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 13 : Week by Week Incompetent Cervix Pregnancy Guide - RISKS OF CERCLAGE

NOTE : For the regular advice on Week 13, 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.

If you have a scheduled transvaginal cerclage, your anxiety may start to set in.  This is the final week leading to THE day.  You have heard of the risks, but you also know that the advantages outweighs the risks, and preventive cerclages have been known to be as high as 80 to 90 percent successful.  Successful as in these IC mommies manage  to carry baby to term, or 37 weeks.  Most IC moms do not even dream of full term, most of us look for the V-day, or the date of viability.  Babies start to have a small chance of survival after 24 weeks, before such date most doctors do not even want to consider any measures to save the baby if it was born prematurely.

So what are the known risks of the transvaginal cerclage?

• As with most invasive surgeries, there is always the risk of infection
  
• The procedure may also trigger contractions which may further damage the cervix, the cerclage, or may cause preterm labor.
  
• Spontaneous delivery may occur during the procedure or soon thereafter.
  
• Premature rupture of membranes
  
• Tearing or rupture of the cervix if labor begins before the stitch is removed, or on the other hand, what is known as cervix dystocia, where the cervix is unable to dilate even after the stitch is removed.
  
• Injury to bladder/uterine rupture
  
• Risks of anesthesia
  

 At this point, you may, or may not want to know what is to come.  Some women find it comforting to know exactly what and how the procedure is carried out, whilst some others would rather not know - in fact some may favour elective general anaesthetic instead of the spinal block so they do not have to go through the ordeal in the operation room!  So, to those of us who want to know, what does a transvaginal cerclage entail?

First of all, of course you would have been told by your doctor to fast the day before, at least 10 hours before surgery.  If you are prone to gastric or heartburn, do let your doctor know so he may prescribe some medicines to be taken the day before.  If you have been using vaginal suppositories, you may want to check with your doctor whether you should continue to do so the day before.  And common sensically, do not have sexual intercourse (besides, at this stage of your incompetent cervix pregnancy you shouldn't even be having anymore pelvic activities!)


The Day of the Procedure

• Just before the procedure begins, an intravenous (IV) line is placed in your hand or arm. It delivers fluids and medication into the body.
  
• You will be given anesthesia. This is medication to keep you free of pain during the procedure. Depending on what type you are given, you may be relaxed, drowsy, or fully asleep during the procedure.
  
• During the procedure:
  
  • A speculum will be put into your vagina to hold it open.
    
  • Local anesthesia may be injected into the cervix to numb it.
    
  • The doctor uses instruments through the vagina to stitch the cervix closed. Surgical thread is used. Knots are made to hold the thread tight until it is cut later in your pregnancy. In many cases, the thread is wrapped around the cervix and pulled tight.
    

After the Procedure

• You will be taken to a room where you’ll recover from the anesthesia. Nurses will check on you as you rest.
  
• You will be watched for signs of premature labor. You will also be given medication that helps prevent premature labor.
  
• Your baby’s heart rate will be monitored.
  
• You will have some light bleeding and cramping. This is normal. You will likely be given pain medication. If you are still in pain, tell the nurse.
  
• You may be able to go home later that day. Or you may stay overnight in a hospital room to be sure you do not go into premature labor. When you leave the hospital, have an adult friend or family member drive you home. (Source  : University of Minnesota Medical Center)
  
  Of course mental preparation is essential as well.  This is the time when you may want to announce the news of your pregnancy to friends and family, perhaps even church members, and at the same time request for prayers for your procedure.  You may find yourself having to explain to them what is incompetent cervix all about, and what procedure this is, including its risks.  And I hope by this time you have informed your employer about your impending bedrest, and that whether or not it will be until birth or just a few days/weeks will very much depend on the development of various factors.
  
  All the best for next week!
  

WEEK 10 : Week by Week Incompetent Cervix Pregnancy Guide - PRE-CERCLAGE ARRANGEMENTS

NOTE : For the regular advice on Week 10, 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.
Ok, this may be the week where one of the things you would want to do before bedrest commences, would be to bring out those boxes of pregnant clothes which you have stored away some couple of years ago waiting for this day! :)  If this is not your first baby, you are probably starting to show, even if you are not, your probably can't squeeze into your skinny jeans anymore.  Your colleagues whom you have not broken the news to may think you should start laying off those daily afternoon tea (which comprised of 3 scoops of chocolate mint ice cream and 3 packets of Twisties and 2 large mango smoothies... and they do wonder why you don't drink coffee anymore at 4pm when your blood type previously was essentially COF2E2?) as you do look fuller and rounder.

