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.

WEEK 23 : Week by Week Incompetent Cervix Pregnancy Guide - COPING WITH BEDREST

NOTE : For the regular advice on Week 23, 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 21 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.
 
 
I remember my last pregnancy (my 2 and half year old was born April 2012), when I was at 23 weeks around Christmas season.  I was going about my usual Christmas shopping, carolling even with the local choir group, and preparing for the most wondrous time of the year 2011. I am expecting an April baby again, but this time around, things are not as fa-la-la merry.  This is my 3rd cerclage and my obgyn observed during the procedure that my cervix was now badly damaged and there were a lot of scar tissues from the previous cerclages.  Bedrest is no longer an option, but a necessity. 

(yup that was me... the one in pants... only I was allowed to wear pants as I couldn't find  a skirt which fits)

Yes, if all things go well with your preventive cerclage (even if it's a transvaginal cerclage and not a transabdominal one, which most will tell you no bedrest is needed with the latter) then more likely than not, you will be able to go on with your normal activities.  Truly, those websites which tell you that now is probably the time when you feel your best - they are not that far wrong.  The nausea is definitely gone, your little one's kicks and punches are assurances that she is doing well in there, and you are no longer looking like a whale yet.  So yea, you should be feeling well.  But some of us may be feeling the woes of an INCOMPETENT CERVIX pregnancy at its peak now, and there are many reasons for it (do read Week 22 here).

But fret not! SURELY there are some stuff you can do lying down right? Here are some ideas :

1) Read all those novels which you bought at the book fair 3 years ago which are gathering dust on your bookshelf!

2) Entertain your older children with the good ole Monopoly, Scrabble or Snake and Ladder!

3) When was the last time you actually sat down through a 2 hour movie? Well, now is the time!

4) Go ahead, feel beautiful and pampered with a pedicure/manicure session!

5) Start a journal for you little one, you can keep it in a box file together with her/his 1st foot print, congratulatory cards and other momentos for your baby's reference in her/his later years! Or if you wish, start a Facebook account for him/her right now!

6) Write a blog, like what I'm doing now. Or write that novel you have always wanted to. Or that poem, perhaps even that song you have always wanting to write all your life but never found the time to!

7) It's almost Christmas right? Bring out those art and craft stuff (ok, get hubby to dig them out from the store room) and start working on handmade Christmas decor and greeting cards with your older kids!

8) Shopping online anyone? Well, I have no choice but to do that (thank God for technology) for my Christmas shopping this year!  

9) Get chatting in parenting forums, incompetent cervix forums, make friends with other mommies from all around the world who understand what you are going through (you will realise that these strangers understand you more than the 600 'friends' you have in your Facebook friend list)

10) JUST LIE BACK! Relax, stare at nothingness and revel in the fact that you are pregnant, sleep, nap, hum a few Christmas tunes, and remember to thank God and sing praises to Him for all the blessings in your life!

1 more week to viability! HURRAY!

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 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!