WEEK 16 : Week by Week Incompetent Cervix Pregnancy Guide - THE TOILET PAPER TEST

NOTE : For the regular advice on Week 16, 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 18 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.
 
If you had your cerclage 2 weeks ago, you should have stopped bleeding by now.  If you still see fresh blood, you probably need to press the panic button and rush yourself to the ER.  You may have more discharge, and they may appear as clear fluid.  And the constant worry is always : Is my waterbag leaking?  Before you press the panic button for this one, do consider the fact that most of those with a fresh cerclage tend to discharge more, ranging from brownish spottin Are you continuing to eat healthily?  Or you just grab whatever available closest to you as you are on bedrest, probably home alone and you can't cook.  Some on you on modified bedrest may be allowed to cook, carry out some household chores, shower, perhaps go to work if it is an office job.

Some of you may have been advised to continue being on bedrest.  I have heard some practices where the doctor actually keep you hospitalised until your baby reaches its viability.  There are just so many different degrees of bedrest, and it all very much depend on several factors (Read Week 15 here).

I was just musing over the fact that we, moms with an incompetent cervix, or for that matter, most pregnant moms (more so those of us with this  particular condition) are probably the only people on earth who would obsess about our toilet paper wipes so much that we stare, examine, smell, touch (or GOD FORBID, TASTE???? Anyone?) them after each toilet visit.  Some of us are understandably stressed each time we had to go to the toilet, and it doesn't help that we are advised to drink lots of water to prevent contractions and infection, plus the fact that being pregnant in itself makes us go to the toilet more often!  It is stressful because we know every trip to the toilet causes pressure to the cervix, and for those who have been advised to "Strict bedrest, get up ONLY for toilet trips".... I mean, seriously? We are not talking about 3 times a day trip, we are talking about hourly trips! 

The stitch is still new and raw, it is perhaps the best time to rest. Take it REAL easy.  If situation permits, just stay off your feet, pee and poo in the bedpan.  It's better to be paranoid than to be sorry, because at this stage your baby is not viable and if you rupture your waterbag, there is pretty much nothing that can be done.  Take it from me, I have had my regrets of trying to cheat on my bedrest only to find myself funnelling to the stitch at this early stage.  It's just not worth it, as even if the stitch DOES hold your pregnancy to full term, why do you want to put yourself through unncessary worry and stress?  Your hubby is probably dead tired from work everyday and he has to pick up the kids, the laundry, get dinner, clean up after dinner, bathe the kids, feed the kids, so the very least you could do now is to be cheerful when he gets back instead of burdening him with further lamentations of yours about how shitty your day had been.

It's never easy, and it's part of the 'curse' of the incompetent cervix, but the blessing is, you will see how patient your husband is, and how stoic he is having to put up with you emotionally and putting up with the kids physically, and it may strengthen your marriage.  Besides, this is also the time when you know who your real friends are... not just those who post "How are you" on your facebook wall, but those who actually comes to visit you with bags of goodies and proceed to do your laundry for you.  There aren't many, believe me.  And when you have gone through this 3 times, your 'true friend filter' will filter out the last of it.  And that's when you appreciate your handful of wonderful friends.

WEEK 15 : Week by Week Incompetent Cervix Pregnancy Gude - TO BEDREST OR NOT TO BEDREST?

NOTE : For the regular advice on Week 14, 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 18 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.

  You should still be home resting.  Or for some of you who had the transabdominal cerclage (TAC) or if you preventive TVC was placed before any changes took place in your cervix, you may be allowed to resume normal activities by now.  With some restrictions, of course - this varies widely from women to women, pregnancy to pregnancy, country to country, hospital to hospital.  It is very individual and it is best to ask your doctor what suits you best.  You have to take into consideration several factors, including :

1) Your cervix length
2) Whether there are any effacement or funnelling of your cervix, if so, how badly
3) Is this your 1st TVC? Are there any scar tissues from previous stitches? If so how may it affect this one?
4) Are you on any progesterone injections/ suppositories or any other medication to prevent preterm labour?
5) Work arrangements and finances
6) Older children
7) Availability of someone helpful at home
8) Personal preferences (yours or your doctor's)

In any case, all very much depends on further changes to the cervx too.  Some went through deterioration, and yet some will actually experience what is called "reversal of the cervix", in other words, your cervix length actually improved after your cerclage!

To know more about follow up and resting at home, do read Week 14.

You should also be getting your follow up appointment this week and this is the time to ask lots of questions, especially if the last 1 week you have been burdened by bleeding, occassional cramping or you felt hardening of your uterus.  Do remember that there is a foreign object, that is, your stitch, at your cervix and your body will naturally attempt to flush it out.  Also, give the stitch some credit - it is there for a reason so trust it, but at the same time, take it easy. Keep off your feet as much as you can if given the choice, but on the other hand follow the doctor's instructions to the letter if you are not given any choice.  Nothing is worth the life of this child.  After all, you have made it so far.

As you may only be bedresting for a week, you may not feel the real impact yet, physically and mentally, of the effects of bedrest.  But perhaps it's time to gather your thoughts about what you would want to do while lying down.  Artwork, blog, DVDs, novels, magazines... and of course internet games and social media... but being on my 3rd prolonged bedrest currently, I can tell you - there is only so much TV and facebook you can with stand - we are human beings and towards  the end of the day, we need human interaction.  Allow visitors, but don't be shy to make it clear that you do not want small children running around nor do you want a mess after that to clean up, because you can't.  And also excuse yourself for having to lie down or sit up once in a while during their visits, and if necessary, allow girlfriends only as you may feel uncomfortable lying down in the presence of their husbands or boyfriends.  Whatever it is, just remember : Your baby is of utmost importance at the moment!

WEEK 14 : Week by Week Incompetent Cervix Pregnancy Guide - THE CERCLAGE

NOTE : For the regular advice on Week 14, 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 17 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.
So it is the week of your transvaginal cerclage if you are having one (of course this varies according to the development of your pregnancy, your doctor's personal preferences and other various factors).  For preparation, risks and what is expected to happen on the day of surgery, do read Week 13.

Today, we shall discuss what is to be expected AFTER you go home.  Usually after the surgery you will be expected to stay over a day or 2 in the hospital to monitor your condition, and to ensure you get the proper bedrest. Yes, this is the beginning of that dreaded (or welcomed) bedrest.

  
*Recovering at Home

• You may be prescribed medication to take at home. This may be medication to relieve pain. It may also be medication to prevent labor. Take any medication as prescribed.
  
• Take it easy for 2-3 days after the procedure. Plan to have others help you as needed. Unless you are instructed to do so, you do not need to stay in bed.
  
