What do you do when it appears that God actually gives you what you asked for?
I feel like that is the predicament that I am in. I wanted to have a choice. Now I do and I'm not sure that is really what I wanted after all.
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I went to my Perinatal Specialist yesterday to discuss treatment and plans for future pregnancies. I went to the appointment with the assumption that my doctor would give me a specific recommendation. He did... but it's not the recommendation that I expected.
Here's my story:
I have an incompetent cervix. What this means is that as the weight of pregnancy (uterus and baby) grows, pressure is applied to the cervix. For most women, their cervix acts as a seal/stopper and it remains closed and tight until you are ready to deliver. That's not the case for me.
As the weight of the pregnancy increases, my cervix is unable to sustain this weight and begins to open and dilate without contractions, unknowingly. I was diagnosed with an IC after the loss of our first son, Aiden at 21 weeks. The weight of a pregnancy comes into play at about 16 weeks. Before that, the weight and size of the uterus isn't heavy or large enough to apply pressure to the cervix.
Statistics say that about 1% of women have an incompetent cervix. I am that 1%.
For my pregnancies with Gavin, Gabe and Jeremiah, I had a surgery called a transvaginal cerclage (TVC). During this procedure the surgeon places a strong stitch into the cervix (vaginally) and more-or-less ties it shut. The cerclage (in my case) is preemptively placed at 13 weeks. This provides enough support to the cervix to keep it closed throughout the pregnancy. The stitch is removed around 37 weeks and nature takes its course.
The TVC has a success rate of about 85%.
My pregnancies with Gavin and Gabe were obviously successful. I was placed on a significant amount of bedrest with Gavin (17 weeks) and not quite as much (11 weeks) with Gabe. Although the TVC was keeping my cervix closed, my cervix was still opening up to the point where the stitch was placed (called funneling). But, in the big picture, the TVC was successful and it was the amount of medical intervention that I needed to be able to carry Gavin and Gabe's pregnancies to term. Praise God!
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Now, we get to the less clear-cut part:
During my pregnancy with Jeremiah I suffered a subchorionic hemhorrage at 12 weeks. I literally stood up and gushed blood. Bright. Red. Blood. Lots of it.
To make a long story short, after I had an ultrasound and was able to see my doctor, I was told that I had a subchorionic hemhorrage and that it looked as if the hemhorrage was resolving on its own. My doctors were going to continue to monitor it, but they assured me that I shouldn't be concerned.
At 13 weeks, my bleeding had stopped entirely and as planned, I went in for surgery and had the TVC placed. Emotionally, this is a HUGE milestone in my pregnancies and a point where I feel like I can finally breathe. My fear begins to subside and I gain a little confidence. Usually.
The day after my TVC surgery, I went back to my doctors for a check-up because I was experiencing some pain. My doctor did an exam of my cervix and the stitches felt as they should. My cervix was really swollen and was bulging a bit- not uncommon after a surgery. During my ultrasound examination, a large pool of blood was noticed between (as I understand it) my uterine wall and my amniotic sac. Again, it was agreed that my doctors would continue to monitor this area and I was told that statistically speaking, I should be fine. Generally, your body either slowly reabsorbs or expells this blood, which appears to be left over from the SCH that I suffered the week prior.
After my TVC cerclage, I began spotting brown blood. Some of this blood was from the actual surgery, but when it continued, I realized that I was also finally (and thankfully) expelling some of the blood that had pooled in my uterus from the hemhorrage.
Now, let me say: Bleeding during pregnancy is terrifying. I dreaded going to the bathroom because I was so filled with fear about what I would see. But, I kept telling myself that my doctors were confident so, I should be too.
At each of my check-ups over the next couple of weeks, the pooled area of blood was measured and it was slowly getting smaller. My cervix was also measured via ultrasound and that looked great as well. Things were progressing and looking good!
They were looking good that is, until the morning of August 4, 2011.
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Again, to make a long story short, I went into labor that morning and when I was seen by my doctors, I was told that I needed to go to labor and delivery immediately and that they needed to remove the TVC because I was dilated to 4cm and my cervix was literally being ripped open, through the stitch, by my contractions.
The current statistics for pregnancy loss with a SCH is 1-3%. Again, I am that 1-3%.
Within 3 hours of my fateful drive to my doctors office, I delivered our precious son, Jeremiah- much, much too early (15 weeks, 3 days). I held him in my arms as his heart took its last beat.
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So, fast-forward to today. It is most likely, but not positively known, that the loss of Jeremiah is related solely to the SCH and not related to my previous diagnosis of an incompetent cervix. Is there certainty that my incompetent cervix is totally unrelated? No. Most likely? Yes.
So, for any future pregancies, what do I do?
Do I take a gamble and trust that another TVC would again be the necessary help that I need to carry a pregnancy to term? It worked with Gavin and Gabe and probably would have worked with Jeremiah.
Or maybe not???
Maybe my body was rejecting the stitch???
Maybe the stitch was complicated and aggravated by the separate issue of the hemhorrage???
Or maybe they really are two completely unrelated situations and statistically, I just personally have really crappy odds and have had two 2nd trimester losses for two separate and relatively rare reasons???
I don't know.
My doctors are human and they don't know either. They can give me statistics until they are blue in the face, but let's face it, I don't feel like statistics have really been in my favor.
So, again: What do I do?
There is another procedure that can be performed that has a 99% success rate for the treatment of incompetent cervix. It's called an transabdominal cerclage (TAC) and it is much more invasive. It requires an abdominal incision (just like a c-section) and suture of the upper part of the cervix via the abdomen. The procedure can be done pre-pregnancy or right around 14 weeks. It requires a c-section delivery and it is a permanent stitch. Therefore, all future deliveries would have to be performed via c-section.
This surgery, although highly successful for the treatment and 'curing' of incompetent cervix, does carry its share of cons. Such as, it's invasive and it requires a c-section deliver, among many other things.
Although my doctor is absolutely willing to do this procedure, he does believe that is it over-kill (my words- not his!). If I were his wife or daughter, he would suggest the TVC and not the invasive and permanent TAC. That is, if you can take emotions out of it and just look at the statistics. Because if you look at my statistics with the TVC, I have had 2 successes and most likely would have had 3.
But, we can't take emotions out of it.
Burying two healthy little boys who were simply born too soon is not something that I can ever forget or ignore. And, I want to make the best decision I can to try to ensure that it doesn't happen again.
But, what is the best decision???
Do I opt for the less invasive TVC and be able to deliver vaginally??? It has worked in the past and probably was working with Jeremiah and probably would work in the future.
Or do I opt for the more invasive TAC and have to deliver via c-section??? It most likely will work, but is also probably more than I need.
Could I live with myself if I chose the less invasive approach and it fails???
Do I want to allow more medical procedures to be done when they probably don't need to be???
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Today, I simply do. not. know.
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If you took the time to read all of my ramblings, would you please take a few more minutes and say a prayer for Tom and me? Please pray that we are able to find some clarity and peace with the decision that we will make. Thank you~
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