The Story Began: Preemies, Prevention, Progesterone (17P): My First Preemie
The Story Continued: Preemies, Prevention, Progesterone (17P): My Second Pregnancy
The Story Continued: Preemies, Prevention, Progesterone (17P): Review of the Medical Literature
I was so afraid of having another preemie born at 33 weeks gestation, that I tried to make the best educated decision I could for my second pregnancy, and agreed to a relatively new treatment of weekly 17P injections, in hopes that the clinical studies were correct: 17P has been shown as safe and effective in preventing recurrent spontaneous preterm labor.
This decision was weighed with the knowledge that potential risks of 17P have not been disproven, as the U.S. Food and Drug Administration (FDA) has not approved this treatment for the specific use of preventing recurring preterm labor, although it has been shown as safe and effective for other conditions. 17P is not approved for use in pregnancy, as the exact dosage has not yet been determined by the FDA. However, my doctor, as well as the clinical studies I consulted, thoroughly explained the efficacy of 17P treatment as it significantly reduced the risk of delivery at less than 37 weeks gestation.
For me, the risk of another premature baby born before 34 weeks gestation (and all of the potential long-term health risks) were too high compared to the potential benefits of treatment.
After making my decision, the only hurdle left for me: I have a slightly irrational fear of needles. How am I going to receive a weekly injection, into the muscle, while I am hugely pregnant and already over-sensitive? I decided my fear of another baby in the NICU (neonatal intensive care unit) was bigger than my fear of needles, so into the nurses office I went. All I can say is: the 17P injections are, well, unpleasant.
There is a process before even receiving the injection, as the 17P serum must be compounded and purchased at a special compounding pharmacy (pharmaceutical compounding is basically the mixing of a drug by the pharmacist to meet the needs of the individual patient. This translates to changing the medication into liquid/injectable form). The progesterone is suspended in castor oil, and the injection given in the upper hip in the back, just where you would consider your panty line sitting at your rear end.
The injections must be administered with a "good size" (nurse's words!) needle, since the castor oil is thick, and the injection given slowly, as the thick liquid goes into the muscle.
I began receiving the injections weekly, and although each one seemed like an eternity, the injection probably only lasts 60-90 seconds. It is helpful to lean over a chair or table slightly, while taking the weight off of the leg that is on the same side as the injection, and to change sides every week, to help prevent some of the soreness.
Before week 33 (after receiving a dozen injections), I began desperately wanting to know if the injections were working, as this was the week my first son was born prematurely. I did not realize the extent of mental anguish I would be feeling at this point in my pregnancy; I was a nervous wreck. During this week, I over-analyzed every ache, cramp and “symptom”, and interpreting it as a possible preterm labor warning sign. Needless to say, it was mentally stressful and physically draining.
Happily, after 15 weeks of injections, I had finally reached the important milestone in my pregnancy: Week 33! As each week went by, I received another injection, and was extremely grateful for each new week's milestone that took me that much further away from a second preemie.
Before I knew it, I had received all 20 injections and had reached the magical number in my pregnancy: week 36!
I was elated! I was finally at 36 weeks gestation, receiving my last injection of 17P, and could not believe it--I would not have another premature baby! I could mentally and physically allow myself to relax a little. I would actually have a full-term baby! My husband and I began to allow ourselves to daydream about our baby boy for the first time; we could cut the umbilical cord, we can hold him right away, we could even count his cute little toes.
In the end, I did not make it to 40 weeks. After my last injection I received during my week 36, presuming the treatment effects last through week 37, I had a routine weekly OB appointment with my doctor, and was already 3 cm dilated. I delivered the following week at 38 weeks gestation.
So...did the 17P injections work?
As with any form of prevention, it is impossible to know what (if anything) was prevented since the adverse effect/condition did not happen. Would I have had a full-term baby without treatment? I believe the 17P did help prevent another preterm labor, as I have a healthy, full-term baby.
I look forward to the FDA approving 17P for use in pregnancy, with the optimal dosage and frequency determined for the utmost safety and efficacy for other women to choose as a treatment. Studies have shown this treatment works safely for more than seven years, and my goal has been to provide other women with information about 17P, while sharing my personal story. The benefits (a healthy, full-term baby) far outweighed the possible risks (premature baby with health complications) for me and my family.
One last word about my second delivery, since I described my first delivery: this one happened even quicker! My labor and deliveries really are made-for-TV, as my water breaking is dramatic with an audible “pop!”, intense labor pains begin immediately, and there is little time to get to the hospital before I am delivering. My second son was born within the hour of my first labor pain, and our second “Rocketman” was more than twice as big as my first baby. As you can imagine, my body took a hit from this fast and uncontrollable delivery, with a long and difficult recovery. And, no, I was unable to have drugs again for a vaginal delivery. Double-ouch.
Our new family-of-four is healthy and having a great time getting to know each other, and I would love to hear your story as well! I am happy to discuss any questions you have about 17P. I hope you all have a happy and healthy pregnancy!