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 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.