WWYD Re: my history of preterm labor

[Aspasia]

My first baby was extremely premature (born at 24 weeks). We took him off life support after several days. Nobody was ever able to figure out what happened, I just went into labor one night and they couldn't stop it.

 

So, for my last three pregnancies, I have had progesterone injections from about 18-20 weeks until 34-35 weeks. Dd was born at 37 weeks and then my last two went to or past their due dates.

 

I'm currently 22 weeks pregnant and haven't started my injections yet, for a variety of logistical reasons. But I'm starting to wonder if I want to do them at all. When I originally decided to do them with dd6, I figured, hey, it's progesterone. My body produces this to sustain pregnancy anyway. How bad could a little extra be? Plus, I was obviously terrified and would have done anything to ensure a full-term pregnancy. After that, it was just part of my pregnancy plan.

 

But recently (I don't know why it took me so long), it has occurred to me that excess synthetic hormones might be a bad thing for anyone, especially a developing fetus. And since I have had three uneventful pregnancies and deliveries, I wonder if I could get by without the injections.

 

My doctor is leaving it up to me, as they all have. She doesn't feel strongly about it either way. Same with dh. Everyone just wants me to do whatever I'm comfortable with. I like the idea of trying to do this without the extra hormones, and there is a chance that what happened with my first pregnancy was just a random fluke--something wrong with THAT pregnancy, not necessarily my body's ability to sustain a pregnancy. If that's the case, I don't want the hormones. BUT, if I have another preemie, I just know I'll hate myself forever because I know now that I CAN carry babies to term. BUT if it's not necessary, I'd like to spare this baby from the exposure.

 

WWYD???

[Jerico]

Personally, i would do the injections.

[littlebug42]

I would do the injections.  I wouldn't want to risk that the uneventful pregnancies were because I did the hormone injections.  

[Joanne]

(((Hugs)))

 

Congratulations! I don't have an answer or opinion but am wishing you and your newest growing baby health and joy and the right amount of stay in mommy time.

[MomatHWTK]

I would  do them as well.  After we suffered one loss I went on Progesterone immediately for the next pregnancy.  I would not be able to deal with the anxiety otherwise. KWIM? 

[Aspasia]

This is what has me freaking out about progesterone.

 

http://prenatalexposures.blogspot.com/2013/05/worse-than-thalidomide-consequences-of.html

 

I don't even know how I came upon it, because I really wasn't looking for anything like this. I was just trying to find a pharmacy that will compound the progesterone (the one I've used in the past apparently doesn't do it anymore). Regardless, it has me second guessing everything. Sometimes I hate the internet!

[swellmomma]

Projesterone is not something I was ever offered in my pregnancies and 3 out of 4 of mine have been prem.  Not as early as yours was though things generally start that early for me but can be stopped. Now aside from my multiple early first term m/c I have managed to remain pregnant until at least 35 weeks without synthetic hormones BUT if it was offered to me during any of those pregnancies I would jump at it.  With oldest labour bleeding started at 14 weeks and contractions causing change started at 26 weeks was stopped and I remained on bedrest until he was born at 35w4d, when my water broke.  dd14 was actually 4 days late so they figured my issues with his pregnancy were a fluke.  Then came ds10, contractions that actually caused change started at 19 weeks, they stopped but I had the issue for the rest of the pregnancy plus bleeding off and on, water broke at 35w1d, held on another week in hospital on IV antibiotics before inducing at 36w0d.  Then was dd6, I spent that whole pregnancy terrified, I started bleeding at 19 weeks again, water broke at 34w3d, I had her 2 days later.  If I had any chance of taking a hormone to help maintain the pregnancy and not have me constantly worried about another prem I would take it.  Personally I feel the risks of exposure to the hormone being an issue to be less than the risk of not taking it and having a prem kwim. 

[RoughCollie]

Long term effects of progesterone on babies, if any, are unknown because there haven't been any reliable studies done.  http://www.effectivehealthcare.ahrq.gov/ehc/products/104/1239/ProgestogensPretermBirth_FinalReport_20120823.pdf

 

Many of the long-term effects of prematurity are known. 

 

I'd go with what is known, and take the progesterone to hopefully prevent pre-term labor.

 

Personally, I would not let what a blog says effect my decision.

[Aspasia]

Long term effects of progesterone on babies, if any, are unknown because there haven't been any reliable studies done. http://www.effectivehealthcare.ahrq.gov/ehc/products/104/1239/ProgestogensPretermBirth_FinalReport_20120823.pdf

 

Many of the long-term effects of prematurity are known.

