QuestionI have hypertension and take methyldopa for it. It still runs high 140's/90's so I have non-stress tests done twice a week. I am 34 weeks along and last friday while on the nst monitor i was having very very strong contractions every 4 to 5 minutes. I was also checked and they said i was 2 cm dilated. They sent me to labor and delivery where i was given an iv for fluid to see if hydration would stop contractions but it didn't. They then gave me the shot of Turbitol(? not sure spelling? and it helped subside the contractionsl. Later that night they gave me nifedipine to go home with and take every 4 hours and they let me go home. They said that they would like me to take it until 36 weeks and that probably after stopping taking it I will go into labor again. I understand that my baby needs all the time she can possibly have inside especially for the developing lungs but since I have been on the nifedipine she hardly moves at all. And since being on it, it gives me severe headaches so they put me on tylenol with codeine which i am sure is also medicating the baby and making her not move as much. Whose choice is it when it really comes down to it? I do not feel comfortable with these medications and especially where she is not moving as much. I do notice that when it is almost time for my next dose my baby becomes more active. This is really bothersome. Can i opt to have the natural process happen or is what they are doing better off right now? I am dilating, her head is down in my pelvis and the contractions are strong. I feel that she should come out when she is ready and I feel she is definately telling me she is ready. Please, I need some ethical advise.
AnswerKristy,
You're in a tough situation. At 34 weeks, your baby's lungs are not developed. Your doctors want her to stay in as long as possible to prevent complications at birth and possibly developmental delays after that. Even babies born at 37-38 weeks can still have respiratory difficulties because their lungs are still maturing.
I completely understand the dilemma you're having with how the medications are affecting her development. It's a question of which is the greater evil: exposing her to medications in utero or having her born a preemie with the potential for respiratory distress, feeding difficulties and developmental delays.
It would seem that the doctors feel there is greater benefit to keeping her in the womb to continue developing than to letting you go into labor at this stage.
From what you've reported, I didn't notice that they were giving you steroid shots to increase her lung development in case the medications didn't stop your pre-term labor from starting again. This may be a prudent step in that pre-term labor is likely to start again.
I know it may seem that your baby is telling you she's ready but your hypertension is the culprit, not her readiness. In most cases, babies fare better with more time in the womb, not less.
My best advice is to nail down your doctors with a long conversation of the risks and benefits to continuing medications and treatment, or allowing your labor to start. Tell them your concerns with medicating your baby and her decreased movement. Share your reactions to the medications. Ask about the status of her lung development. Ask what can be done to increase her lung development.
There are always alternatives, but all choices carry risks. You need solid information to make the safest choices for both you and your child. This is what you're paying the doctors to do - give you evidence-based care and respect your input as the mother of this child and the one carrying her.
You should definitely be a partner in your care. Decisions should be made jointly, not dictated to you.
Good luck!
Catherine
