How do you feel about the use of Brethine to delay labor at 35 weeks?

As a labor and delivery nurse I feel that Brethine (Terbutaline) is appropriate at 35 weeks.

I cringe when I have a 35 week laboring patient because I'm afraid for the baby as the lungs of the fetus are not quite fully developed at this time.

May I be so bold as to ask why you are asking this question? If you give more details I might be able to help you better.

I am currently going to school for RN but my main focus is in neuro-science. I feel I am pretty medically knowledgeable but have to admit I was really nervous when my Dr sent me over to L&D for possible dose of Brethine as I didn't know much about it... explanation: I am 35w4d, 3rd child, when I went in for check-up last Wed I am about 1 "finger-tip" dilated and have a "soft" cervix. That made my Dr nervous as with 1st child I delivered at 37 weeks but was 4cm dilated and completely effaced when I went in, with 2nd child I delivered 36w4d and was 2cm dilated almost completely effaced when I went in. Oh, I am also having braxton-hicks quite frequently and oddly enough, even though this is my 3rd child, he has "dropped". Well, to make a long story short, when I went over to L&D, the RN felt I was not regular enough or showing obvious signs for a need of Brethine. So, I was discharged... So being the medical nut I am, I start doing my research and reach out to all sources I have and find, I'm not too sure how much I like the idea of taking a dose of Brethine this far along in my pregnancy... your thoughts??

To add: 1st boy was healthy, only slightly jaundice but nothing significant, 8lbs 21 inches. (and I'm only 5'1" 115lbs) 2nd boy was 6lb 12oz 19 1/2 inches and both were induced...

If you were not having regular contractions or making cervical changes then there is little need to worry.

Now, just an FYI, it's not the nurse that makes the choice whether you get Brethine (Terbutaline), that is an order given by the doctor, whether in person or over the phone to the nurse.

You do seem to have a history of preterm deliveries, but the use of terbutaline can be contradictory dependent on several things such as your heart rate. If you have a high heart rate terbutaline is contraindicated as it will increase your heart rate even more. The fetal heart rate is also taken into consideration.

A fingertip dilated and a soft cervix is nothing to be concerned about. With this child you could be 4cm for as long as a month. It's all dependent on your contraction pattern and cervical change.

With what you have described to me, without being able to do an exam, I would agree that terbutaline was contraindicated.

Good luck on nursing school. It was the HARDEST thing I ever did in my life!

My Dr did order it :( Her office is in the same building as L&D, and I heard her on the phone when she called in the order, I immediately googled it on my phone on the walk over to L&D and was quite apprehensive about it all... I feel I know my body and I don't know, just felt it unnecessary... I tend to have larger babies and healthy (thank goodness)... I also tend to have anxiety attacks and told the nurse I didn't feel comfortable with it (after researching it and finding out it elevates heart rate, etc) and after being on the monitor and having an exam she also felt it was unnecessary. I love my Dr. but really feel she jumped the gun so to speak on this one. So my next appt is nxt Thursday and I am POSITIVE I will be dilated further and effaced more as well so hoping she does not attempt to send me over to L&D again... and THANKS fot the luck, it has been hard, but well worth it so far... I seem to get side tracked quite often but slow & steady seems to be working... for now anyway lol

While the doctor may have ordered it, you, in essence, refused it. You used your patient rights, and the nurse agreed with you, so you didn't get it. Simple as that. Nothing wrong with what the doctor ordered or what the nurse did. I do it all the time!

You have to remember that the doctor is usually at home or in the office and that they have to rely on my expertise. They can give orders, but that doesn't mean that I have to follow through if my patient does not feel comfortable with it or if I feel it is contraindicated.

Most likely it was charted by the nurse that you refused it, even if you didn't use those exact words.

I don't think your doctor jumped the gun, I think your doctor was being cautious.

There are many things that come into play when making this decision. Fetal heart rate that includes what is called accelerations or decelerations as well as variability need to be reviewed prior to the administration of terbutaline.

So, how far along are you in nursing school? What is your general location?

If I can help you with school, please feel free to ask. ALSO, if you see any medical questions that you feel comfortable answering, by all means please do so!

Great choice of words, she was being cautious and for that I should be grateful. & yes, I definitely did refuse, really glad she understood and felt the same as I did.

I am 2 credits short of being done with my "basics" but have taken several courses (not needed for RN) along the way. I have several certs, mostly tech: Phlebotomy, EKG Tech, Tele Tech, CPR/First aid/ EMT, Patient Care Asst, CNA, did a lot of hours as an ER tech (talk about experience), most of them now I wish I wouldn't have wasted time and money on and rather just went in and started the RN program, but they were all short classes and came easy to me. To be 100% honest, just haven't felt ready to apply 100% to enter the RN program... Have also studied A LOT of psych, all psych... from basic to child psych, adult pysch and every aspect in between.

And I live in South Texas... you?

Okay, so you aren't in an RN program yet? Whew, going to be hard to do with a youngin'

I'm in Tennessee.

Please feel free to look around and start answering questions. Just remember to look at the date the thread was started before you post. Threads a few months old or older should be avoided. Answer the most recent threads.

Again, if I can be of ANY help, don't hesitate to ask!

Nope, not in yet... Thanks so much for all of your help, you ma'am have been amazing :D and def made me feel a lit better about the whole brethine situation... so now my new goal is to take some sort of pharmacology, I need to know about these things! Lol I will most definitely answer questions I feel comfortable answering, thanks. I have looked around quite a bit and I have to be honest, you do a great job answering on these topics, not sure how serious I would take some of these q's, and you just dive right in! Kudos! Have a great evening and I will keep you posted and in mind...

Please call me J.

As a precaution, I would stay away from taking a pharmacology course as it may differ from what you learn in nursing school. You WILL be provided pharmacology in one way or another in school. Unlearning is harder than learning.

Ahhh, so very true, and didn't I just say I wish I wouldn't have wasted time and money... I need you to sit on my shoulder or be my conscience! Ha! I just need to get in the RN program and get it over with. Thanks again for all your help this far and please believe I am going to take full advantage of your knowledge for the next couple of weeks (or until I FINALLLLLY have this little boy)! I truly appreciate all your help and kind words.

Honey, I'm here for you if you need me. Just remember that I may not answer as quickly as I have tonight. I may be busy delivering babies, or taking care of my kiddos, or like now, about to go to bed. But I WILL answer eventually.

I'll be your "big sister" if you need it. Just remember that I've been out of school a while now and I specialize in Obstetrics. So, if I don't know the answer directly, I can at least guide you in the right direction.