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A little thing called a cerclage

Posted Mar 05 2011 11:43pm
I found out very early in this pregnancy that I was pregnant.  Since the first day my doctors knew, I’ve been on a pretty rigorous doctor schedule.  Early on, he started explaining the decisions I would have to make in this pregnancy.  Basically, they never had been able to identify what had lead to my preterm delivery.  My doctor thought it was an incompetent cervix, my specialist doubted it was.  It could have been an abruption on the placenta, it could have been a blood clot on the placenta, it could have been an infection, it could have been a fluke.  No one knew for sure; we were just going to have to take it step by step and monitor closely.  If it had been an incompetent cervix, what I needed was a cerclage (a stitch to hold your cervix closed until 36 weeks).  I met with the specialist and we reviewed my file again, but he was waiting for the report from the hospital to get more information.  Both doctors said I was probably a good candidate for a cerclage. I could either get a preventative one at 13-15 weeks, or wait and see if my cervix did any funny business.  If my cervix started to thin, and I possibly went into preterm labor again, they would have to stop the labor and then put in the cerclage (option two, much more risky and painful).

I did research on cervical incompetence.  Wanna know how they diagnose it?  After losing two or more pregnancies in the second trimester, a woman is diagnosed with an incompetent cervix.  What is that?!?!  That’s like saying, after losing both vision and the ability to talk, we can establish that you are mute.  There was no way I was going through all that I did with JJ, again, so they could know I had an incompetent cervix!  But we still didn’t know that’s what the problem was!

I prayed about it, hoping I would receive a clear answer saying, “get a cerclage.” Or something to that effect.  But if I’d learned anything from these two pregnancies, it was that answers don’t come how we want them, they come how we need them.  So I kept praying and taking to people close to me about it.  I spoke with other women who had lost babies looking for comfort.  Not only was I trying to decide whether or not to get a cerclage, I was also dealing with the anxiety as the 21 week mark neared. 

I was running out of time for the “best time” to have the cerclage.  Then my specialist called me.  My specialist, not his nurse, not his office manager, HE called ME on his cell phone!  He said he’d gotten back my file from the hospital and reviewed it.  He said when I was admitted to the hospital, I was dilated and my membranes were bulging and he thought that was a good sign that I did have an incompetent cervix.  One of my friends has a sister who has an incompetent cervix and was willing to talk to me.   We talked and cried together for over an hour.  She’d lost a few babies in her efforts to make a family, doctors told her to not get pregnant, but she kept trying regardless.  Eventually she was able to deliver three babies in this life.  Speaking with her gave me great peace and I knew that I should get the cerclage, even if it was only for my peace of mind.

I called and scheduled it for my first week of fall break; I was 16 weeks.  I was in the hospital for about 12 hours, racking up over a $10,000 hospital bill (My two day stay with JJ was $13,000- go figure?).  I had to go without food for over 16 hours (in your 2nd trimester, that feels like three weeks!).  I was on mag for 2 hours. I had a spinal and that was the main reason for the long stay- waiting for it to wear off.  All in all though, the specialist was very pleased with how the surgery went.  He was able to get really high on the cervix and make a really strong, tight stitch.

For the following week I was able to take the most lovely, wonderful painkillers.  So wonderful, that right before I stopped taking them, I honestly thought I wouldn’t need them anymore.  (Specialist had said that 1/3 women bounce right back, 1/3 have mild pain, 1/3 are bedridden with pain.) Then, they were gone. Then, the pain returned.  Then a week later, I had to return to school.  That was very tough.  Being on my feet for very long was agonizing.  Making copies was excruciating.  Uh, I’m a teacher.  How am I supposed to do my job without being on my feet or without making copies?  I started to conduct all of my instruction from my stool or desk.  I gave my principal a heads up that it didn’t matter if he was observing me or the Pope was observing me, but I wasn’t going to be able to move around the room for anyone.  One of the office ladies offered to do my copies for me.  I know that woman will receive great blessings in heaven for what she did for me.  My coworkers and team did a wonderful job covering me so I could make all of my appointments and were so supportive.

