Need Input from the Pros

[StressedDad2Be]

First, let me just say that over the last few weeks I've developed a profound appreciation for what nurses do on a daily basis. Whatever your are paid is not enough and all of you are deserving of praise for the sorts of situations you face every day. It didn't take long to realize that neither my wife nor I have the sort of mettle needed to be a member of this profession.

I hope nobody minds this outsider posting to your forum. Here's our situation.

My wife is pregnant with our first. During a routine exam at 24 weeks 0 days, her doctor (who we both really like) discovered she was 1 cm dialated. She was immediately admited to the hospital. Here's what has gone down so far:

Day 1: given steroid shot should baby arrive early, strict bedrest starts.

Day 2: another shot. Ultrasound revealed cervix at 1.7cm with some funneling

Day 4: Ultrasound shows 2.76 cm with minimal funneling

Day 7: ultrasound shows 3.1 cm with almost no funneling. Doctor allows my wife to get up for bathroom breaks and to take 3 minute showers.

Day 14: ultrasound shows 2.74 cm with minor funneling, wife put back on strict bedrest (only allowed up to for BMs)

We are now at 26weeks and 2 days. During this time, there has been no change in dialation, still 1 cm. She has had no contractions other than the occasional Braxton Hicks and those are few and far between. She's pregnant with a girl, which I understand can be a plus.

After the last ultrasound, our doctor decided against sending her home until at least week 28. Her opinion at that time (now 3 days ago) was this:

"...28 weeks is extremely likely at this point and I think 32 weeks is very do-able."

I've done a lot of research and my concerns are what sort of long term problems we can expect depending on how far along we get. My feeling right now is that I don't want to subject a tiny baby to the tortures of heroic, life saving efforts.

I guess my question for those in the know is this:

- given the info I provided, what's your gut feel for a likely outcome, both number of weeks we can hope to get and the sorts of short and long term problems for our little girl?

Thanks so much for your time,

Stressed Daddy to B

[wannabeL&D]

I have been in the exact same position as your wife, and I wanted to chime in with my 2 cents and to encourage both of you!

I was also about 1 cm dilated at 24 weeks with my first pg. and placed on hospitalized bed rest. I made it to 32 weeks and my daughter didn't need oxygen and only stayed 1 week in the hospital. Today she is a happy healthy 4-yr. old in the 95th % for height and weight and at her 4 yr. old check up the dr. was impressed that she was doing things at a 5-6 yr. old level (i.e. recognizing letters and words etc.) Not trying to brag, but I just want to encourage you that you could have a wonderful outcome!

With my second pg., we ended up with a 6 week NICU stay (due to issues other than prematurity) and I became very close friends with the mom of a 25-weeker--they had a long hard road in the NICU, but she just sent a picture of him and he is absolutely gorgeous and right on track for his adjusted age. So, even if she were to deliver now, it would be very difficult, and there can be lots of long-term complications...but especially if you were at CHOP I am sure your daughter could be OK. There are lots of miraculous stories.

That said, as hard as hospitalized bed rest is, and it totally sucks I know...it is still a million times easier than having a baby in the NICU--so any encouragement you can give that she strictly follows drs. orders is fantastic.

From my experience, this is what I would do differently if I were in the same sitution again...

I would insist on being transferred to the hospital with the highest level NICU. I accepted my drs. opinion that it wasn't neccessary, and it did turn out OK for us...but given my experiences since then, I would absolutely not accept no for an answer. It is a fact that it is better for a baby to be born at the hospital with the highest level of care available and much easier to transfer mom than baby. With my son, it killed me to see him be transferred and I was scared to death something would happen in the ambulance on the way. Also, emotionally it is very difficult if she were to deliver, and then the baby had to be taken immediately away to a different hospital. It is hard enough to deal with when your baby is in the same hospital as you--but extremely tough if they aren't, especially if she has a c-section and can't be discharged right away. I am sure the dr. will say this is not needed at this pt., but for me I would never put myself in that position again.

I would refuse any internals...unless she began contracting regularly or there was some indication for it...my dr. wanted to check me twice a week--when really it served no purpose other than to satisfy curiousity--it wasn't going to change the treatment--I was already on hospitalized bed rest, terb., with no bathroom privileges. In my opinion and from the many nurses I have become friends with since then (and also the maternal fetal specialist) it was totally unneccessary, could "stir things up" and introduce infection. But at the time I was really a wimp and didn't trust myself enough to speak up. My water ended up breaking at 32 weeks, and I delivered that night--now maybe it would have broken anyway--but I have to wonder what role the many internals played.

If your wife doesn't have a laptop get her one--there are lots of online support groups for women in similar situations. Also sidelines.org is awesome...and on miraclebabies.org there is a calculater where you put in the gestation and it tells you the likelihood of various complications--I found it very encouraging to check each day watch the percentages go down. Also then you can sign up for netflix and she can watch DVDs to pass the time.

This is probably the most stressful experience you will ever have, but I feel like it brought my husband and me so much closer...and you will never take your beautiful daughter for granted--I still thank God every day for my kids! Your wife really will need a lot of compassion though...it is hard to feel like your body is a failure at the most basic function, and like you can't protect your baby.

Take care and hang in there--you will get through this--just look forward to the first birthday and picture your sweet baby diving into the cake!

Shannon

[riern]

I can only imagine the stress and fear you and your wife are both feeling right now.

I'm a L&D RN. I've seen alot of similiar situations as I'm sure most of us have. It sounds like the doctors are staying on top of things and your wife is a very smart lady. Lots of patients wouldn't say anything about a "feeling". She's gonna be a great mom. The shots they've given her are wonderful and are to help with the maturity of the babies lungs.

