Tuesday, February 26, 2013

1st Cerclage removal and labor/delivery story.

I had the two stitches (Shirodkar) removed at 37 weeks. I had another doctor doing the removal and he was used to ONE stitch and usually the less invasive McDonald (which I had the second time around with Caleb- removal was painless and easy in the dr office). I'm sure not everyone will have the difficulty I had with this particular removal, as this was a more difficult placement and there were two stitches. This doctor said the removal didn't have to be medicated, just snip snip and we would be on our way. I knew it wouldn't be that easy, those stitches were EMBEDDED and his attempt was painful and impossible. I ended up having to have a spinal and it took him FOREVER to have them removed. In fact he ended up leaving a small piece of it in there that is in there to this day and hasn't interfered with any of my other pregnancies, labors/deliveries, or second cerclage with Caleb.
I immediately dilated to 3 cm and they monitored me for a few hours in case I went into immediate labor, but there was nothing, no contractions, nothing. I stayed 3 cm and had to be induced by pitocin at 39 weeks, go figure. Some women, they said, dilate immediately to ten cm after the cerclage is removed and deliver right then, but not me.
Those particular stitches I had were weaved in and out of the cervix all the way around and the only issue I had (which I think is an isolated case due to the nature of my cervix when I had those stitches placed, this is not the norm) is that it made my cervix "stubborn" and around 5 cm dilated, the doctor had to "work it a bit" with her fingers. It caused no real concern or delay during labor though. I continued to dilate normally but they watched the "left lip" of my cervix when I was fully dilated as that section never fully gave way. They made sure it didn't tear or hinder anything when I did a few test pushes. I was in labor with an epidural and pitocin for 12 hours, and pushed for an hour. Easy labor and delivery. Nathan was 7 pounds, 2.5 ounces and 20.5 inches long. He aced his Apgar, no problem. I'm THRILLED that I got to experience a vaginal delivery because I was anticipating a possible c-section for two reasons. The first is, I didn't know if my cervix would react normally in labor and delivery after those particular stitches and I also didn't want to put the stress of a delivery on my cervix in case that affected future pregnancies/cerclage placements. I actually requested a c-section for those reasons but they assured me neither of those were legitimate concerns and they said there was no reason not to attempt a vaginal delivery and that my cervix would be fine for my next pregnancy as long as I waited 6 months-1 year for it to completely heal and become strong again (well, as strong as my cervix can get)

My 1st cerclage placement story

I've been getting lots of emails from women who are either in the process of getting a cerclage, considering it, or have one placed and have concerns. I LOVE these ladies and I am so thankful that they reached out to me so that I can support them throughout their pregnancies. I would encourage anyone else reading and is in a similar situation, please reach out to me. I would love to hear from you.
I've been having a difficult time with Ian's story (my first loss at 22 weeks, 4 days, due to Incompetent cervix and Chorioamnionitis caused by Group b strep/beta strep). I'm sorry for the delay and I want it to be perfect. It will come. Bear with me.
I wanted to get my cerclage stories on here so women can have access to my information, how our doctors handle IC and cerclage here, decisions we made and why, and outcomes! Don't hesitate to ask questions, prompt conversation, vent, cry, whatever you need, I will help you through it. Unfortunately there are so few of us that go through our particular kind of trauma but I've made some great online friends and am so thankful they reached out.
1st Cerclage story- Nathan my living son, delivered full term.
Two altered Shirodkar stitches were placed at 10 weeks because
I had NO cervix and it was the consistency of goo, yep:

Preface: Below will be all the gory details, if you are reading this and you know us personally, we certainly don't mind anyone reading "our story" and all that entails. Just wanted to give you a heads up if you're not up for an over share :-)

Conceiving after a loss:
After losing Ian, we were not warned in any way that we needed to wait at least 6 months-1 year to get pregnant so that my weak cervix had a chance to fully recover it's strength and health. We were told the usual, wait 2-3 periods blah blah with NO information on my new diagnosis', and NO guidance from the medical group that dropped the ball with Ian which ended in his death. I feel that I needed to preface this cerclage story with an explanation as to why we conceived Nathan only 4 months after losing Ian, thus causing more danger. I won't even get into the psychological reasoning behind our decision. That's for another post altogether :-)

How I found a doctor who has experience with cerclage:
Back in 2005, incompetent cervix, beta strep, and cerclage were not discussed like they are now in any forum whether it be the internet or medical practices around our area. It was almost unheard of in Florida so I got NO HELP from the medical field to guide me in what I needed to do and who I needed to go to. So what did I do, I said, hmmmm, who would have experience with cerclage, who who who. I called our insurance company and got the names of high risk doctors that delivered in the city hospitals (we had three excellent ones) and they had to specialize in ART. Why ART Melanie, you didn't have trouble conceiving. No, you're right, I didn't need a doctor to help me conceive, I needed a doctor whose patients are often high order multiples which many times requires cerclages, which means he is experienced in cerclage. And I found one! Let's call him Dr. S. He agreed to take me. So that was the first step to making my cerclage happen.

