Preterm Labor & Contractions

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Archived Q&A and Reviews

Moderate to severe contractions in mid-pregnancy

May 2006

Hi, I'm currently 19 weeks pregnant and for the last week have been experiencing moderate to severe contractions and a lot of upeer left quadrant pain. I've gone to the doctor, the emergency room and I have been told that fluids and staying off my feet (bed rest) should hopefully help but that there is nothing they can really do to help. They have seen, monitored the contractions, done multiple pelvic exams and given me IV fluids. I have been pregnant before, have miscarried twice and have one wonderful 6 year old daughter. This whole pregnancy has been very difficult, I used clomid to concieve, had severe hyper emesis until about 15 weeks and horrible migraine headaches throughout my whole pregnancy. I just feel like I should not be having this much pain, that something HAS to be wrong and hate that I cant get a ''real'' answer from any of the doctors. ''It's normal to sometimes feel contractions'' (I feel up to 20 a day) they all say and since I'm not bleeding or thinning out/ dilating there is nothing other than fluids that they can do to help. I am already drinking 6+ bottled waters a day, I'm not dehydrated and they still say the same thing over and over. Am I worrying too much? Have any of you felt this way and it has been fine? I feel like I'm going crazy...telling myself and thinking this is not right and then having several doctors brush it off. I don't feel like I should be having such strong and painful contrations that I have to use breathing techniques and even cry through some of them. I even woke throughout the night to a contraction. Am I being foolish? Can any of you please give me some advice. I feel somewhat lost in this situation. Thanks.

Did you have an ultrasound done to see if you have uterine fibroids? Fibroids are very common in women in their 30s and 40s. They're often small and undetected b/c they cause no symptoms, but can suddenly grow and cause pain b/c of the pressure they're putting on the uterus and adjacent organs. Excerpt from an FAQ: ''... rarely, the fibroid may grow during pregnancy and cause discomfort and very rarely premature contractions that require bed rest.'' (from http://www.hopeforfibroids.org/faq3pg2-advancedquestandrecovery.html) Marinela

Hmmm. Certain aspects of what you describe do sound common and not a cause for concern. It is okay to have Braxton-Hicks contractions (uterine tightening that is not painful, not causing cervical changes) during pregnancy. Usually, fewer than 4 per hour is considered okay, although the real litmus test is whether you are dilating or thinning or not. I had a time around 20 weeks or so when I was having 10 or more contractions per hour (just uterine tightening -- bothersome but not painful), and this went on for days, maybe weeks. My sisters have histories of preterm labor and birth, and so I was concerned. I was checked many times during that period and, as in your case, there was no cervical change, and everything was okay. The fact that you've had no cervical changes, are not bleeding, and the baby has been monitored and found to be okay are good signs. The advice to rest and stay hydrated is well founded -- dehydration and fatigue can lead to more contractions. Everyone has different reactions to uterine contractions, but the amount of pain you describe seems a little bit outside the Bell curve for run-of-the-mill Braxton Hicks contractions. Are you feeling fetal movement yet? If so, has the frequency and intensity stayed more or less constant or increased (good signs)? Have you had an ultrasound? There's a slight chance you could be having an occult placental abruption (a small area where the placenta lifts away from the uterine wall). Because it is ''occult,'' you could have abdominal pain, uterine irritability, and no vaginal bleeding. Has your urine been tested? Another cause of abdominal pain and cramping could be a urinary tract infection. If you feel that something is not right, I urge you to pursue it with your care provider. It may be, and probably is true, that everything is fine, but if you haven't done the ultrasound or urinalysis, those are worth doing. Best of luck, --NP

I have been there, too, and I know how scary it can be. My contractions started at 17 weeks and I did have a healthy baby at term...although I did go on bedrest and I took medications as well. It seems that most OB docs don't do anything special if there are contractions but the cervix hasn't changed yet. I don't agree with that, but then I am not an OB doc. My story is long and maybe a little bit too much information for the newsletter, but I would be happy to tell you more by e-mail. I hope things settle down for you soon!

