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Discussion

At what point do you stop trying to stop labor???

I've been curious about this and I'm finally getting around to asking. The docs where I work will try and stop labor up until 36 weeks and then after that they just let them go. With all the research coming out on these late preterm babies, I'm wondering why they are not trying to stop it until at least 37 weeks? What are you guys doing at your hospitals?

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    NICU point of view.....they are delivering them. After all, they are 35-36-37 weeks. They'll be fine! Maybe they are, sometimes.

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    • Expert

    It depends. Our docs do sometimes try to stop it if she's not ruptured. If she comes in ruptured and/or already in active labor, they usually go ahead and deliver. Do I think that's necessarily the best idea? Not always. 35-37 weekers are notorious for crumping when you least expect it (so we nursery folk have just started 'expecting it' all the time). Statistically speaking, yes, the odds are overwhelmingly in their favor, but they can and do turn on a dime.

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    We actually don't routinely stop labor after 34 weeks believe it or not. Some docs will try but only with iv fluids/terbutaline. I think it's pretty crazy but I guess because we have the NICU that can handle it.

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    Depends a lot on the individual situation. I've seen a doctor terb a 37-week previous C/S because he didn't feel like coming in that evening to section her then. UCs stopped and she went another week.

    Sometimes they will terb a 36+ weeker, sometimes they will let her go (especially if she's someone who has been dealing with PTL for several weeks).

    Our docs tend to take the late preterm issue pretty seriously. A lot of that has to do with our status as a level 1. Level 3s tend to be a lot more nonchalant.

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    • Author

    We're a level 1 also...our docs just don't seem to care!

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    I think it depends upon Mom's history, also. If a mom comes in for the first time at 36 weeks, most docs I know will try and stop things. If she has a long history of treatment for PTL (meaning that baby has been stressed, and given steriods previously), maybe not. Some decisions are driven by insurance limitations. My plan would not pay for my terbutaline pump and home monitoring beyond 36 weeks. My doc didn't allow me to deliver at that point, though. He kept me on oral meds for another week.

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    The OBs also have to weigh the pros and cons of tocolytic therapy. Some of the meds are not just simple meds - they have their own side effects and effects on maternal body systems. Take, for instance: magnesium sulfate -- it affects the CNS, blood vessels, renal system (can become toxic), cardiac system. Terbutaline affects the CNS and cardiac system. It's all about weighing the pros and cons for BOTH mother AND baby.

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