Med weaning not so going well.

We ended up in OB triage last night. I had 3 hours at home with more than 6 contractions in an hour (6, 8, then 10 per hour actually). The on-call OB in my practice, Dr. H., wanted me to be checked at triage. We got there at around 10. The monitor picked up all the contractions, which has never happened before in any of my hospital visits with either pregnancy. They were coming every 5-6 minutes and lasting 45-60 seconds.

I had an ultrasound to check the AFI (16!) and cervical length (shortened more, but still in an acceptable range). I haven't dilated any more, so that was good.

We were sent home from triage, despite the frequency and intensity of the contractions, at just after 2 a.m. I was hugely frustrated because I expected a med change, or a shot of terbutaline, or something given how quickly the contractions were coming. Getting sent home sort of left me feeling really freaked. But, I did what I was told (unhappily) and called for an appointment with my regular OB, Dr. S., this morning.

I just got home after spending much of the morning in Dr. S.'s office. I feel much better about the plan, even if the outlook hasn't changed since last night. I'll be honest that I think as much as I've had issues with Dr. H's abruptness, triage just makes it so much worse. The doctors call in the orders. There are miscommunications between the patient and nurse that then get more complicated between the nurse and doctor then back to the patient through the nurse. You can't ask questions easily because the doctor isn't on the phone all the time. If I'd had the answers last night that Dr. S. gave me today, I would have had a much easier time leaving triage last night. But you just don't get to sit and have all your questions answered in triage.

Anyway, I spent a good 25-30 minutes with Dr. S this morning. The contractions have quieted a bit, but not gone away. The definitely aren't as intense or frequent. But, given the last three days of my contraction times, there is sort of a pattern. They tend to pick up around 1:30 or 2 and get progressively worse through the night. I'm not really sure why.

Dr. S went into details with me on why she doesn't want me on the terb. Yes, it is hard on my heart, but beyond that, the data that it actually helps preterm labor in the long run is very shaky. She said it is great for one or two-time dosing if the cause of the contractions isn't true preterm labor but is really dehydration, or because of trauma from a fall or car accident. It will calm the stressed uterus that doesn't have a recurring issue but it won't really do anything for a uterus like mine that just wants to have this baby. She said the data on that is newer and that patients have become accustomed to being given the terb so they ask for it. Some doctors try to educate and some just give it. She said it is a lot like people asking for antibiotics when they have a cold or flu. She firmly believes the nifedipine is the better choice in the long run.

So I asked her what sort of markers I should use to go to triage since last night I had 6 hours of intense contractions that were really painful. But we did nothing at triage. Given the pattern I've seen over the past three days, I sort of expect it to repeat and I don't want to go to triage every night to just be sent home. She agreed. So the current plan is to try to get me to 34 weeks. I'm to do even less than I've been doing at home (which is next to nothing, though I have been interacting with Z more from the couch tossing balls or playing with cars on the coffee table). I'm to make the decision to go to triage when the pain intensity of the contractions is too much instead of based on the frequency. They only way my meds will change in the next two weeks is if I start dilating (was still only fingertip last night). Depending on when/if that happens, I may be admitted to hospital for 3 days of magnesium sulfate. The goal is to see if quieting the uterus for a few days will calm the whole system down or not. I won't be kept on it long term, no matter what. If I'm close to 34 weeks or past it, we'll do nothing and just let her come when she's ready. I remember from my hospitalization with Z that the perinatologists wouldn't keep me on mag past 34 weeks so that makes sense to me. They said then that studies showed babies did better just being born at 34 weeks than if they kept the preterm labor at bay until 36 weeks. It was in my preemie book too.

Basically, we've already hit two more milestones than we did with Z. It isn't ideal for her to come now, but the odds are strongly in her favor. I really want to get to 34 weeks so I can nurse right away and not mess with the pump all the time. But I'll deal if that doesn't happen. Plus, she is a good-sized girl and that is in her favor.

So now, we wait and see.