Cervical Insufficiency is a medical condition in which a pregnant woman's cervix beings to dilate (widen) and efface (thin) before her pregnancy has reached term without labor or contractions. Resulting in a premature birth and possibly the loss of the baby, because of the shortened gestational length. It happens in about 1-2% of pregnancies. Resulting in 20-25% of babies miscarried in the second trimester. A normal cervix is considered anything above 25mm in length. It can also cause what is known as funneling where the internal part of the cervix begins to open leaving it held together by only the external part.
Now that I explained that I will start with my history of cervical problems and begin to tell my story. In 2006 I had an abnormal pap smear and was told that I had precancerous cells on my cervix. They preformed a procedure known as a LEEP. It's where they use a form of laser and take off the bad part. I was told the part they removed was the size of a thumb nail. I went back to the doctor after the procedure and everything checked out okay. So I went on with life. In 2009 I had a miscarriage at 10 weeks due to the baby not forming and ended up getting a D&C because I didn't want to deal with the thought of actually having anything come out at any given time since my cervix was still closed. And I didn't want to bear walking around knowing I was technically pregnant but would never have the baby. I've ALWAYS wanted kids and after having this happen I thought my dream of being a mother would never come true. Until....June 2,2011 when it was officially confirmed via the health department. I was so excited but also scared that it would end in a miscarriage again. I made my routine doctor visits and had my first ultrasound done at my very first appointment which was at 7 weeks. The previous doctor I had ended up leaving so I had a new doctor, Dr. B. I explained to her my history and why I was nervous and just wanted to make sure there was a baby this time. Here is what we saw...
Ahhh! Words can't even describe how happy we were. I continued going to the doctor every 4 weeks like I was told. At the next appointment I asked for another ultrasound being extra paranoid that I was and was told my insurance only paid for 2 :( Bummer! So I had to wait until my 18 week ultrasound when we found out what we were having. Oh and I forgot to mention hearing the heartbeat for the first time was amazing! And since I could only get 2 ultrasounds, every visit she used the doppler to hear his little heart. Love it! So back to 18 weeks when we found out what we were having we saw this on the ultrasound....I didn't care what we were having as long as it was healthy. (But secretly wanted a girl). Blake wanted a boy so he could do boy things with him. So he got his wish! We had already talked about baby names and knew the first name would be Levi. I loved the name Jackson for a middle name but it took a while to decide. And then it popped in my head what if we spell it Jaxon that way if he doesn't like his first name he can go by Jax. But I didn't like that spelling so we changed it at the last minute....And so our final decision was Levi Jaxen :)
My next appointment was scheduled at 22 weeks 3 days on Monday, September 26, 2011. And that is where my story and the reason for this blog began...
I requested off of work for 3 days. Sunday we had plans on going downtown to an NFL game to watch the Titans! Monday I had my 22 week appointment at my doctor. And lately we have been big into camping so Monday and Tuesday we go up to Blake's dads farm and camp.
Sunday, September 25, 2011: Yes I know it is perfectly normal for pregnant women to get exercise! But I'm not a huge fan out it. Ha! Never have been and never will be! We parked at the parking garage since his dad has season tickets, which is connected to the pedestrian bridge. It's not a flat short bridge by any means. So I felt like I was climbing a mountain. We get across with tons of other people and try to find our way to the front so we can get an elevator pass so I won't have to walk up the ramps to the top.
Since the game was getting ready to start we discovered the line to get to the elevators was at least a mile long. So you see those ramps?! I ended up walking up them then walked all the way to the other side and up more steps to get to our seats. We got cheap tickets because I didn't really care where we sat as long as we could go since it was suppose to be a surprise for Blake. I'm not good at keeping surprises though so he found out before hand. During halftime we thought it would be a good idea to go stand with his parents. They stand at the top of the ramps. (They get loud and rowdy!) So we take the elevator down and walk to the other side and take the elevator up. We stand there and watch the game for the 2nd half. We ended up winning and I knew there would be no luck at being able to get to the elevators so we walked back down the ramps. And back over the mountain of a bridge. Needless to say I laid down when I got home!
