I was on terbutaline pills every 4 hours around the clock for 5 weeks.
I was allowed to stop at 36 weeks. I was convinced I would deliver
immediatlely. I had to be induced a week later due to pre-eclampsia.
Initially, I felt horribly shakey, like you would feel after a near miss
in a car. I couldn't sleep the first night at all. Of course I was
sent home from the hospital at 1AM. The side effects went away after
about a day.
I was put on mag sulfate when they induced me so that I wouldn't have
convulsions. I was really worried about this drug after hearing how
horrible it was from other women on this list. I must say that for me
it wasn't all that bad. I was hot, and it slowed down my contractions
so that I had to be given pitocin, but other than that it wasn't too
stopped my preterm labor both times, but it is rough. I jokingly called it
the "Rubber Chicken Medicine" because it made me so limp. I quickly
discovered where all of my long muscles were. After 2 days on Mag, I
couldn't even spit out toothpaste when I brushed my teeth because my muscles
were so relaxed. It made me so hot too. Everybody that walked into my
hospital room said it was freezing and I couldn't even stand to have a sheet
over my legs. But, it did keep me from delivering both times I was
hospitalized with preterm labor so it was worth enduring. My boys were born
at 34 weeks and now they're 9 months old and going everywhere around the
house. It's worth enduring almost anything to have healthy babies.
I found it extremely ironic that *I* - who had been on bedrest since 20 weeks to avoid preterm labor, was now being induced. But, I called my doulas, rallied my resources, and prepared myself to deliver these babies. I was sorry they were coming so soon, but very happy that their lungs were going to be OK.
- Regular OB appointment. Extreme swelling in my legs, but no protein in my urine. My blood pressure was a nice, low 110/70. Based on the edema, OB had me begin a 24 hour protein/urine test and sent me to the lab to draw blood for kidney and liver functions. I had no headaches, blurry vision, or stars.
- Late Wednesday:
- Having lots of Braxton Hicks. I really didn't want to go to the hospital (I knew it wasn't 'real' labor) - but I knew it was too early for the boys to be born, so I went. Received two shots of terbutaline to stop contractions. OB ordered an additional set of bloodwork for kidney and liver function - which showed that I was starting to develop toxemia. Thursday morning at 6:30 a.m. I was admitted to the hospital, and shortly after that started on "the Mag Bag".
The initial dose was a 4 gram PUSH of Magnesium Sulfate. Based on this, I know now why Hell is described in Bible as a place of fire. During this 20 minutes of hellfire, I'm sure that the only reason I didn't melt away completely was that two nurses were holding on to me. Every fluid in my body that could escape was violently expelled. (Nurses do NOT get paid enough money!) I was sure I wasn't going to live, but I did. Then I was put on a continuous drip, which makes you feel like you've got the worst flu you've ever had in your life. Raging fevers are intermittently spaced with arctic chills, blurred vision, and skull splitting headaches.
After a day or so, they lowered the "mag bag" dose, and told me I was in the hospital until I delivered. They continued to monitor my liver, kidney and platelets with bloodtests around the clock. They also sent me for an amniocentesis to measure the maturity of the boys' lungs. The initial results were "immature", but the more sophisticated test indicated that they were mature.
- Friday noon
- My numbers took a turn for the worse, and the OB told me that he was inducing labor, and I had until Saturday morning to delivery the babies, or they would have to do a cesarean. He administered prostaglandin gel and a couple of hours later they started the Pitocin drip.
For the rest of the story, see the Labor and Delivery FAQ.
I was put on bed rest at 27.5 weeks after I experienced some strong
contractions. My cervix was a fingertip dilated and about 30 percent
effaced. After home uterine monitoring revealed I was having too many
contractions, I was put on 5 mg tablets of terbutaline at the hospital.
I was supposed to take the terb every six hours. After a weekend on
terbutaline, I called my OB and asked to be put on a lower dose. I was
jittery, my heart was racing (pulse above 125) and my hands shook so
badly I couldn't write.
My OB's solution was to put me on the terbutaline pump, which
dispensed a smaller, more concentrated dose directly into my leg. A
nurse arrived to show me how to operate the pump and change the site
every four days. I had to stick myself with a needle each time I
changed the site, which was unpleasant.
After the nurse left, my contractions were too high and my legs
shook uncontrollably from the terbutaline all night. But I was up
monitoring anyway because of the contractions. Finally in the morning,
they settled down.
I spent five weeks on bed rest and the terb pump. I was still
jittery and could not do things requiring fine motor control (ie.
writing) unless it was right before a bolus (larger dose) from the
pump. I became breathless toward the end of my five weeks on the
terbutaline. One of the monitoring nurses kept on asking me if I was
having trouble breathing. I thought it was the ever-growing babies.
