Monday, October 25, 2010

Incompetent Cervix & Cerclage

Tomorrow is the day. Tomorrow is the day I am dreading. I question in my head whether or not I should be doing it. Is it worth the risks, does it really ensure we will have a healthy, term baby? The real answer is that no one knows. No one knows the answer to this question. Unfortunately, humans are not guinea pigs and it is because of this no one knows if a cerclage really does prevent babies from being born way too early. And that sucks.

With Mairead, I didn't have a cerclage. However, I did have some preterm labor at 29 weeks and I was told during an exam that my cervix was "short" - since they didn't do an ultrasound, no one knew just how "short" my cervix was. By 34 weeks, I was 3cm and 80% effaced, and I ended up being induced at 37 weeks to the day for severely low fluid. At that point, I was 4cm and had a 4 hour labor & delivery with my first baby. Not quite normal, but, don't get me wrong, I was stoked with such a short and easy labor!

With Lilah, it was a different story. During my 19 week ultrasound I had asked the ultrasound tech to measure my cervix. After knowing my cervix was "short" at 29 weeks, I wanted something to go by. The tech asked why I would want this and I told her. She went ahead and did it...and thankfully she did. My cervix measured 1.5cm and funneling membranes...a normal cervix is 3-5cm and obviously, your bag of water should not be funneling or "seep into your cervix". The tech just about passed out - if I hadn't asked, she would have missed something very, very big and potentially devastating to Kevin and I. We met immediately with the high risk doctor and he immediately put the fear into us. I heard words I never imagined I would have to hear myself - "You're going to need an emergent cerclage. Your cervix is dangerously short and if you don't do this, you will risk having your baby soon"....To say we were scared was an understatement. When he went on and told us the risks of the procedure it was even scarier....things like: infection...labor....breaking water....bleeding, early delivery, etc were haunting. The risks were too high for my liking, but the risks for having our baby much, much too soon was even more so. Talk about weighing the risks & benefits. Have it.....and have a healthy baby. Have it....and deliver the baby due to complications from the procedure...Don't have it and risk having a baby that won't survive. And don't bother reading the "statistics" of the success of a cerclage because there aren't any concrete ones that will make your decision for you. Another thing that made it incredibly difficult was the fact that we were away from family and no one really understood the gravity of our situation. It was serious. The risks were serious. The procedure was serious. I had taken care of patients in my time as a labor & delivery nurse who had this problem, didn't know it, and delivered their baby (or babies) much, much too soon for them to survive. I didn't want to be one of them. I look back today and see our beautifully healthy almost three year old, Lilah. We are so lucky to have her here with us safe and sound. Everything we went through was completely worth it....even the 15 weeks of bed rest!

So all this talk about cerclage and a short cervix may have you wondering "what the hell is a cerclage?" - well, I'll tell you in lamens terms and then I'll give you a link to read. A cerclage is a stitch that they put in your cervix to keep it closed and from changing. It is done in the operating room under anesthesia (either a spinal or general), it is a fairly fast procedure - less than an hour, and the stitch is removed after 36 weeks of pregnancy. With Lilah, I didn't have a lot of cervix left for the doctor to put the stitch in, which was pretty scary. They put you in a position called "Trendelenberg", which is when your head is below your feet, this is to bring the baby, uterus, etc way away from your cervix to avoid any trauma, of course, when your membranes are funneling, a needle anywhere near your cervix is very dangerous. Here are two links to read on cervical incompetence and cerclage.

With Clara, it was a different situation. We knew there was a problem. At 12 weeks we met with the high risk doctors and discussed my options. Because I have no real history of an incompetent cervix - meaning, I've never lost a baby due to this problem, no one knows if I just have a normally short for me cervix or if there really is a problem. Most women in my shoes have lost a baby before they've realized they have a problem, and thankfully for me, I didn't. The doctor discussed the risks vs. benefits. Do we wait to see if the same thing happens again or do we place what is called a "preventative cerclage" in. The risks are soooooo much lower to do it before damage has been done, before the baby puts a tremendous amount of weight on the cervix, so we opted to do it. I didn't want to be placed in the same situation as we were in with Lilah. So, at 13 weeks, we had a preventative cerclage placed. I was on bed rest for about a week, and then once everything was good, I was good to go. At 19 weeks, my cervical length shortened to about 2cm and we had to be cautious, but the changes stopped there. I was able to continue on caring for our kids without any "real" bed rest. I laid down when I could and didn't do any strenuous activity. At 36 weeks, they removed my cerclage, and our sweet little Clara was born 2 days later.

So here we are, pregnant with baby #4. I am 13 weeks (by dates) pregnant today and I am right back where we were with Clara. Because I had such a "normal" pregnancy with Clara, we didn't even bat an eyelash about the cerclage. It was something we knew we would have to do. Tomorrow morning, at 6am, I will be checking into Maine Med where I will be getting my third cerclage. I will pray I will experience the same success I had with Lilah & Clara (even more so with her). I am opting for spinal anesthesia, and as soon as I have feeling back in my legs, I will be able to head home soon after. I'll have to spend about 3-4 days on the couch with limited activity and then another 3 days with light activity. Then after that, I am praying for smooth sailing. The thought of the risks still scare me, but I know it is something we have to do in order to help keep our baby safe inside of me for as long as possible and unfortunately nothing we do in life comes with a no-risk guarantee....

So, if you know someone who is pregnant...wants to become pregnant or if you are pregnant, make sure to ask the doctor about cervical length check at your next ultrasound. It may save your baby's life and prevent a tragedy. I tell all of my friends and family do not leave the ultrasound place without them measuring your cervix. Unfortunately, this is NOT something they do routinely...if you can believe that.


  1. Hope everything goes smoothly and by-the-book tomorrow! I'll be thinking about you. You know how well I can relate to the truths in your post... xxoo

  2. Thanks so much, Brenna. I appreciate it...

  3. The story about your emergency cerclage is strikingly similar to my own.
    During a preparatory ultrasound for an amniocentesis, the doctor discovered basically the same issues you had, and my husband and I were sent to the hospital right then for an emergency cerclage. This was October 1, I was at 17 weeks, and am now on bed rest until the baby is born.
    Thanks for sharing here, it's encouraging to read that you had a healthy baby girl. And best wishes in your latest adventure.

    I write of my experiences, too. If you have the time please stop by and compare notes!

  4. i too have had an emergent cerclage, 13 weeks in hospital and now have a beautiful 18 mth old girl.i am currently pregnant 28 weeks with number two, and had a cerclage placed at 13 weeks. much, much better pregnancy, still couch rest, but no emergencies so far. the cerclage works, and it works well!!

  5. I was just in the hospital for 9 days. After several ultrasounds of missing my opening cervix I wasn't told I had incompetent cervix until I was 23 weeks! My cervix was open and I was dialated to 3 and my sac was bulging out. I ended up having to get a cerclage which at 23 weeks is very risky! The first one held but since the sac was bulging they barely got it in so 3 days later I got a 2nd cerclage put in. I was finally able to go home on bed rest and I'm praying he stays in until it's time. I thank god every day that I went with my gut feeling that something was wrong and insisted that I be checked. Other wise he wouldn't have made it. Miracles do happen!


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