Monday, September26, 2011: (This story will probably get a little descriptive.) We had our 22 week appointment scheduled at 8am. I woke up at 6am so I could get ready. The first thing I did was use the restroom. When I wiped I noticed there was a string of mucus. I don't normally have anything like that happen and didn't know if it was 'normal' during pregnancy. I was a little freaked out but also glad I had my appointment in a few hours. Monday morning traffic was horrible and we ended up being 15 mins late. We waited another good 30 mins before they called us back. As soon as you walk back they send you to the restroom for a urine sample. We then go into the room and I tell the nurse what happened. All they normally do at my appointments is ask questions and do the doppler for the heartbeat. The doctor comes in and she asks me exactly what happened and I tell her and also tell her Sunday we went to the Titans game and I walked a lot (more than I normally do). She said not to be worried and that it was probably just from all the walking. So I leave still feeling like something is wrong but she's a doctor and what do I know! We didn't end up going camping that night because I was exhausted and just wasn't feeling it.
Tuesday, September 27, 2011: When I would use the restroom this day there were just tiny pieces of mucus when I wiped but not like Monday. Around 6pm I used the restroom again and happened to look in the toilet and noticed there was something floating. I can't even begin to describe what it looked like other than it was flesh toned and almost looked like tissue or something. I showed Blake and we both got paranoid and he insisted I call the doctor. Since it was 6pm I knew my doctor wouldn't be there but the on call doctor answered and I explained to him what happened and that I was just there yesterday and Dr. B said it was normal. He said as long as there wasn't blood that I should be fine but if I was still concerned in the morning to call and talk to my doctor.
Wednesday, September 28, 2011: I still didn't feel right when I woke up and was still concerned about what happened. Around 9:30am I used the restroom and again I noticed a smaller piece of this tissue looking stuff. Only this time to me it looked like it had a tint of pink. So I'm almost in a panic because I was scheduled to work 12-7 that day. And I just knew something was wrong. I call my doctors office and tell the lady on the other end what happened. She said she would leave a message for the doctor and have her call me back. I called out of work because I wasn't sure what they would have me do. (I haven't called out of work in years so I dreaded doing it). I waited 2 hours and still no call back. So we drive 25 minutes to the hospital which is connected to my doctors office and we go into the ER. I figure if it's something major she would be right there. They take me up almost immediately to a room and have me put on a gown and leave a urine sample in the restroom. The nurse comes in and does the doppler just to make sure the baby is okay and then does a swab down there. (That was all they did while I was there.) We wait an hour for the results. She came back in and said, "Well your water didn't break." So she has me get dressed and tells me Dr.B wants me to make an appointment for tomorrow to come and see her. Mean while I'm getting dressed and notice they never checked my urine because it is still sitting on the sink. So we leave to go home and make an appointment. I knew I had to work the next morning 9-3:30 and the latest appointment they had was at 3:50. I figured it wouldn't be a problem to leave just a little early. So that night I just laid in bed and rested.
