Need Input from the Pros

  1. 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
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  2. 73 Comments

  3. by   SusanJean
    I'm not a nurse (yet) but have been in your wife's situation. I feel for you and want you to know there can be positive outcomes, though it is natural to think of the worse. I don't want to downplay the risks, but w/ proper management and supervision and COMPLIANCE, your wife just may make it past that critical time. I will say some prayers for a good outcome.

    SJ
    (Went on bedrest w/ my son at 20 weeks and stayed there until 35 - then had an emerg. c-section w/ fetal distress. Have a great son!!)
  4. by   cmmcelro
    Hi. I am an RN at Texas Children's Hospital. I do not do patient care any more, but in my distant past, I worked with sick infants. I can tell you that MANY positive management strategies have been developed since I was there and many of the smallest babies can have a good outcome. Of course, there are no guarantees and you never know which wee one will do well and which will not.

    I feel the MOST important issue for you is to have this baby at or near a hospital well equipped to to handle premature infants. We do not deliver where I work, but have trained teams to transport these babies to our center. TCH is one of the largest Neonatal units around. If there is enough time, the neonatal transport team can be in the delivery room to handle any special care required by your baby.

    I wish you the best and pray that all is well.

    Cyndee
  5. by   4Blessings
    Have worked labor and delivery almost 9 years and have seen many situations like yours....I do have a question though. What made your doctor check your wife at 25 weeks? That seems very odd to me. As to outcomes, every day counts. My best frien had her water break at 18 weeks. Completely broke and every doctor told her she would never make it. They encouraged her to terminate right then. She is the director of our local Pregnancy Help Center, very strong Christian , and pro-life. She stayed on bedrest until she was 33 weeks. As it came time to deliver, lots of scans were done and the neonatologist actually said that her son would have no lungs and he would die. He didn't say could...he said would.....Today my daughter Ellie and her son Joshua torment eachother in the nursury at church. He is three.

    I tell you all this to say that I believe all anyone can do is trust in whay God says when he promised not to put anything upon us that we could not stand with His help. My advice would be to share your concerns with your doctors, including a good neonatologist, but don't put all your stock in them. Trust the one who created your daughter and is growing her as we speak.

    I hope this helps. I will put your family on my prayer list. Please keep this thread updated and feel free to continue to ask questions. My colleagues and I can give good nursing care wether on the hospitol floor or on-screen. We are in the buisness of caring.
  6. by   cmmcelro
    Hi. I am an RN at Texas Children's Hospital. I do not do patient care any more, but in my distant past, I worked with sick infants. I can tell you that MANY positive management strategies have been developed since I was there and many of the smallest babies can have a good outcome. Of course, there are no guarantees and you never know which wee one will do well and which will not.

    I feel the MOST important issue for you is to have this baby at or near a hospital well equipped to to handle premature infants. We do not deliver where I work, but have trained teams to transport these babies to our center. TCH is one of the largest Neonatal units around. If there is enough time, the neonatal transport team can be in the delivery room to handle any special care required by your baby.

    I wish you the best and pray that all is well.

    Cyndee
  7. by   llg
    I am a nurse with many years of experience in Neonatal ICU.

    The chances that you will have a positive outcome are very good -- but they require that you take great care. It sounds as if your physician is on top of things. If it were me, I would be 100% compliant with the recommendations and delay delivery as long as you can so that your little girl can have the best chance possible for a healthy start in life.

    However, at some point, your wife will have to deliver -- and may feel guilty that she couldn't "hold on" for one more day. She'll need you to help her feel good about holding on for as long as she did instead of feeling bad about the weeks of maturation that did not occur in utero. You'll both need to learn to look at the glass as "half full" rather than as "half empty" when it comes to dealing with your daughters gestational age at birth.

    Take care and know that we are all wishing you and your family the best,
    llg
  8. by   StressedDad2Be
    Thanks for the replies. My wife told me she had a nagging feeling there could be something not right. It was chance that she had an appointment a few days later. Her doctor listened to her and did an internal check at the office.

    We live outside Philadelphia. The hospital she's currently at is not equipped with a NICU but both doctor and nurses have told us that they can get her to one of the ones in Philly very quickly if need be.

    We inquired about whether we should transfer now, but our doctor and the ones she consulted with at the NICU agreed that our situation wasn't yet at the point where they felt a delivery was imminent enough to justify it.
  9. by   SmilingBluEyes
    You received stellar advice. I have nothing to add that will make it clearer or better----

    If you wife feels something may not be right, I hope she is wrong. Hopefully your next exam will reassure you both things will turn out ok. Will you please keep us informed as to what happens? I am interested. I wish you both the very best.
  10. by   StressedDad2Be
    Sorry, I should have made my last comment a bit more clear. The reason the doctor checked her internally at 24 weeks was because my wife had a feeling something was amiss a few days prior. Turns out she was right and her doctor believed her. I've read many stories about doctors (more often men) not listening to their patients when they've had gut feelings about things like this. I've read a number of books that my wife has on pregnancy and they all echo the sentiment, "Listen to your body and instincts." You'd think some of those docs would be inclined to listen as well.
  11. by   BETSRN
    Quote from 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

    The farther she gets in gestational age (weeks along), the better for the baby. The shots were a steroid called Celestone to mature the baby's lungs. It seems like getting up makes her cervix dilate. Bedrest is a pain but if it buys her time, then so be it. Has there been no further change in her cervix? Personally, I think it is wise for her to be on strict bedrest in the hospital. I know it is boring but there she is watched closely for dilitation. You don't want that at this time. Have they checked her for infection? I would assume so. Get her lots of good reading materials and arange for her friends and work colleagues to visit her.
    Hopefully, she is considering breastfeeding. Breastmilk is the preferred food for all babies but it is expecially iomportant for preemies who have immature digestive systems and are at high risk for gangrene of the bowel. Get rest yourself. Your baby will most likely be born somewhat prematurely, but the farther she gets, the less interventions will be needed. A colleagues grand daughter was just born at 32 weeks (after a week in the hospital with ruptured membranes) and the little girl did not even need any extra oxygen at all! WE'll keep you in our prayers.
  12. by   Jolie
    I just wanted to offer you a little encouragement. With my second baby, my cervix was already shortened to 1 cm at my first prenatal visit. I had an awesome doc (who happened to be the father of 3 preemies), and he promised me that he would do everything in his power to see that I had a healthy baby. He didn't let me down! He took every concern seriously and saw me thru to delivering a healthy preemie at 36 weeks, something I doubted was possible. I began contracting at 16 weeks, and by 23 weeks, was dilated. I spent 13 weeks on total bedrest, much of the time with my head down and feet up because the baby was so low in my pelvis. I was in and out of the hospital, which was nerve wracking, because I lived at quite a distance from the hospital. We lived outside of Philly at the time, too. I delivered at Chester County Hospital, and can't say enough about the excellent nursing care there.

    I wish you and your wife well. I'll say a prayer for a healthy baby for you! Have you chosen a name yet? One advantage (if there is such a thing) to my complicated pregnancy was that I had so many ultrasounds that I had some good pictures of my baby's face, and had an idea what she looked like. We named her early on, and really bonded well before she was born. I hope you have the same experience.
  13. by   OriginalWmn
    You are lucky to be near Philly. CHOP is an excellent hospital. I didn't work in the NICU, but if I had a premie I would want them to go there.
    It's just all around a top knotch children's hospital. I hope your baby doesn't have to go there, but if she does it's one of the best.
  14. by   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

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