The Stitch:
Dr. S was planning on doing the cerclage around 11-12 weeks but he measured my cervix around 10 weeks and it was shortening and soft already. I understand now that he didn't want to alarm me but he needed to get me in there and get some stitches up in me. He DID prepare me by explaining that he would be doing a more difficult stitch, the Shirodkar stitch, and that he may have to place two, TWO?? TWO. He also told me that he was very particular about the material that the stitch would be made out of because there were several to choose from. I'm sure I can ask my husband the details if you need that.
Anesthesia selection:
Dr. S said I had two options for anesthesia. He said I could be awake and receive a spinal shot to numb me from the waist down or I could be put under general for the entire procedure. I had never been under general anesthesia (little did I know I had so many wondrous miscarriages and hospitalizations in my future, when I would have no choice but to be placed under emergency general), but at the time, no way. I wanted the spinal for many reasons- other than my irrational fear of dying or being one of those "I could feel everything but couldn't scream or let them know I was awake" stories, I needed control. I wanted to be aware of what was going on and exactly what my situation was down there. I wanted to be able to ask questions. I felt he would do a better job with me conscious, be less likely to be distracted. That, and if my baby was going to die on the table I wanted to be damn well awake and not in some stupor with a nurse telling me "I'm sorry" as I woke up. I know there is .000000000000000008 millionth of a chance of that actually happening, but I freaked nonetheless and stressed about every worst case scenario. My doctor had never had it happen or heard of it happening but of course they have to review all risks, UGH.

The spinal had its downfalls, weird blood pressure fluctuations right off the bat, which made me nauseous and vomit early in the procedure, and the spinal ended up going all the way up to my chest so I couldn't "feel" myself breathing that caused panic. So they both have their upsides and downsides. The anesthesiologist was terrific though, on top of it with a vomit sucker, some different IV meds, and a kind hand to hold. I was given IV antibiotics during the procedure for the Beta/Group b strep. They pinned my legs up on some bars and it was very much how I imagine a pig getting tied up for dinner.... that was the oddest part of the whole experience. I laugh about it now haha.
The Cerclage Placement Surgery:
Dr. S opens me up with a planet sized speculum, practically hosed me down with iodine, and boy am I so glad I was awake because I could hear the disbelief and the comments under his breath as he viewed my lady parts.

"Oh my God, she has no cervix." "It's completely effaced and softer than even women in labor."
"Ahem, Melanie, I've been doing this a long time and I've seen everything, and you my dear, have the SHORTEST cervix I've ever seen. And you're only ten weeks along. There's nothing for me to work with. I don't even have enough cervix to even put the stitch in so I am going to have to pull and gather. This will take time, it will feel odd to you, and I'm going to have to alter the Shirodkar stitches to try and work with this bare minimum. This may cause uterine irritation and puts you at a higher risk for complications. Do you understand?" I said "do whatever you have to do for however long, just don't break my bag of waters PLEASE be extra careful. He got right to work and what normally takes 30 minutes, took him over an hour, but boy did he get those stitches in there nice and good! After it was placed and we were still in OR, a nurse rolled an ultrasound cart over so we could see our sweet baby and make sure he was ok. Baby waved at us! It was a special moment.

