In this video blog, Darline Turner shares the Healthy Happy Pregnancy Cookbook. Written by Registered Dieticians Stephanie Clarke and Willow Jarosh, the book contains 125 recipes that are not only tasty, but also address many of the common ailments of pregnancy. Today, Darline tries the Blueberry Banana Oat smoothie, designed to give pregnant mamas, most especially mamas on bedrest relief from leg cramps.
In today’s video blog, I am discussing the use of pessaries for the treatment of cervical insufficiency. In answering a question from Mama on Bedrest Rose from our Facebook Community, I share the background on pessaries (typically used for treatment of bladder prolapse and urinary incontinence), how some Obstetricians are using them for cervical insufficiency and what the current research says about efficacy. THIS IS IN NO WAY A RECOMMENDATION FOR YOU TO GET A PESSARY!! If you think that you may be a candidate for a pessary, you may want to share this video with and talk with your healthcare provider.
Uptodate – A medical reference website.
Mama on Bedrest Addison asked this question of the community:
“Previous Bedrest Mama Here… I am currently 26 weeks, 3 days, due Sept. 6. I delivered my first little one at 35 weeks, after 5 weeks of bedrest. This pregnancy, I am getting Makena injections weekly and was wondering if they’ve worked for any mamas with previous preterm labor. Thank you in advance.”
First, I’m really grateful to Addison for asking her question and feeling comfortable enough with our community to share her story. The quick answer to Addison’s question is, “Yes, Makena injections do work.” Now let’s look at why Makena or 17 Alpha hydroxyprogesterone caproate (17OHP) shots work.
It really comes down to simple physiology. We all know that estrogen and progesterone cause the cyclic changes that are our menstrual cycles. In the first 2 weeks of our menstrual cycles, estrogen levels rise as a follicle in the ovary matures an egg in preparation for ovulation and subsequent fertilization. Estrogen also prepares or “plumps up” the uterus to receive the fertilized egg for implantation and subsequent development into the baby. At Ovulation, estrogen levels dramatically drop (and the egg is released from the ovary) and progesterone levels begin to rise during the last 2 weeks of the menstrual cycle. Progesterone maintains the plumped up uterine tissue so that the fertilized egg can implant in the uterine wall. If there is no implantation, progesterone levels drop and the outer uterine layer “sloughs off” and this sloughing is the resulting menstrul period.
If there is fertilization, the progesterone levels continue to rise so that the uterine wall continues to be a plump and fertile “ground” into which the growing and developing fertilized egg can embed. Progesterone levels will remain high thoughout much of the pregnancy, but especially during the first trimester so that the uterine wall stays rich and nutrient dense to “feed” the fertilized egg. By the end of the first trimester, the placenta has developed and it assumes the primary role of feeding the growing infant and progesterone levels will decrease, but still remain high in comparison to non-pregnancy levels.
So one can see that progesterone plays a vital role in the development of an infant. When progesterone levels are not high enough, the uterus doesn’t “plump” enough to be able to host a fertilized egg. When this occurs, a woman may miscarry early on in the pregnancy. This is what I had, and why I lost 2 of my pregnancies in the first trimester. Upon further evaluation, my OB discovered that I had a luteal phase defect; I didn’t make enough progesterone during the second part of my menstrual cycle, so my uterine lining would plump up, but not be sustained in an early pregnancy. Luteal Phase defect has also been named as the reason that I developed Uterine Fibroids. Without adequate progesterone in the second half of my menstrual cycles, my uterine linings didn’t fully “slough off” and my estrogen levels weren’t offset. So I had too much estrogen, not enough progesterone and fibroids-which love and live off of estrogen-and were able to grow.
But why do some women need to take progesterone in their pregnancies? If the placenta takes over the role of feeding and nourishing the infant, why do women need progesterone? The simple answer is because the uterine walls still need to be plump to maintain the pregnancy. This is the major role of progesterone during pregnancy. Yes, in early pregnancy it helps provide nourishment to the developing fetus, but progesterone’s major role is to sustain a rich, plump uterine wall in which the fertilized egg embeds, from which the placental tissue can draw nutrients and develop and so that the uterus remains a safe, protective environment for the growing baby.
Prescription progesterone helps prevent preterm labor in 2 particular situations: Incompetent Cervix and Preterm Labor.
Incompetent Cervix. A woman who has an incompetent cervix has a cervix that is shortening and thinning too early in the pregnancy. If this shortening and thinning occurs before 37 weeks of gestation, a woman is at risk of going into preterm labor. If a woman has a cervix that is shortening and thinning and is only carrying one baby, inserting progesterone gel into her vagina daily (Beginning between 20-23 weeks and continuing until 37 weeks or just before) will help keep her progesterone levels up, keep her uterus and cervix nourished and in functional form and prevent preterm labor. To date, there are no side effects to mama or baby from progesterone gel.
Preterm labor. Preterm labor is labor that occurs spontaneously before 37 weeks of pregnancy. The exact causes of preterm labor are unknown, but the bottom line is that the uterus begins to contract and be “inhospitable” to the growing baby, forcing it out. Progesterone shots have proven to be very effective at preventing preterm labor and preterm birth in women with a history of previous spontaneous preterm birth and who are carrying only one baby. Progesterone shots are either compounded (individually made solutions of) progesterone or Makena, pharmaceutically manufactured progesterone. Progesterone shots are typically started between 16-20 weeks and given weekly until 37 weeks of gestation. There have been no reported side effects of progesterone shots to mamas or babies.
So this is the long and short on progesterone. If you have been prescribed progesterone to prevent preterm labor, know that it has a long track record of efficacy and an equally long track record of no negative effects (except for some mild vaginal irritation with the gel and some mild irritation at injection sites) on mamas and babies. While it’s no fun to have to use progesterone gel or to take progesterone shots, know that this course of treatment is highly effective and will give you and your baby a great chance of going to full term pregnancy.