Monthly Archives: November 2013

Stories of Strength: Colleen’s Story

My second Story of Strength is from Colleen. These are two posts from her blog, nvoutbackwoman.wordpress.com. Colleen is currently 16 weeks pregnant with her rainbow baby and doing well. Thanks for sharing, Colleen! I hope you have an uneventful pregnancy, and will look forward to an update when you have that baby!

If you’d like to share your story, please send it and any pictures to tac.questions@gmail.com.

Broken Hearts

Well, it’s been a while since I posted, and a lot has been going on in our lives since July. Shortly after my last post, and before we moved into the house, we found out we were pregnant. We were both so excited and a little bit nervous. Though my intuition told me earlier, at 18 weeks, we found out we were having a little girl. Besides a little nausea and some heartburn, my pregnancy was going well. We picked out the sweetest bedding at Pottery Barn, a neutral tan color with little owls, and planned a shower for February. I read about the best ways to prepare for a baby, and cut out anything remotely questionable out of my diet. I talked to her all the time, telling her how beautiful and smart she was and how much fun we would have together.

However, on December 8th when I was 23 weeks pregnant, I started not feeling well. I felt cramps, similar to menstrual pains, and saw a tiny bit of blood, so I decided to go to the hospital just to ease my fear. B was at work, so I drove myself. They told me everything looked good. The baby was kicking up a storm, and her heart rate was perfect. The nurse told me I was probably dehydrated, and they discharged me.

All that night the cramping continued, and started to become more painful. Around 6am I returned to the hospital, feeling like there was still so,etching wrong. The nurse finally checked my cervix, and ran out of the room. Another nurse came in and while she rapidly hooked me up to an IV, she told me I needed to call my husband and he needed to get there ASAP. With tears in my eyes I asked her if I was dilating. She told me I was completely dilated and was going to have the baby soon. I was not prepared for this.

After that, everything happened quite fast. B and a friend of mine arrived shortly after my OB, who gravely told me this was not good. He said he suspected that I had a condition called incompetent cervix, and would need a cerclage in future pregnancies. Basically my cervix could not handle the weight of a growing baby, and opened prematurely. He did an u/s to see how our baby was positioned. She was breech with the cord around her neck. The hospital called a special neonatal team to fly in from out of state, and they delayed her birth until after they arrived. Suddenly there were people everywhere, talking to me about viability, asking how much we wanted done. They said they would life flight her to Utah, but that I couldn’t go, though B could. I prayed that God would let me keep my baby.

He did not. After a few pushes, my beautiful baby girl was born. I remember the second they cut the cord and she was forever separated from me. B followed her to the room where they tried to get her to breathe. A few minutes later a solemn woman came in to talk to me. She didn’t have to say anything, but she told me they did all they could. My heart was ripped in two. I hated my body, my doctor, and the nurse that sent me home the night before.

They brought her in to us shortly after, I was not ready to see her and was crying hysterically. She was so perfect, I did not understand how this could be happening. Her skin was still so warm and she was bigger than I thought. She had long legs and fingers, downy hair, and her daddy’s ears. We named her Addison Grace.

The next several days were a blur. We learned how to make funeral arrangements, post an obituary, and how to tell people our daughter was dead.

She will always be our daughter, our firstborn child, and I will always think about the beautiful little girl, and then woman, she would have become. When we have more children, God willing, they will know about their sister.

Proud New Owner of a Bionic Cervix

We left for Chicago on April 12 and spent the weekend enjoying the city before my surgery Monday morning. We checked out the Bean, the Art Institute and had cocktails on the 96th floor of the Hancock Building after a cubs game.

Monday morning we took a cab to the hospital, driving by the incredible Museum of Science and Industry. We really need to go back, there’s so much to do there! The hospital itself was beautiful, brand new, and very modern. I checked-in at a huge white desk and the lady gave me a little buzzer…I joked we must have gone to the Cheesecake Factory by accident. They also had a large screen your loved ones could track your location with (like the airport arrivals board). Pretty cool, but a little impersonal too. We waited quite a while before my buzzer buzzed. Another lady’s had at the same time and as we walked back, she showed me pictured on her phone of her car, which had just been squished by a pile of bricks that randomly fell off of a building. “You never know when it’s your time,” she joked. Thanks….