Post op:
I was wheeled to the post op area and my husband Josh was immediately brought to me. A nurse gave me a cocktail of muscle relaxers and pain killers/narcotics. I couldn't be released until I could prove that I could walk and pee. The doctor came out and spoke with us about what he did and said he felt confident that the two stitches he placed would hold even with all of the unexpected discoveries. He said to expect minimal spotting and cramping for 2-3 days, that while uterine irritation was expected, it should decrease, not increase at any time in those 2-3 days. He also wanted me on weekly Progesterone in oil shots given intramuscular, started ASAP. This was to relax the muscles and bolter the lining of all my lady parts. I do feel strongly that the Progesterone shots kept things at bay. The next day we were at his office (ummm, I was expected to be ass up for weeks, nope) and he showed Josh how to give me the shots.
First week or more after placement:
I experienced some nagging period type "irritation" for about 2-3 days. I won't call them cramps because they were different than anything else I experienced, occasionally regular for the first day/night but more bothersome than concerning in the grand scheme of things. I had no lingering cramps or Braxton Hicks after that third day. It decreased like he said. I BARELY spotted. Hardly anything. I was shocked by the lack of blood. I over-analyzed everything that first time around. Every twinge. I didn't want to sneeze, cough, fart, pee/poop, BREATHE. I was so afraid. I didn't realize during that pregnancy, how tight and effective cerclages were. I didn't need to try and take it easy but I did anyway, it made me feel better to CAREFUL sit down and get up the entire pregnancy and to lean back when I could at work. He assured me none of those things had any impact on the success of the cerclage and after being through two that held the test of time, I can see what he meant.
Precautions or LACK THEREOF!
Now let's talk about precautions after a cerclage is placed. For both cerclages, I was SHOCKED by the LACK of PRECAUTIONS given after the placement!!! And keep in mind I have BETA STREP! The same nasty beta strep that went unchecked, wreacked havoc, and with IC in cahoots, ultimately was the main cause of Ian's death. So when they said "No sex for six weeks".....six weeks? How about not until I DELIVER my baby safe and sound? Why would they want anything up there with that stitch? Also, don't they know ejaculate/sperm can irritate a "normal" women's lady parts?? Condoms maybe, I don't know. We couldn't even fathom that other couples experienced losses like we did and then were able to have sex, even easy sex, while the cerclage was placed.... Josh and I felt very strongly about this. Sex was off the table in all of my pregnancies after my first. It was VERY hard on our relationship, oh yes it was. We even totaled it, and in 9 years of marriage, we've gone 3 years with no sex. We would do ANYTHING for our babies, no sacrifice was too much, we did it. It was the only control we had though. In fact with Nathan, I refused to even have an orgasm until that stitch was out. I think that was a little overkill but there was so little information out at the time and I thought everything was more "precarious" than it was. I didn't know so I didn't take the chance. I also refused baths, pools, anything that would have required my bottom to be emersed in water was a no no. That was another precaution we came up with after reading some articles.
No Bed Rest you say????
I stayed off my feet for a week after placement and used stool softeners like CRAZY. I wanted to be taken off of work for the duration of the pregnancy and placed on AT LEAST modified bedrest. I wasn't willing to take ANY chances, but Dr. S refused to take me off work until a few weeks before I delivered because he said that studies showed bedrest with a cerclage didn't have any increase in success than complete mobility with cerclage. I fought him. He wouldn't give in. I said, how about emotionally then, I need to feel like I am doing things differently this time and being as CAREFUL as possible. Nope, wouldn't budge. If any of you can get bedrest, more power to ya.... I don't give a flying fart what the "studies" said. How about err on the side of caution! 
Check ups and Stats:
I had cervical checks via abdominal ultrasound every two weeks.
My cervix held solid at 4.5 or 5 cm I believe, not exactly sure. No shortening, no funneling, no effacing, no change, no bleeding, the entire pregnancy.  No preterm labor, no infections, no water breaking, nothing. Not even many Braxton Hicks at the end. 
The next post will cover cerclage removal and Nathan's labor and birth story!  Please feel free to drop a line! Let me know you are there!

