24 weeks, Preterm Labor and Hospitalization, Oh My!!!

So, last Friday, April 30th, at 24 weeks on the nose, I went in the morning for my regular OB appointment.  It was an early appointment, so I just left Mike home with Mikaela and went by myself.  When we did the cervical length ultrasound as we had been doing, we discovered that my cervix had gone from 3cm to 2.1cm.  Not a good sign.  They wanted to see it remain at 3cm or greater, but anything below 2.5cm is indicative of preterm labor and at a significantly greater risk for preterm delivery.  My OB went and talked to the MFM (Maternal Fetal Medicine, basically the high risk pregnancy people) and they wanted to admit me to Labor and Delivery for 24 hours of monitoring.  First, they wanted to have my cervix checked to make sure I wasn't dilated.  When she checked my cervix, we discovered I was 2cm dilated and 50% effaced.  NOT good at all at 24 weeks, especially with my history and being pregnant with twins.  I was immediately admitted to L&D and hooked up to the monitors.  Everything from there was a complete whirlwind.  I was having regular contractions and it was a huge concern that Carly and Callie were going to be born.  I was started on Magnesium Sulfate for 2 reasons.  1.)  It is a smooth muscle relaxant and can be used to try to stop or slow contractions in preterm labor  2.)  Studies have shown that inutero exposure to Magnesium Sulfate has significantly reduced the incidence and severity of Cerebral Palsy, a very high risk factor to babies been prematurely.  I was given this via IV for 12 hours.  For those who aren't familiar with Mag Sulfate, it makes you feel TERRIBLE!  You get mega hot flashes and it just overall makes you feel like crap.  But, of course I would do whatever I have to do for my babies!  Aunt Tiffany was able to come home from work to watch the kids so Mike could come be at the hospital with me.  He got there around noon right when they started the Mag Sulfate.  Thank goodness because I was a complete mess and really needed him with me.

I was also started on Indomethacin, another drug used for the treatment of preterm labor to help slow or stop contractions.  I continued this medication for 72 hours.  It is a short acting medication that can only be used for 24-72 hours due to it's potential to cause negative side effects to the baby.  It is hoped that in that time frame it will stop contractions completely, or at least delay birth long enough to get steroids to help mature the babies' lungs and get the Mag Sulfate for neuroprotection.  I was able to get the 2 steroid shots (Betamethasone) 24 hours apart.

They sent a Neonatologist from the NICU (Neonatal Intensive Care Unit) to come talk to me.  He was telling me that at 24 weeks, twins had a 10-40% chance of survival.  He also talked about all the likely things they would deal with, even though we already knew all about it since we had already been through it all with Haley.  It was a lot to wrap my head around - it all happened so fast from what was supposed to just be my regular OB appointment.  They did a growth ultrasound to estimate how big the girls were after the Neonatologist left.  Carly was 1lb 11oz and Callie was 1lb 10oz.  This was good news because they were measuring much larger than they expected them to.  This is good because it has been shown that the larger babies born prematurely are, the better they do.  After the Neonatologist got the results of the growth ultrasound, he came back to let us know that it was great news they were so big.  He estimated their size would give them a 50-70% chance of survival if they were to be born.  I was thankful for my first bit of good news of the day!

So, here I am terrified that my babies are going to be born, I feel like complete crap and I have people having me sign consent forms for anesthesia and Neonatologists from the NICU coming to talk to me about chances for survival and what to expect for babies born at 24 weeks.  To say it was all very overwhelming would be a complete understatement.  Of course we all hoped that we would be able to stop my preterm labor, but all day Friday and early into Saturday, it wasn't looking like that was going to happen.  I think my doctors were just hoping they would be able to delay it long enough to get the steroids and Mag Sulfate on board.  Everyone thought our girls were coming.  Luckily, things didn't turn out that way.

I had contractions all day Friday and throughout the night.  Early Saturday morning around 4am, I started with very painful back labor and constant cervical cramping.  This is when I thought for sure they were coming.  After another dose of Indomethacin at 5am, that feeling finally subsided around 6am.  They checked my cervix and thank goodness there was no change - still 2cm dilated and 50% effaced.  After that my contractions really seemed to calm down. 

By early afternoon, I was stable enough to be moved from L&D to the ward for women.  I was on bedrest with privileges to get up to go to the bathroom and shower while I finished my course of Indomethacin.  I got my last dose of that Monday evening.  I did continue to have contractions, but they were not at all regular.  I was encouraged to get up a little more on Tuesday simulating more how it would be at home (having to walk further to the bathroom, getting my own water and food, etc.) to see how I did.  The contractions continued on just the same - still present (and annoying, might I add!) but not with any regularity. 

Wednesday morning, they checked my cervix and still no change!  So the plan was to send me home on bedrest.  I was scared yet happy at the thought of this.  Of course I want to be home!  It's more comfortable, you get a lot more sleep, and most of all, I really missed my kids!  However, I was scared I wouldn't know when I needed to come back.  Obviously I cannot tell the difference between the contractions that aren't changing my cervix from the ones that are because it was only discovered at my regular OB visit!  I was hopeful that I would come home on either Terbutaline or Procardia as a maintenance tocolytic therapy to keep the contractions at bay, but my current doctors just do not believe in it.  Studies have shown that maintenance tocolytic therapy did no better than placebo in preventing preterm birth from preterm labor.  That is a super hard pill for me to swallow considering this is the complete opposite of my treatment with other doctors when I was pregnant with Mikaela.  But, a new set of doctors with a new set of views and they weren't budging on it.  I did research it online, and the studies do say just as they said. 

Before I was discharged, they did a growth ultrasound to check their overall size and relative size to each other.  That was, again, wonderful news!  Carly was 1lb 14oz, putting her in the 100th percentile and Callie was 1lb 13oz, putting her in the 95th percentile!  First of all, they are both growing relatively equal.  Secondly, they are big girls for their gestational age!  This is great because, again, the bigger babies born prematurely are, the better they tend to do. 

So, I am now home doing bedrest on our couch.  I am happy to be home, but today has definitely been a challenge.  There are a lot of stressors at home with an almost 3 year old running around the house!  Luckily, Haley is a super big help.  Mike is on leave through the weekend, but starting Monday he will have to go to work for 4 or 5 hours a day.  Luckily, he has a really great Chief in charge of him, and it is a woman with compassion!  She said we can try that next week and see how it goes.  If he needs more time than that off they will work it out.  So, he will be working from 10-2.  I will just have to manage for 4-5 hours a day with just Haley to help out.  Hopefully that will go OK.  I think I had no idea how hard bedrest at home was going to be! 

Even still, I know I can do this.  I know how important each and every day that I keep these girls baking makes a HUGE difference on how they start out their lives.  We have been down the micropreemie road, and none of us want to go there again.  Every day is a blessing, but I am hoping for many more weeks of pregnancy before Carly and Callie make their entrance into this world!  We are praying as hard as we can, and we sure appreciate all the wonderful thoughts and prayers from everyone else!  Keep them coming, so far they are definitely working.  :)