Pre term labor question

[Sashie]

After talking to my sister today she told me that when she went into early labor with her daughter, she was administered trabutiline at 19 weeks. When I went in to urgent care at 18 (almost 19) weeks this pregnancy they told me that If I didn't stop and started actual labor they would not give me anything. That they are not able to administer me any drugs until 23 + 5 (23 weeks 5 days). I am curious as to how true this is. They made it sound like there is a period that the BABY cannot handle medications like Mag and such. My obgyn confirmed the 23+5 at my next visit, I'm totally freaking out here. My second kid I went into real labor at 30 weeks and was 75% effaced and about ready to deliver. They administered me Mag and hospitalized me for about a week, later released on procardia and on full bed rest. I was told that I have an incompetent cervix because of a surgery I had a few years back. Hubby is on the ship, and I basically put myself on bed rest only getting up to do what I have to (shower, feed the kids). If I get up and do too much, I feel the cramping, the back pain, cervix pressure and all the starting symptoms I had with my second kid. I was checked at 19 weeks, all closed up they said yet here I am having what braxton hicks at 16 weeks? Along with alot of other symptoms classified as pre term labor, report to your doctor symptoms? I want to make sure I am receving the care I should be seeing as I'm being seen by military doctors.... I'm not too confident at this point.



I think I hit 20 weeks today.

[MaggieBE]

If you have an incompetent cervix you should have had a stitch placed(that is removed with the birth). I'm surprised they didn't do that. Was it mentioned as being an option? I would look for a second opinion. Drinking a lot of water can help with contractions. Is there any way possible you can seek treatment off base? I'm not sure what sort of procedure you would follow. Perhaps you can look up some groups online for military wives. They might be able to give you better advise on how to seek a non military dr for these issues.

Wishing you the best.

[cocobelle]

That military doctors are less competent than civilian doctors is a fallacy. Military doctors receive their training at the same schools that civilian doctors do. Many enter into the military as a means of quickly paying off student loans. That being said...

Choice of doctors anywhere is a crap shoot. Sometimes you get a good one, sometimes you don't. Tri Care pretty much limits the selection process for the military, BUT there are loopholes.

I would suggest that the next time you feel the cramping or such, visit your local civilian ER. They are bound by law to examine and treat you and your unborn child. Tri Care will cover this. (as long as you aren't driving past the military hospital to get to the civilian hospital).

Gestationally, there IS a critical period when specific organ systems are developing. After this time, the fetus primarily grows, as opposed to develops. If the system - because of an extraneous chemical - develops improperly, it will continue to grow improperly. If the system is allowed to develop properly, the potential growth that is affected by medications is minimal.

[DAWNIMMEL]

I am not too familiar with tri care, except for what I researched for a project for my MBA, but I am in the medical field. I can tell you from experience, that if you have an incompetent cervix, you should have a cerclage (a stitch in the cervix) This is generally removed when it is safe to deliver. My daughter in law had hers removed two weeks before her due date. She has had one with all three of her kids. I don't know the actual age where they start giving meds, but I can tell you that they may give you steroids to increase lung developement. Stay on bed rest and try to get to a civilian ER. They will probably admit you for observation in the OB unit for monitoring. Also, Have you had any ultra sounds yet? Things are much different from when I was pregnant 14 years ago, they only allowed me one ultra sound. If you are having complications, you may suggest they do an utra sound to make sure the baby is okay.....Best wishes to you..........Dawn

[Sashie]

Sorry its so long

Thank you for your responses! I wasn't sure about the military doctor training, and I agree that even civilian doctors don't quiet get it. I also understand that some people just freak about pregnancies and report every little detail even when its a normal thing. This is my third child, I had the surgery after my first. While pregnant with my second I kept having pains and my doctor told me that it was all normal, all pregnancies are different he kept telling me even though I felt something was wrong. We moved, went on leave and the pains continued. While on leave I visited a civilian ER and was treated for a UTI, they released me a few hours later. The next day I went to another ER (the first one was on the way home from a cabin trip when I was having serious contractions) and was given more meds for a UTI.. they tried to discharge me and I refused to leave. I was having serious back pains and such, they told me it was normal with a UTI. The on call doctor checked me again, I was 75% efaced and another + 2cm dialated ( I think I was +3 or 4 at this point?) All I heard was him yelling at the nurse to get the mag. I kinda freaked but they gave me steroids, magnesium, some other things I honestly don't remember. I didn't know what was going on, I thought I was gonna loose my baby because no one was explaining anything to me. I was hospitalized for like 7 days and when released put on procardia and full bed rest. I then visited him once a week until I delivered. I was unable to go to our next duty station because the baby was basically just floating there my doctor said. I had to spend the remainder of my pregnant days at my mother in laws while my husband finished his training. My new doctor (the one I saw in the ER the second time) told me that I had an incompetent cervix because of the surgery I had done after my first and to expect to go through this again with future pregnancies.