Once they pulled me back, they made Brady wait in a smaller room while I was prepped. I had to change into the gown and stash all of my stuff into a garment bag. They took my vitals and placed my IV, then let Brady back in. The anesthesiologist came in and asked me a million questions and made me so much more nervous. I was terrified of going under general (thanks to an episode of Grey’s where Mandy Moore never wakes up) and we discussed a spinal instead. They explained the risks were comparable with both and I finally decided to go ahead with the general. The residents also came in and talked to me, and one, Dana, I think, was super sweet and helped me relax. The resident with the anesthesiologist was in ortho and I jokingly forbade him to touch my bones. He was kinda cute and I realized he (and everyone else) would see me naked and unconscious soon…. lovely. Dr. Haney came in there at some point and lightly chided the anesthesiologist (who was actually starting to grow on me) for making me nervous. He explained the whole procedure again and told Brady I wouldn’t remember much for a while after I woke up.

They then started to wheel me into the OR. Brady got to walk a little of the way before they shoo’d him away. Then they had me move to the table and “spread my arms like Jesus.” That part is a little hazy. Then the anesthesia resident put the mask over my face, but it was all weird, like crooked and over my eye. I was making faces so Dana was like, “No dummy, put it this way” and fixed it. Haha she didn’t say that exactly, but you could hear it in her voice. It was much more comfortable and I took a few deep breaths and next thing I know I’m waking up in recovery.

Everything was unbearably loud to me. The monitors beeping, other people talking, the enormous lady they wheeled by that kept hollering. The recovery nurse noticed I was wincing and apologized for how loud the lady was. She then started asking me how I was feeling and explained the PCA pump (push button pain meds). She told me to push it and let me know how it felt. It made me nauseous almost instantly so she unhooked it and called over the anesthesiologist. He was annoyed they gave me the drug they did (dilaudid) as I told them Vicodin makes me feel sick, and it usually reacts similarly. He also asked me if I’d heard about the Boston bombings (which happened while I was out). I was like “ummmmm no… I was unconscious?” It took forever to get a new PCA and then when it finally came, the nurse couldn’t get it to work. At this point poor Brady was wonder what the heck was happening to me. Dr. Haney had come and told him the procedure went well right after surgery, but no one told him why I was stuck in recovery for so long.

Finally they got me to my room. I was thrilled to be somewhere quiet, and Brady was finally called to come up with me. The room was quite large, and had a small room with a computer and a sink attached that made it even more private and insulated from the hallway. The view of the skyline was lovely. Nurses came in and out all evening and I slept most of the time while Brady watched movies. I was excited to eat as there was a Jamba Juice downstairs (we dont have one in our town), so he got me one and I drank a good deal of it. The next morning they said I should try and get up, and they removed my IV and catheter (super fun). The first time I sat up I thought I might throw up from the pain. It was intense

I was discharged that afternoon and we took a cab back to the hotel. There was a beautiful fruit arrangement waiting for me courtesy of my wonderful aunt. It tasted great to me, despite the crazy gas pains I started feeling. Apparently air builds up in your stomach when they open you up and it’s not so fun. We headed to bed early, as we had a flight early the next morning. I told the airport I needed assistance and popped a Percocet when we got there, so the airport is a bit of a blur.

I’ll post more regarding my recovery later, this is enough for now 🙂

Colleen

Colleen & Dr. Haney

Stories of Strength: Meghan’s Story

This is the first story of (hopefully) many I will share here, of how cervical insufficiency has affected women and their families. This story shows how important it is that doctors be aware that IC can be acquired through trauma – it doesn’t have to be congenital. Meghan, thank you so much for sharing your story. You’re one strong mama.

If you’d like to share your story, please send it and any pictures to tac.questions@gmail.com.

I am very “lucky.” My daughter and I survived ten weeks of unmonitored preeclampsia before it finally became severe enough that someone looked back at my labs and blood pressures and symptoms and induced me. My first child (second pregnancy after an early miscarriage) was born 51 hours later, after many intrapartum complications, on my 35th birthday.

