Does your MW underreact? — The Bump
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Does your MW underreact?

So I'm 28 weeks and my most recent u/s showed a shortened cervix of 2.1 from 3.4, six weeks ago. The perinatologist was very concerned. He thinks I got 4 weeks left and baby will be here.

His orders: ?Lay down when I'm home ?lay down after 2 hrs of sitting (which is crazy!) ?no yoga ? no walks around the block ?stay stress free ?call immediately my OB/MW if I feel contractions.

I called my MW and she says he's rediculous and 2cm of cervix is fine. She says continue all your regular activities. I'm feeling like she's underracting. I see her Monday to discuss the perinatologist appointment.

Who's orders do I follow?!

Re: Does your MW underreact?

  • why are you seeing a peri in the first place?

    i would def express the concern that you have of this conflicting advice to your mw at your next appt. 

    can you do some of what the peri recommends?  like a compromise? 

    have you researched what a normal cervix length should be? 

    is this your first baby?

    so, the peri thinks four more weeks, is a cerclage an option?  does he/she think that once is gets really short it will start to dilate?  are you having BH's or contractions?

    do you have another f/u appt with the peri for another u/s?  if not, you might make one for 3-4 weeks from now to see if there have been any changes?

     

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  • I'd go with the more conservative.  Did they do a FFN? 2.1 is pretty short, and I'd want it checked again in a couple weeks (though they don't normally do them after 28w.)  I know some shortening is expected at 28 weeks, but 2.1 is pretty short. (They want above 2.5 normally.  Not sure what they want right at 28w.  Mine was 6cm at 28w, and that's with twins, but they said it was freakishly long.)
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  • It depends on who you have more faith in - the docs or your MW. 
  • I would be following the peri's advice.  2.1 is very short for how far along you are.  I personally would not trust a midwife who thinks she knows more than a peri.  Your peri basically put you on modified bed rest which is the typical prescription for a short cervix.  If you have contractions you need to call your OB and head to the hospital (more than 5 or 6 an hour is too many at this point in your pregnancy), the hospital will check your cervical length, if you are dilated, do a fetal fibronecton test (if negative the chance you will not go into labor in the next 2 weeks is well over 90%, if positive, you may go into labor in the next 2 weeks).  The hospital will also monitor you and your baby for a few hours to time your contractions (if you are still having them) and to see how your baby is handling the stress (not all babies handle the stress of preterm contractions well).

    Preterm labor is very serious and should never be ignored.  If caught in time, the doctors are very good and getting most people to term, and if they can't get you to term they can typically hold it off for 48 hours for they baby to get steroid shots to mature the babies lungs. 

    Thomas ~ 07/07/2008 ~ 8 lbs, 5 oz

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  • Thank you ladies! Yes this is my first baby. I am taking it easy, resting here and there. I rather be cautious than carefree. 

    I saw a perinatologist in the first place because I got a tri screen. I went back so peri could check cervix since I had some cervical work done 10 yrs ago. It is too late for a cerclage but the f/u appt with the peri is in a couple weeks.  MW appt is tomorrow morning.

    I've had more random braxton hicks all day but nothing regular. I will definitely call MW if I have 4 or more within the hr.

    I think I will tell MW that her opinion contrasts so much with the perinatologists that I need some middle ground. I'm going to make an appt with the Birth center's OB and go over the perinatologist report next week.

     

  • image brunette mac:

    I think I will tell MW that her opinion contrasts so much with the perinatologists that I need some middle ground. I'm going to make an appt with the Birth center's OB and go over the perinatologist report next week.

    I think this sounds like a reasonable approach. And at least until you get all the opinions straightened out, I would probably follow the peri's recommendations. It can't hurt to be a little overly cautious, but it may be problematic to be not careful enough.

    Good luck =)

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  • I am not KU, but yes, the MW I was seeing for well-woman care has under-reacted to my care enough that it might not be safe for me to conceive a child due to kidney problems.

    In your case, I'd absolutely trust your peri. Your cervix is way too short for 28 weeks and I think your MW is doing you and your baby a huge disservice in acting like it's no big deal. And also a big ditto to everything Lydia and Honkytonk said-- you really should get those ctx checked out/err on the side of super cautious for a few days, esp with how short your cervix is. It would be better to catch any cervical changes now and have time to get the steroid shots to improve lung function rather than risk PTL without them.

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  • Here's an interesting article about how bed rest might not do anything:

     http://www.latimes.com/health/ct-met-bed-rest-20110129,0,7593859.story?page=1

     

    Maybe this is where your MW is coming from? 

  • I read that article as well. It does not apply to the OP's case.  

    Shortening cervix is helped by bed rest, the article states this clearly on the second page.  The bed rest helps to keep pressure off the cervix so that it will stop shortening.  

    The article suggests placing a cerclage, which the OP stated the peri could not due this late in pregnancy (a cerclage is typically placed early second tri, sometimes they are done emergent later in pregnancy, but I have never heard of one being placed after viability).  The progesterone shots mentioned in the article need to be started at about 16 weeks to be effective, again, OP is well past 16 weeks. 

    I had preterm contractions with no cervical changes.  I was not on bed rest, but I was medicated, to reduce the strength of my contractions to prevent cervical changes and to reduce the stress on my baby.  If I were to have experienced cervical changes (dilation, effacement, or shortening) I would have been put on bed rest. 

    Thomas ~ 07/07/2008 ~ 8 lbs, 5 oz

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    What's in my camera bag: Nikon D5000, Kit Lens 18-55mm, 55-200mm, 35mm 1.8G, 50mm 1.8G, 85mm 1.8G, Tamron 28-75mm, SB 600 Speedlight

    Global Developmental Delay consisting of a receptive language delay and self help skills delay

  • I assume this is the same article as the PP in LA times.

    http://www.chicagotribune.com/health/ct-met-bed-rest-20110129,0,6131409.story

    My husband read this and said "the more I research and read the more I am convinced doctors don't know anything about pregnancy and childbirth."  I kind of agree. 

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