My doctor told me that with a cerclage successfully placed, my likelihood of problems had reduced significantly.  JJ’s one year anniversary and the 21 week mark both came and went during this period.  I could feel my hope strengthening. 

Starting at week 24, I began seeing the doctor every other week for a FFN test and cervix check.  He noted that the stitch was still doing its job well, but my cervix was softening.  He explained that pointed towards the cerclage having been a good idea for me.

I made it to 28 weeks- a huge milestone!  Most babies born at this point will survive.  I made it to 32 weeks, even better! 

As 36 weeks neared I couldn’t believe we’d actually made it this far.  All that talk about a cerclage and the schedule, and here it was.   The week before I spoke with my doctor and asked him what to expect.  He said it was a very easy procedure and shouldn’t take any more than ten minutes.

I believed him, but to ease my concern, the night before I did some research on the internet about cerclage removal.  Everyone else said about the same thing.  Not really any pain, more discomfort.  Similar to the discomfort of a pap smear and it went really quick.  I felt so much better after reading those posts.   I also had Jason give me a blessing.  The blessing brought me a lot of peace about a lot of things I had been worried about.  I took note that it said I would deliver a healthy baby and be able to raise him up in righteousness. I kept that promise with me for the next 24 hours.

We didn’t know what to expect after the cerclage came out, so we had the hospital bag entirely packed, the car loaded, the house ready.  If we came home with a baby, we were prepared.  On February 24, 2011 at 36 weeks exactly, we went to my appointment.  The doctor’s first attempt was about twenty minutes.  He was able to locate the cerclage, but couldn’t find the knots on the end and didn’t want to cut it until he knew he was in the right spot.  He informed me that I could go to the OR to have it removed or we could try again.  I didn’t want to incur the cost of a hospital trip, so asked him to try again.  We took about a fifteen minute break and I tried to relax.  While he was trying to get the cerclage, I would get uncomfortable, tense up, and then he couldn’t see anything.  Second attempt didn’t go any better.  I think I was even more uncomfortable because I knew what was going to happen and was already sore.  After being in the room for about an hour, he assured me that we had tried hard, but the cerclage was too high and the tissue around it was too soft.  He went and made some calls and then came in and said the specialist could meet me at the hospital at 6:00.  He would remove it in the OR with the help of a sedative or a spinal epidural.  At the time it was 3:15. Jason and I decided to just head over to the hospital.

I was a wreck.  All I wanted to do was cry my eyes out.  Here I was, doing everything I could to carry this baby full term, and what was supposed to be a simple procedure was getting blown grossly out of proportion!  While checking in at triage, we let our family and close friends know what was going on.  We told everyone we didn’t know the plan yet, so didn’t really need visitors.  We were under the impression, the doctor would remove my cerclage at 6:00 and then we’d be free to go home, unless there was anesthesia that needed to wear off, and then we’d have to wait for that.

I get checked into Triage at 4:30 pm with one of the same nurses I’d had while there with JJ.  She actually remembered us.  (I thought that was pretty weird, but then I remembered that Chandler Regional normally will not take antepartum patients before 28 weeks.  So since I was there at 21 weeks and lost the baby, I was probably pretty well known around there.)  She was great, walking us through everything.  Getting me an IV (couldn’t eat since there might be anesthesia involved), hooking me up to the monitors, all that fun stuff.  I asked her if they removed cerclages a lot and she said it was pretty rare.  (Lovely, I’m some huge exception!) Then the anesthesiologist came in and said we needed to wait until it’d been eight hours since I’d eaten, so he wanted to bump the procedure to 7:20.  Whatever, it wasn’t like we had anywhere to be.  And the more time I had to think the more I realized, this little rendezvous at the hospital might be enough to bump me to my out of pocket maximum deductible- meaning anything at delivery would cost me nothing.  That thought did help me relax.  But, oh, the righteous indignation I felt about this being such a longer, drawn out experience than anyone online had mentioned!

