(Guest blog by Dr. Alka Tripathy-Lang)
Once you make it to the third trimester, there is one thing that’s worse than making it to (or beyond) your due date. That would be not making it to term, which is defined as 37 weeks for a singleton. In my case, peanut #1 arrived at 35 weeks and 3 days, and he was relatively healthy for a late-preterm infant (a fancy phrase for a preemie born between 34-37 weeks, again, for singletons). He needed a NICU/special care nursery stay of two nights because he was refluxing straight out of the womb, but was a solid 5 lbs 13 oz at birth. That reflux misery didn’t end for 9 horrible months. I chose to exclusively pump for him (that’s a whole other topic/discussion), which made those months even more difficult with the constant cycle of pumping, feeding, holding upright for 30 min (holla, my reflux mamas), washing pump parts, maybe sleeping, and starting over again.
Anyway, when I got pregnant with peanut #2, #1 was 14 months old. I was super excited to be pregnant because we wanted 2 babies, and I wanted to get all this miserable newborn/infant stuff out of the way ASAP (no, I do not love the newborn phase). But for those of you who don’t have babies yet, most babies are easier in the womb than they are on the outside, so we really needed to try to make it past 35 weeks to juggle a toddler and a newborn. The bun baking longer would also decrease the possibility of reflux, and in general, the baby would be further along in all stages of his development. We would get through that dreaded newborn phase faster.
There are a couple of things that I credit with making it to 39.5 weeks, at which point I chose to be induced (see http://www.medscape.com/viewarticle/863383#vp_1; http://annualmeeting.acog.org/support-for-elective-iol-at-39-weeks-growing/#.WT8Z0hPytE4 for information about ACOG discussions regarding elective induction past 39 weeks).
1 – Hydroxyprogesterone shots (Makena) – Oh my god. These are AWFUL. I HATE THEM. First of all, they are a huge pain when it comes to insurance (but then again, what isn’t here in the US). Here’s the story. Hydroxyprogesterone is super cheap to make, and was dirt cheap back when it had zero use. Then, someone decided to see if it would help keep babies in the womb longer for women who had a history of preterm labor. It did! You’re 40% more likely to keep your bun in the oven to term with these shots! So, the makers of Makena, the official name of this drug, jacked the price WAY up. The logic for them to get insurance companies to pay hinged on how expensive a NICU stay is. What’s a few thousand dollars per shot (weekly! between 16-36 weeks! 20 weeks of shots!) compared to several weeks of a NICU stay, which can run into the million dollar range? The pharmaceutical company and the insurance companies came to some agreement, and now we can get our weekly shots, but not without a lot of money, although less than the original amount. I spent hours on the phone trying to make sure the insurance company would approve the drug, and an additional pile of hours trying to sort out how much it would cost me out of pocket, per week. In the end, it was cheaper to go through a pharmacy that doesn’t accept insurance, so I wasted all that time. Thankfully, I was able to get my medicine, and insurance covered my weekly shot being administered at the doctor’s office. Not all insurance will cover that, and will insist that you learn how to give it to yourself. No thank you.
So, let me tell you a little bit about these shots. The medication is administered in an oil, so its very viscous (thick). This requires a large gauge (thick) needle. It also has to be a long needle bc this shot goes into your butt. You need that oil + hormone in your muscle so your body will do with it what it needs. So, every week, you get a big ass shot in your ever growing butt, and they switch sides the next week to make it less painful. People have different reactions to it, but in my case, the site of the shot would itch for 3-6 days. It would swell, so I had these horrible itchy welts. And oh, that shot hurts. It hurts when the needle goes in, it hurts while the medication is being injected, and it hurts while your body absorbs the medication over the course of the week. Just when you’re feeling better, it’s time for your other butt cheek to hurt.
What’s super annoying is that none of the nurses really seemed to understand how to administer this shot either, even with me telling them what to do. It’s supposed to be administered SLOWLY over the course of a minute or so. Not one nurse at my doctor’s office could grasp this concept. I asked them to go slow, and they did – for them. But that meant instead of 2 seconds, they would take 10.
But, in the end these shots were 100% worth it. Peanut #2 stayed in for 39.5 weeks, and didn’t seem in a huge rush to evacuate my uterus until the induction began. So yes, I hate this shot, but I’m so thankful that they exist. I credit this shot with keeping my bun in the oven past 36 weeks.
2 – Belly bands – Just buy one of these things
It’s ridiculous. You feel like one of those moving guys who has to wear a back support to carry your TV down the stairs. You feel very unfit because your own back isn’t strong enough to hold up that ever-growing belly.
But, you feel amazing, too. It saves your back. When you don’t wear it, your belly sags down, almost like the baby is trying to engage well before it should. And, you start sleeping in it because god knows that sleep is so hard when you’re that pregnant. This thing somehow makes it more comfortable. And, when you sit up, you don’t have to grab on and help your belly sit up! The band takes care of that!
I believe that this band helped me keep peanut #2 in as well. It could be total nonsense, but it certainly *felt* like the baby was better supported, generally held higher up than peanut #1 ever was. With #1, everyone told me that the baby was riding low throughout my third trimester. With #2, everyone commented about how nice and high he looked, all the way up until the days before I delivered. Thank you, belly band!
3 – Prescription antacids – The heartburn, for me, was brutal during the third trimester. The reflux was so bad at this point that eating and drinking water became increasingly difficult with each day. This is a problem, particularly when you live in the desert. During one of my many OB appointments, the doctor watched me reflux, and decided that the time of apple cider vinegar shots and Tums was over, and the good stuff was necessary. She prescribed prescription strength pepcid, and immediately, I could eat again. Several days later, we hit that 35 week 3 day point, which was when peanut #1 pulled the trigger and came out. I was antsy. Would my uterus decide that baby #2 needed to come out early, too? That it simply could not handle more pregnancy?
That’s when the diarrhea started. Followed by the waves of nausea. Was my body getting ready for labor and delivery? Early? Again? Exactly at the same time as round #1? OR was this a reaction to the new antacid prescription? OR did I have a stomach bug? Then came the shaking. Was this my uterus dilating? Or was it the lack of water? What was happening? Then the contractions came. They weren’t super painful, and they weren’t more than 6 per hour, but they were definitely happening.
I called the nurse line and they said to stop taking the wonderful antacid that made eating possible again for a few short, blissful days. I was to go in if I wasn’t able to keep water down, or if contractions sped up.
Then, my husband got sick. We were never so happy to both have the stomach flu!
However, the nurse line recommended that I stay off the antacid. Food and water became difficult, again. It was back to apple cider vinegar shots and Tums. At my 36 week appointment, a few days later, the doctor prescribed a different antacid. It was one of those “do not take if you’re breastfeeding” kind of things, but she rightly pointed out that I need to eat, and with the amount of saline I would take in during labor and delivery, it would flush out of my system quickly.
So I took it. And it was glorious. No weird side effects. I could get some sleep without refluxing myself awake. I would eat. I could drink all the water I wanted. And, importantly, the Braxton-Hicks contractions pretty much ceased until closer to 38 weeks. I credit the antacid with ensuring that I was properly hydrated, which minimized contractions, and potentially helped keep peanut #2 in longer.
Will these 3 things work for everyone? Probably not. But might they work for some? Most likely. In the end, you have to do what you need to in order to keep all the babies baking for as long as you can!
Dr. Tripathy-Lang is a kick-ass geologist who lives in the southwest with her husband, sons and a pack of wild dogs. (Ok, just the 2 dogs – but one of them is really, really big.)
*Newborn photography by Annelise Jensen Photography.