OB Nurses - Please read! Very worried about my sister!

Specialties Ob/Gyn

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My sister is 31 weeks pregnant with baby number two. She has been having on and off contractions lately and on Sunday she began contracting regularly - every 6-8 minutes and so she went to the hospital. At that point her cervical check was 15%, and 1. The midwife also said the baby's head was right there. She was given terbutaline which stopped the ctx and she went home. At home she has said they are irregular and she doesn't really notice them. She was on restricted activities and could only go to her classes (she is in nursing school). She was checked today (Thursday) and she was 100 percent effaced and still 1 cm. The midwife sent her home with po terbutaline and plans to recheck in a week and put her on complete bed rest. My mother is helping her with my nephew but she is having a hard time always keeping bed rest.

I am concerned that the midwife is not being aggressive enough. It seems like 100 percent effacement is a big concern. What do you all think... .I realize this board is not for medical advice - I just wanted to her your experiences with this if you do not mind. If it were your sister with your OB knowledge would this be enough intervention or should she be hospitalized?? If you need anymore info let me know.

Thank you very much.

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Specializes in insanity control.

I think you should trust the professional your sister has chosen. We all second guess them but they have the relationship with the patient. If your sister follows orders she may deliver a week or two early. If she doesn't then she could deliver very early. Can't give advise cause don't know what the midwife is doing with your sister nor the history of her care. Most midwives I know use this approach until proven doesn't work then they go for more aggressive treatment. Hospitalizing someone is a very costly endevor. And I am not talking money wise. Emotionally it is better to stay at home if possibe. The family is still together and working toward a common goal. The hospital isolates the patient, causing worry about other children, finances, school, and a multitude of other worries. Even if you have visitors, you still look at four walls most of the time. Give the midwife a chance to do her job. My advice to you is to help your sister by keeping her entertained, play cards, watch movies, or just be there.

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Specializes in Obstetrics, M/S, Psych.

If she has changed from 15% to 100% effaced and is still having contractions at 31 weeks, it is something to be concerned about. No harm in getting a second opinion.

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I work OB. We had a pt w/ simular problems. What the Midwife did is what we did. This pt cont to have irreg contx so was placed on a T-pump.(terbutaline) That kept her better controlled yet she still would breakthrough w/ contr. With a pump service you call into a base site and they tell you how to increase as needed. This way she was able to stay home. She also was placed on bedrest. It has to be ordered by a DR. It worked out well. She still delivered early ( 36-37 wks) but baby was fine. Hope this helps.

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

Sounds reasonable to me. Be sure she calls the midwife or goes to the hospital if she contracts regularly more than 4 - 6 times an hour. THAT is critical. And she needs to follow orders to stay off her feet to the LETTER. She is really in danger of preterm labor and delivery and ideally, should try and hold off til 36-37 weeks. I wish her the best. Sounds as nursing school may need to be put on the back burner a bit to safely carry this pregnancy to term. The best help for PTL is REST and FLUIDS (2 plus liters a day of water alone).

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Specializes in Emergency, Critical Care.

I'm no OB nurse, but from an ER nurse who has had personal experience with pre-term labor with bedrest management, I will say this.... a hard head makes a soft behind.

As a nurse, you deem yourself invincible. So what do I do at 31 weeks, on bedrest? I get a cleaning jag (nesting) to clean the fish tank. 15 minutes later, I was contracting again. Incidentally, i was 2 and 50%. I was placed on a magnesium gtt and my labor stopped. The second time I was admitted, it was with PROM at 34 weeks. Baby was delivered c-section after i had two injections of steroids (to help mature baby's lungs, although i am not sure if this is still practiced). Baby is now almost 3 years old, and health and happy. Tell sister to take it easy, and i too agree that NM is on the right track.

Emmie

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Specializes in Maternal - Child Health.

I had PTL with both of my girls that was very resistant to treatment. With my first, I was 4cm at 28 weeks, and we had a terrible time finding a combination of drugs that was effective in reducing the contractions to a manageable level. With complete bedrest, home monitoring, po meds every 2 hours (the terbutaline pump didn't work for me), I was able to be DC'd home, and had my baby at 37 weeks!

With my second, I started contracting at 16 weeks. I was on complete bedrest at 23 weeks, dilated to 6 cm with the baby at a +2 station by 28 weeks. But the pump worked well with my second pregnancy, and I delivered a healthy baby at 36 weeks.

It is not easy! Bedrest is difficult to maintain, and the meds have side-effects, but none of this compares to the heartbreak of a sick baby. Please do all that you can to encourage your sister to stick to the care prescribed by her doc or midwife. It sure beats sitting at the bedside of a preemie!

Prayers for a healthy baby!

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Well just to update, she is now in the hospital. Her ctx got worse overnight and so they decided to admit her for observation and to help her to keep bedrest. (She was having a lot of trouble with a two year old running around) - even with the help of my mother. I am ten states away and so really it is just my mom and brother in law that can help her with the little one.

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Specializes in LDRP; Education.
With my second, I started contracting at 16 weeks. I was on complete bedrest at 23 weeks, dilated to 6 cm with the baby at a +2 station by 28 weeks. But the pump worked well with my second pregnancy, and I delivered a healthy baby at 36 weeks.

Wow. 16 weeks.

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She should NOT be "going to class" as you say. 100% effaced is not good at 32 weeks. Should the baby come early, it would probably do fine (in a NICU) but still........

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She should NOT be "going to class" as you say. 100% effaced is not good at 32 weeks. Should the baby come early, it would probably do fine (in a NICU) but still........

She isn't going to class. She was originally 15% effaced and the midwife was letting her go then. I don't think you read everything I wrote.

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

at 15% that may have been reasonable to allow normal activity. ( I always wonder how they guage "15% anyhow). At 100%, as you know, now it's a different ballgame. I wish her well! Hopefully the baby will wait til 36 to 37 weeks!

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