• Avoid having intercourse for at least 7 days after the procedure.
  
• Ask your doctor when you can return to work and exercise.
  

Follow-Up

Make a follow-up appointment as directed by our staff. During your follow-up visit, your doctor will check your healing. You can also discuss how your pregnancy is progressing. You will be told when to schedule an appointment to have the stitch removed.

When to Call the Doctor

Call your doctor if you notice any of the following:

• A fever of 100.4°F or higher
  
• Pain that does not go away even after taking pain medication
  
• Contractions or abdominal cramping
  
• Unexpected vaginal spotting or bleeding
  
• Fluid leaking from the vagina
  
• Bleeding from the vagina
  
• Foul-smelling drainage from the vagina
  
• Back or abdominal pain (*Source  : University of Minnesota Medical Center)
  

From my experience with my preventive TVC (transvaginal cerclage), the recovery was uneventful.  It was my 2nd TVC and a preventive one, as compared to my first dramatic rescue TVC at 23w4d.  It was mid-October, and by December I was up and about carolling with a local church choir.  But I was astute the weeks following my surgery to stay off my feet, staying on a strict bedrest, getting up to sit only for meals and walking to the bathroom when necessary with a twice daily quick showers (seated of course).  I moved around in a wheelchair, including attending my eldest son's kindy concert day in one (and the kindy principal very kindly arranged special privileges for me - front seat audience, special carpark and the use of the elevator).  I even climbed up the choir loft during Christmas eve mass and sang my heart out.  I carried till 37 weeks when my TVC was removed, and my 3.93kg baby was born on his due date.

However, with my current 3rd TVC (2nd preventive one) I am still battling a long battle to hold a healthy fullterm baby in my arms.  I was told that I had a cervical polyp during the procedure, and my doctor removed it.  He also mentioned scar tissues from the previous cerclages, and he had to sew around the scar tissues.  He told me to bedrest for at least a month, but of course, I thought this was my 3rd baby, I have had 2 successful TVCs didn't I? So I was up cooking, mopping and cleaning the house.  And just last week, a day after Week 17, I was told I had funnelled to my stitch. As I'm writing this I know the odds have just turned against me, thanks to my know-it-all attitude.  Ladies, if you have just had yourTVC, whether or not you have been advised to rest, may I suggest that you should.  Nothing else is worth a healthy fullterm baby in your arms.

Now, wouldn't you trade this for just a few weeks of your life without cleaning cooking and moving about?

Always remember, it also doesn't harm anyone to be paranoid - not to the extent of stressing yourself out unncessarily, but call your doctor, or go to the ER if you feel something is not right.  Trust your instincts, this is one lesson i have learnt in my incompetent cervix pregnancies - better be safe than to be sorry - this truly rings true from now on.

WEEK 13 : Week by Week Incompetent Cervix Pregnancy Guide - RISKS OF CERCLAGE

NOTE : For the regular advice on Week 13, 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 17 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.

If you have a scheduled transvaginal cerclage, your anxiety may start to set in.  This is the final week leading to THE day.  You have heard of the risks, but you also know that the advantages outweighs the risks, and preventive cerclages have been known to be as high as 80 to 90 percent successful.  Successful as in these IC mommies manage  to carry baby to term, or 37 weeks.  Most IC moms do not even dream of full term, most of us look for the V-day, or the date of viability.  Babies start to have a small chance of survival after 24 weeks, before such date most doctors do not even want to consider any measures to save the baby if it was born prematurely.

So what are the known risks of the transvaginal cerclage?

• As with most invasive surgeries, there is always the risk of infection
  
• The procedure may also trigger contractions which may further damage the cervix, the cerclage, or may cause preterm labor.
  
• Spontaneous delivery may occur during the procedure or soon thereafter.
  
• Premature rupture of membranes
  
• Tearing or rupture of the cervix if labor begins before the stitch is removed, or on the other hand, what is known as cervix dystocia, where the cervix is unable to dilate even after the stitch is removed.
  
• Injury to bladder/uterine rupture
  
• Risks of anesthesia
  

 At this point, you may, or may not want to know what is to come.  Some women find it comforting to know exactly what and how the procedure is carried out, whilst some others would rather not know - in fact some may favour elective general anaesthetic instead of the spinal block so they do not have to go through the ordeal in the operation room!  So, to those of us who want to know, what does a transvaginal cerclage entail?

First of all, of course you would have been told by your doctor to fast the day before, at least 10 hours before surgery.  If you are prone to gastric or heartburn, do let your doctor know so he may prescribe some medicines to be taken the day before.  If you have been using vaginal suppositories, you may want to check with your doctor whether you should continue to do so the day before.  And common sensically, do not have sexual intercourse (besides, at this stage of your incompetent cervix pregnancy you shouldn't even be having anymore pelvic activities!)


The Day of the Procedure

• Just before the procedure begins, an intravenous (IV) line is placed in your hand or arm. It delivers fluids and medication into the body.
  
• You will be given anesthesia. This is medication to keep you free of pain during the procedure. Depending on what type you are given, you may be relaxed, drowsy, or fully asleep during the procedure.
  
• During the procedure:
  
  • A speculum will be put into your vagina to hold it open.
    
  • Local anesthesia may be injected into the cervix to numb it.
    
  • The doctor uses instruments through the vagina to stitch the cervix closed. Surgical thread is used. Knots are made to hold the thread tight until it is cut later in your pregnancy. In many cases, the thread is wrapped around the cervix and pulled tight.
    

After the Procedure

• You will be taken to a room where you’ll recover from the anesthesia. Nurses will check on you as you rest.
  
• You will be watched for signs of premature labor. You will also be given medication that helps prevent premature labor.
  
• Your baby’s heart rate will be monitored.
  
• You will have some light bleeding and cramping. This is normal. You will likely be given pain medication. If you are still in pain, tell the nurse.
  
• You may be able to go home later that day. Or you may stay overnight in a hospital room to be sure you do not go into premature labor. When you leave the hospital, have an adult friend or family member drive you home. (Source  : University of Minnesota Medical Center)
  
  Of course mental preparation is essential as well.  This is the time when you may want to announce the news of your pregnancy to friends and family, perhaps even church members, and at the same time request for prayers for your procedure.  You may find yourself having to explain to them what is incompetent cervix all about, and what procedure this is, including its risks.  And I hope by this time you have informed your employer about your impending bedrest, and that whether or not it will be until birth or just a few days/weeks will very much depend on the development of various factors.
  
  All the best for next week!
  

WEEK 12 : Week by Week Incompetent Cervix Pregnancy Guide - SYMPTOMS OF THE CONDITION?

