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I Questioned the L&D nurse-- and i am SO glad i did!!!-- ALSO A TERBUTALINE WARNING!
- Sep 10, 2009 at 2:16 PM
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I went Into L&D yeesterday afternoon i am 34 weeks 3 days (this is my 2nd( and was having some mild contractions. After the nurse checked me she found i was only to dialated to 1 cm and that the contractions to her didnt look like anything more then discomfort. she called my dr and came back and told me that they could give me Terbutaline if wanted it. I told her i had never heard of the dru and requested more info. she seemed upset that i would question her and told me she has no idea about any side effects.. her exact words were" Most women dont question us.. the just want to stop their labor and have a healthy baby" I asked her to find some info. In the mean time she also put a call into my dr who called me. I talked with her and we decieded to hold off on the terbutaline.. she didnt think i was in active labor at the time and if i didnt feel comfortable with it she said i could forgo it ...
well i got online and looked it up here is what i found:
Talking Terbutaline
Preterm Labor Drug Causes Controversy
When a mom-to-be is struck with preterm labor, all she and the father can think about is stopping it. Every day that full labor can be fought off is another day of development for their baby, and in this case, a single day means a lot.
The medications to stop preterm labor are varied, as are their results. Some generate a great deal of controversy on their safety and effectiveness. But perhaps no drug for preterm labor has generated more debate than terbutaline.
Dr. Randy A. Fink, a board certified OB/GYN in private practice in Miami, Fla., as well as a Fellow of the American College of Obstetricians and Gynecologists, says that terbutaline is from a class of drugs known as beta-adrenergic receptor agonists. These drugs cause relaxation of smooth muscle, such as that of the uterus. The drug is approved by the FDA for treating asthma.
"When the uterus is contracting, such as during preterm labor, we would like to have a way to stop this activity – to relax the uterine muscles and stop the contractions," Dr. Fink says. "A similar medication known as ritodrine was approved by the Food and Drug Administration (FDA) in 1980 as a labor-inhibiting agent (known as a tocolytic), but the drug is no longer available on the market. Since terbutaline is so similar, it is frequently used for this purpose even though it is not FDA approved for labor inhibition."
Dr. Fink says it is important when looking at the effectiveness of any preterm labor drug to understand the difference between preterm labor and preterm contractions. The uterus is a muscle that is built to do one thing: contract. Many pregnant women have crampy preterm uterine contractions that cause them to present to labor and delivery units for evaluation and treatment. Terbutaline is often given in the form of a subcutaneous injection to stop these annoying uterine contractions. Terbutaline can also be given in oral form (a pill) for pregnant women to take at home to stop contractions.
"Preterm labor, however, is when these contractions cause changes of the cervix," Dr. Fink says. "In order for a baby to be born, the process of labor is that strong contractions of the uterine muscle cause thinning and eventual dilation of the uterus' opening, the cervix. Many people confuse preterm contractions (which almost every pregnant woman has) with preterm labor. Some have advocated the use of terbutaline as a longer-term drug to prevent preterm delivery – either in pill form or by way of a continuously dosed pump that delivers medication in liquid form through a needle under the skin."
Dr. Fink believes that terbutaline is effective in stopping preterm contractions, especially in the short term.
"For instance, a patient presents to the hospital at 34 weeks gestation for cramping, and is found to be having uterine contractions," Dr. Fink says. "Terbutaline is administered by a subcutaneous [under the skin] injection, and the contractions stop. The patient goes home. Or a patient has frequent episodes of contractions that frighten her and require repeated trips to the hospital for fear of preterm labor; however, her cervix never starts to dilate. Perhaps she will be given an oral form of terbutaline that she may take either on an on-going basis or only when she feels the cramping. If the cramping stops, she can feel reassured. If not, then I recommend she go to the hospital. I think this is a reasonable use of the drug."
According to Dr. Fink, there have been concerns about the safety of prolonged use of terbutaline. The drug does cross the placenta, meaning it enters the baby's circulation. There are controversial studies showing that the drug may be associated with an increased risk of brain hemorrhage in the preemie, one of the potential complications of prematurity anyway.
"There are problems with the way these studies were conducted, and no large, well-controlled prospective trials have been undertaken," Dr. Fink says. "Also, prolonged use of terbutaline results in a 'wearing down' of the effectiveness over time, and is also associated with some not-insignificant side effects in Mom."
