WEEK 33 : Week by Week Incompetent Cervix Pregnancy Guide - STRIKING THE BALANCE

NOTE : For the regular advice on Week 33, 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 25 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.
  As an IC mommy, it is easy to forget that pregnancy is way more than just a cervix that wouldn't stay closed, or a cervix which just isn't long enough.  But at this stage of the pregnancy, it is time to start worrying about other things.  And of course, to start revelling in the fact that you have come so far and you deserve a break.  At the same time, we have to juggle between pushing it too far and to do all the things we hadn't been able to do when we were in the 'danger zone'.  At 33 weeks, baby is still pretty much premature, and what we are trying to achieve is a full term pregnancy.  Especially if we are carrying multiples, as our babies will be rather small at this point (read Week 32).

So how do we strike the balance?

Other mommies are probably having their baby showers now.  Full blown, perhaps even an outdoor party complete with clowns and ponies.  Well, we can have one too.  But perhaps on a much smaller scale so that you don't tire yourself out.  Invite just the closest friends and family, those who really care.  Order pizza delivery, or takeaway a bucket of KFC.  Serve boxed drinks instead of fresh cocktails. And most importantly, make it clear to the guests that if you need to lie down halfway through the party, well... you just have to.

Other mommies are probably having their pregnancy glamour shots taken as well.  Outdoors, at the beach, the local park, or some historical sites.  Well, we can arrange for everything to be done in the comfort of your home.  Lots of lying down and sitting down positions, of course.  After such a long time being at home, perhaps time to put on some make up and feel good about yourself.  Get your hairdresser to come to your home, or just buy one of those do it yourself hairstyling kits.  In the comfort of your home, you can have those pictures taken without having to feel self conscious about passing onlookers, and hubby may be at ease as well.  Don't forget your older children, of course.  And oh, you can have more intimate shots at home! Great, isn't it?

Other mommies are probably preparing the nursery - painting the room, setting up the crib, shopping in 5 different malls for all the beddings and baby stuff. You can do this too! Yes, through delegation. Hubby, a helpful relative, your older children, perhaps your BFF! And these days you can shop in the comfort of your home - online shopping is soooo totally in!!!!

Other mommies are probably indulging in their nesting instincts - well, you can afford to wait until fullterm - that is just another 4 weeks away. Wait there!

Other mommies are probably indulging in sex too - ok, 4 more weeks. Enough said.

Other mommies are probably obsessing about birth plans, names for the baby, signs of premature labour, pre eclampsia and all other hosts of concerns and excitement - take it easy.  I'm sure by now we all know how to do that, don't we?  We have been through much worse to get to this day.

Everything is about balance.  Now let us just wait it out. 4 more weeks.

WEEK 32 : Week by Week Incompetent Cervix Pregnancy Guide - MULTIPLES PREGNANCY

NOTE : For the regular advice on Week 32, 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 25 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 baby is filling out.  There is not enough room anymore for those early somersaulting and kickboxing sessions he/she was having, so don't freak if baby does not seem to be as active as he/she used to be.  He/she probably still is, but not the sort of movements you have been accustomed to few weeks ago.  Cheer up! Less room means more of baby! Now is truly the time to enjoy your pregnancy now that the danger zone is over and done with! (Read Week 31 here)

For most of us, our doctor has probably eased up on the strict bedrest we have endured the last few months, probably since our transvaginal cerclage was placed at Week 14.  For some of us, this may just be the beginning, especially for those of us who have just been diagnosed with an incompetent cervix without any cerclage - now you are in danger of a preterm labour, and at 32 weeks, eventhough baby has a good chance of survival, he/she is still pretty premature.

If you have just been diagnosed, first of all, take a deep sigh of relief as you are past viability (before 24 weeks, your baby had minimal chance of making it to smell the roses) but of course, it is scary as you are technically speaking only 8 months pregnant and suddenly you are faced with preterm labour. You may be prescribed with bedrest now, but again, take comfort in the fact that it is probably a couple more weeks, unlike most of us who have been doing bedrest the last 5 months or so.   In the meantime, put your feet up and know that in a few weeks' time you will not have this luxury anymore for many many more years to come.  Take it as a blessing, especially if you are the type who are perpetually on the go, multitasking throughout the day.  Someone is trying to tell you to just take a break before little one comes along.

