Before 32 weeks?

[Natalieboo]

I have a client who had her first baby 1 month premature and second baby 2 months premature. She is now pg with her third, and as her doula we have been trying to prepare for another early labour/birth.

What I would like to know is, if she goes into labour and goes to the hospital around say 30-32 weeks, how are the procedures different than if she was full term, and what interventions should she expect?

She wants to be as prepared as possible, and she is afraid that she will have no say in what goes on and won't have any options..

So what should we expect? Thanks in advance I really appreciate your replies!! :)

[at your cervix]

I would probably suggest that you prepare the pt for the (very good) possibility that if she goes into labor prematurely, they will probably give her meds to stop her labor if possible. I find that a lot of pt's that have had a previous premie are very upset that we try to stop labor, they have the idea that the last baby was fine, so this one should be too so why are they going to stop my labor. Although with her history there is a good chance that she will deliver at least a little early, it always helps for pt's to understand that if there are no medical indications for delivery at 32 wees, it is best to try to keep her pregnant if possible.

A few other things, she may have a vag exam on admission but unless contractions are regular and painful, vag exams will probably not be performed very often because increased vag exams in increase contractions and chance for infection. Some other things that may be done, an ultrasound, possibly steriods to help speed up the lung maturation on the baby, group B strep culture, antibiotics (because often preterm labor is caused by infection, sometimes with no other symptoms.), and bedrest!!

Of course these interventions are just some things that may be done, there are a lot of factors that are considered. For example, if she comes in crowning, she probably won't get an ultrasound, they'll just catch the baby and she can probably expect a similar course as with her previous 32 week baby (NICU, IV, possible intubation and ventilator etc.)

Also, some docs will order steriods prophylactically in pt's with a strong history of preterm delivery, she should check with her OB.

She should always have a say in her care but I really feel that it is important for pt's to fully understand why an intervention is being done, what the risks are and what the risks are for not having the intervention, that way they could make an informed decision. I have had pt's that have refused labor stopping meds (tocolytics) because, at 32 weeks "when I had an ultrasound yesterday they told me that the baby is almost 5 lbs so it is big enough, it will be fine." When they learn that size of baby does not reflect maturity of the lungs, they often change their mind and accept the tocolytics.

[Natalieboo]

Thank you so much for your reply, that was just the information I was looking for! I definately have to find out her frame of mind about the "not wanting to stop labour" that is very important for me to know how she is feeling, and then to inform her if she is not informed.

Thanks again, very helpful!