Triage

We had our second trip down to triage yesterday. That's where our hospital evaluates you if you are having any preterm labor symptoms or other problems when you are pregnant. I noticed a slightly painful contraction yesterday just before 3pm. The Braxton-Hicks contractions I've had up until this point were never painful, so I jotted down the time. 12 minutes later, I had another one. 12 minutes later, another. 10 minutes after that, a milder one, and then again after 10 minutes.

By that time I was a little concerned. Also Aaron woke up from his nap so I wasn't able to keep tracking them. But before getting Aaron up, I called Thom to see if he could come home early in case I needed to go down to triage. He was away from his desk so I left a message. Then I called my OB's office and left a message for him. While waiting, I kept calling Thom's office. The 3rd time, he answered. He'd been down the hall and when he kept hearing a phone ring, decided to check if it was his phone. He said he'd leave right away. (I now have his coworker's extension as well, since that is generally where he'll be if he's away from his desk.)

Then my OB's nurse called me back, asked me some questions and then said I should go to the hospital. I started thinking about what we'd do with Aaron. Kim was working at her other job. Larissa is in town and was a possibility, but she's getting ready to move to college later this week. My mom was with my dad who was having some outpatient surgery that day. My sister Theresa had said we could drop Aaron off at her house if we needed to, but I thought she was on vacation. But I called her cell and they were driving home right then and only 40 minutes away. My brother-in-law was leaving town that night so she couldn't just meet me at the hospital, but said we could drop Aaron off at her house on our way to the hospital.

Thom came home soon after that. He had a snack, I packed a bag for myself in case I was admitted and a bag for Aaron to have at Auntie's. I figured if I was admitted, Thom would get Aaron and take him home. If I was going to be very late, Thom would still get Aaron and we'd find someone who could stay with him at the house - I knew Larissa could do it in an emergency, or Kim's daughter who is 20. But hopefully we'd be back later that night to take Aaron home together.

We'd never left Aaron at Auntie's, so we were a little worried about how he'd do, but knew Theresa could handle it. So we drove down to triage and arrived around 5:45pm. We did the whole routine - I peed in a cup, then they hooked me up to a fetal monitor and a contraction monitor and had me lie uncomfortably on my right side while they monitored me. I had one contraction before the nurse came in and could see the little bump in the graph pouring out of the machine. The nurse asked a bunch of questions about the current symptoms as well as my general health and health history.

Then she said they were going to do a fetal fibronectin test (fFN). It is a swab of your cervix, like a pap smear, but it detects fFN, which the pamphlet she gave us describes as the "glue" that holds the baby in the uterus. Before 35 weeks, I guess there shouldn't be any leaking out. If the test comes back negative, you have a 99.2% chance of not delivering in the next two weeks. If it comes back positive, it doesn't mean you will deliver in the next 2 weeks, only that you have an increased risk of preterm delivery. The test takes about an hour to get the results.

Next she examined my cervix, which she said was still elongated at around 2.5 cm and was closed. That was a good sign that the contractions weren't doing much labor-wise. She went off to send in the test and chat with the OB on call. When she came back, she had a vial of terbutaline sulfate. She said it would help calm my uterus and hopefully stop the contractions. She pretty much gave me the shot before explaining it completely, although she did warn me ahead of time that it would make my heart race and I'd feel shaky. And it did. But I thought it was weird how fast it went. I'm used to asking questions about treatment and giving consent. I probably still would have taken the shot if that was the OB's recommendation, but I like to know exactly what is going on.

I have since looked up terbulatine. It turns out is an asthma drug that is commonly used for preterm labor as an off-label use. That means the FDA and the drug manufacturer haven't approved it for treating preterm labor. Some question whether it is necessary or effective. It did seem to calm my contractions. I was monitored for nearly an hour after I was given the shot and only noticed a couple of mild contractions, at least 20 minutes apart.

Right around the time I got the shot (around 7pm), it was time for my dinner. I was concerned about eating because of the gestational diabetes and it had been 3 hours since my afternoon snack. In triage they don't seem to have access to the full cafeteria they do when you are admitted, but she said they could get me a turkey sandwich. It was actually a box lunch with the sandwich, an apple and some sugar free "gel-style dessert". It was the best turkey sandwich ever and the best apple (I was hungry), but the "gel" was less than appetizing. I only ate half the apple since I didn't know how many carbs were in the bread, but I still had a post-dinner blood sugar of 152. I have also since read that terbutaline can cause high blood sugar, so that may have contributed.

After eating, I found out the fFN test was negative, so the nurse thought I could go home. But she needed approval from the OB on call who was apparently in a delivery. So we had to wait around for the OB to call back. We finally got out of there around 8:40pm. The nurse told me no exercise, sex or lifting until my OB cleared me to.

Thom had called Theresa 3 times with updates. Each time it sounded like Aaron was doing fine, although he had teared up a little and asked for Mama or had wanted to go home. But fortunately his cousin Mattea is very funny and she cheered him up. They even cuddled on the couch and watched some episodes of the Muppets. The green frog is funny, too.

I followed up with my OB today. He asked me what had taken me down to triage, so I explained the contractions. Between the negative fFN results and the exam of my cervix, he wasn't worried about preterm labor at this point and said I could resume normal activity. He said the contractions hadn't done anything to my cervix and not to worry unless they were 3-5 minutes apart or much more severe. He said everyone is different and every pregnancy is different, but in my case, for this pregnancy, those contractions weren't doing anything. He even said to resume walking to control the gestational diabetes because that was a bigger concern right now. He also said that if I do go into true labor after 34 weeks (I'm 31 weeks 6 days today) they wouldn't stop it anyway.

But Thom is still going to come home early today and I'll still take it easy for now, although I will continue with my walks. And hopefully Audrey will cooperate and not come early. We really aren't ready yet.