 

I'd go with what is known, and take the progesterone to hopefully prevent pre-term labor.

 

Personally, I would not let what a blog says effect my decision.

I know. It's so stupid. But we know that hormones in our diets are causing all kinds of problems. It makes sense to me that overloading a fetus with extra hormones could cause problems down the road. In theory, people like me might not produce enough progesterone at all, so the "extra" wouldn't be extra--it would just be enough. But if my first pregnancy was a fluke, then maybe I am producing enough on my own, and that would mean that the injections do result in too much.

 

Seriously, I can't have any more babies after this, because my anxiety over it all is just out of control!

[itsheresomewhere]

I am very natural but I would do this.  

[*Alyssa*]

I'm not a doctor, so I don't have an opinion on the injections.  If I were in your shoes, I would opt for a good dose of magnesium in my daily diet.  Magnesium is what they use to stop pre-term labor contractions and is also highly recommended to women who are prone to pre-term labor.  I drink "Natural Calm" daily, along with Vitamin D3, Vitamin K2, and B Vitamins (includes folate).  You can also use the magnesium oil.  (I don't recommend magnesium in tablet form.)  I don't see why you couldn't do this in addition to the injections, if you want to take that route, because you should be getting those things anyways for your health and your baby's.

That is what I would do, but I can't tell you what you should do.  You know your medical history better.  I have went into preterm labor before (30 weeks) and buried children, too.  It's not an easy decision to make when you know what that pain feels like.  My heart goes out to you!  :grouphug:

**All the magnesium warnings during pregnancy are not for regular intake of magnesium.  That is for giving women continuous magnesium in hospitals.  Regular intake of magnesium is important for all human beings, especially pregnant women prone to preterm labor and gestational diabetes.  An overdose of anything could harm you, including water.

[elfgivas]

((((hugs))))  it is so hard to not know. 

 

i'd ask your doctor specific questions about studies that have been done on prenatal exposure and what your doctor has concluded about them. 

 

meanwhile, i would fall back on some of my tried and true strategies.  eg.  one of my rules is that anyone who has to sensationalize an argument (or mention a certain german dictator in the mid-20th century) has failed to scientifically make their case.  so in the case of the link you gave, just the title of the source you sited was enough for me to close the page.  if it is legitimate, it doesn't need to be sensationalized.  it is not worse than thalidomide.  it isn't even a question. 

 

(in the end, i went back and read it.  i am trying to find the study that the author was a part of.  that might be a good question for your doctor.... what did that study conclude, and what other studies are out there?  i found several papers that site the original study, and they appear to be in direction of a possible impact on sexual identity which also doesn't appear to have results that are statistically significant)

 

another thing i use is personal experience.  what do i know already about something?  or think i know? 

you have two test cases who live with you now.  how are they doing?  if they are showing any problematic signs, i would be more concerned than if they appear fine.  (its not necessarily a valid approach, but it seems relevant to me)

 

fwiw, i had a doctor try to scare me off taking prednisone during my third pregnancy.  it was the only way I had two children.  they were then, and are now, healthy.  the next two are healthy, too.... and i took prednisone during their pregnancies, too.  its not perfect, but its better than the alternative, at least for me (and they assure me they'd rather be here than not ;).... but i did research it thoroughly as a result of his statement, and brought in other doctors to help me decide.

 

blessings,

ann

[Moxie]

I would get the shots and think nothing more of it.

[goldberry]

I would do the injections.

 

If something went wrong, I would at least not be anguishing over something else I might have done, whether or not it would have made a difference.

 

:grouphug:

[UncleEJ]

I just wanted to say that I took them with my last pregnancy and I feel your pain. Those injections were not pleasant! If you decide to go through with them, and if I were you I probably would, I will be thinking about you once a week!

[TheReader]

I'm a mom to three preemies, and I took the progesterone injections, though they did not help in my case. If they have helped you carry to term, I would be grateful for that and take the injections. Perhaps if you are very concerned, you could stop them earlier, at whatever point in the pregnancy you feel comfortable with baby's chances/odds for survival? This way you'd lessen the amount of hormone given, while still doing what is needed to carry long enough? 

 

I'd also consider all the interventions that can take place with a preemie who is viable. I do not wish in any way to minimize your loss; I cannot imagine losing a baby to premature delivery. Luckily, gratefully, my boys were all far enough along that they did eventually come home. But the interventions in the NICU are numerous, and it's likely your little one, if born early, would go through things that are more invasive & with more long term effects than the maybe extra/maybe just enough progesterone. Even things as simple as prolonged time on oxygen can have damaging effects on preemies later in life. I'd research what all might go on during a NICU stay and what the various outcomes might be; I think you would find that the progesterone is definitely the lesser of two evils, especially since it has been shown to work for you. 

