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 firstname.lastname@example.org.
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.