Friday, August 28, 2009

Hypertonic Contractions

This was the beginning of the end for me. I had been having normal mild contractions on and off since Friday afternoon. The contractions went from every 6 to 7 minutes during the early morning hours on Monday to pretty much stopping Monday afternoon with one short one every hour or so. One long contraction that never really subsided started about 9 p.m. and was still going when my husband got home at 11:30. It was impossible for me to sit or stand because the pain was even worse when I did. Since it wasn't what I read a contraction was supposed to be like, I called my OB's office and was told by the on-call midwife to come into the ER so they can check me and make sure everything was OK. I went in fully expecting to be sent home.

An excerpt from "Maternal & Child Health Nursing":

"In contrast to hypotonic contractions, hypertonic contractions tend to occur frequently and are most commonly seen in the latent phase of labor. This type of contraction occurs because the muscle fibers of the myometrium do not repolarize or relax after a contraction thereby "wiping it clean" to accept a new pacemaker stimulus. They may occur because more than one pacemaker is stimulating the contraction. They tend to be more painful than usual because the myometrium becomes tender from the constant lack of relaxation and the anoxia of uterine cells that result.

A danger of hypertonic contractions is that the lack of relaxation between contractions may not allow optimal uterine artery filling; this could lead to fetal anoxia early in the latent phase of labor. Any woman whose pain seems out of proportion to the quality of her contractions should have both a uterine and external fetal monitor applied for at least 15 minutes to ensure that the resting phase of the contractions is adequate and that the fetal pattern is not showing late deceleration.

If deceleration in the fetal heart rate, an abnormally long first stage of labor, or lack of progress with pushing (second stage arrest) occurs, cesarean birth may be necessary. Both the woman and her support person need to understand that although the contractions are strong, they are ineffective and are not achieving cervical dilation."

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