Symptom Remedies

Mamas on Bedrest: How Progesterone Helps Prevent Preterm Labor

June 9th, 2014

Greetings Mamas!!

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.

 

Resources:

March of DimesA

Agency for Healthcare Research and Quality: Progesterone to Prevent Preterm Birth.  A Review of the Research About Progestogens for Women at Risk.

Mamas on Bedrest: “Easing” Into Intimacy Post Partum

May 30th, 2014

Hello Mamas,

image003After being on bed rest for several weeks, I imagine that most of you are looking forward to resuming “intimate times” with your partner. However, low estrogen levels following delivery and during breastfeeding results in uncomfortable vaginal dryness. “Ease” back into intimacy with SYLK.

Sylk is a natural, water-based personal lubricant. The “active” ingredient is bio-sustainable New Zealand Kiwi vine extract.  The product contains no chemicals, silicones or petroleum products. Because it is made from natural ingredients, it is safe to use with condoms. It will not degrade condoms, causing tears and/or an untimely pregnancy. The product is also safe for nursing mothers, is not absorbed through the skin, and in no way causes harm to the baby.

We asked one of our “Former” Mamas on Bedrest to try SYLK and share her thoughts. This is what she had to say:

“The lubricant did work well and was not sticky nor did it have an awkward smell like some lubricants have. However, because its water based, it was really messy and it did get all over the place.  That was really the only downfall. The lubricant definitely felt more natural than other lubricants I’ve used, especially store brand ones which become sticky after a couple moments of use.”

So according to our Former Mama on Bedrest, SYLK is recommended, with the kaveat of being prepared for a  bit of a mess with use. Sylk is available via the company website and retails for $17.99

Mamas on Bedrest: Care for your legs to prevent blood clots

May 23rd, 2014

Greetings Mamas!!

TGIF and Happy Memorial Day weekend! This weekend marks the official start of summer in many areas of the northerm hemisphere. As promised, below you will find resources for taking great care of your legs to prevent blood clots from forming while on bed rest. I am giving a HUGE shout out to Mama on Bedrest Sarah for posing the following question to me on our community Facebook Page:

“Any suggestions as alternatives for compression stockings? I can’t do anything that increases abdominal pressure but can’t afford the compression stockings. I do get up several times a day but only to get water and use the bathroom. But I’m still worried about dvt.”

This is a FANTASTIC question and one that all Mamas on Bedrest should be concerned about. Pregnancy in and of itself increases a woman’s risk of developing a blood clot in her legs due to elevated levels of estrogen which enhance blood clotting. (Same thing they worry about when women are on the pill!) Add in bed rest inactivity and Mamas on Bedrest are prime candidates for deep venous thrombosis (DVT) or blood clots to form in the legs and then travel to the heart, lungs or brain to do deadly damage.

Sarah was prescribed compression stockings and that is an excellent recommendation-except they are expensive. Compression stockings can cost anywhere from about $80 on up. They are typically only available by prescription. So what is Sarah and other Mamas like her to do?

1. Exercises. I produced an entire video blog showing how to do leg exercises on bed rest as well as how to massage the lower legs.

2. Massage. While rubbing your own legs is good, Oh much better it feels to have someone do it for you! If your partner is willing, have him/her gently massage your lower legs. (see vlog for details). If you have access to a prenatal massage therapist in your area, or a really good massage therapist who knows lymphatic drainage techniques, a professional massage would be even better!

3. Support hose. Now I can’t speak for other areas of the country, but it is heating up here in Texas and the thought of wearing compression stockings or even support hose is daunting. However, if they are lifesaving-what’s a bit of heat? Sarah mentioned that she could not afford the compression stockings. However, she could do the next best things and wear support hose. These do place a bit of a squeeze on the legs, but not nearly the amount of pressure Compression stockings do. Hence, they are cheaper. Good brands that I know of are Gold Toe and Jobst. I highly recommend ordering products from Special Addition Maternity and Nursing boutique here in Austin if you can’t find products in your locale. They have an entire online shop and you can actually call and they can help you get fitted OVER THE PHONE!!! They can tell you (or a friend or family member) how to measure your legs and then help you select products that will suit your needs and purse!

4. Drink plenty of water. Contrary to what you may be thinking, Staying hydrated will actually help reduce swelling. You body won’t feel like it needs water and hold onto water so tightly (i.e. swell). Also, lowering or avoiding salt altogether is also helpful.

5. Make sure your prenatal supplements are really working for you and your legs in particular. Leg cramps, restless legs and blood clots are all very common during pregnancy. When you have the proper balance of vitamins and minerals in your diet, you are less likely to experience these leg problems or you will experience them to a lesser degree. To avoid leg cramps, restless leg syndrome and blood clots, make sure you have plenty of the following nutrients in your diet:

Calcium. Calcium aids in muscle relaxation allowing certain molecules into your muscle tissue.

Magnesium. Like Calcium, magnesium also aids in muscle relaxation and works in concert with Calcium. Many vitamins will include both minerals either in a 2 to l ratio (Calcium to Magnesium) or will have the minerals present in equal amounts.

Vitamin D. Vitamin D aids in calcium absorption as well as decreases overall inflammation that may be occurring. While many prenatal vitamins contain vitamin D, few if any meet the newly suggested requirements of up to 4000IU recommended by the March of Dimes and the Institute of Medicine for pregnant women.

Fish Oils-Fish oils contain essential Omega 3 and Omega 6 Fatty Acids which help prevent blood clots. However, if you have any sort of clotting disorder or bleeding disorder, you may need to avoid this supplement. Check with your doctor to see if it is safe for you to take fish oils.

Was this information helpful to you? If so, let me know in the comments section below. Do you have other tips and solutions to leg problems during pregnancy? Submit those in the comments section below as well. If you have specific questions, feel free to e-mail me at info@mamasonbedrest.com. If you want to discuss more, you can schedule a Complimentary 30min Bedrest Breakthrough session. 

Be well Mamas and Happy Memorial Day (In the US!!)