However, you may also be threathened with preterm labour at this point if you are having multiples.  The fact that you are having multiples itself is considered high risk towards early labour.  Coupled with an incompetent cervix, there is a chance that you may go into spontaneous rupture of membranes (your waterbag burst) at this point of your pregnancy.

Do look out for signs of premature labour, as your cerclage is probably still in, and you do not want to add to the complications but rupturing through your stitch.  I have never had a multiple pregnancy so I will not know what are the other risks involved.  But I'm sure it comes with other risks, but here let's discuss incompetent cervix.  

In the first place, you would probably been advised against a transvaginal cerclage because there are studies that it may harm your multiples pregnancy.  However, you may have had a TAC, but there is indeed an irony here : a TAC is usually done BEFORE you got pregnant, so you won't even know whether you are having multiples in the first place.  Perhaps the only indication was if you had fertility treatment which often resulted in multiples.  In any case, you are here now at 32 weeks, so let's just get on with it!

The normal progression of labour usually starts with contractions, which will in turn dilate our cervix, and as the contractions become more and more regular and closer in time, at some point, our waterbag will burst.  However, with an incompetent cervix, especially withou a cerclage, we dilate even without regular contractions.  In other words, we are probably not in labour yet, but dilation already happens, and more often than not, our waterbag burst way before we are in true labour.  When this happens, if we have already carried to fullterm or like now... when we are 32 weeks... we will probably be induced to trigger true labour.  Or in some cases, the doctor may still want to keep the babies in for a few more days, even weeks.

For multiple pregnancies, your babies are probably much smaller than singletons, so your doctor may want to keep them in for a few more weeks.  So you may even be hospitalised for the rest of the weeks till you are fullterm.  Usually, that would mean :

• Twins: 37 weeks
• Triplets: 34 weeks
• Quadruplets: 32 weeks

At this point of your pregnancy, whether or not you are pregnant with singletons or multiples, you ought to be keeping a close tab of every signs and symptoms.  Your body will always tell you if something is not right.  And of course, keep the doctor's number handy.  Also, you ought to be prepared by now about what to do and who to call if you need to rush to the ER.  Perhaps time to pack the hospital bag if you haven't already!  Happy waiting!

WEEK 31 : Week by Week Incompetent Cervix Pregnancy Guide - ENJOY YOUR PREGNANCY

NOTE : For the regular advice on Week 31, 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 24 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.
We are almost there.  31 weeks is an achievement for IC mommies like us.  But of course we still want a fullterm baby, as we know what complications may come with a preemie (Read more about a premature baby in Week 30).  During these final weeks, we may start to have even more discharge, and there is more and more on our cervix as the little one puts on weight.

Finally perhaps we can start thinking about 'normal' stuff like prenatal classes, our birth plan, and maybe even names for the baby!  Well, prenatal classes may not be possible if you are still on strict bedrest or even house arrest, but you can always read up or watch youtube videos to prepare yourself better.  As for birth plan, well... can you believe that we can actually plan for our birth after months of worrying about going into premature labour! Ok, technically speaking we are still not fullterm yet, but at least we can see the light now and we can even decide things like : Epidural or no epidural? C-section or natural birth? Yes, if you have a transvaginal cerclage (TVC) you can have a natural birth after the stitch is removed.  But with a TAC you will need to go through a C-section, usually on the same incision line as when you placed the TAC (read here for more info on the cerclage).  One of the side effects of the TVC is that your cervix may not dilate as quickly as it should - in some cases it may not dilate at all (cervical dystocia).  In such cases, you may need to be induced, but if it still doesn't work, you may need to mentally prepare yourself for a C-section after all.  But we will discuss this further in the weeks to come.

