Tag Archives: TVC

Stories of Strength: An Incredibly Strong Mama

The amazing mama who shared this story wanted to tell it anonymously. It’s such a horrible shame that she KNEW she needed a TAC and couldn’t get one because of her insurance. It’s a story I hear way too often. No parents should have to lose a child – let alone TWO children! – to satisfy their insurance. Thanks for telling your story, mama. I can’t wait to hear about your rainbow baby.

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

 

On April, 2008, my husband and I welcomed a healthy baby girl at 40+5 weeks. It had been a fairly easy pregnancy. I was induced and she was born eight hours after the induction. I refused an epidural until the pain became unbearable. At that point, I was told it was too late to get it. I got a dose of narcotics, but that didn’t help much. Though I had an episiotomy, baby turned her shoulders on her way out and tore my perineum. It took about a month to heal, but things got better with time. Five years later, we decided to try for baby number two. I had my Mirena IUD removed and I conceived that month. Everything had been going well except for a couple of episodes of unexplained spotting. I had also been having some pressure in my lower abdomen. Each and every check and ultra sound had shown that baby was fine, but that he was low lying. My cervix was also said to be friable; nothing serious.

However, on 7/15/13, I went for an anatomy scan and no sooner had she started the scan than I noticed her tense. She asked if I have fibroids; I said no. She asked if I was having contractions; I said I had been having Braxton Hicks Contractions on and off but that my OB had said it was normal. By this point, I was beginning to get worried. I mean, why all these questions? The tech kept asking me to change position and also kept pressing my tummy so hard it was somewhat painful. Eventually, she mentioned that the baby was very low. So low that she couldn’t get a good view of his toes. She soon excused herself and came back with Dr. White, Maternal Fetal Medicine (MFM). He asked if I had been having any pain. I told him that I had spotting and bleeding 2 times in this pregnancy but ultrasounds showed that baby was fine. Each time, nevertheless, they didn’t check the cervix. 15 weeks was the 2nd ultra sound due to bleeding, and the tech had said that baby was fine. She did mention, however, that he lay a little low. Nothing to worry about. After that U/S, a nurse practitioner had done an internal check and said that my cervix seemed inflamed but also mentioned that some people just have a lot of blood during pregnancy. I told Dr. White that about two weeks after the nurse practitioner had checked me, I had started having some pain on my right hip and around my groin – right side only. They were about one to two minutes apart and about ten seconds long. They started about 10 pm and went on till the next afternoon. There was no bleeding / spotting. I called my OBGYN in the morning and she had no idea what that would be. She mentioned I may have kidney stones or round ligament pain, but asked me to give a urine sample to check for the kidney stones. I never heard from the doctor’s office, so I assumed that I was good to go.

Dr. White asked the tech to do a vaginal ultrasound. At that moment, Dr. White announced the bad news. My cervix was open. I was so naïve that I didn’t understand the implications of his news. He very gently explained that the cervix is supposed to remain closed until the baby is close to term. However, mine was already fully effaced and dilated at only 18 weeks. He said that this was very serious and that I would lose the baby as he wasn’t viable. He diagnosed me with an Incompetent Cervix and sent me to a hospital one hour away from home with hopes that I would be given an emergency cerclage. At the hospital, I was checked and was told that I was already 2cm dilated with bulging membranes. They kept me for observation. Luckily, I wasn’t having contractions. Later that night, one MFM came in to check me and she said that she might attempt a vaginal cerclage, but that she couldn’t do it that night. She said to wait until the next morning then the next doctor would do it for me.

The next morning, the MFM on duty checked me and said that he wouldn’t do anything at this point. It was too risky. My membranes had already been exposed to the vaginal bacteria for God knows how long. There was no way he was going to try to push back the membranes and attempt a suture. It was too late. I was definitely going to lose this baby. He told me to terminate the pregnancy or go home and wait for the baby to “fall out.” He tried to “console” me that I was still young and that I would be able to carry another baby to term with proper care. He even went ahead and narrated a story about a young woman who got a stitch after her membranes had bulged. How she got a bad infection that had her in the ICU for weeks before finally killing her. He said even if the infection didn’t kill me, it would definitely kill the baby and that I would possibly lose my uterus . . . meaning no more babies! I hated this doctor. I never ever wanted to see him again or be in the same room with him.