 

Hugs & prayers; I know it's not an easy road, at all. 

[gardenmom5]

was there any other reason why you did the shots with the other pregnancies BESIDES the fact your first was pre-term?  any pre-term labor?

 

My sister had lots of pre-term contractions before they started her on progesterone shots.  she had previously had a miscarriage. she was opposed and uncomfortable with the idea - enough that she'd drink a shot of whisky everyday as a "natural" way to calm contractions instead of having a shot.  if she went more than a week without a shot - she'd start contracting like crazy again.  her dd was still born by c-sec at 30 weeks - because of fetal distress that was unrelated to either of the above.

 

I don't think she did shots with her next pg. 

 

eta: they had a day or two to determine what was wrong (and they still didnt' know what was happening until they opened her up) and were giving her injections to help with fetal lung maturity before doing the section.

[Aspasia]

((((hugs)))) it is so hard to not know.

 

i'd ask your doctor specific questions about studies that have been done on prenatal exposure and what your doctor has concluded about them.

 

meanwhile, i would fall back on some of my tried and true strategies. eg. one of my rules is that anyone who has to sensationalize an argument (or mention a certain german dictator in the mid-20th century) has failed to scientifically make their case. so in the case of the link you gave, just the title of the source you sited was enough for me to close the page. if it is legitimate, it doesn't need to be sensationalized. it is not worse than thalidomide. it isn't even a question.

 

(in the end, i went back and read it. i am trying to find the study that the author was a part of. that might be a good question for your doctor.... what did that study conclude, and what other studies are out there? i found several papers that site the original study, and they appear to be in direction of a possible impact on sexual identity which also doesn't appear to have results that are statistically significant)

 

another thing i use is personal experience. what do i know already about something? or think i know?

you have two test cases who live with you now. how are they doing? if they are showing any problematic signs, i would be more concerned than if they appear fine. (its not necessarily a valid approach, but it seems relevant to me)

 

fwiw, i had a doctor try to scare me off taking prednisone during my third pregnancy. it was the only way I had two children. they were then, and are now, healthy. the next two are healthy, too.... and i took prednisone during their pregnancies, too. its not perfect, but its better than the alternative, at least for me (and they assure me they'd rather be here than not ;).... but i did research it thoroughly as a result of his statement, and brought in other doctors to help me decide.

 

blessings,

ann

I've given up on asking doctors. They all seem to support whatever is the current norm. I haven't had any luck in finding doctors who think outside of that. Right now, I'm actually going to an office where I'm seeing a midwife (though there is an OB mainly, mainly for surgeries and emergencies). I really like her and she's very supportive of natural pregnancy and birth, but I think for liability reasons, if nothing else, they are sort of obligated not to discourage me from doing the injections, you know?

 

I think you're right, though. I actually have three living progesterone babies who are all perfectly healthy. I don't know what their reproductive futures will be, but I think you are all right that that is a better risk than prematurity and all its complications. Thanks for helping me think clearly. I get myself worked up and then my mind goes into irrational places. Sometimes I just need reasonable people to pull me out.

 

 

I just wanted to say that I took them with my last pregnancy and I feel your pain. Those injections were not pleasant! If you decide to go through with them, and if I were you I probably would, I will be thinking about you once a week!

I know! And I actually do the injections myself. It never gets easier, but it's a lot easier than hauling all my kids to the doctors office every week.

 

I would do the injections.

 

If something went wrong, I would at least not be anguishing over something else I might have done, whether or not it would have made a difference.

 

:grouphug:

So true. I'm gonna do them.

[unsinkable]

I don't have advice. i am sorry for your loss and I hope this pregnancy goes smoothly and you get the answers you need.

[UncleEJ]

 

 

I know! And I actually do the injections myself. It never gets easier, but it's a lot easier than hauling all my kids to the doctors office every week.

 

.

I did too, well DH did it. Ugh, it was so thick and painful, unlike any shot I'd ever had!

[Aspasia]

I did too, well DH did it. Ugh, it was so thick and painful, unlike any shot I'd ever had!

My dh is a weeny. He won't do them.

[Acadie]

Is it possible and would it be helpful to get your progesterone levels checked?  