NOTE : For the regular advice on Week 12, 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 17 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 prompted me to start this series of blogs in the first place is because I am so sick of tired of scouring hundreds of "Week by Week Pregnancy Guide" sites that tell you the 2nd trimester marks the beginning of your "honeymoon period".  Supposedly, this is the trimester when you are not too large to be feeling clumsy yet, yet the morning sickness is over and the risk of miscarriage is significantly lower and it's time for that short babymoon and back to EXERCISE!!! You know what, whilst it may be true for most women, the start of the 2nd trimester for us moms with incompetent cervix is the start of a long tiring road to holding our little Rainbows in our arms!

No, the end of 1st trimester may be well and good when it comes to morning sickness, but the risk of miscarriage has just worsened, for us with this condition.  Unfortunately, many of us may not even know yet that we have this condition.  More often than not, there are no symptoms until it is already too late, and we don't even know the exact cause of the condition.  Sad to say, in some countries, women continue to lose their babies during late pregnancies without ever knowing why.  From observation, most women lose their babies between 20 to 24 weeks, and at that point of time our little ones are just simply too little to survive.  They are considered not to be of viability yet, and even if they survived after agonising months in the NICU, they may have a long road to recovery, or may even suffer permanent defects. 

At this stage, we have to start being careful about our activities, particularly those involving pelvic movements - sexual intercourse may not be wise as we may not know the condition of our cervix.  The ultrasound at this stage may still be unable to pick up abnormalities of the cervix yet, but within weeks, or even days, the changes may start. Here's an excerpt from Women's Health UK website on possible ways to detect IC : 


"There are descriptions of cervical assessment before pregnancy to try and detect those who may benefit from a stitch. These include checking cervical resistance or compliance, with a dilator, or specialised instrument. Whilst promising, no studies have yet found a predictor of poor outcome as good as a previous pregnancy loss.
Transvaginal ultrasound (TVS) during pregnancy has shown some promise. The usual length of the cervix is about 4cm as measured on TVS. Women with a cervical length of less than 2.5cm have been found to have a 50% risk of preterm delivery in one study. Other studies have looked at opening of the internal section of the cervix ('funnelling' or 'beaking') in response to pressure on the top of the uterus. It does seem that this finding early in pregnancy is suggestive of cervical incompetence and that the findings are progressive throughout pregnancy.
These studies are really still at an early stage and it takes a great leap to presume that on the basis of these findings alone a stitch will improve things. Larger observational studies and a cerclage study on the scale of the MRC/RCOG will hopefully follow and define the place of this investigation. At the present, this type of scan is generally confined to research centres in the UK and is certainly not to be considered 'standard of care'."

A positive outlook is of utmost importance at this point of time.  It has never been particularly pleasant for me, as I enjoyed my physical activities, especially my gym sessions and my running around and clowing around with my toddler and my preschooler.  Sometimes the guilt sets in when they want to be carried, or they just want you to take them to the pool. Do join forums and support groups, it helps to a certain degree.  But towards the end of the day, you will have to find peace within yourself to prepare yourself mentally for what is to come.

WEEK 11 : Week by Week Incompetent Cervix Pregnancy Guide - FINANCES AND OTHER CONSIDERATION

NOTE : For the regular advice on Week 11, 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 17 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.

Heartburn, constipation, fatigue? Yea you are probably still at that stage at Week 11. The morning sickness may be waning off, but it may still be causing a lot of trouble.  My appetite was ferocious for my 1st 2 pregnancies.  With the current No.3, I have no appetite for anything other than tomyam.  It's that spicy and sour soup originated from Thailand, and there is this belief among the Chinese that sour is not good for early pregnancy? But well... eating only tomyam is better than not eating at all!

Some of us IC moms may already be preparing for our TVC. Read Week 10 here.

What all of us have to remember is of course to eat healthily.  I am not a good example, but I was still conscientiously taking my folic acid, as well as plenty of fruits to avoid constipation. As IC moms, one thing we will soon learn is that bowel movements are to be as easy as possible - bring on those prunes and bananas! Well, I developed an aversion to sweet things (I gag at the smell of sweet things) during this 3rd pregnancy so I had no choice but to buy bland fruits like guava and pour lots of salt or saltines on it.  But again, don't take my advice on food! In fact, do read some good websites on healthy food during pregnancy like this http://www.webmd.com/baby/guide/eating-right-when-pregnant

 Do a final take on finances before the day. Check if your insurance covers the cerclage procedure, and whether your company allows hospitalisation benefits, and of course, the cost of the procedure.  I paid not more than RM2500 (USD750) for each of my 3 cerclages, but the cost may differ from state to state, hospital to hospital.

At Week 11 for my current pregnancy, the subchrionic hematoma had already bled out on its own, thanks to plenty of water, bedrest and prayers.  I was put on duphaston 3 times a day, and continued to do so until after my TVC.

I was still reluctant to break the news to anyone, including my own family.  Hubby decided to tell his mom, sis and bro, but that was about it. I told a handful of very close friends, but only because I needed the support emotionally.  Many thought resting in bed doing nothing is a wonderful thing, but if only they peeked at my daily calendar, they would know that REST was never on the schedule and I haven't grown accustomed to it eventhough this is the 3rd time.  I tried as much as I could to finalise my children's affairs, made plans with hubby on chauffering the kids and preparing them to school every morning.  What I do know is by the time I got my preschooler prepared to be out of the door by 8am, I was dead tired (even pre-pregnancy) but I had to continue to prepare myself for work after I drop the toddler off at the babysitter.  So we truly needed help to at least takeover that few hours in the morning from me. Mom in law is the answer, and she has been a fantastic help thus far! 

WEEK 10 : Week by Week Incompetent Cervix Pregnancy Guide - PRE-CERCLAGE ARRANGEMENTS

NOTE : For the regular advice on Week 10, 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.
Ok, this may be the week where one of the things you would want to do before bedrest commences, would be to bring out those boxes of pregnant clothes which you have stored away some couple of years ago waiting for this day! :)  If this is not your first baby, you are probably starting to show, even if you are not, your probably can't squeeze into your skinny jeans anymore.  Your colleagues whom you have not broken the news to may think you should start laying off those daily afternoon tea (which comprised of 3 scoops of chocolate mint ice cream and 3 packets of Twisties and 2 large mango smoothies... and they do wonder why you don't drink coffee anymore at 4pm when your blood type previously was essentially COF2E2?) as you do look fuller and rounder.

