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Archive for the ‘contractions’ Category

Yesterday for hours I was having pretty uncomfortable contractions spaced exactly 5 minutes apart. Eventually they shifted to exactly 4 minutes apart. I wasn’t loving this development, but having a lot of contractions wasn’t the end of the world. After all, that’s what I DO, right? Yes, they were more uncomfortable than usual, but they weren’t alarmingly so, so I wasn’t sure whether it really mattered. I decided that I’d see if I could sleep through the night to decide how alarmed I should be. And that’s when the fun began. The contractions didn’t get better through the night, and I never did get more than about 20 minutes of sleep at a time, but there were only 2 stretches in the night where I even got that many. I spent the whole night trying to figure out when it was appropriate to call the doctor or at least call Matria. Calling at 2:30 seemed silly, I rationalized, since I’d be getting a bolus at 3am. At about 3:15, I fell asleep for 20 minutes, which seemed to me to suggest some improvement, so I figured calling wasn’t strictly necessary. By 4:30 I was in agony, so I considered calling and asking for an additional bolus, except that the auto-doses really weren’t doing much good, so why would I think another bolus would? By 5:30 I was in tears from the pain (as I had been intermittently through the night), but again, only half an hour away from a bolus, so calling seemed premature.

All night the contractions themselves were not only stronger and more regular than usual, but I had cramping so severe I expected to see blood every time I went to pee and pain into my back along with the cramping so strong that I would have sworn I had a kidney stone had it not been so definitely in sync with the contractions. Once I dragged myself out of bed at 6:30ish (with less than an hour total sleep to show for myself), I couldn’t quite figure out WHAT to do with myself. I still felt crappy, but at that point, I wasn’t feeling any worse than I’d felt all night, so I decided to wait to call Matria until it turned over from After-hours to the local center, so that I had a higher likelihood of talking with a nurse who knew me. At 8:30 I called over there and spoke with a nurse who, as it happened, I’d never spoken with before. She suggested giving myself an extra bolus, but also said that she’d recommend contacting the doctor, since this was a change from the norm for me. So she paged the doctor for me.

Dr. P. was on call, which surprised me, since he’s going to be away all this coming week, but that was good since I saw him twice this past week, so he knew what was going on with my medications, etc. He called me directly, rather than trying to relay everything through Matria, which I appreciated. He first told me to raise my basal rate on the terbutaline, and then said he could bring me into the hospital and get me onto a monitor and possibly mag sulfate if I wanted. Alternatively, this is about the last opportunity I’ve got to use Indocin (they won’t use it after 32 weeks), so since I haven’t been on it for a few weeks, and since historically it works well for me, that was my other choice. So I decided to try the Indocin again and he said if I wasn’t feeling better in several hours, I can always come in to the hospital. Fine and dandy, except today is my foster son’s 4th birthday party, so I’d like to avoid that if possible. Obviously, if I need to go, I need to go, and that’s all there is to it. However, if there’s any way to avoid it today, I’d like to. I do want at least my husband to be at the party, and I’d rather not go to the hospital alone (I’m not going to be at the party regardless).

So that’s what we agreed upon. And then… shortly after I talked to Dr. P., I pulled out my pump to give myself the extra dose that my nurse had suggested and I realized that the pouch that holds the pump was a little damp, as was the area around the pump where the tubing attaches to the syringe in the pump. How odd… And I peered closely at the tubing and watched it for a good long while. And I realized that absolutely NO medicine was going through that tubing. In fact, probasbly no medicine had been going through that tubing all night. And in retrospect, when I changed the syringe last night, I vaguely remember that ther was a subtle “crack” sound as I put the tubing on, and I DID check to see if anything looked cracked but didn’t see anything, so I’d sort of forgotten about it. Obviously, I didn’t look closely enough. Whoops. In the two months that I’ve had the pump, this is a first. Still, I feel foolish.