On the emotional side, the bedrest should really be taking its toll now.  After all, if you had been on strict bedrest since your cerclage was placed, (with a TAC you may not need to be on bedrest at all), you may be missing your mobility now.  No matter how much you used to hate driving, you may actually miss it!  You may even miss work, and your colleagues, even your nasty bosses and clients.  If you are like me and you have 2 pregnancies through Christmas, you can only stare at all those pictures of malls with beautiful Christmas decorations and the night lights of the streets in the spirit of Christmas posted by your friends on Facebook.  You will long to hit those malls with your credit cards (ok perhaps its a blessing after all, this bedrest thing).  I mean, what better excuse than Christmas to shop?  But then again, 1 or 2 missed Christmases to hold a darling baby in your arms... I wouldn't trade anything for that.

Fret not, really, 6 more weeks before you ditch the stitch.  6 weeks compared to the last 16 weeks or so which you have endured is nothing.  If this is your 1st baby, remember that once the baby is born, you no longer have this luxury of just bumming around with the TV on and the tab on your tummy and dozens of historical romance novels at your bedside.  No more luxury sleeping at any time of the day.  And the reason you will look dishevelled is not because you are home and there is no need to dress up/make up for anyone, but it will be because you don't have time to and your baby is spitting up on you every hour!

Yes, start thinking about baby names.  Make a list of names and its meanings and share with hubby when he gets home from work.  Get your older children involved in choosing the name of their sibling.  Also, you can start making a list of what to bring to the hospital during your stitch removal.  Some women go into labour immediately after, some will carry to due date and even after.  I had my 1st one about 10 days after the stitch was removed, and No.2 came by on his due date, about 3 weeks after the stitch removal.  Go online and do some shopping for your nursery and baby's clothes, toiletries, feeding equipment etc...  You may also want to consider - co-sleeping or baby in his/her own room?  I co-sleep with both my children until No.1 turns 5 then he gets his own room.  Easier if you breastfeed - they will somehow just learn to find their source of nutrition and you actually don't lose as much sleep!


You should be able to really start enjoying your pregnancy from now on.  Yes, the risk is still there - but take comfort in the fact that your baby is past viability, and we deserve some peace of mind after such a long journey behind us.  Look out for signs of preterm labour, but try not to obsess about it anymore.  Your Braxton Hicks contractions may be more frequent now, but these are only practice contractions so don't worry.  It shouldn't jeopardize your cerclage.  If it bothers you a lot or if you are bleeding/spotting, you may want to check with your doctor.  For me, a change of position or a hot shower usually helps.   

You know, women in normal pregnancies are usually told to enjoy their pregnancies during their 2nd trimester, and that would be their 'honeymoon' period, as they are not big and clumsy yet.  For us, well, we settle for 2nd best.  This should be our 'honeymoon' period, since theirs happened during our most crucial weeks - when baby wasn't viable yet and when the cerclage may fail.  Yes we may be as big as a whale by now, but we are strong mommies aren't we?  We have survived through all those ordeal, of course we should be able to take on the weight gain and enjoy the pregnancy anyway!

Let's start counting down! 

WEEK 30 : Week by Week Incompetent Cervix Pregnancy Guide - THE PREMATURE BABY

NOTE : For the regular advice on Week 30, 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 23 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.
It has been researched that babies born after 23 to 26 weeks of pregnancy have a 50% chance of survival.  That is a good figure especially for some of us who had never carried that far before.  Or those of us who did not know we had an incompetent cervix until it was already too late to have a cerclage placement.  After 28 weeks, the little one has 80 to 90% chance of survival, and a normal healthy life subsequently.  It is also more common for those carrying multiples to have premature babies, not to say some carry to fullterm with a cerclage intact.

Having said that, those who have had a preemie in an NICU (Neonatal Intensive Care Unit) will know better than to expect an easy road ahead.  No matter what the statistics say, there is still the other 20 to 90% chance of something going terribly wrong, and the anxiety alone is enough to make us cringe at the thought of having a premature baby tied to tubes in the hospital for weeks, maybe months.  Breastfeeding is practically impossible, and some of us are not even allowed to hold or touch our baby for fear of infection.