Of course if is your 1st pregnancy and you don't even know you have incompetent cervix yet, you may still  be hitting the gym 5 times a week looking like a fitness instructor still.  But if you are reading this, perhaps it's time to just be a little aware.  Unfortunately this condition does not show itself until much later, well into your 2nd trimester.  Perhaps that's why old people always warn us against too many activities during pregnancy - they know many things can happen.  Besides, this is one condition that is almost symptomless and not very common. You may want to read myWeek 9 post for some of the horrors that can befall upon us. 

For those of you with twins, of course you are starting to look pregnant! I'm not really sure about twin pregnancies - whether you do need to go in earlier for a cerclage. I have read somewhere that yes you may need to but perhaps only a week or two earlier, as they really do need to be sure that your placenta is fully formed and you are past your 1st trimester (at least at the tail end of it) before they attempt a transvaginal cerclage.  They also want to ensure that there are no structural abnormalities and that the foetuses are of a certain growth rate before they decide to place the TVC.

In any case, start preparing for that dreaded (or welcomed) bedrest.  Have you made meal arrangements? Laundry and cleaning arrangements? What about your older kids? Mentally prepare yourself, and mentally prepare dear hubby. He will have to juggle a full time job, a little bit of housework, managing and caring for the kids (who are probably still preschoolers/toddlers) and of course work arrangements with your boss.  Yes, you will have to let him/her know at some point VERY soon.  You may even get the green light from your OBGYN to go ahead with normal activity except heavy carrying, exercise and pelvic activities, but I always tell myself "Prepare for the Worst, but Hope for the Best"

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.

WEEK 8 : Week by Week Incompetent Cervix Pregnancy Guide - THE PREPARATION NOW THAT IT'S REAL

NOTE : For the regular advice on Week 8, 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.

If you are seeing your baby for the first time on the ultrasound, I can feel your excitement! You may even be able to hear his/her heartbeat, and you might be so tempted to announce to the world now that it is sooooo real!!!

But if already know you have the condition of an incompetent cervix and this is another 'IC baby' (as we IC moms fondly refer to our little babies), you may start having mixed feelings.  Along with other 1st trimester pregnancy worries, you know that while others look forward to Week 14 as it marks the end of the 1st trimester, that will be the time when we will have to undergo the cerclage procedure.  Some of us may already have some changes to our cervix, or if you are like me, you have a short cervix to begin with.  You may not know of your condition yet, but some countries are already making it compulsory for cervical length to be checked at 16 weeks (do refer to Week 7 on England NHS's petition).  I have also shared some of the worries (financially, psychologically and physically) in Week 7. 

Some of us do get some bleeding/spotting at this point.  I was diagnosed with subchrionic hematoma
which is supposedly common, but how many pregnant women like the idea of bleeding during her pregnancy? Blood is never a good sign, and seeing a dark patch around the sac on the ultrasound isn't exactly reassuring.  The happy ending says the blood clot will dissolve on its own, the unhappy ending says you end up in a miscarriage.  Either ways, it is especially not a welcomed diagnosis for an IC mom, simply because this should be the last few weeks of normal activity, perhaps even a few more gym sessions before the dreaded bedrest (modified, strict or otherwise), but with a subchrionic hematoma, again bedrest is prescribed. So now what... instead of 6 months of restricted activity, it has become 8???

But well... if it is for the good of having that little bundle of joy in your arms in the end... WHY NOT? If I have to do this over and over again, I would.  But at this point, perhaps the question of whether you would stop having babies may pop up with hubby (ignore the rest, remember?). For me, this is my 3rd IC baby. and my OBGYN noted during my cerclage procedure 2 weeks ago that there were scar tissues from my previous cerclages, and he had to stitch around and away from those scar tissues. It will not get easier or less risky if I do decide to have more babies. He did mention I may have issues with dilation when labour comes (cervical dystocia). And of course, other factors like, will your career be once again stagnanted, how about finances? If you already have 2 or 3 children, you will need to plan for their future as well.  Bedrest may affect them too, as most of them may still be a toddler, or a preschooler, and they  need lots of cuddles and attention and outings. Which, of course, is not possible with bedrest.

Since your pregnancy is now very real (there are statistics that show if you hear and see the heartbeat at 8 weeks, the chances of a continuing pregnancy increases to 98% as compared to just a couple of weeks ago when it was slightly above 60%), this is a good week to start making some solid plans for what is to come.  Start with the short term ones, like who will help out with household chores during the weeks (or months) of bedrest after the cerclage placement, who will chauffeur the older kids around to babysitters, playschools and piano lessons, who will prepare your meals, and what will you do to occupy yourself.  Do you have to inform your employer now? Should you?  It is best to be honest and open, tell your boss the possibilities, from the best to worst case scenario, and what to expect.  As for yourself, Be prepared for the best... or worst. You may be asked to leave, or you may be granted paid leave.  But always remember at the end of all this... what can be worth more than that Little Rainbow you will hold against your breasts?

WEEK 7 : Week by Week Incompetent Cervix Pregnancy Guide - COST AND WORK

NOTE : For the regular advice on Week 7, 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.

Nausea (it's not really morning sickness if it's all day round ain't it?), frequent toilet trips, breast tenderness... are you sure you can still keep this little secret to yourself? With my first two pregnancies, I didn't even know what is morning sickness all about.  It's like THE most popular tell-all for pregnant women (the movies say so) but I never had such thing. My appetite was voracious, I ate everything and anything, and someone who couldn't stand sweet things, my tastebuds suddenly developed an affection for ice cream and chocolates.

Then the 3rd pregnancy came by.  I was nauseous the entire day for the entire 1st trimester.  I was hungry all the time (that was the first sign I suspected something amiss, since No. 3 was not planned) but the moment I prepared myself a sandwich, or a bowl of noodle, I started to gag. And I gag at even the SMELL of sweet things.  Well... what are your stories? DO tell!!!

As I understand it, in some parts of the USA, the doctor will not see you until you are at least 8 weeks.  Here, we run to the OBGYN at the first faint line on our home pregnancy test kit.  Well, if you haven't seen your little one on the ultrasound yet, time to be excited about it. Also, time to prepare those questions you may want to ask. Some of it I have spoken about in last week's post (Read Week 6).

If this is your first pregnancy or  you do not know if you have an incompetent cervix, you may not even bring it up. Some countries have made it compulsory for cervix length to be checked, some have not.  Recently it came to my attention that England has started a petition for it http://www.change.org/p/nhs-england-cervical-incompetence-nhs-to-make-cervical-checks-mandatory-from-16-25-weeks-save-babies-lives and I do wonder if I should initiate one in Malaysia too.  I have heard too many stories of late pregnancy losses among my friends and acquaintance, yet nobody seems to have heard about incompetent cervix when I said I have it.  Your bosses and colleagues may even think you are making it up just to find excuse to take long leave to bedrest at home.  In a way I was lucky to have an understanding employer who made necessary arrangements for me to work from home, but you will know if your colleagues are not too happy about it - the backstabbing and badmouthing would have started. Like... women got pregnant since the beginning of time, what's so special about you?