Thursday, September 29, 2011: I woke up still not feeling well but went to work anyway. The entire time my lower back hurt and I felt crampy. I started getting almost a hot feeling like I was going to pass out so I tried sitting down as much as I could since it was just me and another person working. At 11:30 a third person came in and at the point I didn't even feel like standing. So I asked to go home and was told I could. I went home and laid on the couch until it was time to go to our doctor appointment at 3:50. We get to the doctor and wait until they call us back. I do a urine sample as usual. And sit in the room waiting on the doctor. I explain to her everything that went on since I saw her on Monday. She said it sounded like a had an infection. She does the doppler to check the baby and he had a normal heart beat. Thank God! Then says she's going to do a pap smear again so she can get swabs to test. Before she does this I told her I looked up online what it could be and I was thinking either A: I did have an infection like a uti or something or B: It could be an Incompetent Cervix. I'm no doctor but my symptoms just had me thinking it was possible and since I did have a LEEP and D&C done what I read said it was a possibility. As soon as she looks to do the swab the expression on her face changed and I knew something was wrong. She tells the nurse we don't need to do any testing. She rolls her chair over and looks at me and says, "That is exactly what you have. Your cervix is open and you are dilated to 3 and I can see your water sac bulging out." She had me just lay there until she made some phone calls and said that I would need a Cerclage done. A Cerclage is where they basically stitch your cervix shut. She said she could do it but she would see what the possibilities were and maybe have someone more familiar with them do it. She also said it didn't look good and wasn't sure what the outcome would be and that most people end up miscarrying. She left the room and I instantly start crying. Why Me? Do I really have to go home with no baby and look at his crib that is ready and all of his clothes in drawers? I cried and cried as Blake stood there comforting me. She came back in the room and said she talked to another doctor at a hospital that was actually right down the road from my house and that she would actually preform the Cerclage. (If it was even possible) Since we had to wait for an ambulance to come to take me to the other hospital they decided to go ahead and start all of the prep work at their ER. I get wheeled over in a wheel chair. Still not really knowing what all is going on. They take me up to a room where there are 3 nurses waiting. I stand to get out of the wheel chair and they immediately have a gown and tell me to undress. I get in the bed and they put me in the Trendelenburg position where you're laid flat on your back with your feet higher than your head by 15-30 degrees. (Doesn't that sound fun!) They did this to try and get gravity to pull the sac back in so they could actually preform the Cerclage. They then hooked me up to the TOCO machine which shows whether or not you're having contractions. They never did say whether I was having them or not. They also started an IV in my left hand and put me on fluids and Magnesium Sulfate, which helps preterm labor by slowing down any uterine contractions. Let me just tell you! If you have never had this stuff it is the devil! It makes you literally feel like your insides are on fire. Add that to laying on your head. Not to mention when it goes in your hand it hurts like no other! I was miserable! They also put in a catheter since I couldn't get up. Ouch! And they drew blood. Once they got the labs back they also told me that I had a severe infection from the cervix being open. They started me on an antibiotic through my IV as well. (An infection can lead to a stillborn if not treated). So by this time it is around 7-8pm. The ambulance comes to transport me to the other hospital. Thankfully I had some funny EMT's that made me laugh. I complained about my hand killing me and he even offered to restart the IV but I wasn't about to go through that again! My family also came to the hospital and of course Blake was there the ENTIRE time. They all followed the ambulance. We get there after him driving 90 the whole way. And they take me up to my room. The EMT's were going to just move me over to the bed but said she's pregnant not crippled and made me scoot over. He asked how his driving was and I told him he might have helped my sac go back up when he kept slamming the breaks on because the blood would rush to my head.(Made me laugh) So again I lay there on my head and by this time I was so hot and my hand was killing me that I started crying and was about to jump out of my skin. The doctor comes in and tells me my options. She said, "You could either not get the Cerclage and risk having a miscarriage because at 22 weeks he wouldn't survive. (Which to me I was only hours from doing so anyway). Or she said you could get the Cerclage and still risk rupturing the sac just because it is hanging out. I was out of it and barely heard what she said because my head was pounding and I could barely open my eyes. I told her I wanted the Cerclage done so we had at least a chance of saving him. They told me that they would do it in the morning so gravity had time to pull the sac down. That and I had to get a spinal block done and since I had ate at 2pm they wanted to wait because of the anesthesia. Not sure what changed her mind but at 11pm she came back in saying they weren't going to wait that they were getting things ready and taking me to surgery shortly. I was nervous but relieved. I get into the surgery room. They have me scoot over to the table where they have me lay on my left side to do the spinal block. Not the worst pain I've ever felt but not fun either! It starts working right away and from my belly down is numb. I start freaking out because I couldn't feel my legs. (Not sure why I would want to move them but I guess it was a mental thing knowing that I couldn't). They hook me up to oxygen and I don't really remember anything until they were wheeling me out. I was probably so exhausted I feel asleep. I get back to my room where my family is waiting on me. You would have thought they gave me laughing gas because I was cracking myself up. I would try to move my legs but couldn't. Yet when I looked down they were moving! I also looked over at my little brother who has a 4 month old baby boy and told him he should be glad he has a pecker! Ha! Dr. R comes in and tells us that everything went good and that she was able to get a stitch in but she didn't get it up as far as she would like. They would monitor me to see how it holds. Needless to say I barely slept that night.