Now I'm not so sure.
I was put magnesium sulfate in the hospital in a last-ditch effort
to stop my contractions. I had made it to almost 33 weeks and was also
on the terbutaline pump. The nurses kept on turning up the dose until I
was at the highest level. My hands, face and feet felt like they were
on fire. I felt groggy and uncoordinated and slow. I spent the night
with a compress on my face. Because I was hooked up to an IV, I
couldn't get out of bed and had to use a bedpan. I couldn't eat solid
food because they were afraid the mag sulfate would make me throw up. I
also couldn't drink anything -- just ice chips. My lips were dry and
cracked by morning. I was still having contractions, although not as
many. I started to get double vision. Blood tests revealed
abnormal kidney and liver readings.
When the doctors told me I had
pre-eclampsia and they would have to take the babies, I was so relieved
and *glad* the torture was over. I was taken off all the drugs, and had
an emergency C-Section later that day when one baby developed signs of
distress. I developed spiking blood
pressure after my daughters were born.
After my release from the hospital, I discovered I couldn't breath
well lying down. After three sleepless nights and calls to my OB's
office (she was on vacation), an echocardiogram was ordered. It showed
the left ventricle of my heart was enlarged and not pumping efficiently
(dilated cardiomyopathy). After doing some research, my cardiologist
thinks this heart problem was caused by the terbutaline I took and/or my
pre-eclampsia. He doesn't know which. We held off on the heart drugs
since my pre-eclampsia was subsiding. About 7 months later, a repeat
echo showed my heart is almost back to normal.
Since then, my new OB has told me that "it's common knowledge in
medical literature" that combining preterm labor drugs such as
terbutaline and magnesium sulfate can cause heart problems. I found
some studies that support his assertion.
I did some research on terbutaline at a medical library and on the
Internet. I found reports going back to at least 1981 of heart and lung
complications in women taking terbutaline for preterm labor.
Terbutaline is an asthma drug that has never been approved by the FDA
for use as a preterm labor drug. I've also found studies published in
1996 and 1997 that show that terbutaline doesn't work any better than a
placebo in prolonging pregnancies after a 48-hour dose in the hospital.
These were double-blind, randomized studies.
I would recommend to all women experiencing preterm labor that they
educate themselves about the risks of terbutaline and other preterm
labor drugs. If you do choose to take preterm labor drugs, insist upon
being monitored closely for heart and lung complications. Try to avoid
being put on more than one drug at a time.
Please note: I'm not a doctor, nor am I medically trained.
I've also done some research, and found several studies (also randomized, double blind) which do
show that terbutaline is quite effective. Even one of the more negative studies,
which did not find an overall improvement, found that terb was more effective than the
placebo when treatment started before 32 weeks (when the baby(ies) are most at risk)....
I've also seen substantial anecdotal evidence during my nearly 4 years as an
amature expert of twins
showing a clear link between use of Terbutaline and prevention of preterm labor.
There have been a lot of reports recently about the risks and side effects
of terbutaline for preterm labor, and I can only imagine how these reports
would have worried me four years ago when I was put on the terbutaline
pump for preterm labor at 30 weeks. I am not a medical professional, so my
story should not be construed at advice to anyone considering tocolytics,
but I wanted to share our experience and feelings about tocolytics with
anyone grappling with this issue at this point.
After my OBs prescribed terbutaline, I was very carefully monitored. In
addition to my weekly OB appts, a nurse came to my house once a week to
check blood pressure, blood sugar, heart, urine, and a number of other
parameters. In addition, each night when I called in for my electronic
monitoring session, I had to take my pulse. Any time I had to administer
extra doses (or bolus') of the terbutaline because I was having too many
contractions, I was required to get my resting pulse before the dose was
given and then again later. Although not aware of the studies now coming
out, I was aware that terbutaline was a drug to be used carefully for a
very specific purpose. And my doctors, who were very experienced with
high-risk pregancies and multiple pregnancies, watched my health very
carefully. They also sent me to a perinatologist three times during the
pregnancy to more carefully monitor the health of the babies.
I thank my doctors for their conservative approach to my pregnancy. They
ordered an electronic monitor at 20 weeks because of my reports about
frequent contractions early on, and my insurance co agreed to pay for it.
