Preterm Labor Risk

Pregnancy is filled with random aches and pains, most of which are completely normal and bring commiserating stories from anyone you share them with.  Last Thursday I started having what felt like period cramps, but they weren't too bad.  I knew Braxton Hicks would be showing up soon as I'm entering my third trimester, but my stomach didn't harden (apparently a classic contraction sign), and the cramps were very low (like a regular period cramp).  On Saturday I got our weekly update email from Kaiser explaining everything about being 27 weeks.  One of the things they talked about was preterm labor signs and when to call the doctor.  One of them was menstrual-like cramps.

This started the question of whether I should call.  The cramps were not bad at all (more like day before the period starts, that "oh great here we go" kind of cramping).  They weren't happening at regular intervals, they weren't getting worse, but they were still happening periodically.  So Sunday I called labor and delivery.  She said I should empty my bladder, take a shower, and lay down.  If they got worse or kept happening, I would need to go in.  After doing those things (and falling asleep), they were mostly gone.  I say mostly because I was so hyper aware of every twinge that I was afraid I was imagining them.

Monday morning I went to work, still hyper aware of everything.  I noticed one cramp when I woke up in the morning, but didn't have any others.  My back was also hurting pretty bad.  When I got to work, my secretary and another teacher convinced me that I should just go in.  Better safe than sorry.  I have an awesome sub who was luckily available.  She knows my classes, my routines, my grading, and could pretty much teach without a lesson plan.  When she got there I gave her a verbal overview of the day and left (which is a huge blessing, writing sub plans is a pain in the butt).  I had called Kaiser and actually got the same nurse I talked to the day before.  She said they did want to see me, just to be sure.

They took me back alone first, asking the "do you feel safe at home, is there drug or alcohol abuse at home" questions.  Once they were sure Stephen was not an abusive alcoholic drug dealer, they let him come back as well (this was around 10:45).  They hooked me up to the monitors and we got to hear the heart beat for 20 minutes, which was very cool.  Her heart rate was fine, the cramp that I had did not register as a contraction, and it was looking like we'd be out of there soon.  The nurse said the doctor would come in and may or may not do an exam.

When he came in, he said he was going to do an ffn test and a transvaginal ultrasound to check my cervix, just to be on the safe side.  The ffn test is a swab that tests for a protein that gets released before delivery.  If it's positive, you will deliver within 2 weeks.  If it's negative, they don't really get any more information.  They did the swab and then the ultrasound.

*Update: Apparently I was wrong about my understanding of the test.  A negative result ensures that you will not deliver within the next two weeks.  A positive result is the one that doesn't give you any more information. *

After the ultrasound, he said he was a little concerned about my cervix.  The part that was still closed (which it should be), measured shorter than they like to see at 27 weeks (and 3 days).  He wasn't comfortable measuring the whole thing because the internal part was not closed all the way.  From what I've read, you can dilate internally.  He started talking about putting me on steroids (to stop labor and rush the development of the baby's lungs in case she came early) and possibly admitting me.  He said we would wait for the ffn test, which should be about an hour.  This was now 12:30pm.

The nurse brought us some leftover breakfast stuff (a muffin, cantaloupe, and baby juice box), but the lunch trays hadn't arrived yet.  At 2:00 she finally came back in and said the lab still didn't have results yet.  When she realized we still hadn't eaten, she brought us a lunch tray.  Maybe it was the hunger talking, but it was pretty good.  Then she showed Stephen where the food/water/ice pantry was so he could go get more if we needed it.

Finally at 3pm the doctor came in and said something was wrong with the sample and it couldn't be processed.  They couldn't redo the test because the transvaginal ultrasound gel contaminated possible samples for 24 hours.  He checked my cervix and said the outside was still closed and not dilated at all, so they sent us home and said they would schedule an ultrasound for the next day.  The nurse (who felt really bad that we'd just spent 5 hours there, 3 of which were basically wasted time), said if we didn't get an appointment to call the next day.

So Tuesday, I called at 3pm when I hadn't heard from them.  For the first time in my dealings with labor and delivery, I got someone who was very grumpy and dismissive.  She said there was a "glitch" in the system and that's why they hadn't scheduled it.  I kept pushing, and she finally said the doctor we'd seen was sending a message to my regular OB.  And if he was really worried, he would have us come back in.  That wasn't a good enough answer, but she wasn't going to be pushed any farther.  I hung up and emailed my OB.  By 4:30 radiology called to schedule us an appointment for the next day, and my OB told me to just come up and she would see me when we were done with the ultrasound.

Now Wednesday.  I went to work for my first two periods, but only sat in my chair and had the kids do everything for me.  (A benefit of teaching secondary).  At the ultrasound, we got the nicest tech we've ever had.  She talked to me through everything and was very reassuring.  Then she got Stephen and let us see the baby for a little while.  The baby's still breech, with both her head and her feet up by my ribs.  One of her arms was waving around above her head, and the other one was by her chin.  She was moving around and again refused to give us a profile (never have got a good profile picture).  We did get a good picture of her little feet, which were tapping away.  She looks great, her heart rate is perfect, and the fluid levels are good.  She weighs 2.5 pounds and is right on track for where she should be.

Then we went upstairs to see my OB.  She said most of the pictures of the cervix looked good, but there was one that made her a little concerned.  She said it wasn't necessarily dilation internally, it could be fluid or the angle the picture was taken at.  This was only an hour after the ultrasound, so she didn't have the radiologist's "official" reading yet.  She was also going to have a high risk doctor take a look at it to see what he thought.  She checked my cervix and said it was still closed (which is good), but a little soft (not good).  She also said that since I had been having cramps for almost a week and had not actually gone into labor, that was a good sign.  And even though my cervix isn't as long as they would like it to be, it is not in the "red flag" range either.  So we are basically at an in between, just need to be aware and call labor and delivery if anything changes.

With only 6 days left of school, she left whether I was going to work up to me.  I actually enjoy this time of year where kids get excited and sentimental about promoting, we go to Sunsplash, and then have promotion.  But, keeping the baby safe is more important than any of that.  On the other hand, some of the things that I still need to do (like pack my classroom) are much easier with eager middle school helpers.  So I'm not officially "off" of work, but I am on a modified "off" schedule.  I took today off completely.  Tomorrow I have my awesome sub, but it's not a "sick" day, it's an "activity" day.  I'll go in to finish planning Sunsplash and promotion, but can sit most of the time and won't have any students.  Monday's a holiday and we'll see what the radiologist and high risk doctor say before I decide on next week.  I would like to be at promotion at the very least.

At this point in the day, I am praying I don't have to go on strict bed rest because I will go insane.  I'm not on strict bed rest, so I'm up, but I'm trying to take it easy and not do much.  But when my laundry needs doing, the dishwasher needs emptying, the roses need trimming, etc, it is really hard for me to just sit.  But if it keeps the baby safe and inside for even a little longer, I will happily go insane.  Well maybe not happily...but I'll do it.