Well, I did quit after that to set up my own practice, for more flexible hours since I enjoyed being a mom. But do consider your finannces as this condition comes with a cost.  Insurance of course does not cover this condition in my country (I bet they haven't even heard of it before).  The cost of a transvaginal cerclage with a spinal block and a 24-hour hospital stay is about RM2500 to RM3500 (USD750 to USD1000), perhaps more depending on which hospital and which state you live in Malaysia.  If you are a salaried employee, your employer may or may not be agreeable to a paid leave (if you are hospitalised they may be obliged to grant you paid leave, but if you are merely at home on bedrest, they may even be contractually allowed to terminate your employment).  If you are running your own business, you may lose your clients and customers (again, depending on the nature of your job).  So where will your income be coming from? You need to know when will your cerclage be placed, and what is the period of your bedrest thereafter. A lot of OBGYN won't be able to tell you a definite answer as it depends on the response of your pregnancy (particularly your cervix) to the procedure.

Yes, there will be a lot of uncertainties for the next few months, and you really have to be mentally prepared for it.  If you think your career is more important and decide to return to work just because you feel much better and more secure after your cerclage, WHAT IF.... just WHAT IF you lose your baby again?  Is that a risk you are willing to take? On the other hand, if you do not go back to work, how will you cope financially? Will you be able to cope with prolonged house arrest/bedrest, shut away from the bustling life you used to have?  With No.1 it was an emergency cerclage at 23 weeks, I was not prepared for it at all.  In fact I started bleeding blood clots that night after a kickboxing session followed by step aerobics at the gym, and the previous day I just returned from a babymoon trip with hubby,  As a litigation lawyer I was walking up and down the courtrooms on a daily basis with heavy files and I was a chorister in the local church choir, the state choir and a local choral group.  I never knew the meaning of rest. So the 3 month bedrest after the emergency cerclage which cut me off from the world almost killed me psychologically.

Well, if this is your 2nd or 3rd time bedresting, you  may be more mentally prepared.  You may have downloaded an entire series of James Patterson e-novels, or purchased an entire collection of DVDs of reruns of Law and Order : SVU Season 1 to the current season, but believe me, it doesn't get easier.  So whatever choices you make about your bedrest will not only have to depend on what your OBGYN tells you, but also depends on the support you get from people around you, also, listen to your body, your mind,  and start asking yourself if it is worth the risk of having a preemie, or to lose the baby altogether.  Start thinking, and pray very hard for guidance.

WEEK 6 : Week by Week Incompetent Cervix Pregnancy Guide - EMOTIONAL PREPARATION

NOTE : For the regular advice on Week 6, 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.

Your morning sickness hitting hard, ain't it? Welcome to the world of 1st trimester difficulties.  As promised earlier, this series of blog is NOT meant to duplicate what the other websites are telling you, be it about your baby or the changes in your body.  It is meant to share with you (and you are of course most welcome to share your experiences, joys and pains in the comment section below!) my experience , physically and emotionally (and a whole lot of other aspects) of having incompetent cervix pregnancies.  Oh ya I feel obliged to mention spotting at this point and your fluctuating hormones... all part and parcel of having a little human being formed in you!

And oh, if you have been taking fertility drugs or actually had an IVF or any other fertility treatment, you may want to double check with your OBGYN whether you are expecting more than a baby. ONE baby laying down on your incompetent cervix is bad enough, if you have 2 or more, you may need extra precautions and advice. I don't know, I've never been through multiple pregnancies before! (Thank God? I don't know. If you read my previous weeks' postings, you would have known by now I adore kids).

So, are you ready to share the news to the whole world yet? (Read my take on this in Week 5 here).  There are always pros and cons. If you have had an early miscarriage before, you may want to keep it to yourself first because you know how painful it is when people ask you how's your pregnancy and you had to keep repeating that you already lost it.  Or you  may want to keep it to yourself because you didn't think it necessary to share good news to others who may see it as a bad news. You will never believe what I've been through... when people found out I was pregnant with No. 3, instead of the customary "Congratulations" they are more concerned about whether it's safe to have No. 3, whether I'm sure I want the child (like yea.... more than I want you as a friend you idiot), whether it would affect my work, and whether my hubby 'knows it yet' (like it's akin to news that someone died).  On the other hand, you may want to share it because you are just oh so happy (and of course if this is the first time you are dealing with an incompetent cervix, you probably wouldn't even know about it yet).

You may have already started calculating the date your cerclage will be placed, whether you will need bedrest, if so what sort, complete or modified, for a few days or few months, what should you tell your bosses and babysitters (to your older children, if any).  For me, I know I had to tell mom in law very soon as I would need her to come over to see to the 2 older kids right after my cerclage is placed.  

Emotionally, I know it was going to be difficult.  I had always wanted to be a stay at home mom but due to financial constraints I had to work.  No. 3 is a good excuse to finally reason with hubby that it makes some financial sense as cost of babysitting and the extra tuition and piano lessons are high. I can teach my kids.  I can look after my kids.  I can cook (eating out is costly too), and I can clean (hourly cleaners are costly too). But well, these are things to be considered in the weeks and months to come.  It doesn't harm to start thinking about it, especially if it soothes you emotionally. For me, hanging up the courtroom robe for good and spending time cooking cleaning and caring for my kids is also known as THE PERFECT LIFE! :)

You have about 9 more weeks to go before your cerclage is placed, and depending on various factors, you may need to be on some kind of bedrest for the rest of your pregnancy, so if you feel fit enough to hit the gym, do it now.  Shopping, of course. Clean up the house a bit before it looks like one of those 'before' images of the "Hoarders Intervention" reality series on Home and Health channel in the months to come (come on, even the best house cleaners teamed up with hubby will not be able to clean it the way you do!).  Most of all, spend time with your kids.  Take them out to the beach, maybe even a short holiday.  Other websites will tell you morning sickness may weigh you down and that 2nd trimester is when your 'honeymoon period' is, well... you have an incompetent cervix and the 2nd trimester will be your worst nightmare (sorry for this piece of reality) so leave your babymoon to the 2nd trimester. You know what? You don't have time for morning sickness and complaints about breast pains at this point, you have 9 weeks left to enjoy being a normal pregnant woman!

