Ugggh!!!

This section is for discussions with other women who have probably been through the same signs/symptoms that you may be experiencing. Please note, we cannot offer medical advice and encourage members to discuss their concerns with their doctors. New members, come on in and introduce yourself!
mom29
Registered User
Posts: 1391
Joined: Fri Jul 16, 2004 09:39 am

Re: Ugggh!!!

Postby mom29 » Wed May 23, 2012 06:32 pm

JB wrote:
mom29 wrote: My 33 weeker did not have severe complications, but it was very hard leaving her every night. Some of her nurses were great and some were not. That is amazing your SIL says they had a good nicu experience. Did they have option to stay 24/7? I would have been so thankful to be able to stay with my daughter 24/7. As it was, I was just overjoyed the day we were able to bring her home. Running back & forth to nicu was exhausting. I developed blood clots the day she came home and wound up in the ER. I am so glad that experience is over!


24/7 access makes a huge difference, I think. If I weren't able to be with my daughter whenever I wanted to it would have been much more difficult than it already was. Our NICU had private rooms for the babies (although it took a few days for our daughter to be stabilized enough to be transferred from the pod to her room) with sofas that folded into single beds for a parent to sleep on. They also had hospital grade breast pumps right there in the room we could use, and a kitchenette area for sterilizing our equipment and having meals/snacks. We were allowed to come whenever we wanted, and were only asked to step out when they were performing sterile procedures (for example, inserting and removing chest tubes) or when she had chest x-rays taken. The rest of the time we were encouraged to help with her regular care (diaper changes, taking her temperature, etc.).

I'm so sorry you had a rougher time, including the blood clots. That sounds horrible!


JB, That is WONDERFUL the nicu your daughter was in enabled 24/7 rooming in for you. I didn't anticipate having an early baby so I didn't even consider going to another hospital in our area that has a brand-new nicu with this option. How long was your daughter in nicu?

The blood clots scared me a bit more than having pre-e. Five weeks of lovenox shots took care of it though and I am so very very thankful for modern medicine!

lemons
Registered User
Posts: 77
Joined: Wed Feb 01, 2012 1:41 pm

Re: Ugggh!!!

Postby lemons » Wed May 23, 2012 03:50 pm

mom29- Thanks for posting the actual study.
Diana, happily married since 2007.
Miscarriage at 10 weeks (June 2009).
DD at 30+0 weeks weighing 2lbs 9oz (October 2010) due to PE and IUGR. Today, a happy and healthy toddler.

mom29
Registered User
Posts: 1391
Joined: Fri Jul 16, 2004 09:39 am

Re: Ugggh!!!

Postby mom29 » Wed May 23, 2012 02:42 pm

I hope this OB/GYN publication with the study results will be considered an acceptable source of information.

http://journals.lww.com/greenjournal/Ab ... of.12.aspx

OBJECTIVE: To evaluate the association of a new institutional policy limiting elective delivery before 39 weeks of gestation with neonatal outcomes at a large community-based academic center.

METHODS: A retrospective cohort study was conducted to estimate the effect of the policy on neonatal outcomes using a before and after design. All term singleton deliveries 2 years before and 2 years after policy enforcement were included. Clinical data from the electronic hospital obstetric records were used to identify outcomes and relevant covariates. Multivariable logistic regression was used to account for independent effects of changes in characteristics and comorbidities of the women in the cohorts before and after implementation.

RESULTS: We identified 12,015 singleton live births before and 12,013 after policy implementation. The overall percentage of deliveries occurring before 39 weeks of gestation fell from 33.1% to 26.4% (P<.001); the greatest difference was for women undergoing repeat cesarean delivery or induction of labor. Admission to the neonatal intensive care unit (NICU) also decreased significantly; before the intervention, there were 1,116 admissions (9.29% of term live births), whereas after, there were 1,027 (8.55% of term live births) and this difference was significant (P=.044). However, an 11% increased odds of birth weight greater than 4,000 g (adjusted odds ratio 1.11; 95% confidence interval [CI] 1.01–1.22) and an increase in stillbirths at 37 and 38 weeks, from 2.5 to 9.1 per 10,000 term pregnancies (relative risk 3.67, 95% CI 1.02–13.15, P=.032), were detected.