That midnight, my waters broke and the next day I was induced and delivered my sleeping son. He weighed 240 grams. He was so perfect and handsome. He looked just like his daddy. We were totally shattered. It’s as if our world came to an end. I had always heard of women miscarrying but I had never thought it would ever happen to me. I felt like a failure. My body had failed to do the one thing it was made to do. I felt so guilty. As if I had murdered our baby and destroyed my family. How could this be happening to us? Did we really deserve this? The MFM said that my next pregnancy would be high risk. That I would be followed closely and do a Trans Vaginal Cerclage (TVC) at around 16 weeks. We left the hospital empty handed and left our baby at the hospital, so cold and lonely.

I went back home and threw myself into research. I wanted to know what an Incompetent Cervix was. I wanted to know what my options were. I joined Facebook groups where I heard about other women who had been in my shoes. Though I felt relieved that I was not alone, the overwhelming sadness and guilt lingered. Through the Facebook group, I heard about Abbyloopers, an online group that advocates for a much better stitch than the TVC, the Trans Abdominal Cerclage (TAC). Needless to say, I joined Abbyloopers and delved into further research. As soon as I read about the TAC, how high it’s placed, its success rate, etc., I was sold. I immediately knew that a TAC was my antidote. I was going to get a TAC. I felt relieved and so very excited. Finally, I was going to have my rainbow. No bed rest needed. YAY!

A week after my loss, I saw my regular OBGYN. He told me he had no idea why my first pregnancy went well and this one didn’t. He also suggested doing a TVC at around 13 weeks of gestation and be closely monitored. He also mentioned possible bed rest. I told him I didn’t want a TVC. What I needed was a TAC. He was surprised I even knew what that was. He discouraged me saying it was overkill. It was too invasive, and that a TVC would work just as well. I wasn’t about to let him convince me otherwise. I had to get the TAC whether he liked it or not. He had no idea what I was going through, so to hell with him and his TVC ideas. I looked up a TAC doctor near me and found Dr. Ivar Einarsson at Brigham and Women’s. I scheduled a consult with him and I was so hopeful that this was it for me. Unfortunately, he told me that the kind of insurance I had would not cover the TAC until I tried a TVC and/or had a second loss. What? I almost went insane. How could this be? I was so sure I was going to get my TAC and now this man was telling me I couldn’t until I lost another baby! I called insurance but they refused to authorize a TAC saying it was not necessary at this point. I couldn’t afford to pay $20,000 out of pocket to pay this doctor. I also couldn’t afford the $5,000 needed to have this surgery done by Dr. Davis in New Jersey. This TAC route was looking bleak at this point. It was not going to be a possibility. We had run out of options. Due to this sad fact, my husband and I decided to try the TVC, our only option, and hope and pray for the best. Worst decision ever, needless to say!

In October, 2013, about three months after my loss, I got pregnant. Things started going downhill really early. I had bleeding at around 9 weeks. I went to the Emergency Room and baby was fine. My cervix was checked manually and it was said to be closed. That night, I had a lot of discharge that looked like my mucous plug. At this point, I was in the middle of changing OBGYN, so I had to wait about a week and a half to be seen by my new doctor. She checked my cervix and said that it was so low and open at the external os. She referred me to an MFM who was said to be the best at the area. The next day, I met this new MFM. Ultrasound showed that the cervix was indeed open at the external os but closed at the internal os. She also did a manual check and mentioned that my cervix was bad, that she could easily put a speculum through it. She put me out of work and on moderate bed rest until a week after my cerclage surgery. She also prescribed progesterone suppositories.

At exactly 13 weeks and one day, I had my TVC placed. I continued bed rest at home. A week after placement, I went in for my cervical length check and the doctor mentioned that she didn’t like how my cervix looked. It was tilted backward and she couldn’t see the cerclage too well. She told me not to go back to work until further notice. Each week I had vaginal ultrasounds, things kept looking better and better. My length was always between 4 and 5 cm. However, at 19 weeks, I was told that I was funneling past the stitch. I was given a pessary and put on hospital bed rest with bathroom privileges. Unfortunately, I continued funneling a week later and membranes budged. I was denied an emergency TVC due to slight fever; but was put on strict bed rest. The foot of my bed was elevated, trendelenburg position, and I had to eat, drink, pee, and poop in that position. I was miserable to say the least, but was very determined to do everything in my power to keep baby cooking. I religiously stayed in this position for about a week, but still, my membranes kept bulging to the point that I could feel them with my hand!

