Incompetent Cervix & Cerclage

Without any family history or risk factors (previous D&C, PCOS, DES exposure, cervical trauma, uterine anomalies, etc) I had no clue I would become someone with an incompetent cervix. Actually, with a family history of post dates babies, I would never have thought I would be worrying about prematurity.

In 2006, I delivered our first born daughter, Mairead, at 37 weeks. During her pregnancy, I was still working a a labor & delivery nurse. I would experience cramping and pressure, but was assured this was normal. During my 19 week ultrasound, I remember several technicians including the Radiologist himself trying to get an accurate cervical length - not knowing much about cervical length back then. I was sent home thinking everything was great (not knowing a 3cm cervical length was on the very low end of normal). At 29 weeks, I experienced preterm labor and was sent home on bed rest. I was told my "cervix was short", but because no one did an ultrasound, we don't know just how "short" it was. At 37 weeks, I was induced for severely low fuid. After a quick 4 hour labor (started at 4cm/80%/0), I delivered a healthy baby girl. Thinking I was a lucky girl for having such a quick, easy delivery, I couldn't imagine how easy the next baby would be.

In 2007, I became pregnant with our second daughter, Lilah. In my 2nd trimester, I experienced the same pressure and cramping I did with our first, but was once again assured, this was normal, especially with second babies. During our routine 19 week ultrasound, I asked the ultrasound tech to check my cervical length. She looked at me like I was crazy. She asked "why, is there a reason to?" I told her what had happened with our first born, so she did. As soon as she placed the vaginal transducer, I saw a big "V" and knew something was wrong. The look on her face was a look of shock. My cervix was 1.5-2.0cm with funneling membranes (my bag of water was sitting inside of my cervix). I was told right then I would need an emergent cerclage. The high risk doctor placed fear in us - you can read more about that here. At about 21 weeks, I received an emergent cerclage and it was one of the scariest things I have ever gone through in my life. At 37 weeks, the stitch was removed, and Lilah was born 6 days later in just 2 hours. I had some cramping, called my OB, and when I got to the hospital, I was about 5-6cm without going into labor. Painless dilation.

2009 - I became pregnant with our third child. Since we knew there was a problem, we chose to get a preventative cerclage at about 13 weeks. My cervical length stayed about 2.0-2.5cm throughout the pregnancy with fluctuations down and up. I managed to remain off of bed rest for the entire pregnancy. At 36 weeks, my stitch was removed, and our daughter, Clara, was born 2 days later. Once again, pressure and cramping, but no contractions, Went to the doctor, and I was 6cm dilated. Once things got started, she was born in about an hour.

Here I am pregnant with our 4th baby. My preventative cerclage was placed about 13 weeks. I sit here 16+ weeks pregnant and a cervical length of 2.2cm. I pray I will have success with the cerclage like I did with my previous babies. I have never blogged before and I started blogging to keep a "journal" of the ups and downs of raising small children. Now that I am pregnant, I write about my experiences with an incompetent cervix, cerclage and trying to raise three small children.

I am trying to educate friends, families and now strangers about the significance of incompetent cervix and how it could possibly prevent babies from being born too soon. Unfortunately, doctors do not routinely perform cervical checks in the 2nd trimester, when cervical incompetence tends to rear its ugly head. I just do not understand this - they check for uterine abnormalities in the mother, and test for diabetes, high blood pressure, they check every possible thing with the baby, so why not the cervix? How can we get doctors to routinely check for cervical incompetence? I know it may not help every woman, but it would certainly help some.

I often look at our sweet, little Lilah and wonder what would have happened to her if I hadn't asked the ultrasound tech to check my cervical length.....would she be here? would she have been born too early? would she have been more much more premature? I don't know...but what I do know is that education is key, and I try to tell every pregnant person and anyone thinking of becoming pregnant to proactive in their healthcare. Be a pain in the ass. It is your body. It is your baby.

Interesting Information regarding Cervical Insufficiency (or cervical incompetence):

ACOG Releases Bulletin on Managing Cervical Insufficiency - I find it pretty hard to believe that ultrasounds wouldn't make a difference in diagnosing IC. If a women is already receiving an ultrasound, how hard is it to measure the cervix? It's not hard - believe me.