 

Amy

 

 

[SproutMamaK]

Having had lots of second-trimester losses... I would take the injections. Frankly, at this point you're past the point where the baby's reproductive organs (and pretty much everything else) are formed, and all that's left is getting those parts strong and healthy. If there is a risk for problems due to the hormones, which is extremely debatable, it's been minimized at this point. If it still concerns you in a few weeks, you can always stop once you're a bit more comfortable with how far along you are (at 28 weeks, 32 weeks, etc). In the meantime, this point is crucial for your baby's growth and strength.... I'd play it safe.

[HSmomof2]

Long term effects of progesterone on babies, if any, are unknown because there haven't been any reliable studies done.  http://www.effectivehealthcare.ahrq.gov/ehc/products/104/1239/ProgestogensPretermBirth_FinalReport_20120823.pdf

 

Many of the long-term effects of prematurity are known. 

 

I'd go with what is known, and take the progesterone to hopefully prevent pre-term labor.

 

Personally, I would not let what a blog says effect my decision.

 

:iagree:

 

[RoughCollie]

I know. It's so stupid. But we know that hormones in our diets are causing all kinds of problems. It makes sense to me that overloading a fetus with extra hormones could cause problems down the road. In theory, people like me might not produce enough progesterone at all, so the "extra" wouldn't be extra--it would just be enough. But if my first pregnancy was a fluke, then maybe I am producing enough on my own, and that would mean that the injections do result in too much.

 

Seriously, I can't have any more babies after this, because my anxiety over it all is just out of control!

 

I don't think it is stupid.  If I were pregnant in your situation, I'd think exactly the same way.  I'd be worried that I would make the wrong choice, especially since it is not known if or how this treatment effects a baby long term.  My anxiety would be over the top.

 

I get anxious when I have to make an important decision and the outcome is not predictable due to unknown factors.  That's why I decided to base my decisions on what is known.  This has not proven to alleviate my tendency to second-guess myself and to blame myself when I make a poor decision.  What I do that is reasonable, I think, is to analyze outcomes.  Sometimes I make major decisions that, in hindsight, are poor, and the reason turns out to be something unknowable and beyond my control.  Usually with decisions that are unimportant in the grand scheme of things, a poor outcome is due to my own flaws.

 

The unknown is what paralyzes my decision-making process especially when the risk of a poor outcome, no matter how slight, will have a bad effect on my family.  I try to minimize risk as much as possible and to live with poor outcomes that are not my fault without denigrating myself. 

 

I had to make decisions several times when I was pregnant with my boys.  In one instance, the risks were known, and I decided not to undergo a pregnancy reduction to ensure my boys were not born prematurely.  That was actually an easy decision that DH and I made immediately and never regretted.  The risk came to fruition -- the three boys were born at 27 weeks, and each weighed under 2 lbs.  I could live with that much more easily than I could live with myself after agreeing to "reduce" the pregnancy to one or two fetuses.

 

In another case, I was given a drug on which only one study had been done about how it effected fetuses and that was not a very credible study.  The drug was necessary because I had a few severe illnesses that were directly caused by my being pregnant with triplets and the immense physical stress on my body was also not good for them.  At the time, I had already been hospitalized for 4 weeks for preterm labor. 

 

I took the drug.  The boys were born prematurely.  For years, I worried that my taking that drug had hastened the birth of my sons.  Later studies showed that the drug was safe for pregnant women and their fetuses.

 

My point is that I am well acquainted with anxiety in the decision-making process, especially when the risks are unknown and the recipient of the risk is a baby.  I don't think you are being stupid at all.  I know what this anxiety feels like, and I would have the same response to the situation. 

 

It is what I call a "you can't win for losing" situation.  No matter which way you leap, your decision

could be the wrong one due to factors that are unknowable.  So it comes down to an outcome-based decision, based on the facts you know.  If you take the progesterone, and years later you find out that it caused your child some bad effect, can you live with that?  If you don't take it, and have a premature baby, with a possibly dire outcome, can you live with that?  Which risk is the lesser of two evils, basically.

[prairiewindmomma]

I would take them. If you are deficient in something, I don't see the problem in correcting the deficiency.
 

[Tammi K]

For every negative, there are reports like this: 

 

Progesterone May Increase Babies IQ

A study reported in the British Journal of Psychiatry observed that administering progesterone from the middle trimester of pregnancy for relief of the symptoms of toxemia had some unexpected benefits: “A significant improvement in educational performance was demonstrated among children [whose mothers] received progesterone before the sixteenth week†following conception; and after giving birth their mothers seemed to have greater success at breastfeeding.