However, at least now I know that the terbutaline really IS serving a very important purpose. Because if that was just a tiny glimpse of 12 hours without terbutaline (bearing in mind that the half-life of terbutaline is, I think, 4-5 hours, so I theoretically still had terbutaline in my system that whole time, just less and less of it through the night, then boy, do I not want to know what life woud have been like without it all together. So as many contractions as I feel with the terbutaline… at least I now know that the Terbutaline DOES work. Really well. Sheesh!

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Yesterday for hours I was having pretty uncomfortable contractions spaced exactly 5 minutes apart. Eventually they shifted to exactly 4 minutes apart. I wasn't loving this development, but having a lot of contractions wasn't the end of the world. After all, that's what I DO, right? Yes, they were more uncomfortable than usual, but they weren't alarmingly so, so I wasn't sure whether it really mattered. I decided that I'd see if I could sleep through the night to decide how alarmed I should be. And that's when the fun began. The contractions didn't get better through the night, and I never did get more than about 20 minutes of sleep at a time, but there were only 2 stretches in the night where I even got that many. I spent the whole night trying to figure out when it was appropriate to call the doctor or at least call Matria. Calling at 2:30 seemed silly, I rationalized, since I'd be getting a bolus at 3am. At about 3:15, I fell asleep for 20 minutes, which seemed to me to suggest some improvement, so I figured calling wasn't strictly necessary. By 4:30 I was in agony, so I considered calling and asking for an additional bolus, except that the auto-doses really weren't doing much good, so why would I think another bolus would? By 5:30 I was in tears from the pain (as I had been intermittently through the night), but again, only half an hour away from a bolus, so calling seemed premature.

All night the contractions themselves were not only stronger and more regular than usual, but I had cramping so severe I expected to see blood every time I went to pee and pain into my back along with the cramping so strong that I would have sworn I had a kidney stone had it not been so definitely in sync with the contractions. Once I dragged myself out of bed at 6:30ish (with less than an hour total sleep to show for myself), I couldn't quite figure out WHAT to do with myself. I still felt crappy, but at that point, I wasn't feeling any worse than I'd felt all night, so I decided to wait to call Matria until it turned over from After-hours to the local center, so that I had a higher likelihood of talking with a nurse who knew me. At 8:30 I called over there and spoke with a nurse who, as it happened, I'd never spoken with before. She suggested giving myself an extra bolus, but also said that she'd recommend contacting the doctor, since this was a change from the norm for me. So she paged the doctor for me.

Dr. P. was on call, which surprised me, since he's going to be away all this coming week, but that was good since I saw him twice this past week, so he knew what was going on with my medications, etc. He called me directly, rather than trying to relay everything through Matria, which I appreciated. He first told me to raise my basal rate on the terbutaline, and then said he could bring me into the hospital and get me onto a monitor and possibly mag sulfate if I wanted. Alternatively, this is about the last opportunity I've got to use Indocin (they won't use it after 32 weeks), so since I haven't been on it for a few weeks, and since historically it works well for me, that was my other choice. So I decided to try the Indocin again and he said if I wasn't feeling better in several hours, I can always come in to the hospital. Fine and dandy, except today is my foster son's 4th birthday party, so I'd like to avoid that if possible. Obviously, if I need to go, I need to go, and that's all there is to it. However, if there's any way to avoid it today, I'd like to. I do want at least my husband to be at the party, and I'd rather not go to the hospital alone (I'm not going to be at the party regardless).

So that's what we agreed upon. And then… shortly after I talked to Dr. P., I pulled out my pump to give myself the extra dose that my nurse had suggested and I realized that the pouch that holds the pump was a little damp, as was the area around the pump where the tubing attaches to the syringe in the pump. How odd… And I peered closely at the tubing and watched it for a good long while. And I realized that absolutely NO medicine was going through that tubing. In fact, probasbly no medicine had been going through that tubing all night. And in retrospect, when I changed the syringe last night, I vaguely remember that ther was a subtle "crack" sound as I put the tubing on, and I DID check to see if anything looked cracked but didn't see anything, so I'd sort of forgotten about it. Obviously, I didn't look closely enough. Whoops. In the two months that I've had the pump, this is a first. Still, I feel foolish.