My favorite premie story to tell is one of a patient here who had problems very early in her pregnancy and was on bedrest and givem the shots you speak of from about 23 weeks on..... she was eventually discharged to be on bedrest at home from a hospital 1 hour away that has a NICU. She would come to our local small hospital weekly for stress tests and monitoring and to get her shots weekly. She made it to 32 weeks and came in on me on a Sunday night around 11 pm and delivered a small, pink perfect baby girl who now carries my name as her middle name. She scared me that night, did I mention she was born in the bathroom as her mother stood up from the commode, I caught her foot just before she hit the water and laid her mother on the floor with the baby over her thigh. This little girl is 10 now and plays sports with my daughter sometimes. She's a perfect little girl with no longterm effects from the problems her mother had during her pregnancy.

I will add you and your wife to our prayer list and look forward to updates from you. We never know what the end result will be even in "normal pregnancy" without any complications. Follow your doctors advice , encourage, love and be patient with your wife, and most importantly pray. There is only one who knows what this outcome will be.........God.

Supply your wife with books, magazines, cross stitch ( I cross stitched my son a blanket and bibes while on bedrest), funny movies, laughter is very healing, and lots of friends and family. Tell her we are all cheering for and praying for her here. Maybe copy our replies for her to read.

This little baby will be just fine because it has the support and love of great parents. Being a good parent isn't about having all the answers or knowing everything, it's about knowing where to find the answers and who to ask when you need help.

Good Luck and God Bless

Rie

[StressedDad2Be]

Just an update.

My wife had another ultrasound yesterday. Her cervix was unchanged at 2.75 cm but the doctor did have some concern over a slight increase in the funneling. Apparently it wasn't much but they would have preferred not to see any change at all.

She's now at 27 weeks with the last 3 on bedrest. I just hope we can hold on until 32+.

[llg, PhD, RN]

Just an update.

My wife had another ultrasound yesterday. Her cervix was unchanged at 2.75 cm but the doctor did have some concern over a slight increase in the funneling. Apparently it wasn't much but they would have preferred not to see any change at all.

She's now at 27 weeks with the last 3 on bedrest. I just hope we can hold on until 32+.

Thanks for the update. If I had to place a bet, I would bet that this story is going to have a happy ending. 27 weeks is not too bad -- and she might hold out a few more weeks!

Take care ... and please let us know how everything turns out.

llg

[riern]

I agree with llg. Sounds like things are going relatively well. Your wife's received several celestone shots by now and she has some great support from you. Sounds like she's got pretty good doctors too. Hang in there, keep us posted and try to smile....just a little.

[StressedDad2Be]

Just another update.

We had another round of ultrasounds today. Tomorrow is officially 28 weeks so we're not technically there yet.

Anyway, the ultrasound measurements came back at 2.8cm, up from 2.7 the previous two weeks. In addition, the doctors saw no signs of funneling at all this time. Her primary doctor stated that she considers things to be in, or very near, the normal range. To date, there have been no contractions.

For the first time, her doctor kicked around the idea that there's a chance she may go to full term. Some of the nurses that I quizzed thought there was an outside chance of approaching term as well and all believed we should get to a minimum of 30 weeks. Honestly, I'm just focused on getting to 30 weeks for right now.

So, my wife is headed home today for continued strict bedrest. As her mom volunteered to stay with us during the week while I'm at work, that takes a lot of pressure off of us.

So that's my update. God has truly blessed us in this matter. I continue to pray for a happy outcome. :)

[wannabeL&D]

Congrats on a big milestone! 28 weeks is huge, and definately something to celebrate! It sounds like you could very well have a baby you can take home with you from the hospital!

You will continue to be in my prayers, your wife will need a lot of encouragement to follow drs. orders at home--again, bed rest is very difficult, but totally worth it.

Shannon

[llg, PhD, RN]

That all sounds like great news! Just be sure she continues to follow the orders for continued bedrest and calls her doctor right away if anything unusual happens.

Take care,

llg

[SusanJean]

Continued thoughts and prayers your way. Please keep us posted!!

[SmilingBluEyes]

best wishes to you and yoru wife. take good care!

[Dawn27]

I just wanted to add my best wishes as a midwife in the Uk, I decided not to comment as practise here can be different to the US but nonetheless I can assure you we all need to know how the 3 of you get on. My thoughts are with you both.

[StressedDad2Be]

I wanted to thank everyone for taking the time to reply to my posts and the kind words over the last few weeks.

My wife had a level 2 ultrasound this past Friday with a high risk specialist. In addition to running her own clinic, she's also an associate professor at Drexel University and a doctor with Hahneman in Philadelphia. So she definetly comes with credentials.

Anyway, Friday's ultrasound showed cervical length at 3.4 cm with no funneling, even with pressure against my wifes lower belly. This is up from the prior two weeks when it was at 2.7 cm. The doctor indicated to us that she was still concerned about my wife's cervix being a bit fragile as she pointed out a tiny gap about halfway down. Her opinion is that the gap was left over after it closed back up from it's shortest length of 1.7 cm.

The plan is to stay on strict bedrest at home and, once we get to 30 weeks, allow her to go downstairs once during the day if she prefers to spend time reclining on our sofa. The doctor was unwilling to give any sort of gut feel for how much longer my wife could go (which I comletely understand), but I'm hoping that her request that we come back in 4 weeks for another ultrasound is an indicator of what she expects. She did say she was generally optimistic. She's also not convinced my wife has the traditional IC.

All that said, my wife's normal doctor was very pleased with the latest ultrasound. She called us same day as a follow-up. Her opinion was that we *should* see 32 to 34 weeks and was beginning to think there was a chance she could get to term.

Tomorrow is 29 weeks...a long way from 24 but not yet out of the woods. God continues to bless us and I'm starting to think we may have a positive outcome.