Clinical observations involving ninety children whose mothers received progesterone were summarized thus: “More progesterone children were breast-fed at six months, more were standing and walking at one year, and at the age of 9-10 years the progesterone children received significantly better gradings than controls in academic subjects, verbal reasoning, English and arithmetic.â€

 

I don't think there is conclusive evidence either way.  Congratulations on your little blessing.

 

(PS - anecdotal evidence to be sure but I had progesterone in my last pregnancy and he actually is gifted. 'just sayin' :laugh: )

[sbgrace]

I did progesterone injections in my boys pregnancy because of previous miscarriages. I would do them if I was pregnant again.

[BlsdMama]

Your OP assumes it is "extra" hormones. The truth is your body apparently may not be functioning correctly so you need the hormones to maintain pregnancy.

 

I have a cervix that begins to shorten insanely early. The dead baby in my signature is from preterm labor. Now they stitch me shut (cerclage) and fill me with progesterone, birth daily and weekly. I hate progesterone. I hate how it makes me feel. But I'm very grateful.

 

Hasn't your cervix ever been monitored for shortening? If not, I think that is strange! I have ultrasound monthly, and sometimes weekly, to monitor for the cervix shortening.

 

Has your cervix been measured yet this pregnancy? Often those of us with preterm labor issues tend to have successively short pregnancies or pregnancies that require more maintenance. I'd be in ASAP for at least a cervical length, though it's less accurate right now. It's possible they won't start progesterone this late?

[Aspasia]

Your OP assumes it is "extra" hormones. The truth I'd your body apparently isn't functioning correctly so you need the hormones to maintain pregnancy. You're 22 and haven't started? Mama, that's a dangerous game to play. I have a cervix that begins to shorten insanely early. The dead baby in my signature I'd preterm labor. Now they stitch me shut (cerclage) and fill me with progesterone, birth daily and weekly. I hate progesterone. I hate how it makes me feel. But I'm very grateful. Hasn't your cervix ever been monitored for shortening? I have ultrasound monthly, and sometimes weekly, to monitor for the cervix shortening. Has your cervix been measured yet this pregnancy? Often those of us with preterm labor issues tend to have successively short pregnancies or pregnancies that require more maintenance. I'd be in ASAP fir at least a cervical length, though it's less accurate right now. It's possible they won't start progesterone this late?

They checked my cervix weekly with all of last three pregnancies. It was actually always a tad longer and thicker than average. Because of that, the peri didn't feel the need to monitor that this time around.

 

I think you can start progesterone up to 26 weeks. I've been in touch with my midwife about it. We've had a hard time finding a pharmacy that will compound it (thanks to the relatively new brand name version, Makena, which is insanely expensive). I did find one up in Pennsylvania (we're in Virginia), so I'm just waiting for midwife to send the prescription and pharmacy to send the progesterone.

[Lawana]

I have bioidentical hormone (estrogen and progesterone) cream compounded locally. Is out-of-state mail order an option?

[MtnTeaching]

Advice is always tricky with things like this, because everyone and every pregnancy is so different.

 

When I went into full preterm labor with ds at 26 weeks, I was not offered progesterone.  They quickly wheeled me around the prenatal ICU to significantly scare the pee out of me and to see what could happen, then gave me magnesium sulfate to try and stop the labor. After two days, they sent me home with a Terbutaline pump in my leg (which dh had to change each week), surfactant shots for his lungs, a monitor I had to send in every hour, and complete bedrest.  Could only sit up to eat with my feet up, go to the bathroom, and take one 5 minute shower a day.  Ds managed to make it to 35 weeks.  I had a miscarriage next at 12 weeks, then I got pregnant with dd.  I started preterm labor with her at 24 weeks and the whole Terbutaline process began again.  She lasted to 38 weeks.

 

I know that my mom tried for 10 years to have me and had multiple miscarriages before me at 35.  I am assuming that there may be a genetic factor, but have no way of knowing for sure.  I will definitely let dd know that she should probably be diligent though, when the time comes.

 

I have had concerns about the medicine. I read a lot about the problems that have been attributed to Terbutaline and I took so darn much of it while they were forming and growing.  All I know is that I have two healthy, beautiful, sweet children.  One is ADHD (but so was my dad and I am too), the other is dyslexic, they both have had trouble with their speech.  Could this be attributed to the meds?  I have no way of knowing.  They are perfect to me and if I were to be put in the same situation again, I would not hesitate to do it exactly the same way.  I really dislike and distrust meds, but if it came to the possibility of losing another baby, I would not hesitate.

 

But that is just my personal view.