CONCLUSION: A policy limiting elective delivery before 39 weeks of gestation was followed by changes in the timing of term deliveries. This was associated with a small reduction in NICU admissions; however, macrosomia and stillbirth increased.

User avatar
caryn
Forum Moderator
Posts: 10178
Joined: Fri Jun 25, 2004 06:36 am

Re: Ugggh!!!

Postby caryn » Wed May 23, 2012 02:29 pm

I want to add a quick note about correlation and causation.

While there is data showing a correlation between early delivery and changes in neonatal brains, that does not prove causation. It's in fact quite likely that the early delivery *and* the changes in neonatal brains are both driven by some other underlying factors, and that the changes are not caused by early delivery.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

User avatar
JB
Registered User
Posts: 57
Joined: Sat Dec 31, 2011 4:29 am

Re: Ugggh!!!

Postby JB » Wed May 23, 2012 12:53 am

mom29 wrote: My 33 weeker did not have severe complications, but it was very hard leaving her every night. Some of her nurses were great and some were not. That is amazing your SIL says they had a good nicu experience. Did they have option to stay 24/7? I would have been so thankful to be able to stay with my daughter 24/7. As it was, I was just overjoyed the day we were able to bring her home. Running back & forth to nicu was exhausting. I developed blood clots the day she came home and wound up in the ER. I am so glad that experience is over!


24/7 access makes a huge difference, I think. If I weren't able to be with my daughter whenever I wanted to it would have been much more difficult than it already was. Our NICU had private rooms for the babies (although it took a few days for our daughter to be stabilized enough to be transferred from the pod to her room) with sofas that folded into single beds for a parent to sleep on. They also had hospital grade breast pumps right there in the room we could use, and a kitchenette area for sterilizing our equipment and having meals/snacks. We were allowed to come whenever we wanted, and were only asked to step out when they were performing sterile procedures (for example, inserting and removing chest tubes) or when she had chest x-rays taken. The rest of the time we were encouraged to help with her regular care (diaper changes, taking her temperature, etc.).

I'm so sorry you had a rougher time, including the blood clots. That sounds horrible!
1st - miscarried at 11 weeks in Dec. 2009
2nd - baby girl born Mar. 2011 at 29 weeks 6 days due to severe PE
3rd - baby boy due June 19th, 2012

lemons
Registered User
Posts: 77
Joined: Wed Feb 01, 2012 1:41 pm

Re: Ugggh!!!

Postby lemons » Wed May 23, 2012 12:16 am

I feel it is important to correct a math mistake in one of the previous posts in this thread, especially since, subsequently, it has been quoted.

Guest quoted mom29 regarding a March of Dimes study and then Guest incorrectly translated the numbers into percents, see below (for clarity, I deleted the part of mom29's quote that wasn't directly about the study):

Guest wrote:
mom29 wrote:Regarding the March of Dimes study:
"... The reduction in early elective delivery reduced NICU admissions, reduced both the induction rate and the C-section rate, and ... presumably reduced costs. However, these benefits were achieved at a very steep price. The stillbirth rate increased from 2.5 to 9.1 per 10,000 term pregnancies. Instead of 3 stillbirths between 37-39 weeks among 12,000 patients, there were 11 stillbirths between 37-39 weeks among a similar number of patients after reduction in early elective deliveries"

Those are still pretty remote numbers an increase of possibility from 0.00025% to 0.00091 yes that is a big increase but still very remote possibility.


To calculate percent stillbirth:
for the original, pre-intervention group: (3 stillbirths/12,000 patients) X 100%= 0.025%
for the second, post-intervention group: (11 stillbirths/12,000 patients) X 100%= 0.091%

To go a bit further with the math, this is a three-fold increase (0.091%/0.025%) in the number of stillbirths. Now I haven't seen the study. I can't vouch for the methodology or the accuracy of the numbers as quoted above. All I can do is try to make sure that we do not propagate wrong information as we debate the issues and give support to those of us effected by PE.

