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!