[BlsdMama]

They checked my cervix weekly with all of last three pregnancies. It was actually always a tad longer and thicker than average. Because of that, the peri didn't feel the need to monitor that this time around.

 

I think you can start progesterone up to 26 weeks. I've been in touch with my midwife about it. We've had a hard time finding a pharmacy that will compound it (thanks to the relatively new brand name version, Makena, which is insanely expensive). I did find one up in Pennsylvania (we're in Virginia), so I'm just waiting for midwife to send the prescription and pharmacy to send the progesterone.

 

 

This changes things IMO. Have you found out if your insurance covers the injections. As of the end of my pregnancy with Cate (nine months ago) the company (and I'll leave off what I think of them, cough, puke) won a lawsuit banning obstetricians from providing generic progesterone for the purpose of preventing preterm labor. It took the instructions from about$8 each to approximately $900 EACH. At once a week....

 

Edited to explain:  The "company" is Makena.  http://www.fda.gov/newsEvents/Newsroom/PressAnnouncements/ucm249025.htm 

Where is the vomit emoticon?  Essentially when I was pregnant with Catie, I found a compounding pharmacy to compound generic progesterone for me so I could do my own shots.  At the end of that pregnancy the lawsuit was put into effect to support Makena's right to not allow pharmacies to compound their own but force women to get the progesterone from Makena alone, who makes a KILLING off a dirt cheap drug.   AKA, kill preterm babies for mamas who can't afford OUTRAGEOUS out of pocket pharma costs.  Make me puke.

 

IF you needed them, expense is no consideration. But you saying that your cervical length was longer than average.... Cervical length is HIGHLY indicative of preterm labor (not counting PROM patients) and if your length was over, for example, 3.5-4, I would wait and watch and do nothing.

 

If it was 3 or just a hair over or less, I would absolutely do the injections.

 

With your first pregnancy did they ever test for infection?

[Melissa in Australia]

I would probably take them just for the piece of mind.

 

2 of my pregnancies I was on the pill (birth control) for the first 5 to 6 weeks. I didn't realize I was pregnant.

 

 

[Aspasia]

This changes things IMO. Have you found out if your insurance covers the injections. As of the end of my pregnancy with Cate (nine months ago) the company (and I'll leave off what I think of them, cough, puke) won a lawsuit banning obstetricians from providing generic progesterone for the purpose of preventing preterm labor. It took the instructions from about$8 each to approximately $900 EACH. At once a week....

 

IF you needed them, expense is no consideration. But you saying that your cervical length was longer than average.... Cervical length is HIGHLY indicative of preterm labor (not counting PROM patients) and if your length was over, for example, 3.5-4, I would wait and watch and do nothing.

 

If it was 3 or just a hair over or less, I would absolutely do the injections.

 

With your first pregnancy did they ever test for infection?

Yeah, I remember reading about some battle that company was fighting to dominate the market during my last pregnancy. It's despicable. Then I read something about that being dismissed, but your information is more recent than mine. And it makes sense, since now the local compounding pharmacies are telling me they don't make it anymore. I guess since we have the same insurance that we had for our last two babies, I've just assumed they would cover it. Hmmm...guess I should check.

 

They did a lot of testing after my first pregnancy, and I honestly don't remember what all they tested for. But I remember doing a lot of my own research for explanations, and infections are a biggie, so I know I brought it up with my doctor. The tricky thing about that situation is that we had just moved to Idaho from Utah. After everything went down, we ended up deciding to go back to Utah. So I don't think that my follow-up care was the best or most thorough. My Idaho doctor had the placenta sent away for analysis and I have that report (which indicates a possibility of restricted intrauterine growth). A doctor in my mom's office (she works in an OB/GYN office in Utah) monitored me to make sure my body was recovering properly, but I honestly don't remember if anyone tested for infection. When I got pregnant with dd a few months later, my new OB did a few things, like an MRI to check the shape of my uterus. He wanted to do a cerclage, too, but I knew that wasn't my problem, just given how the labor progressed. But like I said, they did monitor my cervix weekly during that and subsequent pregnancies.

 

Maybe I should ask about having my cervix checked now, and that can help me figure out where to go from here.

 

That's so much for your insight, BlsdMama.