Baby # 3 comes along, I tell them my full history and they tell me that it cannot be charted that I have an incompetent cervix until I have that same bs happen to me all over again. It has to happen twice basically. Thats why they didn't stitch me, I asked about that too after reading up on it. I am now having the same type of symptoms that I had with my second baby that my first doctor was telling me.. oh everything is fine.. not a week after I left his office did I start going into early labor, and I stayed this way for 2-3 weeks because I thought everything was "normal". All I knew basically was that if I did too much activity I started seriously cramping. The base that I live on has their own hospital so I cant really go to another "ER" unless I am not near my house. It looks like there is one about 30 minutes away from where I live. The doctor that I am currently seeing is a good doctor, one of the better ones that I've met anyway here on base. I am just worried that she thinks I'm being a panic attack and not taking what I'm telling her seriously. Even my doctor of my second child was telling me that everything I was going through was normal until he checked me that second time and was like WHOA okay shes not lying. My current doctor tells me don't do this, don't do that, but then she charts that I have no limitations, but recommends that I don't have sex, and don't pick up my 2y and to lay down whenever I can. She told me that around 24 weeks if I am showing signs of early labor they will give me steroids and meds if needed. I have so far had 2 vaginal ultrasounds. The first at 13 weeks to determine the size of the baby, the second to re measure my cervix which she says is fine. I have my real ultrasound on the 9th. On my recent ER visit, I was tested for a UTI and came back normal (had with both pregnancies so I'm expecting one again).

I am worried that I am going to go into early labor and loose the baby because they cant/wont give me anything to stop the contractions, to later on find out that I am able to have medication. I guess what I was asking was am I not able to receive meds because of the safety of the baby, or because its policy of this hospital. I am thinking I'm going to give my old doctor a call and see what he says. I would just go see him but my son is in school and my mother in law has another roommate and no room for me and my 2 kids. My last appointment I heard my doctor talking to someone outside my door about how she had to do a DnC and theres one less to worry about.

[cocobelle]

Okay...time to fight fire with fire. I was not only married Navy, but I was a Marine Corps brat growing up. I completely understand where you are coming from. As of August 1990, it is now completely legit for military dependents to sue for malpractice. Prior to that, there was a protective umbrella over the military physicians for dependent care. There was a really ugly case in Long Beach, where the serviceman sued on behalf of his dependent children after his spouse died. Anyway....

I would internet it.. download your concerns, and substantiations of previous problems. All the information that you can to basically scare the sense back into some of these providers. If the provider again tells you to not worry about it, ask 'would you be willing to risk your license on that opinion, Doctor?'

I understand completely where the providers are coming from. I delivered a pre-term baby at 30 wks... we held off delivery until the last possible time. I'm glad that we didn't use medications prior to the 19 wk time frame. The incidence of congenital deformities is incredible for use of medications during that time frame. Most of the organ systems have completed their development by 19 weeks. Medications given before that 19 wk time frame could affect how those systems develop, possibly preventing them from developing at all. I know that is something that you aren't wanting.

The struggle now is to keep the baby safe and healthy until such a time that they can pharmaceutically treat your condition. Obviously, you've had a recent pelvic. Did it show abnormalities? Have you been bumped up from the 'see ya next month' schedule to a more frequent visitation? You have an appt on the 9th correct? Is it just for an ultrasound, or will there be a cervix check at the same time?

You obviously had a traumatic experience with your second child, one that I am sure no one would like to duplicate. Going through this as a single parent only makes the situation worse. Yes, yes - I am sure that some will read this and think "her husband is with her in spirit"... but there is nothing like having a difficult pregnancy in an unfamiliar area with a deployed husband and dependent children. It's definately alot of stress. Another thing that you could try is family services. Most bases have family services that include nursing care. Perhaps if you talk with family services, they could either a) reapproach the obgyn with your concerns, or b) arrange to have you champus'd out into town. Problem with being champus'd out is that you re-enter that whole crap shoot thing in selection of providers.

good luck to you!

[boonie stomper]

http://webpages.charter.net/mamamojo/terbutaline.htmlJust thought you might want to read this, too, before deciding to try and get terbutaline.

[DAWNIMMEL]

First I want to say, let us know how your ultrasound goes on the 9th. I always thought that Female OB/GYN's were better than the males, but in this case after her comment on the D&C I would have to feel different about this one. She doesn't seem to care about her patients. Is there another OB/GYN on base you can see? My GYN is wonderful and I only wish I had her when I was pregnant with my daughter. Keep your spirits up. My daughter in law was on bed rest the beginning of her pregnancy and the last two months of her pregnancy. We now have a health baby girl, born on the 22nd. She went full term with this one when she went early with the first two. So keep your chin up and question your doctor. They are not gods and they work for you.........Dawn

[maribelle]

I don't have any answers for you, and I know how nearly impossible bed rest is when you have little ones. Is there anyone who can come in and help you during the day so you can completely stay in bed except for bathroom breaks? I wish I had done this with my DS, but didn't, and he too was born really early. What your doctor said was COMPLETELY insensitive and stupid, and its not the first time I've heard of women doctors/ nurses saying stuff like that. In my experience its been the men who have been more sympathetic and understanding. I hope things work out, Sashie, and will be thinking of you!

[Sashie]

Thanks for all the responses, you guys have helped settle my nerves alot.
I'll let you know how the ultrasound goes.