My daughter got stuck in my pelvis at about 1.5 hours of pushing. This was after two episodes of severe drops in blood pressure after an epidural for me that rendered me unconscious, and my baby bradycardic (low heart rate). Despite a vacuum assist after 4 more hours of pushing after she crowned, (thanks to the fact I ran 20 miles a week until I got sick at 26 weeks gestation, I did have stamina), she was not coming out vaginally. This was a surprise to me because my mom birthed three 9.5 pounders and me, with her longest labor 4 hours!

So we went to csection, where a third OB gave a “push from below” in order to disengage my daughter’s head from my pelvic inlet, to deliver her. After my OB saw me post-op the next day, I knew I had a small tear (the lucky part), however at 6 months postpartum, I finally dared to feel it and discovered my cervix was ripped all the way through and still open at 9 o’clock longitudinally. So I knew I had a huge(!) problem – this was no “small tear.”

As a pediatric nurse practitioner working in family birthing/nicu, I know things happen. I see it every day – especially if the mother works in medicine – something invariably goes “wrong.” What pisses me off though is that 1) the OB made it sound like the tear was no big deal (watch and wait next time?), 2) by six months postpartum, she had already done two exams and had not found this, 3) she would have let me go ahead and get pregnant if I had not been one to feel my damage in the first place.

It turns out that my rip was from the lower uterine segment all the way down through, not a “small tear.” In my job I see the “push from below” all the time and I want to yell at the OB to put that in the OP note (thankfully mine was, but the extent of the damage was not accurate), and gently write a letter to the patient (to be opened 3-6 months postpartum when they have their feet under them again) to make sure they become aware that this could be an issue later on, but I cannot.

My husband and I were going to go ahead with another severely monitored pregnancy with only the preeclampsia over our heads. When I found my injury, I knew I would have an incompetent cervix and had already researched my options and had found Dr George Davis online, so when I was finally referred to him a year later, after discussions between the OB and MFM, I already knew what I wanted. I had a hysteroscopy and consult with him. As my OP note was unclear and my damage so severe, Dr Davis could not tell us exactly what was to happen, but theorized that I would need a transabdominal cerclage (TAC) for cervical competence and a transvaginal CervicoIsthmic cerclage (TVCIC) to keep a mucus plug in my open cervix to ward off ascending infection (the TVCIC is different than a normal transvaginal cerclage – TVC – in that it is much higher up the cervix and has no free strings that could allow an ascending infection). Dr Davis also recommended delivery early at 34 weeks, as my lower uterine segment was probably also going to be weak. I think the early delivery was the part I could not get over – an early delivery because of in-pregnancy issues is one thing in my mind because we are doing the best thing for the baby at that point, but planning for an early delivery was different – I was planning and choosing to put my child at a developmental disadvantage and it was a hard pill to swallow for me.

That was exactly two years ago, but my husband decided that between the early preeclampsia and my incompetent cervix, an attempt at a sibling for our daughter was not in the cards. I grieved this – I was not done. I was angry.

Fast forward to this summer and I was giving away my baby stuff (not just loaning out, as I had been doing), and my husband became concerned that this was the end of our possibility of having another child and mentioned another baby. He had always wanted another, but was too scared for my health and for our daughter potentially not having the same momma around if the preeclampsia was severe and early again, but me giving away our car seat was too permanent for him.

I called Dr Davis, who previously had been understanding and supportive of our decision to not go ahead and get the TAC. I told him we wanted to go ahead and get the TAC and investigate my actual damage. He was absolutely on board with this plan. I was TACed last month. Whether it was the 3.5 years since my delivery, or an incomplete and incorrect operative note, I don’t care – my body had done the best job of healing itself and my TAC went on beautifully, with a thick lower uterine segment and still approximated upper cervix – all this allowing no TVCIC needed and delivery at 39 weeks if we choose to get pregnant.

I am now awaiting my husband to digest all of this and come to his own conclusion that it is ok to get me pregnant with lots of monitoring for preeclampsia. My IC is now fixed. My broken heart will be fixed with another pregnancy and sibling for my beautiful daughter once my husband has battled his anxieties and fears. If my husband cannot come to that conclusion, I will most certainly grieve again, but will be thankful for my daughter and will continue to spread information about preeclampsia and IC.

For more information about preeclampsia, or to register as a woman or family member affected by preeclampsia for long term study, please see www.preeclampsia.org and for an IC support group and options, google Abbyloopers.