[Aspasia]

Well, this is interesting. Apparently the makers of Makena filed a lawsuit against the FDA in 2012 and it was dismissed: http://www.reuters.com/article/2012/09/06/us-fda-makena-idUSBRE8851ER20120906

 

And then just this week a court of appeals ordered that judge to reconsider her ruling: http://www.bizjournals.com/stlouis/morning_call/2014/01/kvs-battle-with-the-fda-isnt-over-yet.html

[BlsdMama]

Yeah, I remember reading about some battle that company was fighting to dominate the market during my last pregnancy. It's despicable. Then I read something about that being dismissed, but your information is more recent than mine. And it makes sense, since now the local compounding pharmacies are telling me they don't make it anymore. I guess since we have the same insurance that we had for our last two babies, I've just assumed they would cover it. Hmmm...guess I should check.

 

They did a lot of testing after my first pregnancy, and I honestly don't remember what all they tested for. But I remember doing a lot of my own research for explanations, and infections are a biggie, so I know I brought it up with my doctor. The tricky thing about that situation is that we had just moved to Idaho from Utah. After everything went down, we ended up deciding to go back to Utah. So I don't think that my follow-up care was the best or most thorough. My Idaho doctor had the placenta sent away for analysis and I have that report (which indicates a possibility of restricted intrauterine growth). A doctor in my mom's office (she works in an OB/GYN office in Utah) monitored me to make sure my body was recovering properly, but I honestly don't remember if anyone tested for infection. When I got pregnant with dd a few months later, my new OB did a few things, like an MRI to check the shape of my uterus. He wanted to do a cerclage, too, but I knew that wasn't my problem, just given how the labor progressed. But like I said, they did monitor my cervix weekly during that and subsequent pregnancies.

 

Maybe I should ask about having my cervix checked now, and that can help me figure out where to go from here.

 

That's so much for your insight, BlsdMama.

 

I'll call the compounding pharmacy in Portland and ask again today actually.  They were the first to let me know they were being forced to stop at the end of Cate's pregnancy.  I was glad I had bought enough to get me to 36 weeks.  Cate was born March 2013, so it would have been right in that time frame that they were forcing pharmacies to stop.

 

DO get the cervical length.  Make your decision from there.

 

So, background information:  I carried two babies to full term (40+ and then 37) but on my third pregnancy, something went wrong.  We had preterm labor starting crazy early (like around 4 months) and by 20-22 weeks it was apparent we were in serious trouble.  We delivered Hannah at 26w 1d.  *BUT* they "knew" it was a fluke or an infection because I had carried to full term.

 

Pregnant with Liz (#4) we started having the same pre-term labor they said wouldn't happen.  They weren't really using progesterone then.  It was early 2001 and my OB decided to do a cerclage.  My mother had ALSO needed a cerclage for "incompetent cervix" (and had lost a child late in pregnancy) but not hereditary.  True that true incompetent cervix is NOT hereditary, *but* low progesterone IS hereditary.  (And my sister had her first child at 35w 1d and hasn't had another yet.) 

 

So, they don't want to do a cerclage when he sends me off to the perinatologists at Loma Linda.  Wait they say.  She doesn't have cervical incompetence they say.  By 20 weeks my cervical length was between 1.6 and 1.8.  It's obvious I'm not going to carry this baby.  So they do an emergency cerclage at 20 weeks because we're going to lose her no matter what so it's a Hail Mary shot.   It held.  No one knows why a cerclage works....  Especially now knowing what they know.  It ought not work for people like me, but it held, thank God.  She was delivered at 36w 1d via c-section.

 

Next pregnancy they do a cerclage automatically and so on and so forth.  Rebecca (#5, 2nd cerclage), Tim (#6, 3rd cerclage), Abigail (#7, 4th cerclage), Sarah (#8, 5th cerclage), Daniella (#9, 6th cerclage), Olivia (#10, 7th cerclage), and Cate (#11, 8th cerclage.)

 

By Olivia, my cerclage ripped through around week 33.  Hospitalized for two weeks, we ended up making it to 37, ironically.  With Cate they decide let's do progesterone.  They double up and did internal progesterone daily and progesterone injections weekly.  It was an emotional pregnancy (OH MY WOW, that's how most pregant women feel???!!!) but much easier with a lot less problems. 

 

We're getting ready to do cerclage #9 next month with baby #12.  We're doing it because so much damage has been done to the cervix at this point we have no faith in it holding alone, but just to say this so that you understand that I'm not taking a shot in the dark... I've had extensive experience with preterm labor, lol.

 

I'm curious to see if you're a very "level" person.  I don't have PMS, I'm not an emotional pregnant person.  I always thought people were exaggerating about being moody, or joints (hips) hurting, or crying easily, or all that jazz, lol.  Then they jacked me up on progesterone!!!! LOL!   I have NO DOUBT I deal with low progesterone, lol.  It's crazy how normal pregnant women feel.  My husband scheduled a vasectomy consult at the end of that pregnancy.  We don't actually believe in birth control (off topic) but he's never dealt with a hormonal, emotional pregnant woman before, lol.