These side affects may include jitteriness, increased heart rate, tremors, headaches, dizziness and, very rarely, increased blood sugar and seizures.
The controversy concerning terbutaline stems from the FDA and the lack of controlled studies concerning terbutaline.
The FDA sent out a letter in 1997 warning about the use of terbutaline and especially use of the pump used to give a measured dose of terbutaline. In conclusion, it stated, "In the absence of data establishing the effectiveness and safety of the drug/device, FDA is alerting practitioners, home health care agencies, insurance carriers and others that continuous subcutaneous administration of terbutaline sulfate has not been demonstrated to be effective and is potentially dangerous."
Dr. John Elliott, a perinatologist and the medical director of Maternal/Fetal Medicine at Banner Good Samaritan Hospital in Phoenix, Ariz., has studied and treated preterm labor for years and has developed a national reputation for care and management of women delivering high-order multiple births (triplets or more). He disagrees with the FDA conclusions and uses terbutaline quite regularly with his patients who warrant it.
"People have to remember that the FDA is also a political organization; those who think that medical organizations aren't political are fooling themselves," Dr. Elliott says. The FDA warning was issued after two women died. One woman had been off the terbutaline when she died and the other died under very suspicious circumstances. For this, the FDA has issued a warning about terbutaline and the terbutaline pump, despite two publications in the medical literature documenting the safety of the therapy in over 18,000 women.
The lack of quality-controlled trials is also an issue in the case of terbutaline. A controlled trial consists of a certain number of people receiving the medication being studied while the others receive a placebo. Because of the circumstances, most physicians feel it unethical to give a placebo to women undergoing preterm labor. There are many observational reports demonstrating the effectiveness of the drug, but clinicians interpret the data differently, leading to the difference of opinion surrounding the use of terbutaline.
"Using the terbutaline pump is not only very effective because it is bio-available and quickly absorbed into the body, but it allows the patient to go home, which is far better than having her stay at the hospital," Dr. Elliott says.
What it comes down to is that all prospective parents should be informed in case preterm labor is an issue. That way parents can question their doctor knowledgably and be a part of the decision-making process. Educating yourself about parenting is a crucial part of being a parent. Why not start before birth?
Dr. John Elliott, a perinatologist and the medical director of Maternal/Fetal Medicine at Banner Good Samaritan Hospital in Phoenix, Ariz., gives the following preterm labor tips:
- Pregnant moms should be aware that preterm labor will occur in about 20 percent of pregnancies, and 10 to 12 percent will deliver preterm.
- The symptoms of preterm labor are subtle, and are common in normal pregnancy: cramping, pressure, backache, change in vaginal discharge, pressure in the inner thighs and a feeling that things are just not right. Preterm labor can happen to anybody. Be alert!
- If you are diagnosed with preterm labor, become educated. Learn about the cause (it may not be known), and discuss with your doctor what medications he or she is going to use and the dosage. Do not accept it if your doctor tells you that tocolytics do not work and he won't be using them. Ask about home contraction monitoring. Be assertive with your doctors; do not assume that they know best. Preterm labor demands aggressive action. http://www.pregnancytoday.com/articles/medications-and-herbs/talking-terbutaline-4545/3/
Some of this is soo scary! I am so gald i questioned that nurse!
Alot of women just take waht the nurses or drs say and dont do the reasearch! i am not saying dont take the terb. if is is offered to you. I am just saying mommas LOOK INTO THINGS FIRST! alot of times drs dont know or wont tell you!
Comments:
I'm glad you asked!! Hope you will be okay and all goes well! Take it easy!!
man, i wish i would have asked them not to give this to me. i went in at 35 weeks and was having contractions every minute and a half, but i was not dialated and the nurse just came in a gave me the injection. i only took the pill for 2 days because i had an allergic reaction and swelled all over and hurt to the touch (couldn't even have a blanket on me). i had the tremors and dizziness, along with severe nausea. what frightens me more after reading this is that my dad is borderline epileptic, so why would they even think of administering this medication to someone with family history of seizures!?
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I had it twice with my son. Once at 24 weeks, I was contracting regularly and was dialated to a 1. And the other time at 35 weeks dialated to a 4. I was really shaky after the first one, and nothing after the second. My son was born at 36 weeks.
- Cavalrybaby02
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