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 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 24 : Week by Week Incompetent Cervix Pregnancy Guide - VIABILITY!

NOTE : For the regular advice on Week 24, 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.
 
 
REALLY??? We are in Week 24 already? Well, we made it to viability!

Ok, so what is this viability all about? What does it mean? Does it mean my baby will definitely survive if he/she is born now? Does that mean I don't have to restrict my activities anymore and there are no more worries? 

Well, the good news is... Yes, your baby will have a chance for survival if she/he is born now, and if you do go into preterm labour, your doctor will probably take all the necessary steps (do whatever they can) to save the baby.  Before this... well... before this, they may just tell you 'that there is nothing that they can do', which translates to : If your baby is not yet 24 weeks, they will just consider it an unfortunate miscarriage which they can't do anything about.  But now if you do go into preterm labour, they will do everything that they can to save the baby!

 (Source : http://www.mamasaidknockyouup.com/2013/02/fetal-survival-rates-week-to-week.html)

The bad news is... the baby is still terribly premature. 24 weeks is about 6 months... we are still 3 months short, and there is a good reason why nature requires a 9-month period of gestation, not 6.  In fact, in normal pregnancies, these women are told to watch out for signs of preterm labour as from now till Week 37, our babies are still considered premature and will have to be confined to NICU for a while.  

So, NO, viability just means that the doctors may try to save our babies, and our babies have a better chance at surviving and then go on to live happy healthy lives, but that doesn't mean you are off the hooks.  Why take unncessary risk when you can help it? Stay off your feet still - bedrest isn't all that bad (Read Week 23 here).  Ask any mom who have had a premature baby, and you will know the tears and heartache which you will have to go through before your little one can finally go home.  I mean, wouldn't it be a truly happy occassion if your baby can actually latch on and feed off your breasts right after he/she is born and to be able to breathe on his/her own without painful tubes all over them? Both my boys were jaundiced when they were born, and seeing them naked under the phototherapy is painful enough to watch, what more if they have to breathe and feed through tubes.  So ladies.... hang in there.  After all we have made it so far so why take risks?

But on the psychological side, yes, you can mentally relax.  Stop fretting over every single tingle and twitch, and start to enjoy the pregnancy from now onwards.  Enjoy your healthy meals (and those no-so-healthy tub of ice cream and 3 pieces of crunchy deep fried chicken) and enjoy bonding with your little baby who by now is creating a little gymnasium of his/her own in your tummy.  Take comfort in the fact that if the worst happens and the little one is born now, there is at least a 50% chance for survival, unless the previous weeks.  Anxiety is NOT a healthy part of pregnancy, and many believe that it will affect your baby's mental wellbeing as well.  Try to smile more to dear hubby who has been so supportive all these weeks (eventhough some days they may not SEEM to be so TO YOU, but truly, they HAVE BEEN).  Believe me... I know.

This is a good week. And congratulations that you have made it to this date.  Before you knew it, the 3 months would have sailed by and you will have your little bundle of joy in your arms.