The severity of complications that may be involved either immediately after birth or later in life very much depend on the birth weight of the little one (read further http://www.healthline.com/health/pregnancy/preterm-delivery-premature-baby#1) and the neonatal care received.  A lot of other factors will also determine the survival of a premature baby, and it is widely believed that baby girls are more likely to survive, as are singletons than multiples.  One deciding factor is also whether the doctor had time to administer steroids before the birth to speed up lung development.

All mommies with a preemie will tell you the thing they look forward most is to bring baby back home - it is usually an indication that the doctor is confident that all is well from now on.  Then of course the practical issues of looking for clothes and booties small enough for the little doll come into play.  And mommies being mommies, some of us will stay up all night eventhough the little one is fast asleep as we just feel the compulsion of checking on his/her breathing every 5 minutes.  Caring for a premature baby at home is sure to be different from caring for a fullterm baby, but it does not have to so gut wrenching.  Get all the support you are offered, and ask all the questions you need to ask your specialist before you leave the hospital.

Yes it may not be the road we would have desired, but with an incompetent cervix, this is a possibility which we always have to consider.  The possibility of having a preemie, that is.  Many of us carry to term, of course, with proper care and preparation, but for those who don't trust in the statistics, and trust in God.  And once baby is back home, treasure the homecoming, cherish the moments, perhaps even have that baby shower (Read Week 29 here) which you have planned earlier but had to cancel you went into labour before the party day.  Baby is home.

But hey... if you are still happily pregnant, I'm sure you will be feeling more at ease now.  Stitch is still there, you are back to running to the bathroom every half hour, and you are waddling around without being able to see your toes, but even if baby comes now, there is no longer the intense worry and anxiety you endured earlier when baby wasn't yet viable.  Now just enjoy the rest of your pregnancy and get those things which you haven't been able to get going the last few months... GOING! Yes, and I mean the crib, the nursery, the shopping, the nesting!

WEEK 29 : Week by Week Incompetent Cervix Pregnancy Guide - A BABY SHOWER OR NOT?

NOTE : For the regular advice on Week 29, 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 23 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.

Now that we are past viability and in our 3rd trimester (Read Week 28 here), and the reality of finally having this beautiful rainbow in our arms is more imminent, should we finally shoot down the taboo and announce to the whole world about our pregnancy and start stocking up on the baby stuff?  Some of us may want the news of our pregnancy be kept a secret still, maybe because we have suffered losses before and it would be easier to cope if we don't have a load of people asking us about our 'baby' or our 'pregnancy' should we lose this baby too.

Yes, this is one of the emotional upheavel that we have to deal with, which not many may understand.  Many do not understand why we simply refuse to share such good news, or why do we have to make it such a big deal by keeping it such a hush hush.  But oh, who would understand the feeling of renovating and decorating the entire nursery only to come back from the hospital without a living baby?  Or the feeling of shopping for baby booties, rompers, diapers, towels, cute little hats only to have it hung meaninglessly in the closet for many more months to come?  What about those thousands of pictures of your bump and ultrasound scan you uploaded onto your Facebook in the album titled "The New Addition to the Family!"  How are we going to go through that again if it happens yet again? 

One of the Jewish traditions is that we should not even have any items for the baby in the house before baby is born.  For the traditional Chinese belief, the child should not be given a name yet, so go as far as not to even mention the gender of the baby. Friends and relatives should respect those who hold on to this belief and not buy gifts for the unborn baby just yet, or to enquire of the gender.  On the other spectrum, many cultures hold baby showers to celebrate the arrival of the pending newcomer into the family.  Many women take this opportunity to announce their pregnancies, and of course, to distract them from the pains of pregnancy.  Others have more practical reasons, like receiving gifts for the baby before the arrival so that they know what do they already have to avoid duplicity when they shop for their baby.

