The Critical Time Period

I have officially entered the scary time of my pregnancy.  I am 17 weeks 4 days today.

My cervix was stable on Tuesday with a CL of around 3.4cm, it's hard to get an exact reading and they measure it multiple times!  My last appointments my CL was 3.3cm, 3.6cm and now 3.4cm so that is great.  There is no funneling or any sign of changes taking place.  The cervix is a weird organ and can change length constantly but it is unlikely, but possible that it could shorten dramatically by next Tuesday.  Dr. P just said to really watch things this week, abnormal discharge or cramping is the first sign something is wrong.

If I were going to have any cervical issues it would likely happen in the next few weeks so I am KMFX that my cervix stays nice and stable!
The other fear comes from losing Lindsey. I checked in to the hospital at exactly 18 weeks with her and had her 5 days later at 18 weeks 5 days.  Just approaching that time period in this pregnancy is terrifying.  I would love to say that I won't be nervous anymore after making it to 19 weeks without complications but that would be a lie.  I am going to be terrified until we reach 26-28 weeks when our little guy has the best chance of survival if he is premature.  Even being born at that GA is risky and he can end up in the hospital for weeks or months but we are just hoping beyond hope that I can carry him to full term, 37 weeks.

Another thing that I learned is that I am GBS + or Group B Strep +.  Many people are actually, I am just a chronic carrier.  Dr P actually thinks that this may have caused us to lose Lindsey last time because GBS is powerful enough to cause a bad infection and cause premature birth.  However, the doctors did not do the right tests after we lost Lindsey to determine what kind of infection was present.  They jumped to conclusions and decided I had IC without looking into any other possibilities, which makes no sense to me whatsoever but you can't change the past right?
After looking over my medical history with Dr. P, I tend to agree with her that the infections was first.  I did some research about GBS and my symptoms did fit.  We won't know for sure, ever, which is hard but we can make some educated guesses about what happened.
The placenta was severely infected and possibly even Lindsey.

So the biggest fear for me right now is having or getting an infection and not knowing it.  There were really no symptoms last time that would have made me think I had an infection besides the dilating but by that time I was very infected and very sick.  Dr. P indirectly said that I was lucky to have made it out of the hospital with my reproductive organs and my life.  She also disagreed with the course of treatment that I was put on.
Ok, back to infection.
I have already had GBS found in my urine and was put on ampicillian QID for 7 days to clear that up.  I make sure that my urine is checked for GBS at least every month.  I think they will do it when I ask actually because I told them that they were doing it this past appointment!  I am just totally terrified that GBS has infected me and that I won't know it and when I think about that I just panic so I try to just tell myself everything is okay.  I am going to express my concern at my next appt. on Tuesday so that maybe they can do something, like blood work or tell me something to ease my mind.  I'm just really freaking out about it more and more as i approach 18 weeks.

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!

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

Getting Closer

Very day that passes brings me closer to TTC again.
Lindsey never leaves me, I think about her day and night and miss her every second.  A part of me feels guilty for TTC again, it will only have been 2 months on the 24th of July since she was born.  She has inspired me to continue the TTC journey.  The love that I felt for her and the love that I saw DH feel for her made me realize how much we do want to be parents and how much we want to bring a baby home with us.
I had always said that if I had a second miscarriage that I wouldn't try anymore.  I couldn't bear the thought of going through that again.  However, here I sit, almost two months after giving birth to our 18w5d old daughter due to IC thinking about trying again.  Don't get me wrong, sometimes I wonder why I'm putting myself through this and how I got here.  I can think back and remember how I used to think, how our life used to be and I can see how much both DH and I have changed.  Sometimes I miss my high school life, I miss my college life and I miss my naive and optimistic TTC journey of years ago.  I like who DH and I are today, I could just do with a little less tragedy.  I would like to think that after all of the heartache that things can only get better, but usually when I think that way I'm quickly brought back to real world.
I know too much about life, too much about TTC and too much about pregnancy.  It is great to know so much because only then can you make good decisions about your medical care but at the same time it takes a little, no a lot, of the joy out of it.

I know once I am pregnant again that I will have to work hard every day.  As I told DH, we are going to celebrate the next baby and the next pregnancy as much as we did the last.  We are not going to let the fear take away our happiness and we are going to try to be optimistic but logical.  I know I will struggle some days but I know that we are both strong and that we will get through it.  When I struggle, I remember Lindsey and how much we love her and how happy we were to hold her in our arms.  She pushes me to keep going and to move forward and to try again.  I feel like her sacrifice will help her brother/sister have a better chance at survival and that she will be largely responsible for helping us have a family.  I feel like I need to make sure she had a purpose her on earth, but in the end, she did so much in so many different ways.

Hope
Life is a gift and every moment in time is a miracle to cherish.