Worried about taking Terbutaline for contractions

Can anyone offer any insight on using terbutaline to control braxton hicks contractions? I'm 30 weeks pregnant with twins. I've been having contractions since about 12 weeks, they've been getting progressively more frequent (at least 8 an hour) and sometimes regularly spaced for a period. I had alot of bh contractions with my first pregnancy (singleton) as well, with no problems. Though nothing bad has happened -- no preterm labor -- my doctor feels it's time to start controlling the contractions with terbutaline and bed rest to prevent the onset of premature labor. I want to do everything I can to prevent having preemies so I'm taking the pills, but I worry about the long term effects on the babies. The skeptic in me wonders how taking something every 4 hours for 6 weeks could not affect their development in some way. Especially when I read on the internet that terbutaline is not actually approved for controlling contractions! Any insights? Any alternatives? Thanks in advance.... Susan

I went into preterm labor at 30 weeks with my first child and was put on bed rest and terbutaline (spelling?). I also worried about taking this drug after being warned to avoid even Advil during pregnancy. On full dose (a whole tab every four hours round the clock), I felt like a speed freak, shaking hands and all. Thankfully my OB/Gyn halved it, and at least the shaking stopped. The contractions also stopped. I guess my terror at having a pre-term baby superceded my concern over the drug, so I continued on until, at 36 weeks, my OB/Gyn said bombs away and took me off it. I had my daughter four days later: a few days premature but otherwise healthy in every way. This was almost four years ago, and I've seen no ill effects whatsoever. I'd say get horizontal and take the terbutaline so your twins stay in as long as possible - I've known several women who've dropped their twins way too early, to disasterous outcomes. Good luck to you! Julie

Susan - do internet research -- beginning with http://www.owc.net/~twins/terbquestions.html which should make you feel better. Terbutaline is listed as a Class B drug -- no side effects to fetus... A much better deal than delivering 10 weeks early (which a friend has been through with her wonderful twins -- born at 30 weeks with a combined weight under 5 pounds -- and with side effects after 5 years).

Terbutaline is a bronchial dilator, and the assumption is that it also relaxes the muscles of the uterus. It is not something I took while pregnant (and asthmatic) but I did take albuterol and theophyllin in huge quantities. My kids are now 12 and 8 and aside from weird senses of humor (genetic predisposition) they suffered no ill effects. Because I moved to Europe during the second pregnancy, the prescriptions were written by the OB there -- and he was allowed because in Switzerland (where he was) preterm labor would have been an on-label use for those asthma drugs among others.

Again, punch Terbutaline into a net search -- and relax. Stress is NOT a muscle relaxer! Heather

I took terbutaline for pre-term labor for 2+ months in 1987. It was horrid at first (gave me the shakes, shortness of breath, and uncontrollable crying). I was in the hospital for 2 days at first and they injected me with the stuff because the Dr. was so concerned about the baby being born too soon. I was allowed to go home with orders for strict bed rest, being told I was lucky the Dr. would allow me to get up to go to the bathroom!

The hardest part for me was monitoring my heartbeats with a stethoscope to determine whether I could take a dose. This is very important. Because I had to take the terbutaline every X number of hours (can't remember--maybe 3 or 4 times a day), there was always a 2 a.m. wakeup to do this. The reason is, if the heartbeats were too fast (X number of beats in 15 seconds of monitoring), then the terbutaline had to be postponed until the heartbeats calmed down. This happened to me once or twice, and the advice was to elevate my feet and relax!

After a few weeks, my Dr. did allow me to go to evening birth-prep classes, but she told me I could not do certain things, like pretending to push. There was a woman in there who had pre-term labor and was on the same medication, but she did not follow the instructions for strict bed rest, etc. and as a result, she went into labor early.

By the time I was 2 weeks from my due date, the Dr. took me off the terbutaline. As I recall, I was able to go for longer and longer stretches without feeling any contractions and took the medicine less and less (with Dr. permission). So, for the last couple of weeks I could do things like go to the movies or have lunch and a short walk with a friend.

I am convinced the terbutaline helped me keep my baby to term and quite possibly saved her life. My daughter is 13 now and I can see no ill side effects (nor can her pediatrician). My OB/GYN told me that Terbutaline is an asthma medicine that they discovered works for pre-term labor, although she agreed with me that the side-effects of the shakes and shortness of breath would seem to be just the opposite effects one would want either for asthma or for stopping contractions! (Those symptoms went away over a period of about 2 weeks.)

By the way, the common cure for pre-term labor prior to Terbutaline was to put the woman on an alcohol IV drip or make her drink vodka all day long! Seriously! I have a friend who roomed with a woman while they were having their babies, and her roommate was instructed to drink a bottle of vodka a day in order to keep her baby to term. This poor woman was a teetotaler and started each day with a Screwdriver!! (This was in a era prior to the discovery of fetal- alcohol syndrome, although there is a certain duh factor here, isn't there? Actually, when I asked my Dr. about this, she said that a baby with 2 or 3 months to go wouldn't have the kind of damage that a fetus in the earlier stages would, but it still is not a good thing. . . My Mom drank wine and martinis and smoked when she was pregnant with me in the early 50's and I guess I'm normal. . . but what a risk we now all know that is.) Becky

Terbutaline: I'm no doctor, but my experience is that this is pretty safe stuff. It relaxes the smooth muscles, like those in the uterus and lung (bronchi). That is why it is used both to reduce contractions and treat asthma. My doctor switched me to terbutaline for asthma when I was pregnant (inhaled) since it was safer than other medications; I had no problems, and have great kids. My cousin was on oral terbutaline from 18 weeks on, to combat pre-term labor. She also did fine and has a great kid. Leslie

First of all Susan, congratulations on having twins and also on doing such a great job of reaching 30 weeks w/o many problems!

