OB nurses: What do you think of this?

Nurses General Nursing

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Thank you in advance for any responses to this.

To OB nurses: if a patient with prior preterm labor and premature delivery came into your hospital with painful contractions about 5 minutes apart, would the doctors at your hospital have her cervix checked?

I am asking because I am 33 weeks along, have already dilated to almost 2 and 50% effaced, and my doctor tells me that my contractions are normal. (every 2-5 minutes) She did not even check my cervix....she only did the NST for about 30 minutes and declared that I could go home.

This does not sound right to me. In my last pregnancy, I had PTL many times between weeks 23 until birth (36 weeks). I was always treated in the hospital for the contractions. I am now at home and very worried and in a lot of pain.

Does her behavior and reasoning sound normal to you compared with the doctors you work with?

Thank you so much!

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Some more thoughts: Did they check to see if there is an infection process? For example, do you have a bladder infection, Also, how well-hydrated are you? Are you drinking a minimum of 2 liters of WATER a day? How is your dental health? I ask because many do NOT know, a mild form of gingivitis CAN be linked to preterm labor. It's epidemic, actually. If you have not seen a dentist lately, I recommend you do this and get taken care of! CRITICAL! Just an aside, I learned flossing the teeth EACH AND EVERY DAY adds roughly 5-10 years to your life versus only flossing OCCASIONALLY. This was eye-opening information given me by my hygienist. I share it with all my patients now.

Some reassurance: I contracted for several weeks very regularly with my dd for about the last 8 weeks of my pregnancy (to 38 weeks at which point, she was delivered by csection for breech presentation). I never changed my cervix at all, but was always worried about preterm rupture of membranes, esp with breech positioning. I urge you to seek further investigation to see if there is some cause you can address to stop this contraction pattern. Even a lady partsl yeast infection can do this to you. Also,I would ask about FETAL FIBRONECTIN testing to see if you are really on a pattern of preterm delivery. It is not perfect, but a fairyly good predictor.

I wish you luck! Hang in there!

Thank you all for your responses. I am still contracting about every 3-5 minutes just as I was when I went to sleep last night. I do understand that she thinks these are harmless contractions.....however at 33 weeks, I am not willing to take that gamble. Mag sulfate is the ONLY thing that saved our first DD from being born too early for survival, and before the pregnancy was over, it had to be used about 5 times more.....and it always slowed down the contractions enough to be at a safe level. Maybe SHE is willing to risk my baby coming at 33 weeks by sending me home with contractions every 2 minutes, but my husband and I are not. I was so worried when I came home last night because the pills she gave me kicked in and I literally had to be helped into bed. I was so afraid my water would break or something and I would not be alert enough to realize it. It was 200 mgs of Senocal (sp?).

Anyway, I just don't think it's any trouble to her if I had stayed overnight in the hospital, perhaps gotten some IV fluids to help with the contractions and then maybe checked again before leaving. I was there for 5 hours with contrax every 2 minutes, and they did not bother to check me before I left. I have no idea right this moment if I am 2 centimeters or 5. :(

Thank you all for listening and helping. To answer some questions above....yes, I knew about the gingivitis risk, and no I don't have it. I also drink a large amount of water each day, and am careful to keep my bladder empty. I lie down on my left side as much as possible (since I dilated at 27 weeks), and I take all the usual "preterm labor" precautions. :)

Specializes in LDRP; Education.

Sometimes we have hesitated to do bimanual cervical checks on preterm patients because we don't want to stimulate the patient further into labor. By manipulating the cervix we can aggrevate the prostaglandins and such which can initiate labor. Although probably a sterile speculum exam would have been more appropriate.

Preterm labor used to be my "thing" back when I worked OB. If you were 33 weeks with a hx of preterm labor, I wouldn't have done a cervical check. I would have done a sterile spec exam to see if I can visualize any cervical change.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

200 mg seconal......eeeeeeeeeeeeeeeeeeeeeeeeeeeeeee I would be so gone. Good luck...never quit asking questions or getting info to your satisfaction!

I totally was. Yikes, I have never felt that drugged in my whole life! After it kicked in, I started freaking out worrying about the baby....but she said it was safe so I guess it is.

An update...

I talked with her today and she said that at 33 weeks, her usual "plan" is to do brethine shots and if that doesn't work and there is no dilitation, then to try a sedative. Of course, how does she know that I didn't dilate since they didn't check me after all those hours of intense contractions. I told her I was not happy with her casual attitude but she said that she felt mag sulfate was not called for. I'd love to know when she thinks it is then. (33 weeks, dilated to 2, effaced 75%, and contracting every 2 mins. Hmmmmmmm) She said my contractions were not in a "labor pattern" which apparently means they must be about 8 minutes apart. That's what she said. She said labor contractions are usually not 2-3 minutes apart. Huh??????? She also said that contractions that concern her are the ones that involve the whole uterus. Of course.....I KNOW that. And they WERE. My whole uterus was like a huge hard watermelon.

Anyway......let's just hope my little angel stays in there despite her casual attitude towards these contractions.

Originally posted by Sick&Pregnant

Well tonight I decided to just go to the hospital to have my cervix checked. I had not dilated further, but my contrax were every 2 minutes and very strong (lamaze breathing). About a 6 or sometimes even a 7. She gave me 3 shots of brethine and those did not work. So she SENT ME HOME!!!!!!!!!!!!!!!!!!! Can youi believe this? She gave me a pain pill and said to go to bed. I'm so mad right now I guess I will have to conront her. 33 weeks pregnant, contractions every two minutes........I'm sorry but I think that warrants mag sulfate. :(

Contractions do not always mean labor no matter how much they hurt. You had not dilated further; so, you were not in labor.

They should have checked your cervix and given you IV fluids and the Brethine right off the bat.

If you were in labor, your cervix would have changed. It didn't; you weren't. You still were pregnant 10 days later. So, they made the right call.

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