Felicity is an Australian TAC mama! She has written from the other side of this whole TAC experience – from over the rainbow, I guess you could say. She has two gorgeous, healthy girls. Note that her TAC is not mersilene, but IV tubing; an interesting variation from most TACs placed in the US. Thanks so much for sharing your story, Felicity!
If you’d like to share your story, please send it and any pictures to firstname.lastname@example.org.
The Delight a Cervical Cerclage Promises
The story of Australian mum, Felicity, and two very different pregnancies.
Pregnancy One: Baby girl, Allegra, born by c-section on 09/09/09 at 39.5 weeks.
“What if I sneeze?” I asked.
“Yes, that could bring on labour” my obstetrician noted with that calm bedside manner you expect.
And after spending a few nights at the Gold Coast’s John Flynn Private Hospital he then said “it’s best if we transfer you to the Mater. If you deliver now we can’t look after the baby anyway – you’d have to go there.”
That was the third precautionary advice I’d been given in a matter of days. The first was at the scheduled ‘growth scan’ when the sonographer said “I think the doctor will admit you immediately. You may not be going home.” The second, that really stunned me, delivered by the resident obstetrician at the scan sounded much like this – “you really need to get to 28 weeks.” My thoughts immediately jumped to how I was going to control my ‘incompetent cervix’ and ensure it didn’t reduce in length anymore. I couldn’t come up with a plan. After all, I hadn’t even felt it shorten – no contractions, no indication whatsoever.
For a first pregnancy, the detection of a single umbilical artery and a baby with only one kidney at 12 weeks, an amniocentesis at 20 weeks, identification of an incompetent cervix at 25.5 weeks and diagnosis of gestational diabetes at 29.5 was making for an eventful 2009.
By far, the most significant statement though, made on 10 June 2009 read like this: “There is funnelling of the membranes down the internal os of the cervix which is now only 10 mm in length. This may remain like this for several weeks or may result in early PPROM or PTL. In view of the high risk for preterm delivery suggest administration of steroids and bed rest.”
With a new obstetrician, I was to become a patient of Brisbane’s Mater Mothers’ Hospital, the Queensland hospital of choice for high quality maternity services with an unmatched neonatal intensive care unit.
And so it was true. I was administered steroids, prescribed progesterone and nifedipine, hospitalised for 60 days and ordered to total bed rest (with a further 30 days of bed rest at home). Total bed rest meant I was allowed to stand to walk to the bathroom – only. Yet one week earlier I was delivering a large arena event for the Queensland Government which incorporated thousands of students and teachers. In fact, the results of one scan at 25.5 weeks meant life slowed down to the pace of a snail!
At 34 weeks my care was transferred back to my original obstetrician at John Flynn Private Hospital, I was released from hospital and awaited the planned delivery of my baby by elective caesarean at 39.5 weeks.
Finally, she was greeted by two passing statements from that same obstetrician who was so calm many weeks before – “Felicity, you have a girl” and “your cervix is completely blown out.” And so it was, the distress, worry, sadness and anxiety turned to glee, with just one moment of calm to punctuate the crisp, sterile air of the operating suite.
Pregnancy Two: Baby girl, Ilaria, born by c-section on 28/03/14 at 37.5 weeks.
Prior to even falling pregnant with baby number two I set a precedent for this experience by doing the research, followed by the advising. I wasn’t going to put myself in the anxious position of reactive reasoning as I had with my first pregnancy. To my obstetrician at the Gold Coast’s John Flynn Private Hospital I asked what he would do. The reply – a trans vaginal stitch. I knew it only had a success rate around 60%. I wasn’t satisfied.
To Laurie Brunello, a Brisbane-based doctor I had found through extensive online research – “I’m here to find out about a trans abdominal cerclage, and it’s success rate for incompetent cervix.” He replied “a cerclage will enable you to maintain your normal activity level throughout your pregnancy. Just don’t go sky diving.” He added that he’d been doing cerclages since the mid-1970’s, is one of a few obstetricians who do the surgery in Australia, can claim a 90 – 95%+ success rate and believes no woman should have to lose a baby to request the procedure. Dr Laurie Brunello was to be my saving grace.
In February 2012, under general anaesthetic at Brisbane’s Mater Private Hospital he lassoed my cervix with a ring of plastic IV line. I remained in hospital for five days post-surgery as the healing process started for the second cut along my previous c-section scar.
With some sadness, albeit great trust and admiration for Dr Brunello’s specialty, I had to take his advice to have my future pregnancy monitored by Dr Alexander Alexander. The time had come for Dr Brunello to retire. My confidence remained steadfast though – Dr Alexander had been trained in the cerclage procedure by Dr Brunello.
By July 2013 I was expecting baby number two and by September I had seen Dr Alexander for the first time. To my new obstetrician I explained that while I hadn’t lost any children, a shortening of my cervix to 10 mm with baby number one was unexplained by no family history, no previous pregnancies and no surgery. What I did know though was that I simply did not have the emotional strength to go through another pregnancy with forced bed rest from 25 weeks. Sensing my concern and noting my past history his advice was to reduce activity from 18 – 26 weeks. At this point I was reminded of Dr Brunello’s humorous storytelling of sky diving, or lack thereof. I shared this with Dr Alexander and told him I had grate faith in the cerclage, had chosen the pioneer and best specialist in Australia for the procedure, and felt positively able to continue my pregnant life along the same vein as my pre-pregnant days.
Unlike pregnancy one in 2009, 2013 and 2014 presented as a very uneventful ante-natal period. I walked each morning up until 18 weeks gestation then remained relatively sedate until 26 weeks. I did however swim most days during months five and six of the pregnancy, undertook light gym activity post-26 weeks up until 34 weeks and continued working fulltime until 36.5 weeks.
Control would be one way to describe this pregnancy. I felt in control. But also, health, excitement, and energy are words that spring to mind. I was doing this! And with complete elation I heard correctly when Dr Alexander announced he would bring Dr Brunello out of retirement to assist delivery of this beautiful baby on 28 March 2014 at Brisbane’s Mater Mothers’ Private Hospital.
When the day arrived and our bundle of joy cried out for the first time, “Ilaria!” we replied after Dr Brunello asked what her name would be. With a gentle Italian lilt he spelt “I .. L .. A .. R .. I .. A..” and announced “my father is Ilario – names ending in ‘a’ signal the female variant. In Italian it means happy, cheerful.”
Not only were we happy and cheerful, but in the same room for the first time was the complete team that made this pregnancy stress-free, joyful and successful. What a delight!