Unfortunately, my water broke and my pessary and cerclage had to be removed. My MFM explained that these were foreign objects and that she did not want to risk an infection. I was checked every few hours for infection. I was informed that as long as I did not develop an infection, then baby would stay in until 32 weeks. I had hopes. My doctor came in one morning and gave me important dates. Dates that included when steroids would be administered, when baby was viable, when baby would be 28 weeks, and finally, 32 weeks, delivery day. I was so hopeful. I prayed and prayed. Sadly, that same day, my cord prolapsed. The pregnancy had reached an end. I had to be induced. The next day, February 27, 2014 @ 21+4, we lost yet another perfect baby boy. We were beyond devastated, but then my husband and I decided not to lose hope; to look into the TAC once again.

I called up Dr. Einarsson, the TAC doctor I had met after my first loss and after consulting with him it was decided a TAC was my only option if I wanted to have more babies. My MFM was also 100% on board with this option. Luckily, or let me say ironically, my insurance covered my TAC, no questions asked. On 4/20/2014, while the Boston Marathon was taking place, I had my TAC done. It was bitter sweet that I finally had the one thing that I had needed from the word go. I felt relieved and hopeful that at last, our nightmare was at an end. My husband and I felt like we had another much safer chance at having our rainbow. We now have hope. Hope that eventually, we will put this TAC to work and that it will help us finally bring home a sweet and healthy, full term baby.

A Step in the Right Direction

Update: If you’d like to read the specifics of my surgery and recovery, see this post. If you have questions, or would like to contact me privately, please email tac.questions@gmail.com.

Okay, I was waiting until everything was planned to really discuss this, but now that everything’s been arranged, I’ve had a hard time working myself up to it. I want to explain the next step we’re taking to make sure that what happened to Lucy won’t happen to any of our other babies in the future. I also want this post to be a source of information for any women out there looking for an idea of what they should do next, because I know it can be hard to find. So before I really start, let me say that I am clearly not a doctor, and this is just my attempt to assemble the relevant information I’ve been able to gather. I’m not going to cite sources, although I may come back in the future and do that. Also, this post is going to be LONG and discuss lady parts in great detail and with diagrams, so that’s just a warning.

Before I get to the nitty-gritty, though, let me just break it down really simply for those who don’t want to know the details. David and I have decided that we’re going to do everything in our power to prevent my stupid dysfunctional cervix from hurting any more of our babies. Neither of us thinks we could live through another experience like we had with Lucy. What I’m doing is flying to New Jersey to have a surgery that will essentially permanently prevent my cervix from dilating. Technically, it’s reversible, but it’s meant to be left in place, and it will mean that I will be required to have a cesarean delivery for any future pregnancy. Not only that, but due to certain risks, I’m not even supposed to labor, so the C-section will be scheduled a little early. That’s the basic idea, and I know it sounds extreme (especially for someone who always wanted a natural delivery), but read on if you want to know more.

If you don’t know me, and you got to this post while searching for information about incompetent cervix/cervical insufficiency, then you’ve probably experienced a loss (or losses) like we did. I’m so sorry. I know the pain you’re feeling, the confusion, the anger, and the frustration with your body. I’m so terribly sorry you’ve had to go through this. If you’re like so many of us, your doctors have told you that your loss was a fluke, or maybe they are pretty sure it was IC. My case was pretty clear, although many times it’s difficult to diagnose IC. Other things can cause preterm labor – infection, problems with the baby, problems with the placenta or cord, etc. So if you have any of those things, it’s hard to know: did one of those things cause labor, which then caused your cervix to dilate, or did your cervix dilate first, causing labor to begin? In my case, there was no infection, nothing wrong, just a 3 cm dilated cervix, bulging bag of waters, and contractions. Anyway, my point is that some doctors are reluctant to diagnose IC. My advice to you, if you’re not sure, is to get enough opinions about your case that you feel comfortable in your own mind that you know what happened to you. Sometimes you just can’t know, and no doctor will be able to help you. You’ll just have to do your research and follow your heart.

The day that my sweet Lucy was born, while she was very much alive down the hall in the NICU, two different OBs told me what we were going to do next time. That’s how they say it. They say “here’s what we’re going to do,” and it is inferred that it will work. People trust their doctors, and when their doctors give them one option, and tell them it will work, they mostly put their faith in them. Doctors are, in general, wonderful knowledgeable people, whom I respect greatly. But they’re also people, and I’ve always thought it was my job as a patient to make sure I was well-informed about any course of treatment. That’s what started me doing research about this, and I assume that’s why you’re reading this. What my doctors told me was that I had an incompetent cervix, and that during my next pregnancy, we’d do a prophylactic TVC (trans-vaginal cerclage) at 11 weeks and I’d have progesterone shots starting at about 16 weeks. My guess is that, if you’ve had a loss, you’ve heard something similar from your doctor. The problem is, that’s all they say. There is a lot more information that they don’t give you, and you really need to have all that information to make an informed decision.