Regarding terbutaline to reduce contractions: Has your doctor advised you to use a Tokos type monitor? These devices can detect uterine contractions through a sensor on a belt that you put around your belly. You lay down with the belt on for a period of 15 minutes or so. Then you remove it and place the sensor into a base-set that sends the information via telephone line (modem) to a facility where they read the results. This helps to establish how many contractions you are experiencing. This information is valuable since a continuous, regular pattern can indicate labor.

I used the Tokos monitor and Terbutaline with bed rest when I was expecting twins, who are now 9 years old. The Terbutaline does seem to help to reduce the strength of the BH/contractions. Unfortunately for me, the Terb. alone was insufficient and I was hospitalized for more than 11 weeks on a therapy of Terbutaline and intravenous Magnesium Sulfate. These two meds saved the lives of my daughters and they were born at 31 weeks. They never experienced a single detrimental effect and are healthy and wonderful in every way. They were premature, technically, but twins can tolerate early births quite well. The birth process itself helps to mature the infants. My girls were born vaginally and I had no anesthesia or pain med at all. I wanted to be fully aware and awake to see them! The several extra Amniocentesis procedures I had in the weeks before birth had me worried about their lung development. When I heard them cry in the operating room everyone laughed at the volume! One girl was in the NICU for several days because she wasn't breathing well; it had more to do with her being born second, rather than prematurity.

Terbutaline is kind of a mystery. It is a medication approved by the ADA for helping with breathing difficulties. No one ever did completely explain to me why it worked to help stop uterine contractions. I have known many women who have used it, while no one likes the side affects (nervousness or shakiness), they would do it again. The important objective is having those babies, strong and healthy.

Please fee free to Email me privately if you would like any more info or would like to talk about parenting twins. You have a wonderful adventure ahead of you! (Are you the person I helped find a MacLaren twin stroller?) Sharon

To reduce early contractions and the chances for early delivery, I too was given terbutaline and bed rest when pregnant with twins. At about 34 weeks the doctor told me to stop taking terbutaline. The very next week he started talking about inducing labor! Like you, I worried about the effect of terbutaline on the babies-- physically the drug made me feel awful. Both of my babies, thankfully, were completely healthy and normal when they were born at 35 weeks, though they were technically considered underweight and premature. They caught up quite quickly after birth, no problem. Donna

Hi Susan, I can tell you about my experience with two pregnancies and two different medications for premature labor. With my first pregnancy, I had premature labor at 31 weeks and I took terbutaline to control these contractions. It did not stop them completely, but it did take the bite out of them and, with complete bedrest, my baby was full-term. She is now almost 8 years old and she is beautiful, intelligent, well-adjusted, wise beyond her years...an incredible child (if I do say so myself). She is very healthy and her behavior falls into a normal range. If the terbutaline had any affect on her, it must be a positive one to date as there is really nothing negative to be said. Since you didn't say anything about the awful (very temporary) side effects that terbutaline can have on you, I wonder if you are taking enough? It is a type of adrenalin that will raise your heartbeat (my nurse told me you could tell if you were taking the right dose if your heartbeat was up to 110 beats per minute) and, guess what, it causes you to feel a lot of worry and anxiety...adrenalin will do that to you! It's based on the flight or fight syndrome thing...when adrenalin dumps into your system (you get ready to fight or flee), your smooth muscle relaxes. The uterus is smooth muscle so it relaxes (hopefully).

