AHH! Showing SO.MUCH.MORE than I was with Owen at this point! It's crazy!
This time around we are seeing a group of Maternal and Fetal Medicine Specialists and thankfully the program here is one of the most evidence-based in the country, particularly for pre-term labor. My medical records with Owen are spotty, I didn't deliver here and I did carry Owen to term so it was decided we would treat this pregnancy as if this were my first time. They didn't recommend taking drastic (risky) precautions so we would not place a cerclage (a stitch placed surgically to hold the cervix closed) in the first trimester.
Today I started progesterone injections (P17 shots) which Jeremy will give me weekly in my hip up until 36 weeks. There is evidence to show this can prevent preterm labor. The progresterone has to be compounded at a pharmacy and shipped to our house. It is suspended in a very thick oil, so the needle is pretty big. Today the nurse showed Jeremy how to give me the injection (note: surgeons don't give people shots, at least people who are awake anyway!) Once he saw how big the needle is and how long it takes to draw up the liquid, he felt awful having to stab me with it. He figured if he went a little slower it might hurt less... I think we'll speed it up next week ;) Poor guy. I honestly think it was harder on him than it was on me.
The other precaution is that I will receive bi-weekly cervical measurements (via ultrasound) at the office. Today my measurement was 4cm which was completely normal (anything less than 3 is worrisome) and they were very pleased with the way it looked. The measurements go from now up until 24 weeks and then the exams are digital therafter. Since I went into preterm labor with Owen at 27 weeks, they'll continue to keep an eye on me but after 24 weeks with good measurements no cerclage will be placed.
All this said, I could still end up on medication if I start contracting AND the contractions cause cervical changes too early. Some amount of irritability is normal, we just don't know how much is normal for my body. And now that I know what it feels like to contract, I'm hyper sensitive about it. Already I've had a few bouts of contractions here and there so to see a healthy, long cervix today made me very happy.
Bed rest is not an option this time around. I need to care for Owen and our doctors believe it does more harm in terms of possible blood clots and depression than it does good. Limited activity could be factored in, but we'll cross that bridge if we get to it.
That's our plan, coupled with LOTS and LOTS OF PRAYER for a healthy, FULL-TERM baby.
Please keep us in your thoughts xoxo
What do your docs say about if your cervix were to become very thin? Still no bedrest? Is that risky? I'm very curious about their point of view as it hits close to home! Hang in there, Mama - so glad all was great today!
ReplyDeleteThis plan sounds so different from what your doctor in Dayton wanted to do on round two. It's interesting to me how different docs. look at things so differently. Glad you are with a practice you trust. Here's hoping for at least 37 weeks!
ReplyDelete@Megan, they do not prescribe FULL bedrest - only limited activity. There is not enough evidence to suggest that FULL bedrest actually contributes to keeping the baby in. That's the thing (and most frustrating part) about OB, it's all a crap shoot.
ReplyDelete@Elizabeth, yes, this plan is VERY different than what we had discussed in Dayton but we met with lots of specialists here before even conceiving a second time and the same plan was put forth by all of them. There wasn't a single doctor here willing to put a stitch in me at 14wks after reading that I carried to term.
I think my doc is more conservative with bedrest considering I was 100% effaced at 25 weeks...but luckily, she and my perinatologist agreed no cerclage based on the fact that I never dialated until my water broke with C. Hoping our cervixes hold strong, Mama!
ReplyDeletelots and lots of prayers. very interesting to hear the differences, but based on hearing my own midwife discuss these sorts of things, it definitely sounds like best practice stuff. yay for no pelvic rest ;) heehee
ReplyDeleteThe intramuscular progesterone in oil (also compounded) that we use in horses gets injected through an 18 or 19 gauge 1.5" needle. We typically mix it with a little cortisone (triamcinolone) since it has a tendency to make these fillies sore at the injection site. Just wondering how the "people" version compares. Granted we use it primarily for control or suppression of the estrus cycle. :)
ReplyDelete@Andrea Can I just say I LOVE when you compare people to animals ;) You crack me up. But to answer your question, sadly, it's the same. I did luck out with a 20 gauge (but the nurse said she likes to draw it up with an 18 but sometimes forgets to switch it out..) Fun? right? It is not mixed with cortisone and definitely makes for a sore injection site.
ReplyDeleteJust came across your post and as a high risk mom who lost a preemie and had two tough pregnancies (cerclage, bed rest and progesterone) I can truly understand. Hang in there and try to enjoy your pregnancy. (As hard as that can be some days.) I just published a book titled, High-Risk Pregnancy-Why Me? Understanding and Managing a Potential Preterm Birth to help other moms understand all the medical 'stuff' and cope. I talk all things cerclage, cervical lengths, P17, FFN... I would love to send you a book. Check out my website www.hrpwhyme.com (There's a table of contents too.) Email me if you're interested (kelly@hrpwhyme.com). Good luck and happy baby baking!
ReplyDeleteI had those progesterone shots for 10 weeks? 20 weeks? an eternity?... I don't remember... during IVF. They SUCK. I'm sorry. Hopefully they'll keep that baby in tight, though! Good luck, Mama!!
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