Early Contractions & Bladder Irritation

I am 24 weeks pregnant and have been having Braxton-Hicks contractions for a month. Two ultrasounds indicated that the contractions are not altering my cervix. This is my first pregnancy, and the doctors are concerned that I started contracting so early. Bed rest didn't help. I have been limited at work and I rest throughout the day, but this makes me nervous. Also, my bladder is constantly irritated by the contractions, and I am on medication for a suspected infection (undetected by testing). The doctors think that my uterus is turned in such a way that it irritates it.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Actually, the uterus contracts continually throughout pregnancy, and we used to pay this no mind. It has only been within the past few years that we have come to see that reassuring everybody that these are normal, might misinform clients who really may be in preterm labor.

At 24 weeks, you should be having Braxton-Hicks contractions, however, they should not be regular (five or more an hour), they should not cause cramping or backache and they should not be changing the cervix.

Recently, some new research has shown that the fetus manufactures a substance called fibronectin, which may serve as a precursor to the beginning of labor. You could ask your providers to do some reading on this to see if you would be a good candidate for such a test.

In addition, some research has been done on cervical ultrasound with transvaginal sonography, which can monitor cervical changes far better than we can do with a random pelvic exam. If you had this type of sonography, and they have measured the "funnel" of the cervix with no changes evident, I would feel reassured. A "thrust test" can be performed to see if fetal pressure downward affects cervical length.

Bed rest has never been shown to be a reliable method of delaying labor, but it is part of an overall plan to help the woman avoid undue exertion. One has to weigh this against the risks to the mother's mental health.

I would ask my provider about these tests and tell him/her that bed rest does not seem to change the contraction pattern.

If your cervix is long, thick, closed and posterior -- and ultrasound demonstrates no early cervical changes -- I would feel confident in asking my provider about slowly going back to full activity.

Bladder irritation requires a urinary workup for bacteria, beta strep, voiding and emptying. At 24 weeks, I cannot think of any uterine position that would affect the bladder unless there is a structural problem with the bladder. This would have to wait until after delivery for a full evaluation.

I hope you can hold on for a while, and your providers will give you more reassuring news about your cervix so you can get off bed rest. We'll be thinking about you.

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