My TAC Experience

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Well it turns out that it’s difficult to do things like write blog posts with a new baby. There are people who are much better at it than I am, but the fact is that I’m not very good at it. It’s hard enough to stay on top of the house work when I just want to spend all day cuddling my little boy. I thought my next blog post would be a picture-heavy run-through of William’s first several weeks, but instead it’s going to be about how he got here. No no, not that, get your mind out of the gutter.

If you’ve already lost interest, that’s fine. This is really for all the women who find this blog looking for information about incompetent cervix and the Transabdominal Cerclage (TAC). This is my experience with the TAC surgery and how it’s held up since. But I have to start at the beginning. Feel free to skim – as you know, I’m a talker.

The day that Lucy died, as we were driving home from Bakersfield, David and I looked at each other through our shock and grief and agreed that we’d still like another child. This may not seem like a big deal, but you can’t understand what that decision feels like right after you’ve lost your baby (unless, of course, you’ve lost your baby, in which case I’m so sorry and I’m sure you do understand). But we knew even then that we wanted Lucy to have a little brother or sister, as she would have had she lived. So it didn’t take long – maybe a few weeks – for me to start researching my condition. It was easier for me to start than it is for many women, because the doctor who delivered Lucy had diagnosed me with incompetent cervix. This, unfortunately, is not the case for the majority of women who lose a child to IC. Doctors are reluctant to diagnose IC as it is not a straightforward or easy diagnosis. Sadly, this sometimes means a woman will lose more than one baby before she figures out what the problem is. As I said, this was not the case for me, so a few weeks after Lucy’s memorial service I sat at my computer googling “incompetent cervix.” It didn’t take me long to find the most common solution, which is what my doctors had suggested for next time – the simple TVC (transvaginal cerclage). I then found a group of women who had taken it one step further with the TAC. I won’t get into all the differences and pros and cons here. If you’d like to read about that, I wrote about it here.

After reading the posts of the Abbyloopers (on the web here and on Facebook here) women for a week or so and researching the TAC extensively, David and I decided it was the only way for us to go. If we were going to try to have another baby, we were going to give it the best chance we could. I contacted Dr. Davis in New Jersey and Dr. Haney in Chicago. They, along with Dr. Sumners in Indianapolis are the experts on the TAC in the US, and perform the most surgeries in the US as far as I know (although rumor has it Dr. Davis is nearing his retirement). I discussed my case with both of them (by email and by phone), and they agreed that it sounded like a classic case of IC and suggested I have the TAC surgery. I started checking into insurance coverage for a pre-pregnancy TAC. Then, out of the blue, I found out I was pregnant. I had always had irregular cycles, and it took us so long to get pregnant with Lucy that I didn’t think anything of it when my period was one week late, then two. When I finally took a pregnancy test and got my positive result, I was already 7 weeks pregnant. As in-pregnancy TACs are usually placed between 10 and 14 weeks, I hit full panic mode. How was I supposed to schedule a cross-country trip and clear everything with my insurance that quickly? I originally intended to fly to Chicago to have the TAC placed by Dr. Haney, but after two weeks of trying to get in touch with his assistant she finally told me he would be on vacation during the time I needed to have the surgery. Now I really panicked. Here I was, 9 weeks pregnant and without anything scheduled. Fortunately I was able to get in with Dr. Davis, and we planned our trip from Southern California to New Jersey. And because of Lucy’s time in the NICU, we’d already hit our catastrophic limit with our insurance and didn’t end up paying a thing for the surgery, which was covered without incident (again, many women are not so lucky, so I count myself very fortunate). Dr. Davis is outstanding at getting insurance to cover the procedure, and he usually takes care of everything. If you don’t have insurance, or they won’t cover a TAC, Dr. Davis is the only doctor I know of who offers an out-of-pocket option at cost. It runs about $4500-$6000, I think.

I planned for our trip through my morning sickness, which completely disappeared the day before we were scheduled to fly out (hallelujah!). We flew into Philadelphia (PHL) on Wednesday, which is definitely the closest airport to Kennedy Hospital. We got a rental car and settled into our hotel, the Hampton Inn in Turnersville. We got the federal employee rate, and the hotel was nice, clean, had a decent breakfast, and was pretty close to Kennedy Hospital. Next door is a Friendly’s, and there are many other (mostly chain) restaurants very close by. Be warned if you’re not from the area: New Jersey has these really weird left turns called jug handles. You go right and loop around to make a left, and it’s strange to get used to. There’s at least one close to the Hampton Inn, so you’ll probably see what I mean.