However, at least now I know that the terbutaline really IS serving a very important purpose. Because if that was just a tiny glimpse of 12 hours without terbutaline (bearing in mind that the half-life of terbutaline is, I think, 4-5 hours, so I theoretically still had terbutaline in my system that whole time, just less and less of it through the night, then boy, do I not want to know what life woud have been like without it all together. So as many contractions as I feel with the terbutaline… at least I now know that the Terbutaline DOES work. Really well. Sheesh!

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Tonight I will be packing a hospital bag. Because, you know, it seems like there’s a possibility that I might need it at some point. I probably wasn’t clear enough in my last post. In fact, I was downright misleading when I said, “So I’m just going to sit around waiting to see if it’s a trend.” What I’d been told yesterday by my Matria nurse was that one day of high blood pressure wasn’t really a good data point and that if I had two days, then they’d decide what to do. So at the time I wrote my post this morning, I was waiting for my Matria nurse to call (since I’m not doing contraction monitoring anymore, she calls me in the afternoon, rather than in the morning after morning monitoring).

Anywhozit, my nurse called me around 12:30 and told me to take my BP again around 1:30 and see if it was still high. It was (125/94), so she called my doctor’s office. They promptly had me come into the office to be seen and the nurse at my doctor’s office suggested that IF I already have a bag together I might want to bring it with me, but if I didn’t already have it together, not to worry about it. Well, phooey. That wasn’t entirely what I wanted to hear. Suffice it to say, I didn’t have a bag packed anyway, so it was a moot point. And so… off to the doctor’s office. Dr. P. was in the office I went to, which made me happy (he’s a very calming influence). My BP was, annoyingly, elevated but not high while I was there (130/84). High for me, but not high enough to be problematic. My cervix has shortened by about half a centimeter. That’s not fabulous, but Dr. P. pointed out that at this point we want to get these babies another three weeks, not another three months, so it’s manageable (at its shortest, it was 1cm, it’s longest was 1.6 which used to be about as short as it would get).

Anyway, Dr. P. ordered some labs and a 24-hour urine collection. He said that obviously they’ve been doing their best to manage me as an outpatient for as long as possible, and that now they’ve kind of got a choice, which he left with me. Did I feel more comfortable being admitted now so I can be monitored 24/7 or would I be more comfortable and less stressed at home? I told him that honestly if he’d asked me last week I would have told him to admit me, but I really, really wanted to go home today. Next week, I said, I’m all yours. You can take me. In fact, I said, it’s probably best to admit me next week, so that I’m not trying to navigate the issues of dealing with getting to the hospital or doctor’s office if I need to in the midst of the Jewish holidays. He said that was a good point, and we’ll talk about it again before we get there. He wanted me to still come in for my already-scheduled appointment on Friday and we’ll see how it goes. At this point we’re just taking things one day at a time, and that’s okay.

Right now I’m really uncomfortable. The contractions are really getting intense. I gave myself an extra dose of terbutaline, which I normally try to avoid, particularly at night, but that’s the way it goes. But it’s okay. Not far now, right?

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Tonight I will be packing a hospital bag. Because, you know, it seems like there's a possibility that I might need it at some point. I probably wasn't clear enough in my last post. In fact, I was downright misleading when I said, "So I'm just going to sit around waiting to see if it's a trend." What I'd been told yesterday by my Matria nurse was that one day of high blood pressure wasn't really a good data point and that if I had two days, then they'd decide what to do. So at the time I wrote my post this morning, I was waiting for my Matria nurse to call (since I'm not doing contraction monitoring anymore, she calls me in the afternoon, rather than in the morning after morning monitoring).

Anywhozit, my nurse called me around 12:30 and told me to take my BP again around 1:30 and see if it was still high. It was (125/94), so she called my doctor's office. They promptly had me come into the office to be seen and the nurse at my doctor's office suggested that IF I already have a bag together I might want to bring it with me, but if I didn't already have it together, not to worry about it. Well, phooey. That wasn't entirely what I wanted to hear. Suffice it to say, I didn't have a bag packed anyway, so it was a moot point. And so… off to the doctor's office. Dr. P. was in the office I went to, which made me happy (he's a very calming influence). My BP was, annoyingly, elevated but not high while I was there (130/84). High for me, but not high enough to be problematic. My cervix has shortened by about half a centimeter. That's not fabulous, but Dr. P. pointed out that at this point we want to get these babies another three weeks, not another three months, so it's manageable (at its shortest, it was 1cm, it's longest was 1.6 which used to be about as short as it would get).