Today that might be harder because some studies are showing that the
monitors might not be any better than a weekly discussion with a nurse in
preventing preterm labor. I would have been one of the grim statistics in
that study, because my labor was picked up by the electronic monitor in the
form of contractions I didn't even feel. I had been having SO many
contractions since 18 weeks or so, that did not cause any thinning or
dilating of my cervix, that when they increased to one every three minutes
during the hour of my evening monitoring session, I was still only feeling
about 5 in an hour - I wasn't supposed to call in unless I felt more than
6. Thanks to the monitor I was sent to the hospital where we found that I
was contracting every 3 minutes. Because we caught it so soon (thanks
again to the monitor) my cervix had only thinned a little and dilation was
only fingertip. I was sent home with a terbutaline pump and a nurse came
to my house to teach me how to use it. Had I developed any cardiac
complications during this time I would not have suspected a link with
terbutaline, because I already knew I had a heart murmur and suspected
mitral valve prolapse. Interestingly, no one had been able to hear my
heart murmur since childhood -- until my first exam after I got pregnant.
So the murmur was there long before terbutaline became an issue for me. I
wonder, though, whether I was followed as carefully as I was *because* my
doctor's knew of my history. Maybe this conservative care wasn't the
I did have three very rough days on the terbutaline until I got used to
it. I was too winded to talk on the phone, even while lying down, and my
heart raced constantly. I was asked to check my pulse frequently, and had
it gotten going too high (can't remember what was allowed) I would have
been put in the hospital. It did even out after a few days and I felt much
better. I had felt so bad before the medication that it was tough to say
what was caused by medication and what was due to that pound I put on over
the past three days (you've heard of the 'straw that broke the camel's
back?' I was waiting for that 'pound that pushed the pregnosaurus over the
Five weeks later, after an ultrasound showing big, well developed babies, I
was taken off the pump. My last dose was at noon on a Thursday, at 35.5
weeks gestation. One of my doctors watched me waddle (actually, that word
sounds too fast and graceful for what I was capable of at that point!) out
the door and said "glad I'm not on call this weekend because you're going
to keep somebody up all night!" Sure enough, at 10pm I suspected labor was
beginning. At four am Fri. there was no question, and, after a dose of
pitocin at 5pm to speed things up, we kept the other doctor up all night to
deliver our miracles at 6:01 and 6:03 am Saturday morning. At 7.5 and 6
lbs, they were ready to go home before I was!
I might have been a bit more prepared for medical intervention than many,
because our twins were conceived with Perganol, Metrodin, and HCG and I
took progesterone for three months to maintain my uterine lining. Because
of new reports at that time (1993) about a possible link between ovarian
cancer and fertility drugs, we had already had to weigh the risks and
benefits of medications. In reading the studies I noted that the authors
suggested that it was possible that infertility might have been a symptom
of a condition which predisposed these women to ovarian cancer, rather than
a result of the fertility medications they took. We decided to go ahead
with the treatment, with the idea that if we heard later this link was
verified, I would be especially careful monitoring my ovaries, just as I
already am with breast cancer monitoring (due to family history). My
desire to be a parent outweighed the risks, which I thought might be
overstated anyway, AND I felt that I just might have to take steps later to
protect myself (yearly ultrasounds, etc) if the link ended up being a real
one. Incidentally, last that I heard the statistics were pointing to the
fact that it was the women who did NOT become pregnant on fertility drugs
who later developed ovarian cancer. Therefore it seems (haven't read the
current studies, so don't quote me!) that it was in fact another condition
altogether. I do know several people who elected not to pursue medical
treatment because of these studies, and, when I look at my two little
miracles, I am now so glad I was not one of them.
This is the way I felt about the terbutaline, too. I was aware that there
were some risks associated with the medication, but I was even more aware
of the risks of NOT taking it. When we
found out we were having twins, we read the pamphlets on tocolytics and the
signs of preterm labor. We also visited an NICU. It's not like I'm
looking for trouble, but just wanted to be prepared ahead of time for
whatever came up. What I saw in the NICU was both wonderful and sad. I was
ready to deal with preterm birth if it had to happen, but if there was some
way for me to prevent it, or to get the babies closer to term than they
would be without intervention, I had to do it. To me, monitoring the
mother closely during tocolytic treatment to watch for some very rare side
effects seems a small price to pay to avoid the medical problems that very
premature babies cannot escape.
So, to those of you trying to decide how you feel about tocolytics, talk to
your doctor, and get a second or third opinion if you don't feel
comfortable. You might also want to visit the NICU if you are at risk for
pre-term birth. This was suggested to us by friends who delivered a 2 lbs
baby 11 years ago (who, by the way, is a wonderfully normal 11 year old).
They were terrified when they first hit the NICU, and feel that the first few
days would have been alot easier had they been prepared for and understood
what all the equipment was for. This family, by the way, had a similar
risk/benefit decision to make, since the steroid injections for lung
maturity were experimental at the time. They had time for two days of
injections, which they credit with keeping their two pound baby from having
any respiratory difficulties after birth. Now this treatment is used every
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