The next morning I had a consultation with Dr. Davis, then later met my friend Ruth and her wonderful family for dinner. The morning consultation was easy – a quick vaginal exam to check my cervix, an abdominal ultrasound to check out the baby (then almost 13 weeks and measuring large), and a question and answer session. I had him take me through what would happen during the surgery (he had a handy Powerpoint presentation to show me) and we asked a bunch of questions about safety of the baby and other things. He didn’t rush us at all, and he let us get all of our questions out. He has a dry sense of humor, and he’s easy to get along with. The truth is, Dr. Davis is a bit of a talker too, which is actually nice when you’re used to doctors rushing you out. We also discussed food – I asked him where we should eat, and he had a lot of ideas. We wanted the quintessential New Jersey experience, so he recommended a diner that we enjoyed for lunch. We were there for over an hour and left feeling very reassured. Oh, after we left his office I went down to the lab to do my pre-op bloodwork also.

After dinner with Ruth’s family we went back to our hotel to relax. I wasn’t to eat or drink after midnight, and we had to be at the hospital at 7:00 am to get registered. Both our consultation and the surgery took place at Kennedy, by the way, although Dr. Davis also has offices elsewhere. We got to the hospital, registered, then waited and waited and waited because they were running a little behind. I didn’t mind too much, but I was hungry and thirsty of course. Finally they brought me back to the pre-op room without my husband where I dressed in a gown, met the anesthesiologist, got my IV, briefly met with Dr. Davis, then waited some more. At some point David was allowed to come back and sit with me.

Since I was pregnant and wanted the least medication possible going to my baby, I opted to be awake for the surgery with a spinal, just like for most cesarean sections. I’d had surgery before, but never awake, and that part was a little scary. Finally (after noon by this time – I was starving and so thirsty!) I said goodbye to David and they wheeled me back to the operating room. The anesthesiologist placed the spinal, which was weird and hard for me to deal with (needle issues), but it was actually nice when I felt it moving down my legs because I’d been so cold, and then only my top half was cold. Oh, there was a really nice nurse, a handsome Marine, holding me steady and keeping me calm while the spinal was placed. They then put up the curtain and flipped up my gown. By the way, when you’re awake for a pelvic surgery, you have to just let go of any dignity you thought you had. Actually, just get used to it, because it only gets worse when you actually have the baby. I chose to have the TAC placed with a traditional open incision – the same kind they use for c-sections. They gave me a quick shave where the incision was going to go. I normally might have been pretty embarrassed by that, but when you’re numb from the chest down and you can’t see it, it’s like it’s happening to someone else. Oh, at some point in here they pushed some antibiotics through the IV in my hand, which was incredibly painful. In fact, that was the most painful part of the whole surgery I think. It burned, and it made my wrist feel like it was breaking. The anesthesiologist was really nice though and brought me warm blankets for the top of me that was still cold. I mentioned that it might be cool to watch the surgery on the TV screen they had in there, and they would have let me except I didn’t have my glasses. So if you’d like to watch, ask them to let you bring your glasses back if you need them.

I remember wondering when they were going to start, and then I smelled burning. I wondered what it was for a second, then realized oh, hey, that’s my burning flesh as they cauterize the incision. It was a bit weird feeling a lot of pulling and tugging and not knowing what was going on – I kind of wish they’d say “ok, this is what we’re doing now.” But Dr. Davis was just chatting with everyone in the room, and at one point started quizzing people: “how many cups in a pint?” and “how many feet in a mile?” Then he asked “how many two cent pieces in a dozen?” Trick question of course, and his assistant surgeon fell for it: “umm, 6?” “Nope. Anyone?” Nobody answered, so finally I said “12. There are always 12 in a dozen.” Everybody stopped, then Dr. Davis leaned over the curtain to look at me and said “Yes, Jill is correct.” Haha. Anyway, the surgery was progressing fine, and it didn’t hurt at all, but it did feel like they were trying to pull my lungs out through my belly. Partway through they put me into a steep Trendelenburg position, which means that they tip you head down. I had to lay like that the whole time I was in labor with Lucy, but this was a steeper angle and they did it so quickly it felt like I was going to slide off the operating table. When he was finished placing the TAC he did an ultrasound directly on my uterus, and I got to see my healthy squirmy little baby looking fantastic.

After what felt like kind of a long time, they finished up and cleared out really quickly, wrapped my torso up tightly with a binder, then I was wheeled back to recovery. They brought David back to see me, and he told me he’d received texts letting him know the surgery was going fine. I thought that was a nice touch. After a little while (not sure how long) they took me to my regular hospital room. I was happy and awake and felt pretty great. They gave me Duramorph – a morphine injection – through my spinal that lasted most of the next two days, and I didn’t need any other pain medication until I left the hospital. I was on a liquid diet (bummer) until the next morning, and I also had the catheter until the next morning. I HATE the catheter, but it wasn’t a big deal. After they took it out, they wanted me to get up to use the bathroom. It was a little tricky at first, but I managed fine and just held a pillow against my incision while I walked. The next morning they took off the binder and said my incision was all the way closed after 12 hours, and I could shower after 24 hours. (I showered back in the hotel before we left.)

Just an aside, and probably TMI, but this is a concern for many women having this surgery. Many, many women had trouble with constipation and painful bowel movements after the surgery. This was NOT a problem for me, but I think I’m in the minority. They give you Colace stool softener in the hospital, and you should definitely take it, but you should probably start it a few days before the surgery if you think you might have any trouble. Also try to eat foods high in fiber, and you should be fine.

