WEEK 9 : Week by Week Incompetent Cervix Pregnancy Guide - POSSIBLE CAUSES OF THE IC

NOTE : For the regular advice on Week 9, I suppose there are hundreds of other websites to tell you how it goes. This blog serves to supplement those sites, my personal favourites being What To Expect, Baby Centre UK and Parents. Do take note, however that I am not a professional physician, I practise law for a living and the only thing I know about incompetent cervix is through my own experience as a mother of 2 and a 16 week old baking in the oven! :)  The purpose of this blog then is just to simply share the joys and heartaches, the blessings and curses, the sadness and happiness and the disappointments and the pleasant surprises of our journey as a mom with an incompetent cervix.
What I remember about Week 9 isn't all good. I lost a baby before my surviving No.2 at 9 weeks due to, it seems, chromosamal issues.  But a loss is a loss. Eventhough it was just a 9 weeker.  It was heart wrenching. I wrote about it Losing Jamie as part of enduring the loss, but the pain did not really go away. Of course when I got pregnant again (it was 2 cycles later after the D&C, quite unexpectedly) I was scared shit at Week 9, but no... baby stayed with me. All the way through the cerclage and little baby G is 2 and a half years old today! 

With the current pregnancy, again I had a scare at Week 9.   I was still actively carrying heavy files walking the courtrooms, singing in choirs, hitting the gym 4 times a week and carrying my baby G and sometimes even my 25kg 6 year old because I knew once the cerclage is in I couldn't do all that anymore.  But God has other plans for me.  Apparently I needed to start slowing down! I bled. At the OBGYN, I was told I had subchrionic hematoma, not a large one, but worrying nonetheless. (Read Week 8 here) 

So it was the beginning of bedrest. 5 weeks earlier. No good. But all in the name of having another baby in my arms, planned or not. The trauma of loss is not something I wish upon my greatest enemy.

Well, for those of you who still have the luxury of going about life until THE CERCLAGE DAY... enjoy it! But just be very aware of any changes.  I have come across women who reported that there are already cervical changes at this point. It is perhaps most worrying for those of us with a SHORT CERVIX rather than an incompetent cervix. But then again, some women with short cervix reported that they went on to have very normal pregnancies without the need for a cerclage.  Despite hearing stories from my mom about how one of her colleagues used to need a cerclage (did they have such a thing back then in the 60s/70s?) because of an incompetent cervix, I have scoured the internet and I am not too sure when it was first diagnosed.  But judging from the general ignorance about the condition from people around me when I first told them of it, it appears to be a very uncommon condition lacking in research.  Women are still losing their babies in late pregnancies (my OBGYN has just told me of one of his new patients who just lost her 9th baby and her previous OBGYN NEVER diagnosed incompetent cervix!) and developed countries are still petitioning for compulsory cervix length measurement today! http://www.change.org/p/nhs-england-cervical-incompetence-nhs-to-make-cervical-checks-mandatory-from-16-25-weeks-save-babies-lives

So what is exactly is the cause of this condition?  Many websites state that the cause of your incompetent cervix may never be known.  But these are some of the common causes :
:

• Changes in hormones during pregnancy
  
• An abnormal cervix or abnormally short cervix
  
• Damage to the cervix, such as during surgery (previous abortion or a cone biopsy procedure) or after a difficult delivery of a baby
  
• Certain medicines, such as diethylstilbestrol (DES). This medication it seems was prescribed to our moms in the 70s to prevent miscarriage, the side effect of which is it caused an incompetent cervix in the female babies (US!!!)

Unfortunately this condition is almost without symptoms.  Your baby is healthy, and it is a physical , technical defect of your cervix rather than any hormonal defects  and it is sad that most babies do not survive because they are just too premature.  By the time you get to the hospital your waters have already probably broken, or membranes already ruptured, of which then there is nothing much that the doctors can do for you or your baby.  While those with 1st trimester loss may be able to find solace in the fact that there is nothing they can do or not do to save their babies, for us moms with incompetent cervix, we often than not blamed ourselves for not knowing our bodies, or for having done too much.  I almost lost No.1 my dear Ian because I spent almost a week on my babymoon walking and touring and taking pictures, and then instead of resting upon returning, I went to the gym for my kickboxing and step aerobics classes.  That night I bled clots.  Still, I didn't think much of it (well, all those websites say it is normal for pregnant women to bleed once in a while, don't they?) and waited till the next morning before I see my OBGYN.  I remembered the horror on his face when he exclaimed upon doing a vaginal exam, "Girl, you are dilating!"  I was 23 weeks 4 days and 2 cm dilated, no cervix length left.  At times, in retrospect, I thank God I didn't know anything about incompetent cervix at that time, as I would have gone into hysteria.  I was calm and didn't think much of it still when I was wheeled into the OR an hour later, and had an emergency TVC placed.  I was on strict bedrest for the rest of the pregnancy and stitch removed at 37 weeks. Ian was born a week later.  He is 6 today.

Not many women have a happy ending like mine to tell.  My heart bleed each time I look at the pictures of their little tiny angels, all dressed up to go back to meet their Maker.  I cry with all the moms whom I have became friends with the last 6 years (I found this wonderful support group on facebook Incompetent Cervix Awareness when I was on bedrest with Ian) whenever I read about their losses and their struggles to have their first rainbows in their arms (Rainbows are surviving babies, Angels are those who did not make it).

Therefore, I have since learnt that it is always best to listen to your body, and don't worry about being labelled a paranoid.  Enjoy your pregnancy, yes, but at the same time, be alert. BE EDUCATED. And always have God by your side to guide you.