Whatever beliefs, traditions or superstitions you may hold, you are still very uncertain at this point whether to start piling up on the diapers, and whether to start setting up the crib.  Of course you are.  You baby is still very premature at this point if he or she is born, and with an incompetent cervix, with or without a cerclage, only God knows what will happen tomorrow, or even the next minute.  

For me, with No.1, I didn't know of my condition until after I started dilatting at Week 23.  So of course the whole world knew about my pregnancy, I was hitting the gym 5 times a week 3 hours a day with my bump, and I practically announced to the world the moment the pee stick showed 2 lines.  It was my 1st baby!  But with No. 2, I was more cautious, eventhough I had a strong preventive cerclage in at Week 14.  But I went on with my activities a month after my cerclage placement, so those who noticed... knew about my pregnancy.  No. 3 (my current 23 weeker) is a totally different story.  It is my 3rd stitch, and my cervix has been traumatised over and over, and I am allowed only bathroom and meal privileges - otherwise I'm off my feet. And home.  Alone.  I have only told family and closest friends of my pregnancy, and I do not intend to tell anyone else until the baby is safely in my arms.  I need a lot of positive energy and support, and there is really no need to announce to those who may be snickering behind your backs saying "2 wasn't enough with that condition? or "Didn't she have that cervix thing? No.3? Serious?"  

Whatever you may decide, it truly depends on how you FEEL.  You don't have to feel obliged to anyone to hold a party or to tell them about your pregnancy.  Hold the baby shower at Week 37 after your stitch is out if you want to!

WEEK 28 : Week by Week Incompetent Cervix Pregnancy Guide - 3rd TRIMESTER!

NOTE : For the regular advice on Week 28, 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 23 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.


Are we really in the 3rd trimester already? Yes, we are almost there! Can you believe that we have actually stayed in bed for the entire 14 weeks since our cerclage??? WOO HOO!!!! This calls for celebration! A glass of red wine, perhaps. I heard it's good to settle down contractions. :)

While other websites for normal pregnancies will tell you to look out for signs of diabetes, pre-eclampsia and all those 'normal risks', well, as IC mommies, what we should look out for is preterm labour (read all about it in Week 27).  You may ask, what is the difference between the 'normal' preterm labour and preterm labour as a result of the incompetent cervix?

Well, preterm labour can happen anytime after your 20th week of pregnancy (before the 20th week it is considered a miscarriage), and there are many causes, including an incompetent cervix.  The thing about an incompetent cervix is, there is usually nothing wrong with our babies, or uterus, or the placenta, or even our physical wellbeing.  We are healthy, there is truly nothing wrong with us or our babies, it's a MECHANICAL problem.  The cervix is supposed to do its job and keep the baby IN and other things (like infection) OUT (read Week 9) .  It is supposed to shorten, dilate and open only shortly before labour, not in our 2nd trimester! Unfortunately, this is what it is all about. It either shortens, or dilate, or funnel, way before it is supposed to.  Some of us are born with a short cervix anyway.  The cerclage (read Week 13 and Week 14) seems to be the popular option, believed to be 80 to 90% successful in keeping the babies in until fullterm.

Most doctors prescribe bedrest together with a preventive cerclage in a planned incompetent cervix pregnancy, and I remember I was up and about a month after my 2nd preventive transvaginal cerclage.  But each cerclage is as different as each pregnancy is different, as each woman is different. If you have come this far, you will be in a state where you know the chances of survival of your baby is high even if she/he is born prematurely now, but then again, we always want the best for our babies.  If we can carry till fullterm, why do we want to take any risk at all?

This is a week where you just sit back and reflect.  Your journey may have been different from mine. You may have lost your babies before, and Week 28 is the furthest you have ever been.  You may be pregnant for the 1st time and struggling to understand what is this incompetent cervix all about.  Or you may have been thoroughly prepared, mentally, physically and financially, for this pregnancy which you know is going to be a high risk one.  Or you have just been diagnosed and it is too late for a cerclage and you don't know if you can carry to fullterm.  Whatever your journey entails, stay strong and have faith.  I never knew I was going to have 2 beautiful boys, and pregnant with a 3rd one - a baby girl, what with PCOS and an incompetent cervix to top that.  Miracles do happen.