Anyway, Dr. P. ordered some labs and a 24-hour urine collection. He said that obviously they've been doing their best to manage me as an outpatient for as long as possible, and that now they've kind of got a choice, which he left with me. Did I feel more comfortable being admitted now so I can be monitored 24/7 or would I be more comfortable and less stressed at home? I told him that honestly if he'd asked me last week I would have told him to admit me, but I really, really wanted to go home today. Next week, I said, I'm all yours. You can take me. In fact, I said, it's probably best to admit me next week, so that I'm not trying to navigate the issues of dealing with getting to the hospital or doctor's office if I need to in the midst of the Jewish holidays. He said that was a good point, and we'll talk about it again before we get there. He wanted me to still come in for my already-scheduled appointment on Friday and we'll see how it goes. At this point we're just taking things one day at a time, and that's okay.

Right now I'm really uncomfortable. The contractions are really getting intense. I gave myself an extra dose of terbutaline, which I normally try to avoid, particularly at night, but that's the way it goes. But it's okay. Not far now, right?

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So while I was in the hospital I was on Indocin for 24 hours. This isn’t a drug that can be taken long-term in pregnancy because it reduces the amount of amniotic fluid, which is bad (and after 31 or 32 weeks causes bigger problems), but for short term use, it works quite well as a tocolytic, as I’ve discovered a couple of times now. So, while I was in the hospital, my contractions went down to only a few per hour, which is great.

I didn’t bother to monitor the night I got home, because I figured I’d been monitored enough all day. And the next morning (Tuesday morning) I had zero contractions. This isn’t shocking, considering that I still had some Indocin in my system. (Though, honestly, I can hardly remember another time that I had zero contractions in an hour.)

Tuesday night, however, I had fifteen contractions in an hour. The Indocin, clearly, was no longer in my system. (I had my uber-husband look up the half-life of Indocin, which turns out to be 4.5 hours, so that worked out about right) So I had to give myself a demand dose of terbutaline and remonitor (shock of shocks). And I had 10 contractions. So the nurse said “Well, should I have you remonitor again, or just call the doctor?” Uh, yeah, let’s think about this. It was 10:30pm. If I remonitored, by the time I heard back from her it would be close to midnight, by which point if I still had that many contractions, they’d be calling and waking up a doctor. No thank you. So I told her to call the doctor. In an ideal world, frankly, I would have called the doctor, but for whatever reason the after-hours nurses prefer to speak to the doctors directly, so whatever. I suggested that she mention that I do have Indocin at home and ask if I could take that for another 24 hours.

Dr. R. was on call again (she was the doctor on call who admitted me on Sunday), so she knew that my fetal fibronectin on Sunday had been negative, knew what my cervical length was, and knew what the orders in the hospital had been off the top of her head, so she was okay with me taking the Indocin for 24 hours, and was otherwise unconcerned. For the record, I wasn’t concerned either. This is just what I do at this point. I contract. A lot. Often. But, admittedly, if it had kept up at that rate, there was no way I was going to get any sleep, because it was making me pretty darned uncomfortable. And so…. I went back on Indocin for 24 hours last night. Easy enough.

And this morning I had 3 contractions. And tonight? One contraction. Gee, do you think this stuff works? I think so. Shame I can’t take it continuously.

Edit: Jennifer from Arkansas asked You’ve posted about the side effects of the terbutaline (sp?) as far as how it makes you feel. What is the indocin like? Any immediate sife effects to speak of? (other than the fact that it ROCKS in taking care of the contractions!!)