On a side note, I don't think being in the 0.025% or the 0.091% of patients that ended up with a stillborn baby is anything to discount as just being a "very remote possibility". We often speak about percentiles and probabilities on these forums and I would like to remind everyone that behind these numbers are real families dealing with the very real grief of losing their baby.

StrongMom, I'm sorry that you had such a traumatic experience during the birth of your son and I hope that you are able to find some peace with your situation.
Diana, happily married since 2007.
Miscarriage at 10 weeks (June 2009).
DD at 30+0 weeks weighing 2lbs 9oz (October 2010) due to PE and IUGR. Today, a happy and healthy toddler.

mom29
Registered User
Posts: 1391
Joined: Fri Jul 16, 2004 09:39 am

Re: Ugggh!!!

Postby mom29 » Wed May 23, 2012 09:51 am

I am so sorry you suffered ptsd and that your son had a complicated nicu stay. Perhaps a group for people who have had ptsd would be helpful to you? It might be encouraging for you to connect with other mothers whose babies have been born at 37 weeks. They would understand your specific concerns. I joined a preemie message board and the moms were so gracious in answering my questions.

I'm sorry your son has speech delays. Have you checked into your state's early intervention program? You might also be able to find an online message board for parents whose children are speech delayed and get some helpful tips.

It might be helpful for you to write a letter to the nicu clinical manager to express your concerns/dissatisfaction with the care your son received. I am so sorry he had a complicated stay. My 33 weeker did not have severe complications, but it was very hard leaving her every night. Some of her nurses were great and some were not. That is amazing your SIL says they had a good nicu experience. Did they have option to stay 24/7? I would have been so thankful to be able to stay with my daughter 24/7. As it was, I was just overjoyed the day we were able to bring her home. Running back & forth to nicu was exhausting. I developed blood clots the day she came home and wound up in the ER. I am so glad that experience is over!

Again, I am very sorry for the trauma you have experienced and the problems your son has. I hope your next pregnancy goes full-term and that you have a care provider that you feel confident with.

User avatar
JB
Registered User
Posts: 57
Joined: Sat Dec 31, 2011 4:29 am

Re: Ugggh!!!

Postby JB » Tue May 22, 2012 09:37 pm

akoons wrote:
It depends on who's defining 'full-term'. There has been a push to label 34-37 weekers as 'late pretermers'.


I was going by ACOG guidelines, which state that labor that begins before 37 weeks is considered "preterm."
http://www.acog.org/~/media/For%20Patie ... 2208028709

I'm very sorry you felt pushed or coerced into inducing your pregnancy earlier than you believe was necessary. At the very least the next time you will know what to expect and can demand to see any test results yourself before making any decisions based on them. However, I do think your experience is the exception on this forum, as most of the women here had very real and very serious medical conditions that justified their early deliveries.
1st - miscarried at 11 weeks in Dec. 2009
2nd - baby girl born Mar. 2011 at 29 weeks 6 days due to severe PE
3rd - baby boy due June 19th, 2012

StrongMom
Registered User
Posts: 17
Joined: Sat Jun 25, 2011 4:58 pm

Re: Ugggh!!!

Postby StrongMom » Tue May 22, 2012 08:32 pm

I don't think I did.... they told me at the hospital that my blood work came back abnormal and I had bps in the 130/85ish range-- which is high, but not alarming (especially given my pre-pregnancy baseline was 125/80ish). My other doctor just recently looked at all of my blood work from the hospital as part of determining which tests we were going to do to ensure everything was good to go for another pregnancy and I had a question about them asking me to participate in a study about having postpartum anemia. When she looked at the records she said that all of my labs were normal.

Obviously, there is the very real possibility that this could have progressed into preeclampsia. And I will treat my next pregnancy as if it was just to be on the safe side. However, I don't think we were at preeclampsia yet. I am not sure if they were looking at the wrong info at the hospital or what. I trust what my other doctor says, since she is able to see the results and has been very transparent with all of my care. The drs at the hospital were hard to get info from or track down.

