that sometimes my contractions get out of control, and the best they can do is try to control it with the medications they have available for the time being. Definitely, though, bed rest is doing a good job, because my cervix is hanging in there and is much improved from how short it became right before I got thrown on bed rest. So I have to keep hanging out in bed/recliner for the long haul.
Oh, he also talked about the fact that most women have more contractions at night… 4pm-4am you definitely see increased uterine activity. I definitely have noticed EXACTLY this, and thought I was losing my mind. But he said it makes sense if you want to take *any* lessons from evolution, this is one you probably could take seriously… that most mammals need to give birth under the protective cover of night. Even though this isn’t so relevant to humans (at least not today), it’s still a documented scientific fact that uterine activity increases between 4pm and 4am. There are also more labors that start in the middle of the night than, say, mid-morning. Interesting! This is why when all hell was breaking loose with me on Saturday night he said he wanted to raise my basal rate on the terbutaline and then let me sleep if I could and see how I was doing in the morning, because doctors are much more concerned if contractions are at a high rate during the morning hours… they tend to be much more troublesome. Since I was still over threshold in the morning, that’s why he called in the Indocin…. because the morning pattern was much more indicative of a problem than the evening-into-late-night pattern had been.
The other thing he’d done Sunday morning was raise my threshold to 8 contractions per hour… and the reason he did that was because he said at this point with triplets it’s a lot more realistic to expect to see 4-6 contractions per hour regularly, but 8 per hour is definitely alarming, so rather than getting up in arms about something which could be normal (and bear in mind that all weekend I was above 8 anyway, so I was still justified in being concerned), raising the threshold would allow us to focus in when there really was something that needed attention.
Anyway, that was the appointment. It was a good appointment overall. Dr. P. wasn’t saying he’s not concerned, because he is, but he’s definitely on top of things, which gives me a lot of hope and peace of mind. Meanwhile, we’ll take it one week at a time, and if necessary, one day at a time.
And now, I really, really, really must go to bed.
ChezPerky 