After the surgery my cervix grew to 23mm which is almost normal. So for the next few days they monitor me by drawing blood every single morning at the crack of dawn and hooking me up to the TOCO machine for an hour twice a day. (The nurses worked 7am-7pm shifts) So at the start of the shift they did that, the doppler, checked my BP, oxygen level and took my temperature. They took me off of the Magnesium Sulfate since I wasn't having any contractions. You have no idea how happy I was! And also took out my catheter so I could get up. TMI but you have no idea how constipated you get until you have laid in a bed for days!
Monday, October 3, 2011: I had my favorite nurse today only because she got called in. Yay for me! I ended crying to her because my hand hurt so bad from the IV. She asked if she wanted me to move it and at first I said no because I was scared but she ended up moving it to my right hand after not being able to get it in by my wrist. Thank god for numbing medicine! And to my surprise it didn't hurt anymore! I love her for that! She ended up leaving at 11am since she had already put in her hours for the week. She told us we could move rooms finally. We had been asking for a more comfortable bed and a bigger room since we weren't sure how long we would be there. They came in the morning and did an ultrasound internally to check my cervix. They also did one on my belly because they wanted to make sure the baby was okay. (And of course he was. His heart beat was always 140-160). I was excited because like I said I was told I would only get 2 ultrasounds to see him. She wouldn't tell me what my cervix looked like and looking at the screen I couldn't tell what anything was. A little after lunch Dr. R comes in and tells me that my cervix had gone back down to 9mm which is barely anything and probably just held together by the stitch. She scheduled me for another Cerclage on Wednesday the 5th to try and get it up further. She said another doctor in her group would do it because they rotate weekly so she wouldn't be there. I was kind of sad because she is an awesome doctor but knew it needed done. There was a lot of crying this day because I didn't know what would happen.
Tuesday, October 4, 2011:. I couldn't take a shower because they didn't want me standing that long. So I got my first bed bath. It is so hard washing your hair in bed but thanks to my previous nurses aid skills I managed. I also got to hang like a bat again this night to prepare for surgery the next day.
Wednesday, October 5, 2011: Surgery Day :( The nurse came in after breakfast and told me my second surgery was going to be at 11am. And that she had to put the catheter back in because obviously they didn't want me getting up. Didn't hurt so bad the second time. So off to surgery I go. I'm getting nervous because I know the spinal block is coming and I really didn't want to panic again. I told the anesthesia lady that last time I freaked out so she went ahead and put oxygen on me. I started crying and she wiped my tears for me. The second surgery didn't take as long. They also had to take my catheter out and put it back in so she could see what she was doing. As they were getting me ready to go back to my room the doctor was making notes in my chart and asked me about my cervix history again. She said she was able to get another stitch in but didn't really say anything else. Which made me think okay that doesn't sound like it went well. They wheel me back to my room and we wait for the doctor to come in to talk to us. She never came and ended up leaving before we could talk to her. We were a little mad but not sure if she had an emergency or what. They hooked me up to the TOCO machine when I got back just to make sure I wasn't having contractions and sure enough I was. They put me back on the Magnesium Sulfate. I cried because I was assuming like last time it would kill my head. Luckily my favorite nurse solved that problem! Blake had to work 10pm-6am this day so it was my first night being alone. My mom offered to stay but I said I would be okay.
Thursday, October 6, 2011: This day they planned another ultrasound in the morning. I had the weirdest ultrasound tech that pretty much rearranged my side of the bed so I couldn't reach anything. How rude! She also didn't show me the screen at all! I asked her what my cervix was now and she said 45!!!! Holy cow! It went from 9mm to 45mm which is way beyond a normal cervix length. I was excited but since she was a little out there I thought I would wait for the doctor to talk to us. I thought I was told a normal length was 25-40mm so I wasn't sure how it got to 45mm in a short time. Blake and I were sitting there talking when Dr. R comes walking in. (She did the first surgery). She confirmed that it was 45mm! When we asked how far she got the second cerclage in she said she wasn't sure because the other doctor didn't make a note of it. Okay?! She said since things looked good that they were taking me back off the Magnesium Sulfate but that I had to wear the contraction belt for a few hours just to make sure. And that they would be doing another ultrasound on Sunday to check everything and then we could go from there and cross our fingers I could go home on bed rest. Around 10-10:30 I started cramping really bad. I made the nurse hook me up to the TOCO machine just so we could see if it was contractions or (TMI) constipation cramps. She gave me an ambien since I was hurting and couldn't sleep. I was out and never even heard her come back in or felt her take the monitor off.