A little before 7:00, my nurse came in to have me sign some waivers.  While I’m signing the waivers, she noticed the baby’s heartrate was dropping.  (I’m not sure if I’d learned this from stories on the internet, TV shows, magazines or where, but I knew this could mean an emergency c-section.  Jason, on the other hand, had no idea.)  Within sixty seconds all of the nurses are in our tiny little triage tent (talk about flashbacks) trying everything they know to help get the heartrate up.  One nurse left to call the on-call doctor to get ready for an emergency c-section and the others remained giving me oxygen and having me flip from side to side.  Eventually they had me on all fours and the baby’s heartrate started to climb again.  While I’m sitting there with my head buried in the pillows, I really wanted to cry.  “For the love of all!  All we have wanted to do for the last six hours is get this gosh darn dumb cerclage out!  Could it be any more complex!?!?!”  But I remembered that blessing and I knew that even if this all happened with an emergency c-section and we brought that baby home tonight, he would be fine.  We would be fine.  It would be the Lord’s will.  Jason swears that if that doctor had moved a bit more quickly, we probably would have brought a baby home.  But he didn’t, and we didn’t. 

The specialist didn’t arrive at the hospital until 8:15.  He chatted with me briefly and said they would try to remove the cerclage without any anesthesia, thinking the better stirrups and light in the ER would help him to remove the cerclage.  I made sure to explain to him that part of our problem earlier was that I would get uncomfortable and make the process more difficult, knowing then he’d at least start me with a sedative.

They put me in the OR, set me up and then the specialist came in. I could feel myself tensing up and was still in pain from the earlier attempts.  I realized then how gentle my doctor was being as the specialist started locating the cerclage.  Within seconds I was squirming and making sounds, the blessed anesthesiologist made an immediate decision to put me to sleep.  He asked me to take ten big breaths and… then I woke up.  I noticed on the clock that I had been asleep for about thirty minutes, now 9:15.  The first thing I said was, “Is it gone?”  They assured me that it had been removed and I felt a huge weight lifted from me.  It didn’t matter now, whenever that baby came, it would be fine, I was in the clear.

When they wheeled me into an L&D room (the same one for JJ), I knew they were going to keep me longer than they had been saying.  My nurse told me that due to the drop in heart rate, they wanted to monitor the baby over night.  It didn’t matter to me, my cerclage was gone and my out of pocket maximum was very close!  The specialist came in and spoke with me.  He confirmed everything my doctor had said.  It had been difficult to locate and to remove, took him 15-20 minutes.  Keep in mind this man puts more cerclages in than anyone in the Valley and removes more too- and it took him that long in an OR.  I informed him that if he hadn’t put in such a good stitch in the first place, he wouldn’t have had such difficulty.  What goes around, comes around.  I also expressed my extreme gratitude that he took time out of his schedule to come and do this for us.

I was able to eat right after the surgery and already felt a lot better. The night passed in a blur of restless sleep.  They had given me an Ambien, so I was always able to fall asleep, but couldn’t really stay asleep.  I had no pain after the surgery, just a few contractions.  It didn’t go so easily for Jason, as he never does well when I’m in the hospital.  He slept for about two hours and the rest of the night just stared at the walls not wanting to wake me up with the TV.  Being able to stay in the hospital overnight was good for my peace of mind.  I knew that when I left the hospital everything was fine with the baby and I was not in labor. 

My doctor checked on us the next morning and was happy to hear I was doing well.  Yesterday at my appointment he informed me that he had talked with the specialist.  They both were amazed at how well that cerclage was in there.  They said it is possible for it to shift and stay in there so well, but usually pretty rare.  I’m not sure how I feel knowing they were discussing my cervix together…

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