For my second pregnancy, I had premature labor at 28 weeks and this time I took a different drug, the name of which I can't remember. But it is a drug for lowering blood pressure that came into use for stopping contractions between 7 & 5 years ago. I bet you doctor would know about it if you asked him for this alternative, unless it has fallen out of use. I did not have a particularly good experience with it and did not think it was so effective at stopping contractions as the terbutaline, but it did not cause me to have so much nervous energy. It did cause me to feel dizzy and nauseous. What eventually happened with it was that, as it did not stop my contractions, the doctor kept upping my dose until I became convinced that the baby had greatly reduced motion as a result (and I didn't feel too great either) and stopped taking it on my own recognizance. The midwife was upset and wanted me to start taking it again immediately (which I didn't do), but when the doctor was reached she said that if the baby was moving less then there was something wrong and I should do what I felt was right and let the chips fall where they may. (I should add that by the time all this happened we were well past the dangerouse 28 week mark, although we were still several weeks away from the wonderful 37 week mark.) She said if the uterus was not a good place for the baby, the baby might as well come out. But the baby stayed in and was born full-term, despite thousands of contractions that I had all day and MOSTLY from 1:00 - 5:30 every morning. I took warm baths and drank lots, glasses and glasses, of water during that time and my baby stayed in! He is now 3 1/2 and is also beautiful, intelligent, active, healthy, normal. A real sweetie,...a much more physical, active, wiggly person than his older sister. I always find that kind of interesting...with her I took a physically stimulating drug and she is not a very athletic person, but is very cerebral, very imaginative, and can read for hours and hours. With my son, I took a drug that physically made me (and him) less active, but he is a very physical, athletic little person on the go. And there's no way to ever know if the drugs played a role in this, but they are wonderful kids. Good luck with your twins and the terbutaline! Laurel

Hi Susan- I was also put on Terbutalin and bed rest at 30 weeks for possible preterm labor. I have to say it is pretty yucky stuff. I was on the medication for about 2 or three weeks until I was able to get off of it with the help of an absolutely wonderful acupuncturist who specializes in treating pregnant women. Her name is Laurel Brody and she has offices in El Cerrito and Sabastapol (sp?). I can not say enough good things about her and her treatment. I had acupuncture treatments 2x/week and took Chinese herbs. At first I was nervous about taking the herbs but they were very gentle and really made me feel better. I ended up carrying my son 5 days past due and he was perfectly healthy. I highly recommend her.

If you do end up having to be on Terbutalin for the rest of the time I'm sure it will be okay too. My sister in law was on it for 7 weeks and her son is now 10 yrs. old and healthy as can be. There is a good bulletin board with people's experiences on bed rest/meds. on Babycenter.com which you might want to check out. Good Luck! Royce

In response to the concerns regarding terbutaline use, I would have to say that it is a very widely used drug with no known adverse effects on the baby. When I took it in the 32nd and 33rd weeks of pregnancy, it made me shaky for a few hours, but this is a minor side effect. Premature delivery, on the other hand, can be life-threatening and often has lifelong negative consequences. Terbutaline is a drug also used to control asthma, and other related drugs are used safely throughout pregnancy with no apparent ill effects. You probably need to weigh your fear of the unknown longterm effects of the drug on the babies against your fear of the known possible negative consequences of premature birth. Sara

I was on a high dosage of Terbutaline (10mg every four hours) for twelve weeks due to preterm labor which began at 23 weeks gestation. It isn't a pleasant drug to be on (as you probably know, the indications are that the next dose not be given if your resting pulse is over 120, and on several occasions mine was), but it's a hell of a lot better than IV magnesium sulfate, which is another anti-tocoltytic that I was on for a week. My daughter apparently has no lasting damage from having been exposed to Terbutaline in utero, although of course it raised her heart rate as well as mine.

I developed gestational diabetes from taking Terbutaline, which I believe is quite a common side-effect. As a result of my high blood sugar, my daughter was born with low blood sugar -- not dangerously so, but in order to keep her blood sugar up, we did need to give her a bit of formula the first two days of her life until my milk came in.

All three of the anti-tocolytic drugs that are used (Magnesium Sulfate, Terbutaline, and Nyphetapine (sp?)) are off-label i.e. none of them are approved for controlling contractions, but are regularly used for that purpose. I think Nyphetapine may be the least risky of the three, but I'm not sure about that -- and it wasn't effective for me at all. But you might want to ask your doctor about it.

I got acupunture treatment as well as taking conventional drugs. I found the acupuncture to be very effective. I also did a lot of visualizations, talking to my daughter and asking her to stay inside, etc.

I followed the bed rest protocol very, very strictly until I was 32 weeks along, at which point I did get up to sit out in the backyard every once in a while, or to move to the living room.

Best wishes to you and your twins -- and congratulations, you are already passed the 28 week point, after which most preemies do just fine. (But of course you want them inside as long as possible...) Alysson

I was on terbutaline from 26 weeks on for preterm labor with my twins (they were born at 33 weeks). I started with one pill every 4 hours, moving to 2 pills every 4 hours, and finally, in my 31st week, with injectable terbutaline at night, when I had most of my contractions. My babies, now one year, have suffered no side effects, and neither did I. If you are concerned, I would ask your doctor for more literature on the drug.

