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Pregnancy Complications

Preterm Labor

Tips for Coping With the High-Risk Preterm Labor Pregnancy
by Deborah L. Davis, Ph.D.

As if you haven't been through enough, you may be facing a high-risk pregnancy. This can be especially discouraging if it adds to the feeling that you just can't do ANYTHING right. But rather than turning against yourself, your baby needs you to work with your body even though you may wish you could trade it in for a better one!

The Worry

How many of us lead lives so full, so busy, and so hectic, that we would leap at the chance to spend a few weeks in bed? We'd surround ourselves with good reading, beloved projects, and all those movies we missed that are now out on video. But when you MUST stay in bed for weeks UPON weeks because you are trying to carry a baby to term, nothing could be worse. The overwhelming feeling is not relief, but terror.

It can help to put things into perspective. Preterm labor is when uterine contractions (the uterus tightens and softens) occur more than 4 times every hour and the cervix starts to dilate before 37 weeks gestation. However, many women at one time or another, can have more than 4 contractions per hour without dire consequences. (For instance, the prostaglandins in semen can make your uterus practically dance without harm to the baby.) There are also women who walk around for weeks before delivery a little bit dilated (generally less than 2 cm.) So although these symptoms will spring your OB or midwife into action, they may be harmless.

To add to the mystery, nobody really knows what causes preterm labor, and there is no way to tell whether a certain mother will benefit from treatment. Preterm labor is aggressively diagnosed and treated in the U.S., and yet rates of premature birth have not dropped. Medication to stop or slow contractions along with complete bedrest may delay delivery until term. But some mothers deliver prematurely in spite of intervention and others would have carried to term without any meds or bedrest (some need to be induced as they go past term!)

If you've been diagnosed with preterm labor, this does not mean that you should stop popping your pills or hop out of bed. Intervention may actually be effective in your case. But preterm labor also does not mean you are doomed to deliver a tiny sick baby. You will worry. This is natural. But you can also have hope that your condition might be perfectly normal for you and that you will carry to term in spite of an irritable uterus and an open cervix.

It may also help to remember that every week, every DAY that your baby stays inside is another day of growing. As you turn the corner past 25 weeks, then 27, 30, 32, your baby's chances of surviving and being healthy improve dramatically (like from 10% to 90% or thereabouts.)

The Feelings of Failure and Worthlessness

Even though the drugs can make you feel jittery and bedrest can make you feel depressed, RE- MEMBER: with meds & beds, you're DOING SOMETHING NO ONE ELSE CAN DO to keep the baby safe and inside. So the next time you feel like a failure, remind yourself that just by remaining pregnant, you are SUCCEEDING. And if you feel worthless for getting nothing done, REMEMBER: YOU ARE GROWING A BABY. This is your JOB. And that's the BIGGEST JOB in the world. The Guilt About Being Dependent on Others

You are used to being an independent adult. When you want something, you go get it. But when you are stuck in bed, you have to ask someone to get and do things for you. This can feel awkward. You may find it doubly hard to ask, for things after you've been served a delicious home-cooked meal and your 'slave' has just finished cleaning up the kitchen. You may feel like you're imposing, that you are too demanding. You may believe that you don't deserve to have your needs met. Like many women, you may be accustomed to being the primary caregiver, not the care receiver.

It may help you to reframe things a little. First, you DO deserve to have your needs met. Granted, you are used to doing a lot for yourself, but you need some temporary help just now. Second, your true friends and family are eager to be there for you. People get great satisfaction out of helping others through hard times. Don't deny them this opportunity to contribute to your baby's safe arrival. Third, if anyone offers to do anything, say 'yes' for your partner's sake, since this lightens the load. Finally, anytime anyone does anything for you, it is more accurate to say they are doing it for your baby. After all, you are still capable of doing it all, but for your baby's sake, you refrain.

The Strain on Your Marriage

Bedrest is definitely something you cannot do alone. To make it, you MUST have an emotionally supportive partner. Enlist his support by reminding him that every meal he provides, everything he does that keeps you in bed is helping the baby to grow too. Bedrest is not something you've invented to torture him. It is something you do to promote your baby's well-being! Let him know that he is an indispensable contributor, a DADDY. The more real the baby becomes to him, the more eager he may be to help. Include him in feeling the baby move, what it feels like to carry a child in your body. Borrow or buy a cheap stethoscope (ask your health care provider) so Dad can listen into baby's world.

The Strain of Giving Up Control

If you are used to being in charge of the laundry or the cooking or whatever, it can be hard to give up control. You are used to having things done your way, the right way. You cringe at the thought of ill-sorted clothes begetting mud colored whites. You are sure he isn't loading the dishwasher at maximum efficiency. And the broccoli is always overdone.