Remember to eat healthily, take the opportunity to rest and see this bedrest as a blessing to soul search.  To bond with your children at home.  And be thankful for all the support you have received through this all.

WEEK 27 : Week by Week Incompetent Cervix Pregnancy Guide - PRETERM LABOUR

NOTE : For the regular advice on Week 27, 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 23 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.
 

How are we all doing?  You know, one of the scariest thing to happen to us right now is to wake up in the middle of the night with a gush of water coming out from our vagina.  That is just not good.  Neither is wiping (or worse, gushing) bright red blood from under there.

This week, let us discuss what we dread : PRETERM LABOUR.  It is our main concern - heck, it is the ONLY concern of IC mommies.  Many of us know too well about how our babies were looking hale and hearty in the ultrasound scan just few days ago only to wake up the next day with a traumatised loss of a perfectly healthy baby.  For those of us who did not have a cerclage in (Read WEEK 26 on IC without cerclage), it may even be more worrying than ever, and we are probably obsessing over every little sign of a preterm labour.  If you are carrying multiples, I can only try to understand the worries that are going through your mind.  We IC mommies more often than not have turned into OCD worry warts :)  The good news is, the majority of women who have symptoms of preterm labour WILL NOT DELIVER EARLY.  But it helps to recognise some of the signs and symptoms as the earlier we catch it, the earlier we are able to seek treatment.

So what are some of the signs of preterm labour?

• Regular contractions: That is, those that come every 10 minutes (or more often) and do not subside when you change position (try lying down on your side). These are not to be confused with Braxton Hicks contractions that you've possibly already begun to feel, which are practice contractions that are no cause for concern (they’re irregular, don't intensify and subside when you change position). If you're not sure, call your practitioner anyway.
• Change in vaginal discharge: Look for blood-streaked discharge (“bloody show”) or vaginal bleeding.
• Fluid leaking from your vagina: It could be a sign your water’s broken. Take a sniff test: If it smells like ammonia, it's urine. If it doesn't, it could be amniotic fluid.
• Period-like cramps: Strong cramps you feel in your lower abdomen or lower back could be a sign of labor.
• Back pain: A constant low, dull back pain may be a sign of labor. 
• Increased pelvic pressure: If you feel a significant increase in pressure in your pelvic area, call your doctor.

Keep in mind that you can have some or all of these symptoms and not be in labor (most pregnant women experience pelvic pain/pressure or lower back pain at some point). But only your practitioner can tell for sure, so pick up the phone and call. After all, better safe than sorry.

What to expect if you experience premature labor

If you're experiencing any symptoms of premature labor, your practitioner will want to assess you – either in the office or the hospital. Here’s what to expect:
Tests for premature labor: You'll first be hooked up to a fetal monitor to check for contractions and to make sure the baby is not in any distress. Your cervix will be examined to determine if any dilation or effacement has begun, and your practitioner will probably use a vaginal swab to test for signs of infection and possibly fetal fibronectin. You might also receive an ultrasound to assess the amount of amniotic fluid and to confirm the size and gestational age of your baby. If these tests and exams show that you aren’t in labor, you'll be sent home, often with instructions to take it easy — or perhaps to go on modified bed rest.
If your practitioner thinks you're in premature labor: Because each day a baby remains in the womb improves the chances of survival and good health, your doctor’s main goal will be holding off labor for as long as possible. He or she may put you on bed rest. Or, depending on how far along in the pregnancy you are and what other complications you may be having, she may admit you to the hospital, where you may receive any or all of the following:

• Intravenous fluids: The better hydrated you are, the lower the chances of continued contractions.
• Antibiotics: You may receive antibiotics, especially if infection is believed to have triggered labor. And if you haven't yet been tested for Group B strep (the test is usually performed after 35 weeks), you'll be given IV antibiotics to prevent possible transmission of the bacteria to your baby in case you are indeed a carrier.
• Tocolytic agents: Your doctor may give you medications (like magnesium sulfate) to relax the uterus and, in theory, temporarily stop contractions. These are usually only dispensed if you're less than 34 weeks pregnant and if your baby's lungs are deemed too immature for delivery.
• Corticosteroids: If your baby's lungs are still immature, you’ll receive these medications to speed fetal lung maturity.