The most important thing (as everyone will tell you) after the surgery for your recovery is to get walking as soon as possible. Right after the surgery, it will help your body get rid of extra gas caused by the surgery. This is a problem for every surgery, but is even worse for laparoscopic procedures, so keep that in mind. It’s scary, but walk as much as you comfortably can. Your incision will probably burn at first, but the more you move the better it will feel. Don’t overdo it, of course. In the long run it’s even more important to walk a lot right off the bat. If you don’t, you’re more likely to develop scar tissue, and I can tell you that it is not pleasant. As my pregnancy progressed it became apparent that I had some scar tissue (confirmed by ultrasound), and it was incredibly painful as the baby pressed against it. One of the most painful things I have EVER experienced, in fact. So walk. Just do it. This is probably even more important if you’re already pregnant when you get your TAC, especially if there’s any chance that you’ll end up on bed rest like I did. You want to be as active as possible while you can, and if you have a complicated or difficult pregnancy, you might have trouble with it later.

I was discharged from the hospital the next morning, less than 24 hours later (so it was an outpatient procedure, not requiring pre-authorization from our insurance). They took me in a wheelchair down to the car, and we drove straight to the pharmacy. I took other women’s advice and filled the pain-medicine prescription at a Walgreens near there. I’ve heard that you can’t fill it out of state (although that doesn’t make sense to me, so I don’t know), and that the hospital pharmacy takes a long time. Anyway, we picked up my Percocet and I took one since I knew I’d be moving more. We drove back to our hotel and hung out there the rest of the day (Saturday by now, surgery was on Friday). I slept a lot, and David went and got dinner and brought it back, then we got a sundae from Friendly’s. I took the Percocet the rest of that day and mostly stopped it by Sunday. On Sunday David and I took a drive out to the Pine Barrens to explore. On Monday we went back to Dr. Davis’ office. He removed the staples (he uses staples instead of dissolving stitches), which didn’t hurt at all. I couldn’t even feel it really. He covered the incision with steri-strips. He also did a vaginal ultrasound to check the TAC and take pictures to send to my OB. We saw the baby again, then sat with him while he wrote a letter to my OB. We thanked him and left the hospital, driving straight to the airport. Oh, not quite, we stopped for bagels.

Back at the airport in Philadelphia we got a wheelchair escort. I could have walked very slowly, but we were running a little late, and I knew I had a long day ahead of me. I’m a little paranoid about the full-body scans, so I opted out of that and the TSA agent very gently patted me down. The escort left me at our gate, and I realized I needed to use the restroom before we left, so I set out to find one. It took forever, it was way back out of the terminal. When I finally got back, people were asking David if I was going to be okay. It was nice that people were so concerned; you don’t normally think of strangers being that worried about you. The flight attendants offered to let me board first, and I did very gratefully. We had booked a nonstop flight, thinking it would be easier not to have to transfer. I had an aisle seat (definitely recommend to my fellow TAC mamas) because you need to get up and move during the flight. Unfortunately, it was a very turbulent flight, so the seatbelt light was on most of the time. I got up when I could, and was fine. Oh, you should also be drinking a LOT, and therefore will probably pee a lot. Try to get a seat near the bathroom if you can. I took the Percocet at regular intervals all day Monday, more because I wanted to stay on top of the pain than because I was actually in pain. We got back to LAX, where I didn’t use a wheelchair. We just walked slowly and took the shuttle back to our car. We had a 3 hour drive home still so we set off immediately. We stopped once to stretch and use the bathroom and got home pretty late.

I think I only took one Percocet after we got home because I felt fine really. I stayed mostly in bed for a couple of days and took a shower after a few days. The steri-strips mostly just fell off, and my incision healed really nicely. In fact, my OB used the same incision for my c-section, and 6 weeks post-op it is still just a thin, flat red line. David took really good care of me. Dr. Davis hadn’t given me any restrictions. He said I could do anything that felt okay whenever it felt okay. I asked about swimming and he said it was one of the best things I could do. He said sex was fine whenever we felt up to it. I was swimming very gentle laps a week after the surgery, driving myself to the dentist ten days after surgery, and feeling pretty much completely back to normal a week and a half after surgery. Again, probably TMI, but sex did happen pretty shortly after surgery and it was perfectly fine.

So that was my experience of the surgery. I had other complications of my pregnancy, and they may or may not have been related to the TAC. I will write about that at some point, but here’s the most important thing: the TAC held strong until I was full term (39 weeks) and had reached my scheduled c-section date. I have a delicious, wonderful, beautiful, perfectly healthy baby boy because of Dr. Davis and the TAC. I only wish I had known enough to have it done when I was pregnant with Lucy, because then I’d have my sweet little girl with me. Of course, if that had happened I never would have had William (he was conceived before Lucy’s due date).

Okay, I hope this is informational for women thinking of or planning on having the surgery.

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