So hang in there.

WEEK 5 : Week by Week Incompetent Cervix Pregnancy Guide - GOOD NEWS AND BAD NEWS

NOTE : For the regular advice on Week 5, 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.

By this week, your pregnancy test would probably show an accurate positive. YAYYY!!!!

If you have been trying for a baby forever, or if you have just experienced a traumatic loss (be it due to incompetent cervix or other reasons) this may come as a wonderful news.  I have shared how different it is my feelings towards having a positive on my home pregnancy test kit. (Read Week 4 here).  To share further about the anxieties when No. 3 made an unexpected appearance, well... it was an immediate joy.  I have always wanted 7 children.  But due to the darned cervix I knew it was not a very practical want. Hubby was adamant that 2 beautiful healthy boys was enough.  Our financial situation was just getting better as I have my own law practice and each time I had to bedrest for long months, the income just wasn't there anymore. When you are your own boss, you just don't earn when you are not working. With No. 2, the bedrest was longer as I was put on bedrest since Week 15, the week the cerclage was placed.  And when I was 5 months along, still bedresting, hubby lost his job.  It was an extremely tough time.  So naturally I understand why hubby was so reluctant to have another baby, even with a now stable income and in fact a new home!

But I would give up any material things in the world for another baby in my arms! So I was elated... but breaking the news to hubby was one of the most unnerving thing to do.  I went to the OBGYN the next day(who happens to be hubby's childhood friend and bestfriend) to confirm the pregnancy. And he wished me luck with breaking the news to hubby.  He actually found it amusing! :)  That night, I was shivering and shaking all over when I gave the ultrasound picture to hubby.  He stared at it for a second and asked me what it was.  I told him "Our baby". He took another look at it and asked me "Is this real?" I said yes. He stared at it EXPRESSIONLESS for a good 5 minutes without a single word. His facial countenance revealed NOTHING. Then he took a deep breath and asked, "So when is it due? When is the cerclage? You do need a cerclage right?"  

It wasn't easy and I am writing this at 16 weeks, sometimes I still get the feeling that he hasn't come to terms with it yet.  And sometimes he does blurt out "This is the EXACT reason why I didn't want a third one," whenever I had a bad day, or sometimes he would jest (and it's not funny I tell you) "That's why we shouldn't have a 3rd one" when we discussed our state of celibacy.

Speaking of which, if some of you think that it's time to be having lots of sex now since you would be on pelvic rest till fullterm, do consider the fact that your cervix may already be funnelling, effacing, or even dilating at this point. Very unlikely but don't take any chances. If it is already shortening or dilating, there may be risk of infection (the very reason the cervix is there is to protect your pregnancy from infection but if it's already giving way, then....)  Best check with your OBGYN. This is no time to be bashful.

I am going to sound like an old broken record the next few weeks, but EAT HEALTHY!!! FOLIC ACID!!!

And oh, you may or may not want to share this piece of good news to others yet.  The risk of a miscarriage is still high (not due to IC but due to other early pregnancy losses issues) and if you are like me and you have had enough of those well meaning (and not so well meaning) people telling you rudely to 'keep your legs closed' and 'stop having kids' and 'you can't even handle 2 you sure you want another?', then you may want to just enjoy this little secret with the closest and trusted friends and family first.  For me, the last  count of such close and trusted friends was less than 5 fingers.  

Ok, let's get ready for next week!

 

WEEK 4 : Week by Week Incompetent Cervix Pregnancy Guide - THE START OF AN IC PREGNANCY JOURNEY

NOTE : For the regular advice on Week 4, 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.

If you have successfully conceived, your baby has already entered its embryionic stage!!! Its organs are beginning to be formed. CAN YOU BELIEVE IT?!!! Of course you still have no idea whether you are pregnant, and the most sensitive and expensive pregnancy test kit at this point may still come out negative!

You may or may not have experienced implantation bleeding (read Week 3 here).  And if you have, it is probably happening this week, and you may have recognised it. And there may even be a faint line on your kit, so yippee!!! To tell hubby or not to tell hubby? For me, with No. 1, I made that phone call immediately.  With No. 2, I waited till he gets home. No. 3 was unplanned and I knew how apprehensive he was, so I didn't say anything until the ultrasound at the OBGYN confirmed it.  Well, it's all up to you!

Well, since you can read all about the excitement and anticipation in other websites, maybe we can talk a little about those of us with an incompetent cervix.  It gets rather real now, doesn't it?  Your pregnancy test kit may have confirmed a pregnancy. Which means... another long road to holding a fullterm baby in your arms.  If you have had a bad experience or a loss, you just have to be positive this time around.  Maybe this time your cerclage will hold up.  Maybe this time your preventive cerclage will be much better than your emergency one the last time.  Maybe you are able to be on your feet again a few weeks after your cerclage! Again these are questions you want to start compiling to ask your OGBYN during that first visit soon.  If you are on facebook, do join this group of lovely ladies Incompetent Cervix Awareness.  I survived through 2 of my IC pregnancies with the support of this group.  They are not judgmental and they are ever ready to share and to give you lots of positive vibes.  Believe me, bedrest will take its toll on you physically as well as emotionally!

Continue to eat healthy. I cannot say this more.  Continue to enjoy these last few weeks of physical activity.  Clean your house, clear the mess, go shopping, exercise, a short holiday, and of course, lots of intimacy with hubby.  Soon both of you have to practice celibacy (well, at least he can still enjoy orgasm either on his own or with your assistance, but you have to be on STRICT PELVIC REST! ) so now is the time to perhaps satiate yourself :P

Again, steer clear of negative people.  Be around supportive and loving friends and family.  You will need lots of positive vibes for what is to come.  I don't mean to scare you, but we are going through a HIGH RISK PREGNANCY.  We cannot deny this fact.  Some well meaning advice, even from those whom had difficult pregnancies before, may not be relevant, perhaps even unwelcomed. Simply because our situation are different.  In fact, even among IC mommies, we react differently to the cerclage, and our cervix certainly do not respond the same way to the same procedures or medications. So just continue to be strong.

WEEK 3 : Week by Week Incompetent Cervix Pregnancy Cervix Guide - APPREHENSION VS EXCITEMENT

NOTE : For the regular advice on Week 3, 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.

So, wasn't last week an exciting and um...  SEXY week?

So there is nothing much you can do this week except to wait. That 14-day wait can be tiresome, really.  Especially if you have fertility issues like me.  The knowledge of an incompetent cervix may even be so stressful that it adds to the 'bad hormones' that may prevent conception. Sigh... not easy being a woman, eh?  You look for every little symptom, every little sign that may point to early signs of pregnancy.  But we also know that signs of pregnancy mimic signs of PMS!!! ARGH!!!! Why doesn't it get easier?