Well, all drugs have a side effect profile, of course, but the short answer is that Indocin doesn’t really have any negative side effects for me. Indocin (or indomethacin) is a non-steroidal anti-inflammatory drug (NSAID) like Aleve or a variety of other drugs. Normally NSAIDs are contraindicated in pregnancy, but obviously there are controlled exceptions like this one, but I wouldn’t recommend taking an NSAID just for fun while pregnant. Anywhozit, the main side effect for me is that it helps my headaches ever so slightly. It can also cause stomach pains or upset, so it’s recommended that one take it with food or Tums, which I find is helpful, but rarely remember to do. (I never found that Aleve hurt or upset my stomach, but I do find that the Indocin does a bit… which is funny because I took a LOT of Aleve before I was pregnant and the Indocin isn’t any more potent) Anywhozit, that’s pretty much it. I don’t think there are any other major side effects.

I’m also now taking the Nifedipine every day which has a few side effects itself, most notably it is a beta blocker, so it can lower blood pressure (which isn’t a bad thing, since Terbutaline raises blood pressure). The lower blood pressure can also lead to dizziness and whatnot, but that hasn’t been a problem for me. Yet.

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So while I was in the hospital I was on Indocin for 24 hours. This isn't a drug that can be taken long-term in pregnancy because it reduces the amount of amniotic fluid, which is bad (and after 31 or 32 weeks causes bigger problems), but for short term use, it works quite well as a tocolytic, as I've discovered a couple of times now. So, while I was in the hospital, my contractions went down to only a few per hour, which is great.

I didn't bother to monitor the night I got home, because I figured I'd been monitored enough all day. And the next morning (Tuesday morning) I had zero contractions. This isn't shocking, considering that I still had some Indocin in my system. (Though, honestly, I can hardly remember another time that I had zero contractions in an hour.)

Tuesday night, however, I had fifteen contractions in an hour. The Indocin, clearly, was no longer in my system. (I had my uber-husband look up the half-life of Indocin, which turns out to be 4.5 hours, so that worked out about right) So I had to give myself a demand dose of terbutaline and remonitor (shock of shocks). And I had 10 contractions. So the nurse said "Well, should I have you remonitor again, or just call the doctor?" Uh, yeah, let's think about this. It was 10:30pm. If I remonitored, by the time I heard back from her it would be close to midnight, by which point if I still had that many contractions, they'd be calling and waking up a doctor. No thank you. So I told her to call the doctor. In an ideal world, frankly, I would have called the doctor, but for whatever reason the after-hours nurses prefer to speak to the doctors directly, so whatever. I suggested that she mention that I do have Indocin at home and ask if I could take that for another 24 hours.

Dr. R. was on call again (she was the doctor on call who admitted me on Sunday), so she knew that my fetal fibronectin on Sunday had been negative, knew what my cervical length was, and knew what the orders in the hospital had been off the top of her head, so she was okay with me taking the Indocin for 24 hours, and was otherwise unconcerned. For the record, I wasn't concerned either. This is just what I do at this point. I contract. A lot. Often. But, admittedly, if it had kept up at that rate, there was no way I was going to get any sleep, because it was making me pretty darned uncomfortable. And so…. I went back on Indocin for 24 hours last night. Easy enough.

And this morning I had 3 contractions. And tonight? One contraction. Gee, do you think this stuff works? I think so. Shame I can't take it continuously.

Edit: Jennifer from Arkansas asked You've posted about the side effects of the terbutaline (sp?) as far as how it makes you feel. What is the indocin like? Any immediate sife effects to speak of? (other than the fact that it ROCKS in taking care of the contractions!!)

Well, all drugs have a side effect profile, of course, but the short answer is that Indocin doesn't really have any negative side effects for me. Indocin (or indomethacin) is a non-steroidal anti-inflammatory drug (NSAID) like Aleve or a variety of other drugs. Normally NSAIDs are contraindicated in pregnancy, but obviously there are controlled exceptions like this one, but I wouldn't recommend taking an NSAID just for fun while pregnant. Anywhozit, the main side effect for me is that it helps my headaches ever so slightly. It can also cause stomach pains or upset, so it's recommended that one take it with food or Tums, which I find is helpful, but rarely remember to do. (I never found that Aleve hurt or upset my stomach, but I do find that the Indocin does a bit… which is funny because I took a LOT of Aleve before I was pregnant and the Indocin isn't any more potent) Anywhozit, that's pretty much it. I don't think there are any other major side effects.