My son does have a slight delay in the area of speech. Most other areas seem to be right on or even a bit ahead.
DS born 2010 at 37 week 5 lbs 13 oz due to pre-e

mom29
Registered User
Posts: 1391
Joined: Fri Jul 16, 2004 09:39 am

Re: Ugggh!!!

Postby mom29 » Tue May 22, 2012 08:08 pm

StrongMom wrote:
mom29 wrote:[quote
Every relationship in my life has suffered tremendously from it, including the one with my son. That is part of the reason that rather that the health care professionals need to present everything in the BRAND. Women need to get the choice to decide based upon those risk factors that they find most important to control for with those risks and their related probability presented in a non-emotion driven way.


What is the BRAND? Am I understanding correctly that you feel women should get to make the final decision regarding delivery based upon risk factors and what they are comfortable with? Our OB's or MFM's have one thing we mothers do not, extensive training and lots of experience managing mothers & unborn babies in high risk situations. They are responsible to keep both safe. At a certain point the risks of an early birth outweigh the risks of continuing a high risk pregnancy.

BRAND is evaluating the Benefits, Risks, Alternatives, and Do Nothing. I absolutely feel that women should have the choice of how their pregnancy is 'managed' with the guidance of their physician. I have seen and learned waaaaay too much since having my son to put blind faith in a doctor. I have interviewed different doctors since then, and have been amazed at how many times they have 'managed' a pregnancy not based on what was best but what would leave them with the least liability. This is part of the reason that the US has one of the worst maternal mortality rates in the developed world despite countries which have the same risk factors in their population (i.e. hypertension, obesity, ect). Absolutely, there are times that early birth outweighs the risk on continuing a pregnancy. However, there are also a lot of doctors who act before that time has been reached due to fear of being sued, not what they truly think is the best course of action. I know that there are good OBs/mfm out there who can think selfishly, but they are few and far between. And I know that in situations I know where I risk being sued, I personally act differently so I cannot blame them for that.

I remember my MFM telling me anything after 32 weeks was frosting on the cake when I was admitted at 30 weeks. That didn't mean my baby would encounter no difficulties, but that he preferred an early birth with resolvable issues vs. me having a seizure or stroke and suffering permanent damage. Also, the doctors take into account how you are feeling (swelling, headache, visual disturbances, increased bp), not just the lab results.

"Resolvable issues" in a MFM's book and in my book are very different. Yes, having a child who survives is paramount--- but if the cost is disability when it hadn't needed to be that is still not "resolvable" in my book. MFM very rarely look at long-term affects. They look at short & mid-term affects-- often they do resolve. They often stop following the child when they hit school age, which is when many issues start to become apparent. Whether these raise to the point of having a disability or just are 'different' from their peers in some of the 'soft' neurological signs are part of what the difficulty in defining "resolvable issues".

I don't know any mother who has had an early delivery not wonder if she could have stayed pregnant longer or done something different. I thought I wasn't feeling "that bad", but when looked at my old messages to my friends and my posts on a message board I realized I had forgotten just how bad I really was feeling. It really took me awhile to get past the second guessing and what ifs. Staying home from Oct. to April was hard and having a preemie who was gaining weight slowly the first few months was nerve wracking.


I had absolutely no signs or symptoms other than a slightly raised bp, I have asked others and everyone around me says the same. (no swelling, no headache, no pain, no general uneasiness) I felt better than I had my entire life.[/quote]
************************************************
StrongMom, I am very sorry to hear you had a 37 week delivery. It sounds like you are saying that you did not even have pre-eclampsia? None of the typical symptoms of headache, swelling, spilling protein, sudden weight gain, two or more elevated bp's 140/90?

How is your ds doing now? Has he hit all the developmental milestones so far? What kind of complications did your son encounter during his nicu stay? Did you have to keep him isolated during RSV season (that is hard, especially during the holidays)?


Return to “Ask the Experienced”

Who is online

Users browsing this forum: No registered users and 2 guests