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Preterm Labor and Birth Paper
Bradley Ohlwine
Lakeview College of Nursing

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	Preterm labor and birth is a struggle that can affect families throughout the entire world.  It is a challenge to deal with during pregnancy, labor, when the baby is born, and even if the baby dies the struggle continues.  Spencer’s story was an in depth look at how it affects the mother, father, and sibling of a preterm baby.
	Preterm labor is defined as, “Contractions and dilation of the cervix before 37 weeks of pregnancy” (Murphy 2010).  Most preterm labor is caused by premature rupture of membranes (PROM).  The reason for PROM and preterm labor mainly idiopathic but many studies lean to the body responding to an infection in the uterus or amniotic fluid for the causes of preterm labor (March of Dimes 2010).
	Treatments for preterm labor are widespread from tocolytics to steroids.  Of the tocolytics Magnesium Sulfate is the most common. Magnesium Sulfate is given as IV only and is administered 4-6 grams over 15-30 minutes and then 2-3 grams per hour thereafter to keep levels high.  Side effects that the mother can feel from the treatment include cardiac arrest, respiratory failure, facial flushing, nausea, blurred vision, dry mouth, and headache.  When the baby is born its muscles will be relaxed from the effects of Magnesium Sulfate and will seem like its muscles do not work properly, this effect goes away as soon as the medication is flushed from its body (Mercer 2009). 
	Other treatments for preterm labor include terbutaline sulfate which can be administered PO in 2.5mg or 5mg every 4-6 hours, or it can be administered subcutaneously also known as the terbutaline pump which will slowly administer at least 3 mg every 24 hours. Dosages can be higher in more serious cases and there seems to be a lot of controversy as to how much is too 
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much.  Side effects from terbutaline sulfate include tachycardia, tremors, jitteriness, hypotension, hepatotoxicity, seizures, dysrhythmias, angina, and anxiety (Flick 2010).
	Celestone, a corticosteroid, is given to help promote good lung development in the fetus during preterm labor.  With such a preterm labor the fetus’ lungs might not be fully developed and the corticosteroid boosts the fetus’ chance of having functional lungs upon birth.  Celestone is given in two doses either 12 or 24 hours apart 12mg IM each.  Its greatest effects are found to be around seven days after the initial dose (Stuebe 2006).
	If a baby is born prematurely there will be many consequences and struggles the family and baby will have to go through.  As it was stated earlier the lungs of a preterm baby might not be fully developed and the child will have to have breathing treatment because of respiratory problems.  The newborn will most likely be placed in the newborn intensive care unit (NICU) so they can be closely monitored.  Other studies show that preterm newborns are at a higher risk for cerebral palsy, mental retardation, autism, and behavioral problems (March of Dimes 2010).
	To know what interventions to perform the most important nursing diagnoses must me accounted for.  Nursing diagnoses for a preterm labor patient would include risk for infection related to a premature rupture of membranes as evidence by the patient’s water breaking.  Another nursing diagnosis would be ineffective coping patterns related to unknown outcome in pregnancy.  These two are the most important nursing diagnoses without regard to the patient being on any preterm labor medications.
	With those two being the most important nursing diagnoses the interventions will directly follow those two and try to help the patient with the two diagnoses as best as possible.  First 
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intervention would include antibiotic therapy for the mother because once her water has broke there is a much greater chance for infection.  Another intervention would be to educate the patient on what it will look like when her water breaks, and the importance of getting into the hospital or in touch with a doctor as soon as possible.  With regard to ineffective coping the patient should be sat down and educated about the hospital policies and treatments they are doing for her baby.  Ineffective coping can lead to stress and that is the last thing a preterm labor patient needs, bed rest is necessary for her to relax and to keep the fetus from any further harm.  Lastly the soon to be mother should be advised to go to support group meetings for preterm labor patients, or other educational classes that can keep her informed on what is going on in her body. 
	Spencer’s story is a heart breaking story about overcoming a mother’s worst fear and how the family deals with tragedy.  We don’t always know why or how something happens but we do know that the better educated we can become is directly related to the greater chance of us helping stop another premature tragedy like Spencer’s death.  

	

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Reference Page
Flick, A. (2010). An examination of the clinical benefits and cost-effectiveness of tocolytic replacement following recurrent preterm labor.Thieme Journals, 27(1), Retrieved from https://www.thieme-connect.com/ejournals/abstract/ajp/doi/10.1055/s-0029-1241734 doi: 10.1055/s-0029-1241734
March of Dimes. (2010, April). Your premature baby. Retrieved from http://marchofdimes.com/baby/premature_indepth.html
Mercer, B. (2009). Magnesium sulfate for preterm labor and preterm birth. Obstetrics & Gynecology,114(3), Retrieved from http://journals.lww.com/greenjournal/Abstract/2009/09000/Magnesium_Sulfate_for_Preterm_Labor_and_Preterm.24.aspx doi: 10.1097/AOG.0b013e3181b48336
Murphy, T. (2010). Management of common problems in obstetrics and gynecology, fifth edition [Ch. 3]. (PDF), Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/9781444323030.ch3/summary doi: 10.1002/9781444323030
Stuebe, A. (2006, February). Treatment of preterm labor: steroids and antibiotics. Retrieved from 

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http://www.healthline.com/yodocontent/pregnancy/preterm-labor-adjunctive-therapy.html