Of course if is your 1st pregnancy and you don't even know you have incompetent cervix yet, you may still  be hitting the gym 5 times a week looking like a fitness instructor still.  But if you are reading this, perhaps it's time to just be a little aware.  Unfortunately this condition does not show itself until much later, well into your 2nd trimester.  Perhaps that's why old people always warn us against too many activities during pregnancy - they know many things can happen.  Besides, this is one condition that is almost symptomless and not very common. You may want to read myWeek 9 post for some of the horrors that can befall upon us. 

For those of you with twins, of course you are starting to look pregnant! I'm not really sure about twin pregnancies - whether you do need to go in earlier for a cerclage. I have read somewhere that yes you may need to but perhaps only a week or two earlier, as they really do need to be sure that your placenta is fully formed and you are past your 1st trimester (at least at the tail end of it) before they attempt a transvaginal cerclage.  They also want to ensure that there are no structural abnormalities and that the foetuses are of a certain growth rate before they decide to place the TVC.

In any case, start preparing for that dreaded (or welcomed) bedrest.  Have you made meal arrangements? Laundry and cleaning arrangements? What about your older kids? Mentally prepare yourself, and mentally prepare dear hubby. He will have to juggle a full time job, a little bit of housework, managing and caring for the kids (who are probably still preschoolers/toddlers) and of course work arrangements with your boss.  Yes, you will have to let him/her know at some point VERY soon.  You may even get the green light from your OBGYN to go ahead with normal activity except heavy carrying, exercise and pelvic activities, but I always tell myself "Prepare for the Worst, but Hope for the Best"

WEEK 1 : Week by Week Incompetent Cervix Pregnancy Guide - ANOTHER IC BABY

NOTE : For the regular advice on Week 1, 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.

This is your menstruation week. The battle you had with PMS last week is finally over. You may have cramps, but well, we know what to do, don't we? 

After all, if we have been battling infertility problems (and somehow I found out that either by coincidence or by scientific reasons, those suffering from incompetent cervix tend to suffer from PCOS as well - that's Polycystic Ovarian Syndrome, a condition where you do not ovulate regularly if not at all), the first signs of a period is the most welcoming sight. It means we are starting that journey to holding a baby in our arms!

Yes, Week 1. Some of us may have planned for this baby all our lives.  Some of us may have been trying for the longest time, and the signs of period means another session of sitting on the toilet bowl bawling our eyes out as it means our last attempt about 2 weeks ago failed yet again. Yet to some of us, this is just another cycle, life goes on.  For those who are indeed trying for a baby, do start on those folic acid.  Yup, a good time to start preparing for that journey to motherhood by just simply taking enough supply of the good ole folic acid.

If you are planning for your first pregnancy, you probably wouldn't have heard of incompetent cervix yet.  Sadly, you will first hear or it either when you are already on the verge of losing your baby, or you have already lost one. Or two. Or more. Losing a baby is not something I would wish for my greatest enemy, so if it has happened to you, I am sorry.  Truly I am.  If you are on your 1st pregnancy and you read this blog on time, please ask your OBGYN about this condition when you are approaching the end of your 1st trimester. Ask for a cervix length check. Just be aware.  But if you have lost a baby due to this condition before, or if you are trying for a second baby after a successful cerclage previously, there tend to be some apprehension.

Yes, after the last ordeal, perhaps you don't want to try for anymore children.  Whether or not you already had a surviving child or not, you just cannot imagine going through the ordeal again.  I almost lost my No. 1 at 23 and half weeks and was already bleeding blood clots, but my OBGYN performed a TVC (transvaginal cerclage) anyway, and I was on bedrest for the rest of the pregnancy and gave birth to a beautiful baby boy at 38 weeks. Ian is 6 years old today.  And well, many told me that perhaps I should stop there. No more babies. Too much risk.  Too many issues.  Too financially and emotionally straining.  Some gave unwelcomed advice like "You shouldn't exercise when pregnant" (I mean yea, I was hitting the gym 5 times a week 3 hours a day doing kickboxing and step aerobics but that is not the cause of an incompetent cervix!!!) and many thought this is the case where my womb isn't strong, or that I'm simply not a strong enough woman to carry a child.  So at this point, if you are preparing yourself for another pregnancy, just bear in mind that it is yours and your husband's decision. If he is being influenced inadvertently by all those ill informed advice (eventhough may be well meaning) then pull him back and head to your OBGYN's office. Listen to the professional, not the ignorant advice (again, though may be well intended).  YOU CAN HAVE ANOTHER BABY.

So, breathe in, take your folic acid, quit smoking and drinking, and prepare your body for next week... the week for intense lovemaking sessions :) :)