A New Path

The reason I haven't posted in the last few weeks is simply because of how overwhelmed I have been.  We have learned a lot, had to make a lot of big decisions and it has been exhausting physically and emotionally.

After being pushed in one direction by my regular OB, we sought a second opinion from a MFM Doctor. I didn't really expect to be switching doctors or hearing our story in such a different way.  However, the first MFM doc we saw was from Swedish American Hospital.  He and his staff were wonderful and the office was calming and free of confusion and stress.

He looked through my medical records and asked a lot of questions.  Ultimately, his final recommendation was to monitor my cervical length weekly until we were out of the danger zone of having issues with an incompetent cervix.  The reasoning behind this was that I had a bad infection when I was admitted to the hospital and it was impossible to tell why I was dilating with that kind of infection present.  IC is overly diagnosed and cerclage is overly used, two things of which I already knew but to this point we have been told that we needed a cerclage.  He was confident that it was most likely if I did have any cervical changes that they would catch it on one of the u/s before anything bad happened and put a cerclage in.  He also said that it is possible I do need the cerclage, but it is impossible to tell.

We fought with the decision of getting the cerclage and not getting it for weeks.  It was very stressful to say the least, as you feel that you are making a life or death decision for your unborn baby.  So many fears and questions run through your mind.  Everyone has an opinion too.  "You should do this, you should do that"…. it helps to hear everyone's opinions and ideas of course.  Everyone has a different perspective but it's hard to make a decision when everyone is telling you what they think you should do.
We, more than anyone else in the world, are putting our baby first, to give our baby the best chance while also minimizing the risks for both me and baby.  Some people didn't seem to understand why I even considered myself when making the choice.  I almost lost my ability to have a baby with Lindsey, I could have even died and I don't see how me doing that again will benefit anyone.

We made the decision to be monitored and not get the cerclage unless it was needed.  Our regular OB did not agree with this decision when we told her at our next appt.  I was just a mess after that appointment.  She told me she remembered better than I did about what happened before, during and after my loss.  I just felt confused and guilty for disagreeing with her.  When I think back, I really did not feel comfortable and I felt like our decision wasn't being taken seriously.  Not to mention the chaos of that office….

She then told  us that we were seeing a MFM doctor the next morning to get another opinion.  I assume she wanted someone to agree with her about the cerclage.  So we went to this other doctor ready to hear whatever she had to say.

Well she thought even more than the other MFM doc that the infection was first.  She also said that it cannot be ruled out that I will not need a cerclage but that she would suggest waiting so that there was no unnecessary surgery or risks.  All in all, we ended up transferring to MFM at Rockford Memorial Hospital with Dr. Platt.  She is our primary but there are 3 other doctors, whichever is there when we are is the one that we see.  I will write more about this later, just wanted to update everyone as to what happened over the last month!  It has been crazy and emotional but it is settling down and we hope it stays that way!

Fears

I told myself and my dh that we would be positive with our next pregnancy.  We would celebrate it every day and not live in fear as we did with Lindsey from the first day we found out I was pregnant.  We were always waiting to buy things, waiting to tell people, waiting to pick names, always waiting.  I didn't want to act like something would go wrong this time.  I know the possibilities, believe me, they lurk in the back of my mind but I do my best to deal them!

I am fighting the urge more and more every day to wait and wonder, instead of celebrate.
The first thing is getting through the first trimester or at least making it past the early stages.  After my first 8 week u/s I was much more confident that things are going to be ok.

Being on progesterone I am more scared.  The progesterone keeps the pregnancy going and my fear is always a repeat of my first m/c where it was missed for 2 weeks because I was on progesterone and nature could not take it's course.  However, with my last pregnancy I was also on progesterone and everything was fine.  That is just a very real fear for me and the one that I am struggling with right now.

The next big step will be the second u/s, which is on Monday, November 21st.  I will be 12 weeks and 1 day so we should be able to see a bigger baby and hear the heartbeat again!  I just love watching them squirm around on the screen!
Another thing taking place at our next appt. is getting a baseline cervical length.  There is not much weight on my cervix at this point (it really starts with significant weight at 18-20 weeks) so we are just going to check it and see if or how it changes after the cerclage and as the baby gets bigger.
I am feeling confident that the baby is doing well since I have had no signs of anything being wrong.

We should also be discussing and scheduling the cerclage at the appt. on Monday.  I need to start networking with other cerclage moms because I am terrified about the whole thing.  I have heard tons of success stories but also a few unsuccessful stories that just scare me to death.  There are risks during the procedure, after and every day after that.  I know it's going to be hard emotionally and probably physically as well.  I worried about complications after the cerclage; contractions, infection and bleeding.  The cerclage is a huge step in this pregnancy but I know that I'm going to need a lot of support because it is going to be terrifying for us.  BUT we hope that it is the thing that will help us to bring this baby home next spring!

So what’s the plan?

Despite what has happened this past year we still have a strong desire to be parents, maybe even more so than before.  Losing a baby is probably one of the most traumatic things that a mother and father can go through and for some; this puts a halt to their journey to parenthood.  For Angel Moms and Dads, all subsequent pregnancies are tough.  We know too much to enjoy all the aspects of pregnancy that most parents do; we are no longer carefree, we have lost our innocence, as we Angel Moms say.

I believe the most important thing to do is research to fully understand what happened last time and what treatments are available to treat you and your LO next time.  Of course, another very important thing is to have a doctor that understands and can deal with your specific situation.  A good doctor will have a plan for subsequent pregnancies and will communicate that with you as my doctor has. 

All of my pregnancies from here on out will be considered high risk.  This simply means that my baby and I have a higher probability of something going wrong than a normal mother with no history of complications.  Having lost a baby at almost 19 weeks and likely having IC puts me at higher risk for complications such as preterm labor, PROM (pre-mature rupture of the membrane), infection and so on and so forth. 

As you can see in my previous post “SHG and MRI” I have had a few tests done to check for polyps, uterine abnormalities and any significant structural issues. 

So here is the plan now:

Once I get a BFP your hCG (human Chorionic Gonadotropin) levels are generally checked by doing multiple blood draws.  This is the hormone is produced by the cells that make up the placenta and is also the hormone which gives you that BFP!  They should double every 48-72 hours. 

My progesterone levels will also be tested at this time.  Progesterone maintains the pregnancy until birth.  My levels were on the low side of normal in the past so I generally use progesterone creams. 

I will also be requesting a CBC (complete blood count) to check my white blood cell, RBC, iron, etc. 

A cerclage will be placed at 13-14 weeks, or sewing the cervix shut.  Done at this time, it is called a preventative cerclage.  For the weeks after the cerclage is placed I will be on BR and antibiotics to ensure there are no infections. 

After that I will be monitored every week to every other week.  Cervical length will be checked at this time.  As long as my cervix does not shorten I should not have to be on very strict BR but will have to take it easy.  That means no working, no standing or walking for long periods of time, no exercise, no vacations or leaving the city and a lot of other “no’s!”.

Well, I think that’s enough info for now!  This process is very long and detailed but we are just hoping for the best at this point!  

Cerclage - Photo provided by Laura L. Oliver