WEEK 17 : Week by Week Incompetent Cervix Pregnancy Guide - CERCLAGE WOES

NOTE : For the regular advice on Week 17, 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.
 

How's the bedrest coming along?  Whether it is a modified bedrest, strict bedrest or simply told to 'take it easy' after the cerclage placement, your lifestyle would have changed quite a bit.  If you were a health freak to begin with (read : 3 hourly 5 day weekly intensive gym sessions) then any form of 'take it easy' will be enough to make you cringe by now.  After all, it has been 3 weeks.  I felt totally incompetent after my strict bedrest with No.1 (it was an emergency TVC at 23w4d that no one saw coming) but at the end of it when I held my full term baby in my arms (truly, my miracle baby, as I didn't even know the implication of being 100% effaced and 2 cm dilated at that point of time), it was all worth it.

Listen to your doctor.  Even if you feel upbeat, anything can happen anytime.  Your cerclage is not foolproof.  You don't really want to take a gamble, because once it happens... there is no way to stop it.  And there is no turning back.  You would have lost a baby, as your baby is not yet viable at 17 weeks, and you really don't want to be going through what I went through (and am still going through)  (read Week 16).  You just have to be mentally strong, for the sake of your baby.  I agree that no amount of preparation would prepare you for a prolonged bedrest, but see it as an opportunity to gather your thoughts, indulge in your hobbies like reading, crocheting, or maybe just being a couch potato for once.  I mean, since the birth of your oldest child, when was the last time you caught up with the latest season of CSI and CSI: New York and Law & Order : SVU?

Well, you may even want to catch up with friends, arrange for them to visit, or a simple chat over the phone or over the internet.  Learn to meditate, pray, start a blog, and what I learnt 19 weeks into my 3rd bedrest is... HAVE A SCHEDULE!  If you can get yourself into a routine, time will pass faster.  I have even arranged for my miracle 6 year old to be home after school instead of daycare so that I can spend some time with him.  He can even help with fetching me a glass of water or picking up the toys he and his 2 year old brother left behind the previous evening.  Once there is a routine going, it wouldn't be so bad.  Here's an online forum which offers great help, advice and sharing from moms who are in the same boat as you! http://mamasonbedrest.com/2011/01/2100/

Also, this week, especially if this is not your first pregnancy, look out for the familiar flutter in your tummy.  You may begin to feel the little one moving, and it is another milestone where you are suddenly reassured that there is actually a little human being inside you.  Continue to eat well, and be alert and aware at all times of any tightening, and any discharge.  Many of us worry about colourless discharge at this point, as we often worry about leaking amniotic fluid due to our incompetent cervix.  But bear in mind that you may be on progesterone suppositories, and this may increase some watery discharge.  If the tightening persists over long periods of time, or becomes too often throughout the day, do mention to your doctor. In normal pregnancies (and you may read this on other normal pregnancy guide websites), this is called the 'practice contractions', or the Braxton Hicks contractions, which, in NORMAL pregnancies, may not affect your cervix.  But we already know don't we, that our pregnancy is far from normal.  In fact, it is a high risk pregnancy.  And an incompetent cervix means you dilate without symptoms in the first place. So any form of contraction is no good.

The take home this week is : Stay alert.

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 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.