I took terbutaline to control pre-term labor for my now 10 year old son. There are no long term effects that I've detected. My only complaint is that my labor was then 5 days late and my son was 10lb 4oz, and so my body was probably pretty sure of what it was doing in the first place. Veronica

Second pregnancy after pre-term labor in the first

I'd like to hear about other people's experiences with a second pregnancy after pre-term labor with a first pregnancy.

I started having contractions at 23 weeks and was admitted to the hosptial at 24 weeks because I was 70% effaced (no dilation). I was on magnesium sulfate for a week (which made me violently ill), and then terbutaline for the rest of my pregnancy. I continued to have very mild and increasingly infrequent contractions until my water broke at 35 weeks (3 days after I stopped taking terbutaline).

Does anyone else have an experience of their water breaking seemingly coincident with going off terbutaline?

What are people's experiences with subsequent pregnancies following pre-term labor? I'm trying to understand how likely it is that I would have pre-term labor again if I were to get pregnant again. I am extremely reluctant to risk having a very premature baby -- the really little ones in the NICU were heartbreaking.

I had a similar experience with my first child, and went full-term with my second child. I had contractions and was 1 - 2 cm dilated with the first pregnancy at about 25 weeks, was on bed rest, took the drugs, etc.: like you, I didn't want to go through that worry again nor did I want to knowingly risk having a premie, if the risk was substantial! I saw my doctor before getting pregnant to discuss the possibilities. In my case, I had a specific uterine structure that made pre-term labor a strong possibility, but also had factors (like stress and lots of driving for work) that when eliminated might reduce the likelihood of pre-term labor. Anyway, the real answer is to ask your doctor about your own specific risk factors and likelihood of repeating pre-term labor; they will vary from person to person. Best of luck with a second pregnancy!

I suffered preterm labor for both my babies. Happily both went to term, but both pregancies had highly moments, so I really feel for you.

For the first pregnancy, I was on bedrest for about 3 weeks (Weeks 34-37) due to really strong contractions. I avoided meds and the hospital, but I was pretty much in bed all day and night, only getting up to go to to bathroom. It was torture, but I made it through with the support of my husband who then worked from home.

For my second pregnancy, Kaiser put me in a special program right from the start because of this history of preterm labor. At first it was a little annoying because I was feeling really strong and happy and healthly with Baby #2. A specific nurse called me every week to find out how I was doing, and documented my progress by putting the main points of our conversation in the computer after each discussion. This was a bother when all was going well, but, at 24 weeks, I started to spot. I was out of the country visiting family at the time (no less, argh!), but they since had insisted I take my medical file with me, and provided a number I could call if I had any troubles, I had a method of action. (Was I EVER glad to have all that information with me!) They told me to go get monitored at a local hospital, and they were really wonderful about reimbursing me the costs. (imagine that!)

Once home, and back to the routine of taking care of my then 3.5 year old while my husband worked out of the house, I really needed support. So I spoke a lot to my np and the ladies at the preterm labor line. They told me to rest one hour every morning and afternoon. Ya, right - with a preschooler?? They said do whatever it takes. Does your child like videos? Sweets? Juice boxes? USE THEM, they said, for baby #2 needs you to put his/her needs before any mother-guilt of having baby #2 watch too much tv. That gave me 'permission' to do whatever I needed to do to take care of my pregnant self. (And of course we did try to balance all this out by reading books on the couch/bed. I also minimized snack-getting by putting stuff in the fridge at my daughter's height. Things like glasses of milk, cheese sticks, bowls of grapes, even bags of crackers.)

My husband was still supportive - he took over making dinners and doing laundry (the lifting - I could still fold!) and even getting the groceries at night. He never once complained, although I was once again miserable for feeling so hopeless/useless. But I NEEDED to stay down; I continued to spot right up until delivery, with many a trip to L They never found out what caused this problem, but I actually delivered three days late and the baby was over 10 lb, so I guess the rest was good for him!

So I guess my advice is this: stream line as much as possible, for you may suffer preterm labor again, and it is important to take care of yourself just as much this time as the the last pregnancy. (Forgive my being so obvious; I just needed to hear these words myself at that time, and it was a hard reality to face while I had a preschooler to take care of.) And get SUPPORT! Tap those friends/family that say they will help you, put your child in more care (although this may be hard and expensive....), have your partner take really good care of you and the home, and try to get the best medical care you can. Also, I read a number of books on the subject, so I tried my best to educate myself/be prepared. There are also a number of cyber communities that could help, or at least be a support of others in the same spot. ParentsPlace.com has a number of pregnancy boards, and I am sure they have one for preterm labor/bedrest pregnancy.

Good luck with your pregnancy.