Ok, so I found this website many years ago (remember the sitting on the toilet crying when period started? Read Week 2 here ). It was truly helpful (but believe me, only psychologically) in getting that dreaded 2 weeks to pass before you can actually go to the pharmacy and empty the shelves of pregnancy test kits! http://www.twoweekwait.com/    You will find yourself doing a lot of silly things during these 2 weeks, but don't worry, this website will assure you that there is no need to visit the psychiatric department just yet :)

Oh ya, one thing I learnt is,implantation bleeding is very real. All my pregnancies... I thought dear Aunty Flo has visited again... but turned out to be just implantation bleeding.  So watch out for that ladies, and don't panic nor fret when you see bleeding.  It may just be that.  Especially for those of us with an incompetent cervix... hey we don't dilate this early. No mucous plug whatsoever to worry about. If the little one has already been created, just give it a little time to travel to your uterus (it takes between 6 to 16 days I believe) and implant itself into the uterine wall. Continue to eat healthy, remember the folic acid, and wait for a while more....

You may want to continue your lovemaking sessions though... because you know what? With an incompetent cervix, you may be prescribed complete pelvic rest as well. Which means no sexual intercourse, no sexual stimulation whatsoever and definitely no orgasm! That would be a good 36 weeks of celibacy (ok, maybe you can still do it before Week 14 when your cerclage is due to be placed, and maybe after Week 37 after the cerclage is removed, but still..... 20 plus week of celibacy is no fun!)  Also, go enjoy shopping, kickboxing, carrying your toddler if you have one, and all those physical activities you may not be able to do anymore very soon.  If you haven't heard yet, bedrest is part and parcel of the life of a pregnant woman with an incompetent cervix.

Emotionally... of course if this is not your first pregnancy, you will have mixed feelings. Anticipation, fear, excitement, apprehension... if you have supportive friends and family of course things do get a LITTLE bit easier.  But if you have been listening to endless "One is enough" or "Why do you want to go through this again?" then well... be strong. You are not asking them to go through the pain with you. Neither are you asking them for any favours when you are bedresting.  They could be worried about your psychological as well as physical well being... but if only they knew how much you want to have this baby.. they will soon understand.  As for those who are simply irritating beings planted into this Planet, just ignore them.  In fact, when you do get pregnant, make sure they are the last to know! You don't need to share this good news with them, much less get any negative energy from these negative people!!!  Just stay close to hubby, he is the only one who is important in this journey other than yourself. And if you do have another little one (or two) at home running around, give him or her plenty of attention.. Perhaps a good time to go for a short holiday in Disneyland or Legoland, reassure him or her that mommy will always love him or her (or them) just the same. LOVE MULTIPLIES, NEVER DIVIDED.

WEEK 2 : Week by Week Incompetent Cervix Pregnancy Guide - ONE IS ENOUGH?

NOTE : For the regular advice on Week 2, 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.

Your period has stopped. You are feeling like a brand new woman (at least, for another cycle till PMS sets in again, unless, of course if this is the week you successfully conceived, then it will be PMS for the next 36 weeks or so!).  The sun is shining and you are prepping yourself up for the lovemaking sessions that is to come.  Some of us may be preparing for IVF, yet some of us may be frantically measuring our basal temperature, checking our cervical mucous for that 2-inch stretch, or buying all the ovulation kit you can find in the local pharmacy.  This is an exciting week!

But hey... RELAX.  From my experience, when I was told to 'do it every other day from days 7 to 15'... it didn't work.  If you are like me and you have PCOS, you may be put on Clomid and Metformin.  Then told to do the deed when it's time to do so.  Both times, it didn't work for me. With No. 1, I gave up after 6 rounds of Clomid and plenty of crying on the toilet seat when the first signs of period showed up.  I conceived the following month without any meds.  For No. 2, I conceived after 4 cycles of Clomid and Metformin, but lost the baby at 9 weeks for some unknown reasons.  After my D&C and lots of crying, I conceived within the next 2 cycles, again, without any meds.  No. 3 (the current 16 weeker) was the best.  I'm supposed to be PCOS right? So what's the probability of conceiving without any meds? No.1 and No.2 may have been 'triggered' by the meds.  But No. 3 made an appearance unexpectedly 3 months after I weaned off my 2 year old without any meds.  Just plenty of gym sessions and stress free lovemaking sessions!

Ok so I guess moral of the story is... a little bit of exercise, a lot of love and intimacy, and medicate if necessary. But miracles do happen.  Of course, if this is your 1st, you still have no idea that the incompetent cervix may be lurking behind the shadows of the excitement and anticipation, but if you are trying for a 2nd pregnancy, well, you know the cerclage will be coming in handy and the success rates are high (80% if I remember correctly from the websites I scoured).  If you already have a TAC (transabdominal cerclage), don't fret. You already know before you did it that it will barely affect your chances at conception.  Let worries worry themselves.  Don't forget those all-important folic acid, it doesn't matter if you do not conceive this month.  It won't harm you. Read Week 1 here

Of course, there may be some apprehension on hubby's side.  He may still be worried about your first loss, or your first bad experience with a preemie, or even if it was a full term pregnancy you may have gone through a traumatic emergency cerclage - whatever it is, lift each other up. Support each other and pull this through together.  Don't ever let that outsider tell you that 'one is enough'.  Keep your head up, maintain your stoicism, and have fun!

WEEK 1 : Week by Week Incompetent Cervix Pregnancy Guide - ANOTHER IC BABY

NOTE : For the regular advice on Week 1, 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.

This is your menstruation week. The battle you had with PMS last week is finally over. You may have cramps, but well, we know what to do, don't we? 

After all, if we have been battling infertility problems (and somehow I found out that either by coincidence or by scientific reasons, those suffering from incompetent cervix tend to suffer from PCOS as well - that's Polycystic Ovarian Syndrome, a condition where you do not ovulate regularly if not at all), the first signs of a period is the most welcoming sight. It means we are starting that journey to holding a baby in our arms!

Yes, Week 1. Some of us may have planned for this baby all our lives.  Some of us may have been trying for the longest time, and the signs of period means another session of sitting on the toilet bowl bawling our eyes out as it means our last attempt about 2 weeks ago failed yet again. Yet to some of us, this is just another cycle, life goes on.  For those who are indeed trying for a baby, do start on those folic acid.  Yup, a good time to start preparing for that journey to motherhood by just simply taking enough supply of the good ole folic acid.