If at any point your practitioner determines that the risk to you or your baby outweighs the risk of preterm birth, he or she will not attempt to postpone delivery. The good news is that for about 30 percent of women, preterm labor stops on its own, and only about 10 percent of women who go into preterm labor give birth within the next seven days. (Source : http://www.whattoexpect.com/pregnancy/preterm-labor/)

 So, lesson to take home this week : PREPARE FOR THE WORST, BUT HOPE FOR THE BEST!

 

WEEK 26 : Week by Week Incompetent Cervix Pregnancy Guide - IC WITHOUT CERCLAGE

NOTE : For the regular advice on Week 26, 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 23 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 LITTLE DARLING IS A 2 POUNDER THIS WEEK!!!  And her/his peepers which have been closed shut the last few weeks are starting to... yes, you guessed it, PEEPING NOW!!!  Ok, while the other normal pregnancy mommies are revelling in the colour of little babe's eyes and whether those Asian babies have a double eyelid or not (a constant discussion in this part of the world where I'm from), I understand that we IC mommies have other things in our minds.

Some of us are back to work as usual (that is, if our work designation allows us to do so, and our cerclage is textbook cerclage with no complications).  Many of us are still not supposed to exercise (Read WEEK 25) nor have sex.  At this point of our IC pregnancy, most of us are more or less settled with our cerclage, even for those of us who had an emergent one.  

 

Unfortunately, if this is your first pregnancy and first diagnosis, your doctor may have refused to perform the emergency cerclage as it is usually performed before Week 24.  Your doctor may also have refused to perform the cerclage as you are already more than 2 cm dilated, or your waters have broken.  Some doctors even refuse to do it if your membranes are bulging, but do get a second opinion as I have heard of doctors who successfully perform an emergency TVC even with bulging membranes.

 

If you do not have a cerclage, you are probably prescribed with strict bedrest and progesterone medication (it could be in the for of vaginal suppositories, injections or taken orally).  Some of us need to be in hospitalised bedrest and be in an 'upside down' position, otherwise known as the "Trendelenburg position".  The idea is always to take pressure off your cervix.

 

 

The latest technology suggests the use of a cervical pessary.  It is a device that fits inside the vagina and is designed to hold the uterus in place, in order to help lessen pressure on the cervix.  Being a fairly new technology it is still debatable whether the pessary works for us IC mommies, but then again, bedrest and cerclage are considered 'controversial' in some quarters too. 

 

 

Remember, miracles do happen and there have been many success stories.  You can still carry to term even if you have been diagnosed with an incompetent cervix and it is too late for a cerclage.  In fact, some women have reported that even after their waters are broken, they are able to keep the baby in with antibiotics and other medical intervention.  Have faith, and say a little prayer.  Do join the facebook Incompetent Cervix community where this group of ladies will just keep you company throughout your journey (they have helped me through my 1st emergency cerclage and my 2nd preventive cerclage and currently my 3rd baby!) without being judgmental or insensitive.  Take heart!

WEEK 25 : Week by Week Incompetent Cervix Pregnancy Guide - The Fitness Mom

NOTE : For the regular advice on Week 25, 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 22 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.
 
 
From now on, take comfort in the fact that baby is going to put on more and more weight.  And birth weight is always associated with viability of a preterm baby (Read more about viability in Week 24).  Of course we are still heading towards fullterm, but we also know that our pregnancy is a high risk one. 