I'm also now taking the Nifedipine every day which has a few side effects itself, most notably it is a beta blocker, so it can lower blood pressure (which isn't a bad thing, since Terbutaline raises blood pressure). The lower blood pressure can also lead to dizziness and whatnot, but that hasn't been a problem for me. Yet.

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Many thanks to my pinch-hitter husband for posting for me this morning. As he said, I was sent to the hospital for monitoring last night after my 4:30 monitoring session had 15 contractions in an hour. Suffice it to say, it was a fun day all around.

So… off to labor and delivery triage we went. Where we quickly discovered I was still having far too many contractions. The nurses were great, the hospital was boring. My doctor called after a bit to suggest some options. We settled on trying 3 doses of Nifedipine over an hour and half and if I was still over threshold after that, she’d admit me over night for observation, get me on Indocin for 24 hours, and check my cervix in the morning and probably let me go after that.

Three doses of Nifedipine later, and just as many contractions, and there was a room with my name on it. And so, my darling husband went home to get some things for me, including (bless him) a toothbrush/toothpaste which hadn’t even occurred to me, but BOY DID I LOVE HAVING THAT! And the fun began. They got me back on the monitors… three fetal monitors and a contraction monitor. Now the ironic thing about that set up is that to keep the fetal monitors in the right place, I had to be laying on my back. But that made the contractions worse. But rolling onto my side disturbed the fetal monitors too much. Finally around midnight, the nurses called my doctor and asked if they could just leave the contraction monitor only on so that I could get more comfortable and hopefully sleep. At 1:30, they came in and took off the three fetal monitors, I rolled onto my side and went to sleep. At 4am I got my second dose of Indocin. At 6am, I woke up and my day started… for the last couple hours I’d only had a couple contractions. Miracle! (Indocin works well for me…it’s just that it can’t be taken long term)

Anywhozit, around 8 I was brought the world’s most disgusting breakfast (kosher hospital food… never a good thing… ick!). and a bit before 9 I was taken down for an ultrasound and to meet with my doctor. My cervix was, at its shortest, 1.7cm… shorter than last week, but not so much shorter than it was 5 weeks ago when this whole bed rest crap started in the first place. She recommended raising the basal rate on my terbutaline pump, adding Nifedipine XR again on top of the terbutaline, and having a fetal fibronectin test done weekly along with the already-scheduled weekly cervical measurements.

She was fully prepared to let me go home and asked if I had any questions. And I said, well, I wasn’t trying to be picky or anything… but I was doing the 4x daily finger sticks for blood sugar testing because I couldn’t take the three hour test, and since I hadn’t had a single blood sugar reading out of the range of completely utterly normal, could I maybe cut back on the number of times I had to test…but I was willing to do whatever she wanted me to. She said I could just do it twice a day if I wanted, but forewarned me that as I got later into the pregnancy, they’d probably still make me return to four times a day anyway. No problem. She went off to type up the ultrasound report and then popped back in and said, “Hey, since you’re in-house right now anyway, do you want to just DO the three-hour glucola test?” Uh, YEAH! Except I’d already eaten breakfast. No problem. I had eaten breakfast at 8, so they’d do the test at 4 and I could go home after that, unless I’d feel better staying another night (NO THANK YOU).

And so… I spent the most boring day of my life in the hospital today, internet-less, bored, with limited things to read or do. But on Friday, I should know whether I have to keep finger-sticking myself! And I was home at 8pm tonight. Safe and sound. All is well, the babies are all healthy and fine. The contractions are better for the moment. And life is good because I have my precious internet back. Gawd I’m an addict. Thanks everyone for your kind thoughts. I suspect this won’t be the last time I have a visit to the hospital before this is all over, but at least this wasn’t a terribly long orientation… 🙂 I’ll try to catch up on your blogs tomorrow.

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