If you are planning for your first pregnancy, you probably wouldn't have heard of incompetent cervix yet.  Sadly, you will first hear or it either when you are already on the verge of losing your baby, or you have already lost one. Or two. Or more. Losing a baby is not something I would wish for my greatest enemy, so if it has happened to you, I am sorry.  Truly I am.  If you are on your 1st pregnancy and you read this blog on time, please ask your OBGYN about this condition when you are approaching the end of your 1st trimester. Ask for a cervix length check. Just be aware.  But if you have lost a baby due to this condition before, or if you are trying for a second baby after a successful cerclage previously, there tend to be some apprehension.

Yes, after the last ordeal, perhaps you don't want to try for anymore children.  Whether or not you already had a surviving child or not, you just cannot imagine going through the ordeal again.  I almost lost my No. 1 at 23 and half weeks and was already bleeding blood clots, but my OBGYN performed a TVC (transvaginal cerclage) anyway, and I was on bedrest for the rest of the pregnancy and gave birth to a beautiful baby boy at 38 weeks. Ian is 6 years old today.  And well, many told me that perhaps I should stop there. No more babies. Too much risk.  Too many issues.  Too financially and emotionally straining.  Some gave unwelcomed advice like "You shouldn't exercise when pregnant" (I mean yea, I was hitting the gym 5 times a week 3 hours a day doing kickboxing and step aerobics but that is not the cause of an incompetent cervix!!!) and many thought this is the case where my womb isn't strong, or that I'm simply not a strong enough woman to carry a child.  So at this point, if you are preparing yourself for another pregnancy, just bear in mind that it is yours and your husband's decision. If he is being influenced inadvertently by all those ill informed advice (eventhough may be well meaning) then pull him back and head to your OBGYN's office. Listen to the professional, not the ignorant advice (again, though may be well intended).  YOU CAN HAVE ANOTHER BABY.

So, breathe in, take your folic acid, quit smoking and drinking, and prepare your body for next week... the week for intense lovemaking sessions :) :)

The Blessings and Curses of the Incompetent Cervix

What is incompetent ccervix? If you come from this part of the world where I come from, you probably wouldn't have even heard of it before. Cerclage? Modified bedrest? TVC? TAC? Strict bedrest? Shirodkar? Macdonald? What are those?

Just google. Yes Mr G our bff. And you will get an answer. The dos and donts, and many of the websites will tell you pretty much the same thing, main thing being "One of the symptoms of an incompetent cervix is multiple previous pregnancy losses". Like... huh??? You need to lose a baby or 2 before you get diagnosed? Oh it's just a miscarriage isn't it? After all, another website will tell you a certain percentage of women suffer miscarriage anyway don't they? I have miscarried at 9 weeks before, and let me tell you, it was devastating.  But with an incompetent cervix there is another painful twist to it. You would have carried the baby way past 1st trimester, your baby is fully formed, with arms and legs and eyes and nose... yes... it's a BABY. You would have bonded with the little one, prepared your nursery, named the child even, and felt those little kicks. With an incompetent cervix, your little baby is hale and hearty, no chromosonal defects whatsoever. YES. THE DEFECT IS WITH YOUR DARNED CERVIX. It can't hold your pregnancy. And you perfectly healthy baby slips out of your womb because your cervix is incompetent.

Look at my title. Blessings and curses? What blessings can there possibly be? Well, to divert for a while... I have long noticed how many hundreds of websites there are providing a 'week by week pregnancy guide' and these are guides for a healthy no risk pregnancy. Whenever Week 14 comes, they even tell you "OH THIS IS YOUR HONEYMOON TRIMESTER!!!" Well guess what? For women with an incompetent cervix. That is simply not the case. Week 14 is probably the week where you are scheduled for a cerclage. Ok I'm rambling. Point is, I will try my very best with just my experience and a little I gather from the forum for incompetent cervix women I'm in, I will start another blog WEEK BY WEEK starting from Week 1 itself. For women with incompetent cervix. There, I will explain further what is this all about.

But well... since I mentioned blessings. Ok, blessings. First of all, of course, the fact that you may almost certainly appreciate your babies more.  Every surviving child is a miracle child.  Some women who were never diagnosed went on to lose their babies in late pregnancies, with no surviving children at all.  Some women, eventhough diagnosed, lost their babies anyway even after a cerclage.  Some women had surviving preemie who never went on to have a normal life due to defects caused by just simply being a preterm baby.  So if your carried fullterm with an incompetent cervix, or if your surviving baby lives a happy healthy normal life... you will tend to appreciate your children more.  The little rainbow. The little miracle.

Secondly, the bedrest may be a good thing after all. It makes you slow down a little in terms of your career and all the activities you have been juggling since your schooldays.  You finally have time to read those books collecting dust on your bookshelf, or watch that DVD you bought ages ago, or to write that article you had always wanted published, and of course... time for soul searching. If you are like me, you finally have time to finally have time to gather your thoughts and find constructive ways to leave the job you have always despised.  You may even have time to get closer to God, perhaps open up that Bible you have left at the very bottom shelf....

Thirdly, you are now aware that this is a very real very possible condition.  You can help others. Create awareness.  Share your story with your friends. They don't have to lose anymore babies if they are aware that this is a possible condition and may even checked with their O&G if they have this condition.  You will be surprised that as learned and well read as you are, you never knew that this condition exist and is said to affect 5% of childbearing women.  All those week by week pregnancy guide will briefly mention incompetent cervix in a sentence and dismissed it as rare. How many of us will think that we belong to that 5%? We either don't want to consider it, or we don't think it's possible we are that unlucky. Ignorance is not bliss!

Let's not dwell on the curses shall we? I mean, by now you would have known what it comes with. But this is only the tip of the iceberg. Do follow me in my "WEEK BY WEEK INCOMPETENT CERVIX PREGNANCY GUIDE" if you want to know how is it like, week by week, day by day, for a woman with this condition.

To sum it up, I wanted 7 children since I was 5 years old. I watched Sound of Music and I wanted my own DO RE MI FA SO LA TI (remember that scene with Julie Andrews and the von Trapp children on the bullock cart and she was just pointing to the children with the horse whip while they sing their respective notes DO MI MI, MI SO SO, RE FA FA, LA TI TI) but then I was diagnosed with PCOS (this is another story altogether) and then the incompetent cervix. So I am already indeed blessed that I have 2 beautiful healthy boys and no.3 is 16 weeks in the oven! (Oh yeah, I'm bedresting and hence the ability to sit back relax and write this blog). Don't  think there will be anymore as the scar tissues from the previous cerclages are taking its toll on my cervix. But well, who is complaining?