Try to let go of the things that really don't matter. And be creative. Only wear dark clothing (and so what if your underwear isn't blinding white.) Imagine the dishes having more room to happily splash around for a few months. Develop a temporary aversion to broccoli. For the things that do matter, couch it in terms of your concerns, not your demands. For instance, if you want to make sure that he washes the cutting board really well after chopping up raw meat, remind him that the doctor is concerned about the risk of toxoplasmosis, a parasite found in raw meat (killed by cooking until well-done.) This gives him an excellent reason and motivation to do it "your way."

The Boredom

At first, you may be content with flipping through magazines and TV channels. But that gets old, fast. Then the weeks, days and hours appear to yawn endlessly into the future. Even the minutes are ticking by. Gradually, you will discover a routine that works for you, and this structure can make the days go faster. If you take medication, this will also block off time for you, and you'll find yourself saying, "Oh, is 3 hours up ALREADY?" Weekly doctor appointments can also be concrete evidence that time IS passing.

At first, bedrest may feel like an opportunity to get a lot of projects done. It can be quite disappointing to discover that lying on your side can rule out some activities like needlepoint, knitting or writing. But you will discover that there are plenty of other activities.

  • Some pesky projects that are easy to put off might be just the thing to keep you busy now--organize the recipe box, insert and label photographs in albums, clean up the mess in your address book.

  • Some regular household projects you can try in bed: going through the mail, folding laundry, sorting silverware out of the dishwasher, clipping coupons.

  • Stay in touch with friends and family by phone (if you worry about imposing, make phone dates so that you know they've set aside the time for you).

  • Invite visitors to come see you. Who cares if you're supine the whole time? You can still be a lively conversationalist in your jammies.

  • If you find daytime TV depressing, tape good evening programming to watch during the day. Don't forget PBS for quality shows,

  • Enlist a friend who enjoys going to the library or video store (or someone who shares your passion for gardening books and Hepburn/Tracy movies) to keep you stocked with interesting reading and watching. (Don't forget that many libraries lend out videos and magazines--for free.)

  • Rediscover daydreaming. Look through old yearbooks and remember when . . . Fantasize about what you'd do if you won the lottery . . . Plan the ideal trip around the world . . . What 5 foods/friends/animals/books would you want to have with you on a deserted island? If you had 10 cats/dogs/birds/bunnies, what would you name them? The possibilities here are unlimited.

  • Smooth baby things. You may consider this too optimistic but it can give you hope and that is good.

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Miscellaneous Tips

From sister Robin who spent 7 weeks on meds and total bedrest and at 37 weeks (2 days after stopping treatment), gave birth to a healthy baby, Olivia Pearl:

  • Staying in bed is a HUGE job. Surround yourself with people who appreciate that.

  • Talk to others who have been through it. Are there any women in your doc's office that have been through it? Ask for an appointment with them. They may be able to talk with you on a more frank and personal level.

  • Even though no sex is allowed, stay affectionate with your partner.

  • Read books that you can't put down - they make time fly.

  • Read books about pregnancy and fetal development. Information is empowering.

  • If it will make you more anxious, don't take a tour of the NICU (Robin didn't want to be haunted by images of tiny sick babies-she wanted to envision healthy fat babies, "like what MY baby was gonna be!")

  • Ask your health care providers questions--otherwise, bedrest will be spent festering over worries and the unknown. Especially ask why it's so important to keep the baby inside. Many parents think it's just the lung development that they are waiting on, but every organ system in the body needs time to mature. (At 32 weeks, Robin's husband wanted her to just have the baby--until he found out that it's not just the lungs . . . complications can arise with the brain, digestive system, heart, etc. and the lungs may still have trouble too. Plus, who wants to leave the hospital without the baby . . . not THIS cowgirl!!!)

  • Remember you can call the doctor anytime, day or night. That's what they are paid for.

  • DO ASSUME that your baby will be OK. Pessimism can cost you dearly in terms of energy, hope and peace of mind. Optimism is free and the benefits are priceless.

  • Robin admits, "There are good things about it, like being the center of attention, being pampered, everyone is hovering, concerned and caring." (This feeds into everyone's childhood fantasy-'if I had cancer/cholera/whooping cough, then they'd care about me!') "And now," she says, "looking back, it was just a blip in my lifetime. AND the happy ending made it all worthwhile!"

Deborah L. Davis, Ph.D. is a developmental psychologist who specializes in perinatal and neonatal crisis, medical ethics, parental bereavement and adjustment, parent education and child development. Dr. Davis is the author of four books for bereaved parents, Empty Cradle, Broken Heart (Fulcrum, 1991; 1996), Loving and Letting Go (Centering, 1993), Fly Away Home (Centering, 2000) and Stillbirth, Yet Still Born (PILC, 2000). With Mara Tesler Stein, Psy.D., she is the coauthor of The Emotional Journey of Parenting Your Premature Baby: A Book of Hope and Healing (NICU Ink, 2002).

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