Friday, February 1, 2013

My husband

I need to blog about my husband. Some of you may know him, some may not. This is not a "my hubby is the best ever and has never done anything wrong and he is perfect" kind of blog. He and I have made horrendous mistakes in our marriage, in many ways we have marred each other forever when we were feeling low and couldn't offer each other the support we needed because we were going through hell. No, this blog is about the reality of a marriage that started innocently and in love, that has, in the last ten years, endured horrors that no one should ever have to go through, burying children, precariously hoping through pregnancies that we would have a live baby this time, major medical issues causing major financial issues even with good insurance, spiritual issues, separating from my poisonous parents and being disowned by them because we chose to live our life with love and kindness.
We left a house that we had bought down in Florida that we loved. Our finances were in order, terrific credit, etc. But we could no longer be around them and weren't being true to ourselves and moved back to Virginia. And then I had miscarriages, my mental illness reared it's ugly head, I began job hopping and then finally I couldn't work any longer. This is very unlike me. Yes, life has beaten me to a pulp. I was always the main bread winner and controlled all of the finances, but I was stuck in my despair, unsure if I wanted to stay on this planet.... How does a spouse deal with this, and for years and years with no seeming hope or end? Watching his wife in pain. Watching her try therapy and a million different meds (which we can't afford) and still no peace for his wife.  I liken this to the movie "What Dreams May Come" with Robin Williams when he has to go to the "depths" to bring his wife back. That is us. I'm still not totally back, I'm hanging off a ledge and he has a firm grip on my hand as he is standing at the top of the ledge and as I hold on he is inching my way to the surface of the rock. In real life, My husband immediately took over and it was so very hard for him because he has a creative mind, not one that easily takes care of "business and finances" but he had to do it. He got multiple part time jobs to make ends meet, dealt with (and is still dealing with) our terrible debt and poor credit because I just can't work right now. I'm physically and emotionally unable to be an employee in any capacity, particularly not my usual line of work. I'm Bipolar and if anyone has ever lived with a person diagnosed with Bipolar, you know how DIFFICULT it is. So very difficult. But he loves me and he says he would have it no other way. The last two years have been particularly hard. But if we can get through the hell that has been the first 10 years of our marriage, and we still love each other and want to be together, than we feel we will be together forever, nomatter what is thrown our way.
I thought I was getting comfortable after having Caleb and deciding that our two boys made our family complete. Then I realized, just because our journey to have children has ended, there are a million other journeys we are now facing and that my husband and I stand united in front of this entity "What is to come" and stand tall, holding hands, appearing strong and united. We hand "What is to come" a book of how we were able to get through everything, everything that has been thrown at us thus far and we are better than ever together. You may think, how can you be better than ever when you are hanging from cliff and he is holding on to you for dear life?
Because my friends, in a true loving relationship, the true test is how you hold up as a couple when things aren't going well. I would take this Melanie and this Josh anyday, even after everything we have been through, even though I am hanging onto him for dear life at the moment. Because now we know after being tested over and over, that we aren't going to break, that meeting these tragedies and difficulties head on and TOGETHER in love has made us better people independently AND as a couple. That is priceless and it can't be attained any other way.  The Melanie and Josh from when we first married and who were what you would consider "better than ever" because we were standing together looking to the future and we had our things in order.... but we hadn't been tested.  And in the tests, love of infinite dimensions develops in a relationship, it comes from many places. From being in the moment with that person when you deliver a baby/or are watching her deliver your baby and he dies in your arms, true character and true LOVE is displayed during these moments and after, when we had to hold each other up in different ways and at different times, letting go of the anger together and moving through the grief, you learn a lot about someone going through something like that. Sharing pain and grief that no one else could experience in this situation, learning what your partner is like in the worst of circumstances, holding each other up, becoming new people that are changed and hopefully in time we can be better and better. And then each tragedy afterwards may be equally as horrible but now you know as a couple that you can DEAL with this and come out on the other side stronger in your relationship. And I can say for both of us, that if we had a choice, we would go through it all again, the same. Yes, sounds crazy. But THIS Melanie knows that my husband is behind me 100%, will support me through anything life has to offer, he will support me and vice versa. There is comfort in that, it adds a new dimension to the love I have for him that could have only been acheived by going through the trials we have. Neither one of us would trade that for anything. We also feel that changing anything we've been through isn't what was supposed to be..... we have learned to accept and love having a son (and three other children) in heaven and that binds Josh and I together even more. It's sad to hear that couples who have lost children have a higher divorce rate. Don't get me wrong, we have had some bad times of our own making and not dealing with issues and not communicating well and those have been the lowest times in our relationship. It's not easy. But if you perservere, are sensitive to each other, and communicate, and becoming stronger together is a goal, YOU WILL MAKE IT! And maybe one day you will be surprised like I was, that wow, our relationship is so far beyond what I thought it could ever be. I love him/her more than I ever thought even as we are going through (name whatever trial you are going through). From the very beginning after Ian died and we would weep in bed together every night.... we commited to getting through this stronger. We said that we would NOT let this break us independently or as a couple. Unfortunately I have struggled greatly with the tragedies in my life breaking me but Josh understands and offers his hand over the cliff, and we work our way back together. 
And I told you guys I would be perfectly honest on here so I have to add that whenever I picture us standing face to face with "What is to come", the only fear I have in my brain I whisper as a prayer to The Almighty.... "Please don't take my soul mate. I can handle anything in this life if he is here. Please don't take him. I don't know if I can live this hard life in this hard world without my best friend. Please don't have that in yours plans. He and I can get through anything you throw at us. Just not that, please."
I love you Josh, my soul mate, my best friend, always and forever


