I generally do contraction monitoring twice per day: once in the morning and once in the evening. My current "threshold" is 8 contractions per hour. If I have fewer than 8 contractions in the hour of monitoring, I don't have to do anything. That's how many I'm "allowed". If, however, I have 8 or more, I have to re-monitor, and depending on the timing, may have to give myself an additional dose of terbutaline (depends on when my last auto-dose was). The nurses at the monitoring company are allowed to have me remonitor twice (for a total of three monitoring sessions) before they have to call the doctor. If during any of those monitoring sessions my contractions drop under my threshold, the cycle stops and I get to go back to doing nothing. It's a simple enough plan, right? Right.
If I remember correctly I'd had a bunch of contractions Saturday night, but it was easily resolved with one additional terbutaline dose. Sunday morning I monitored from 8:30 to 9:30. This should have been a relatively decent time to monitor contraction-wise because I get an auto-dose at 9am so at least the second half of monitoring should have been relatively quiet. No dice. I had 15 contractions in that hour. So the nurse asked if I could tolerate an additional dose at 10am and I said I thought so, so that's what I did, and re-monitored from 10:30 to 11:30 figuring that all would be well, and that I would still have all afternoon to get a shower, change the site for my terbutaline pump, and laze around. No dice. I had 8 contractions. One too many to be off the hook. I was getting an auto dose at 12, so I was asked to remonitor from 12:30-1:30. This should be a breeze, though. Three doses in that short a time frame... it was getting hard to breathe comfortably, and I rarely needed that many doses to control the contractions. Surely this would get me down to SEVEN contractions, right? No dice. Nurse called me back at 2ish and said I'd had 12 contractions. Honestly, every time she called me, she sounded more despondent. I felt like I was letting her down! So this meant plan B... calling the doctor. So she went to do that and I waited, figuring I'd take a shower once I heard back.
And I waited.
At 2:40 or so the nurse called me again asking if I'D heard from the doctor, but I hadn't, so she re-paged the doctor. I wasn't super-stressed, because I figured the doctor would probably put me back on a 48-hour indocin treatment again which is what happened last week when this happened and it worked, so why not do it again? A little before 3:30, the nurse called again saying that the doctor wanted me to try one more demand dose of terbutaline at 4pm (I'd gotten an auto-dose at 3pm) and remonitor for an hour before deciding whether to have me come into the hospital to be checked. I was hesitant because the cumulative effect of all the terbutaline boluses was starting to get to me, but I agreed to call the nurse back at 4pm, check my pulse and figure it out. By 4pm it was a different nurse (on weekends, it goes to the after-hours center in Philly at 3:30), and she said if I felt comfortable giving myself another dose, I should do so, but otherwise, she'd call the doctor for me. Since my pulse was fine, I went ahead and followed the plan, gave myself a demand dose, and remonitored from 4:20-5:20. Fifteen contractions. And off to the hospital we went.
At the hospital, they did a fetal fibronectin test (thankfully negative), and I was put on fetal monitors (3) and a contraction monitor (for a total of four monitors... Seth threatened to take a picture of my belly, but I forbade him). Since I was still having a lot of contractions (go figure), they put me on IV fluids. The doctor called me and talked about some options and we settled on trying three doses of Nifedipine (Procardia) spaced half an hour apart. If the contractions didn't calm down by the end of that hour and a half, she recommended admitting me overnight for more monitoring/observation and an ultrasound in the morning. Unsurprisingly, the Nifedipine did NOT slow my contractions enough, so I was admitted per the plan. Also, she put me on Indocin for 24 hours (still not sure why she did 24 hours and not 48 hours like they'd done the previous week, but whatever).
The Indocin, unsurprisingly, DID work overnight, and by 6am, my contractions had slowed to just a few per hour. So I went for an ultrasound first thing in the morning and met with the doctor. Now, this is the doctor I see the least of all of the practice members... she spends most of her time in the Silver Spring office, and I spend most of my appointments at the Rockville Office, and also, she's unlikely to deliver me as she's moving back to Boston in September, so I've not made a conscious effort to see her more often. She's a very good doctor, and spends a lot of time with me, so I've got no complaints. I hated her the first time I met her, but when I had to follow up with her the next day, she turned out to be absolutely amazing and perfect, so I completely revised my initial impression of her. (I think the reason I hated her the first time I met her was that I was hearing not good news and I didn't know her... had I already known her, I probably would have taken the news a lot better) Anyway, the ultrasound was okay. Mostly, they wanted to make sure that my cervical length was still stable. It was significantly shorter than last week, but not any shorter than it had been before I went on bed rest, so she wasn't stressed about it. Neither was the other doctor who was in the Silver Spring office that day, who is very conservative about such things. The babies are all doing just fine, which is always the case. Their health and development has always been perfect. The only thing in question all along has been MY ability to keep them on the inside for long enough.
While I was there, she asked if I had any other questions and I said that I wasn't trying to be a nudge, and I would do ANYTHING I was told to do, but that my Matria nurse had suggested I ask... but anyway, since all my blood sugars had been perfectly, utterly, completely, ridiculously normal, and since the only reason I'd been taking them in the first place was because I'd failed the one-hour screening and couldn't sit for the 3-hour test ... could I maybe take my blood sugar levels slightly less often (I take them 4x per day now). She said I could take them twice per day if I wanted to, but warned that the further I progressed in the pregnancy, they'd probably make me go back to 4x per day anyway. Fair enough. May not be worth giving up the four times per day then. It was worth a shot. I don't really mind doing it, but boy are my fingers sore. Anyway, the doctor went off to type up the ultrasound report and was probably going to let me go home mid-morning after a bit more monitoring.
But then... a miracle! She popped her head back in the room and said, "well, hey, while you're in-house, do you want to just go ahead and take the 3-hour glucola test?" Heck yes! Except, uh, I'd already eaten breakfast (and can I just say how unbelievably disgusting kosher hospital food is? ICK!). No problem, she said, they'd just wait until 4pm to do the test, and I'd just not eat anything in the interim. Fair enough? Yep. Worked for me. I'd still get discharged that evening if I wanted (the doctor did say that if I felt more comfortable staying another night or two, that was fine with her... uh, no thank you). I figure it was win-win all around, aside from having to spend a day without internet. Either it will turn out that yes, I DO have gestational diabetes and I have to continue to monitor my perfect blood sugars but I won't have to be bitter about it, or it will turn out that I DON'T have gestational diabetes and I won't have to monitor my blood sugars anymore. Either way, it's a win for me. :) I don't have the results yet, but until then, I'll just keep monitoring my blood sugar and doing what I'm told. It's all good.
So now I'm home. I got home around 8pm last night. I'm very tired, but happy to be home, with Julian & Seth and my precious internet. The hospital wasn't terrible and I know I'd survive extended hospital bed rest if I had to, but I'd rather not find out just yet. The nurses were all terrific, and it could have been far worse. But I am still quite grateful to be home for the moment.