Hellobee

Because my second pregnancy resulted in a premature birth of Panda, this pregnancy I qualified for treatment to prevent preterm labor and delivery. The treatment options that I discussed with my Maternal Fetal Medicine (MFM) specialist, a high-risk doctor, included the Makena hydroxyprogesterone shot or a vaginal progesterone pill. My MFM highly recommended the hydroxyprogesterone shot, which is a weekly shot that begins in week 16 (it can be started between weeks 16 and 20) and goes through week 36. My MFM admitted that the effectiveness is more questionable for those who had later premature births (as was the case for Panda), but also said that some studies have shown effectiveness in preventing placental abruptions (which I am at higher risk for because of the abruption with Lion). The vaginal pill is taken daily, but according to my MFM is not as effective.

Self-portrait silhouette at 35 weeks.

With the strong recommendation from my MFM, I reluctantly elected to go ahead with the weekly Makena hydroxyprogesterone shots, which I began in mid-July. Of course, since then, there’s been controversy over the effectiveness of the medication based on new trials. In late October, nine members of the FDA’s Bone, Reproductive and Urologic Drugs Advisory Committee voted to recommend FDA withdrawal of the drug for use in preventing preterm birth; 7 voted to leave the product in place but require new confirmatory trials.

To be honest, I really hated these shots. I wasn’t eager to begin weekly injections, but after experiencing the shots, I really began dreading them. First, I had a huge insurance approval problem, which my doctor predicted based on the pharmacy my insurance plan required at the time (when I switched jobs and therefore insurance, there was a world of difference). Although my MFM’s office submitted paperwork and called my insurance at 12 weeks, I didn’t get approval until 17 weeks. Additionally, the pharmacy refused to do direct shipments and would only ship to my MFM’s office, which is located in a hospital and created hurdles on their end. (After switching jobs/insurance/pharmacies, I got approval within one week and they were more than willing to ship to my home).

Once I actually received the injections, it became a weekly ordeal. I received instructions from the nurse in the MFM’s office and also did some research on tips and tricks online. Mr. Dolphin was in charge of administering the injections each week, since the recommended injection site is the upper buttocks area.

The shots were painful! I typically don’t flinch at shots or getting my blood drawn, but these injections were no fun at all. Because the progesterone is suspended in oil, it can take awhile to push the plunger all the way down to administer the full cc of liquid. Once the medication was actually administered, the injection site immediately became sore and sometimes would be sore for days afterward.

To make matters worse, I was allergic to the shot which, I understand, is a fairly common side effect. The injection site would become red, hot, itchy and swollen each week. My MFM said I was probably allergic to the oil that the progesterone was suspended in, but said she felt so strongly that it was an important part of my treatment that I should take Zyrtec daily and use soothing lotions. My OB definitely felt less strongly about the effectiveness of the progesterone shots from the start and, after hearing about my reaction, said he would support my decision to stop taking it. While I continued the injections through 36 weeks, I don’t know that I would do it again knowing the controversy over its effectiveness today. I mostly continued taking it because I felt guilty, thinking that if I stopped taking it and then went into preterm labor, I would blame myself for not doing everything I could to prevent it.

I’m now at 38+ weeks, but have no idea whether it’s a result of the weekly injections or if I would have made it this far anyway. This pregnancy has definitely been much smoother than my first two and it’s looking highly likely that I’ll make it all the way to my induction.

For those who do elect to use this course of treatment, here are a few tips that I learned:

• A heating pad is your friend. I would plug in the heating pad a few minutes before it was time for the shot. The heating pad was super comforting to put on the injection site immediately following the shot.
• Warm up the medication. The nurse recommended rubbing the vial between your hands before drawing up the medication into the syringe in order to heat the oil and make it easier to administer. I did this for a few weeks, before using the heating pad to heat it up which made a huge difference in how long it took for Mr. Dolphin to actually inject the full amount of the medicine.
• Positioning. I read somewhere that the best position is lying face down on the couch or bed with your toes pointed inward (pigeon-toed). This is what we did the majority of the time. Once, I was having a hard time getting comfortable (we had just moved and didn’t have our couch set up yet and I didn’t want to go up to our bedroom yet, so I was sprawled out on the floor) on my stomach. Mr. Dolphin suggested I just lie down on my side and he could do the injection that way. Big mistake. That was by far the most painful shot.
• Rub the injection site immediately following the shot. This helps spread the medicine into the muscle a bit and helps with soreness. I would have Mr. Dolphin push and rub as hard as possible, before switching over to the heating pad.
• Treat yourself afterward. Every Saturday evening after receiving the injection, I indulged in a treat. Typically, I had the Talenti gelato oak-aged vanilla. So yummy. Three times, we were out of town and I ordered a milkshake to indulge in immediately following the shot. Having something to look forward to was definitely nice.