Friday, October 7, 2011: 24 Weeks Pregnant by the grace of god! I got woke up at 4:30am to get my blood drawn. Seems like it got earlier and earlier everyday! Around lunch time Dr. R came in and said she was moving my ultrasound to Saturday. And she also told me that my infection was gone and my white blood count was normal! Yay! They had also switched me to a different antibiotic and was on my second to last dose of it. My last dose would be in the morning and then no more IV if all went well!
Saturday.October 8, 2011: I got woke up at 5am to get my blood drawn and she blew my vein! I still have a huge bruise from it. The ultrasound tech came in after breakfast. She was the nicest out of all of them. She turned the screen so I could see Levi and we she printed out ultrasound pictures. I think he has a cute nose! When she did the internal ultrasound I asked her what she saw. She said my cervix was still good and at 32-35mm. Still above normal! She also said that my second Cerclage looked really good. She could tell that she got it in further than the first one. The nurse also came in and said that my blood work was normal. We played the waiting game to see when the doctor would come and what she would say. The nurse I had that day ended up telling us that the doctor was writing my discharge papers and that she would be down shortly. We immediately started packing our stuff and I was so excited that after 9 days I would be able to go outside! I knew I would still be on bed rest but at least I would be at home with my dog who missed me like crazy. Dr. R came down a little after noon and basically told me the same thing the nurse and ultrasound tech had already said. She told me to call her office on Monday to schedule and appointment with her Thursday at her office across the street. Around 2pm the nurse came in with my discharge papers and explained everything I needed to do and not do. Blake went and got the car while I waited for the nurse to bring a wheel chair. As we were waiting for the elevator my favorite nurse happened to look up and I waved at her. She ran over and gave me a hug. I almost started crying. She is the sweetest and best nurse I have ever had and I can honestly say I miss her! So there we were back to what felt like 'normal' and headed home. Blake was starving so he wanted to stop and get lunch. I made him stop at the gas station and get me an Icee. Yummy! I walked in the door and my dog freaked out and jumped all over me. I laid on the couch until it was bedtime with her laying right beside me.
( To read the rest of my story until I gave birth December 27 check my daily entries)
The only medicine she put me on is Indomethacin which is used for preterm labor and to help stop any uterine contractions and also helps develop the baby's lungs in case he does come early. I take it 4 times a day every 6 hours. I take one at midnight and 6am so I've been staying up until midnight to take it and then setting an alarm at 6am and I normally fall back asleep until 9 or 10. Glad I have nothing to do!
My next appointment is Thursday, October 13, 2011 with Dr. R. I still haven't called my regular OB yet to get an appointment. Which I should but she makes me a little nervous to see her because of everything that was missed and could have been prevented. I feel like they could have been more hands on in helping me but more or less just pushed me aside and kept making excuses. Blake had a lovely little talk with her at the hospital about why all of this was over seen. Let's just say she didn't like what he had to say.
It is now Tuesday and as I lay here on the couch typing this I am so thankful for everyone that has been thinking of me and that I got an amazing doctor. I went from almost losing our little boy to having a miracle still alive inside of me. It amazes me everyday and I just pray that nothing else goes wrong until it is time for him to come out! And I hope that I will never go through something like this again. Words can't even begin to describe the physical and emotional pain I went through this week. Praying he makes it he will be our only child. I know that a normal Cerclage is done at 13-16 weeks so more than likely I wouldn't go through this ordeal again but I don't even want to think about it. Who knows we may change our mind down the road but for now I have no thoughts of even trying!
And that is my story. I wanted to write this in hopes that someone dealing with an Incompetent Cervix would read this who needs help and reassurance that everything will be okay. That miracles do happen!