You are probably piling on some, too. Weight, that is. If you were a fitness freak who thought you could kickbox your way through to birth day, you may have been sorely disappointed when you were diagnosed with an incompetent cervix as you know then it is no longer possible.  Even for those of us who need not go on strict bedrest, high impact exercises are certainly not encouraged.  And for some reason the flab comes on faster than the muscles don't they?  I mean, it took us ages to tone those thighs and arms, but now 6 months into our pregnancy and perhaps bedrest for the last 3 months and there... the clumpy flabby disgusting looking bye bye granny arms and thunder thighs. UGH!!!! 

Fret not!  First of all, we will probably lose all the cellulite (that's what those clumpy looking thing is, and it's made up of water retention due to our pregnancy and of course... lack of exercise) within the first 6 months of exclusive breastfeeding (I lost mine within 3 months as I was producing something like 18oz of breastmilk every 4 to 6 hours - yea they call me COW).  And of course you can go back to the gym after your period of confinement.  Just to encourage you guys, I gained a total of 24kg for my 2nd pregnancy (I was on modified bedrest since cerclage was in at Week 15 all the way till Week 37 when stitch was off and my appetite was GREAT at all times) but lost 27kg within 4 months after given birth all just through breastfeeding. No dieting (if I was eating like a horse during pregnancy, I was eating like 5 horses throughout my 2 year breastfeeding period) and no intensive exercise.

Ok, that's after confinement.  What about now? Surely there are some exercises we can do now, bedrest or not? Furthermore, totally no movement isn't exactly healthy and may cause side effects like deep vein thrombosis and pulmonary embolism.   Here are some exercises which you may safely do even with prescribed bedrest, but DO CHECK WITH YOUR DOCTOR first, as all our incompetent cervix pregnancies are different.

1. Kegels: Draw the pelvic-floor muscles that surround your vagina up like an elevator climbing up to your belly button, tightening them as if you are stopping the flow of urine; do not squeeze your buttocks. Hold for 10 seconds, breathing normally, then slowly release. Repeat 10-20 times. Benefits Helps you identify, control and strengthen your pelvic-floor muscles; this can help prevent urinary incontinence and speed healing after childbirth.

2. Chest and shoulder opener: Lace your fingers behind your head, opening your elbows wide. Sit tall and lean back slightly, lifting your chest as you breathe deeply until you feel your ribcage expand. Exhale as you draw your elbows down toward your knees and relax. Do five times, building up to 10. Benefits Increases lung capacity, improves posture, stretches the chest and shoulders and makes you feel alert and awake.

3. Ribcage breathing: Grasp your upper torso, spreading your fingers wide along your ribcage. Inhale deeply through your nose (feeling your ribcage expand under your fingers). Exhale through your mouth as you gently draw your belly in and do a Kegel. Do five times, working up to 10. Benefits Strengthens your deep abdominal and pelvic floor muscles; improves breathing and circulation, giving you a boost of energy.

4. Gentle pelvic tilts: Sitting “Indian style,” with knees bent, inhale through your nose as you lift your chest and lengthen your neck, arching your back. Exhale through your mouth as you round your spine, gently tucking your pelvis under, and draw your abs in as you do a Kegel. Return to the starting position and do five times, building up to 10. Benefits Promotes circulation throughout your entire body and gently tones the deep belly muscles, aiding digestion.

5. Upper-body strengthener: Pull your abs in and draw your shoulders back and down as you raise your arms out to the sides at shoulder height and bend your elbows 90 degrees. Inhale, then exhale as you press your arms overhead, squeezing your arm, shoulder and upper back muscles. Keep squeezing as you slowly lower your arms. Repeat 10-15 times. Benefits Increases upper-body strength and stamina (you’ll need these to carry your baby and all her gear!) and improves posture.

6. Lower-leg mobility: Stretch your legs out in front of you and pull your abs in. Roll your ankles clockwise10 times, then switch directions. Next, flex your feet, pointing your toes toward your knees. Repeat 10 times. Benefits Increases lower-leg circulation and helps maintain strength and flexibility.
(Source : http://www.fitpregnancy.com/pregnancy/pregnancy-health/bed-rest-workout)

If you are advised to refrain from even these exercises, then do so.  After all, we are already at this point, and we do want a healthy fullterm baby don't we?