I do have a post about my two cerclage experiences in draft form but it's long and I don't know when I will get time to finish it right now. However I've been reading some blogs lately and I'm horrified to see that MANY women have second term losses and have been diagnosed with Incompetent cervix or are confused because they had an infection of the membranes and doctors don't know if the incompetent cervix allowed the bacteria up there or if the infection happened and then the women just went into pre term labor. I am AN EXPERT ON THIS SITUATION. DEMAND AN EARLY CERCLAGE at 12 weeks of any subsequent pregnancy, whether your diagnosis was certain or not. DO IT. DO IT. It's scary, but you will not lose your baby during the procedure, the doctors who do these procedures are EXCELLENT. Waiting to see if your cervix will hold later in the pregnancy and then bed rest or an emergent cerclage ARE NOT SUCCESSFUL in A LOT OF CASES. A 12 WEEK CERCLAGE will give you the most opportunity to hold your babies if you in the above categories. I also had intramuscular injections of Progesterone, the oil, injected weekly by my husband. The shots were successful for me and I haven't tried any other way because my doctor said this was the best and only way to get the progesterone where it needed to be. I also refrained from SEX and BATHS during the entire pregnancy. DO NOT TAKE BATHS!!! Some doctors won't tell you this stuff! They say you can have sex a few weeks after the cerclage is placed, don't chance it, not even with condoms because if you have group b strep or other nasty things in your lower vagina, anything in there can push it up to the cervix. I don't even like vaginal wand exams after the cerclage and my office will not do them. Advocate for yourself. FIND SOMEONE who does CERCLAGES and is SUPER CAUTIOUS if your current OB-Gyn is the wait and see type and doesn't want to do cerclages. I'm APPALLED by a story I just read on a blog, the women lost a set of twins to the circumstances above, which was my own as well (singleton though), and when she got pregnant with a second set of twins, a doctor should have IMMEDIATELY set her up for a cerclage. Multiples are saved as well from this procedure and I can't believe there is any evidence out there that this isn't successful with multiples as well. Women with multiples may have more restrictions with a cerclage to keep extra weight off of the cerclage but I've read about women carrying twins having a cerclage and she worked until the very end and had no issue.  Cerclages SAVE BABIES. Plus, it was a relief for me so have it in. It held tight and I promise to put my experience on here soon. DO IT! Don't be afraid, Cerclages are amazing and the risks don't outweigh the benefit=living baby. I have LOADS of information so in the meantime if you need to email me so we can chat about it personally, please please, email me. I will help you make this difficult decision. I had the worst case scenario, group B strep and other bacteria in the vagina and and incompetent cervix. Scary. But I have two living children and wonderful pregnancies and full term deliveries using a cerclage. I have no damage to my cervix and with my second son (first we lost at 21 weeks to IC and infection of placenta and fluid) and I had the WORST CASE scenario when at 11 week, I went in to have my cerclage placed (I opted to stay awake, control thing) and I heard the doctor say in the middle of putting it in, this is the shortest cervix I've ever seen, I'm going to have to pull it to give me something to work with and put two in, and he had to do the Shirodkar which is an older and more invasive procedure. So I am the worst case. I think my short and effaced cervix at that point was due to the fact that we got pregnant three months after losing my first and that wasn't the smartest thing to do. My uterus and cervix were not ready. But I had a cerclage placed and it did it's job. Email me for more info. and my next post will be about my cerclages. For my third son I had a McDonald cerclage at 12 weeks, so I've had them all except a transabdominal. Luckily we didn't have to go that route but we absolutely would have if it meant keeping my baby in until term. And I went to two different surgeons because we had moved from Florida to Virginia. The care was terrific at both places, cerclage placement is more common than you think. Advocate for yourself, it is YOUR DECISION whether or not you have a CERCLAGE PLACED. IT'S YOUR DECISION. YOURS, NOT THE DOCTOR. If they say it's their decision, pack up and go to another doctor. If you've had a 2nd trimester loss or an almost loss (you had a emergent cerclage or bedrest kept your babies in ) and there was any question as to whether or not your cervix was involved-you have the RIGHT to REQUEST A CERCLAGE at 12 weeks in your subsequent pregnancies. Even with multiples, YES!