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!
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!
