Question of the Week Responses
Q: What have midwives used successfully to slow down/halt preterm labor symptoms, i.e. lots of early contractions in clients as early as 26 weeks? I'm interested in alternatives to tributaline. Bed rest/taking it easy is a given. Has anyone had good results using progesterone creme (external application)? Homeopathy? Other? I myself have used counseling and teaching self-hypnosis techniques occasionally for stress reduction.
-Constance Miles, LM, RN
I have had excellent results with the following: 1500 mg. calcium + 750 mg. magnesium daily. Also include 6 tablets of alfalfa daily and nettles. If contractions come on and are more than normal Braxton Hicks, have the woman take black haw tincture--usually 10-20 drops, one dose; if she is still contracting in 20-30 minutes, repeat the dosage. Combine this with bed rest. She also needs to drink plenty of water daily (more than she wants). Of course, she should be checked by a doctor if the herb doesn't stop contractions.
-Linda Myers, CPM
I have had pretty good luck using vistaril, up to 100 mg orally every 4-6 hours. Opposed to terbutaline, which tends to make the heart race and makes the woman feel anxious, vistaril relaxes *everything* and most women go to sleep (as they should anyway!). I also rule out infections and hydrate with at least 3 quarts/day (unless it's hot, and then I suggest more), but I assume other midwives do these things anyway whether there are preterm contractions or not. I don't call it preterm labor unless the cervix is changing. If it is, I have terrible luck stopping it, even with mag.
-Cynthia Flynn, CNM, PhD
I use several different methods, depending on the woman. But I have had good luck with all of these: Benadryl, cell salt (mag phos), rescue remedy, valerian, vodka, checking for urinary infection (get it treated), and a moist heating pad on mom's lower abdomen, right above her pubic hair. Also if baby is breech or in another malposition that is stimulating the cervix, I give pulsatilla to get the baby moved. I also use bed rest with baby's head off the cervix. Calcium with magnesium also may work. Humor and prayer can work well too.
A doctor in the town where I work (I am an RN, not CNM) advises his patients to drink one or two glasses of red wine if they are having contractions. I do not know the efficacy of this, but I do know we don't get very many of his patients coming in in preterm labor.
-M. Farney, RN
We had women drink a small glass of red wine for prodromal labor and it worked well. We also increased the protein intake to 100 grams a day in moms threatening either preeclampsia or preterm labor. We never saw either.
It's very important to examine existing research as well as consider our subjective perceptions--we will find that the definition of "lots of contractions" doesn't exist. From the earliest weeks of pregnancy, the uterus contracts. Only after the gestation has obtained some indeterminate size; the placental production of hormones has reached a certain blood level; and the gravida herself notices a change in perceived uterine activity does the idea of questionable excessive number of contractions occur. Undoubtedly the norm varies widely.
The major concern is to identify and treat "preterm labor" in order to prevent "preterm delivery." Preterm labor must be understood to consist of cervical changes, i.e. dilitation and effacement in excess of what would be normal for a given gestation. Only preterm delivery is a definite diagnosis, generally considered labor (with effacement and dilitation) leading to delivery of an infant before the 37th week of pregnancy.
...Even more frustrating is that a number of pregnant women will experience "silent" preterm labor, suddenly experiencing advanced labor without any generally acknowledged warning signs such as cramping, bleeding, ROM, backache, or even increased number of contractions Moreover, it is impossible to determine which treatments actually help prevent preterm delivery vs. those that simply appear to decrease the number of contractions.
...Most providers admit that they substantially over-treat "preterm labor." Such chemical agents as terbutaline, magnesium sulfate, and nifedipine appear to suppress uterine contractions by various pathways. But do they truly prevent preterm delivery? This is debatable and very difficult to analyze with good controlled, blind-study research. Are we to risk *not* treating possible preterm labor? How then do we find good controls?
Perhaps the only truly well researched standard of treatment is provision of steroids to the pregnant woman with actual advancing cervical changes. This simple treatment speeds fetal lung surfactant production and can help prevent respiratory distress syndrome in the preterm infant.
My advice would be that a midwife "get to know" and document fully (length in cm., dilitation of os and consistency/firmness) her client's cervix so that actual changes can be readily noted by any provider in future exams. Then, when concern arises regarding the number and strength of contractions, serial cerivical exams--performed very gently--can help determine whether the patient is truly at risk for preterm labor/delivery. Patients (or a chosen friend or family member) can even be taught how to examine the cervix by themselves at home.
To conclude, in a normal singleton pregnancy for a woman with no known risk factors for preterm delivery, the client should receive education regarding all potential pregnancy warning signs, including those specific to preterm delivery, at the most appropriate time in gestation. Should she seek advice regarding any signs of preterm labor--including "lots of contractions"--she should be thoroughly assessed for cervical changes.
Let's get some good, hard prospective studies going so we will have evidence and true justification for any treatment instituted rather than just assuming that we should blindly follow protocols based on fear, not research. And please, let's consider what we are doing to women's lives, families, careers and future health when we blindly advise "bed rest with bathroom privileges." We are asking of them an overwhelming sacrifice with which few can truly comply.
-Patti Warren, CNM
I have had very good luck with the herb vibernum opulus (cramp bark). I use a dropperful of tincture in water as needed (up to every five minutes) to stop contractions (in addition to rest and fluids, of course). I also used the tincture--3 times daily for the first trimester--to prevent miscarriage.
Reprinted from Midwifery Today E-News (Vol 1 Issue 32, Aug 6, 1999)
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