 

We're all dreading the beginning of the progesterone, but honestly, it works.

 

On the other hand, if you're not seeing a short cervix, it is just unlikely that you'll have preterm labor.  BUT, like you said, sometimes you make choices on what you can live with.  When I was pregnant with Abigail they gave me the option to do JUST progesterone and no cerclage.  I'd LOVE (LOVE) to not do that stinking surgery.  I hate it.  It's humiliating.  :(  However, I just decided I couldn't live with myself if something happened.  And that's okay.... To err on the side of caution too.  If you're a praying mama, pray.  Do what you can with the information you're given and go from there.

 

(((HUGS)))  And you may certainly PM me anytime you want to discuss it.   There's nothing like living through a pre-term baby NICU stay and death.  :(

 

[Aspasia]

I'm curious to see if you're a very "level" person. I don't have PMS, I'm not an emotional pregnant person. I always thought people were exaggerating about being moody, or joints (hips) hurting, or crying easily, or all that jazz, lol. Then they jacked me up on progesterone!!!! LOL! I have NO DOUBT I deal with low progesterone, lol. It's crazy how normal pregnant women feel. My husband scheduled a vasectomy consult at the end of that pregnancy. We don't actually believe in birth control (off topic) but he's never dealt with a hormonal, emotional pregnant woman before, lol.

 

 

Well, my dh jokes that we have almost gotten divorced every time I've been pregnant, if that tells you anything. I kind of don't remember my PMS symptoms (I don't have my period when I'm breast feeding, so extended breast feeding coupled with all these babies relatively close together, I've had maybe ten cycles in the last eight years). But I do vaguely recall being very emotional, crying easily. With pregnancy, I can be a little snappy and a lot hypersensitive. So basically, "level" is probably not a word that describes me. ;)

[Aspasia]

Well, is it possible to wait until you have symptoms of labor? Or is it too late at that point?

I had pre term labor issues. The first pregnancy they had me take pills (which were awful btw). Then with my second I had the same problem, but they said they no longer prescribe those pills. I just dealt with labor pains all through my pregnancy (but no I didn't go into full blown labor early).

 

If you can wait, wait. If not, I might do it. But really it is up to you.

I worry that it would be too late. My last two labors were 45 minutes and 2 hours, respectively, from start to finish. It's marvelous when you're full term(!), but kind of terrifying to think of it happening pre term.

[BlsdMama]

Well, is it possible to wait until you have symptoms of labor?  Or is it too late at that point?

I had pre term labor issues.  The first pregnancy they had me take pills (which were awful btw).  Then with my second I had the same problem, but they said they no longer prescribe those pills.  I just dealt with labor pains all through my pregnancy (but no I didn't go into full blown labor early).

 

If you can wait, wait.  If not, I might do it.  But really it is up to you.

 

:)  No, this isn't an option with true pre-term labor.  The only thing that can stall true labor is magenesium sulfate being administered IV, in the hospital.  All else is muscle relaxers which can alleviate contractions that are causing a shortening and thinning cervix.  But once it's shortened and thinned to a point, it's inevitable.  :(  (And mag. is not something one wants to experience firsthand.  Blech.)

 

No, no, be proactive.  Go.  Get a cervical length.  If you're at 4, at 22 weeks - hooray.  If you're at 3 or less, I'd take the progesterone and not even think twice.  ((Hugs))

 

ETA: Sorry to be obnoxious and keep posting on this thread, but this topic is really near and dear to me. ;)

[MtnTeaching]

:)  No, this isn't an option with true pre-term labor.  The only thing that can stall true labor is magenesium sulfate being administered IV, in the hospital.  All else is muscle relaxers which can alleviate contractions that are causing a shortening and thinning cervix.  But once it's shortened and thinned to a point, it's inevitable.  :(  (And mag. is not something one wants to experience firsthand.  Blech.)

 

No, no, be proactive.  Go.  Get a cervical length.  If you're at 4, at 22 weeks - hooray.  If you're at 3 or less, I'd take the progesterone and not even think twice.  ((Hugs))

 

 

I second the mag comment.  Horrific stuff... just horrific.

[prairiewindmomma]

Mag sulfate is like liquid fire in your veins....just so you know. Go to a peri for a one time eval if you feel like the midwife isnt getting you the info you need to make a decision.