So, now to the diagrams, as I try to explain my understanding of the available procedures. There are essentially three types*:

1) TVC – transvaginal cerclage

a) Shirodkar stitch
b) McDonald stitch

2) TVCIC – transvaginal cervico-isthmic cerclage
3) TAC – transabdominal cerclage

a) Traditional open approach (laparotomy)
b) Laparascopy (through 5 small holes usually)
c) Robotic laparascopy (via da Vinci robot)

*It’s important to note that different doctors (and doctors in different parts of the world) may call these procedures different things. For example, a traditional Shirodkar stitch is somewhat complicated and placed high on the cervix. However, most doctors performing “Shirodkar” cerclages these days are really doing some variation, a modified Shirodkar. Similarly, any cerclage placed through an incision in the abdomen is technically a TAC (transabdominal cerclage). However, some surgeons placing a “TAC” are actually doing a modified McDonald or Shirodkar stitch through the top of the cervix via an abdominal incision. This is NOT recommended and is more likely to cause damage to the cervix and uterus during a normal pregnancy and any contractions. Make sure your doctor explains the procedure he or she plans to perform.

You’ve probably seen this before, but this is what the female reproductive system looks like:

uterus
This image is from MedlinePlus.

However, I’m simplifying it. Please forgive my extremely crude diagram. The important part for this discussion is that part of the cervix lies above the vagina, connecting to the uterus at the internal os, and the rest protrudes into the vagina, ending at the external os. Normally, and during a normal pregnancy, the cervix is long and closed (during pregnancy, you develop a mucous plug that prevents bacteria from entering your uterus). During labor, the cervix thins and opens (effaces and dilates), allowing the baby to pass through.

basic

So, what happens in a TVC is the doctor goes in through the vagina, reaches as high as they can on the visible part of the cervix, and stitches around the flesh of the cervix, pulling it tight like a purse-string. There are two main stitches used, although there are variants on each: the Shirodkar and the McDonald.

TVC copy

This is the procedure that most doctors recommend. Sometimes they will wait and watch your cervix for signs of funneling (when it starts to open at the top) or shortening. If it begins to funnel or shorten, they will then do an emergency/salvage/rescue TVC. Other times, they will do a prophylactic cerclage late in the first trimester or early in the second, then monitor the situation. The stitch is usually done with a spinal in place for anesthesia. When the pregnant woman reaches term, the stitch is cut and removed, allowing a vaginal delivery.

A TVCIC is relatively uncommon, although possibly becoming more common. (My doctor had never heard of it and accused me of using “chat room lingo.” As I said, doctors don’t know everything.) A TVCIC is an attempt to place a band made of mersilene (a very tough woven polyester fiber – you want it to be 5 mm) as high on the cervix as possible, still accessing it through the vagina. This is done by making two small cuts in the lining of the vagina in front of and behind the cervix. Then the band is inserted through the cuts, then tied around the cervix as high as possible. A TVCIC is usually placed during pregnancy (unless it is intended to be permanent), and can be done under general anesthesia or spinal, I believe. I have read some studies that report that a TVCIC should be intended to be permanent, but at least one doctor I’ve spoken with does it a little differently. He leaves the knot inside the vagina (instead of tucked away above) so that it can be snipped and removed to allow a vaginal delivery.

TVCIC copy

A TAC is a full-blown abdominal surgery. The surgeon places the woman under general anesthesia (often, although in my case, since I was pregnant, my doctor felt it would be better for the baby if I was awake using just a spinal block) and makes a bikini cut at the bottom of the abdomen (just like in a C-section). They then carefully move the bladder (which is in the way of the cervix). Spacers are placed in the cervix to make sure the mersilene band is not fitted too tightly. (Edit: No spacers were used in my surgery. Dr. Davis told us that during pregnancy, the cervix is swollen, so he ties the band as tightly as possible. Then, after delivery, the swelling goes down and leaves a functional cervical canal.) The band is then tied around the very top of the cervix, just below the internal os. If it is placed correctly, there is enough room left for all normal functions of the cervix (enough room for semen, menstrual blood, even enough room to have a D&C if that is necessary). The band simply prevents the cervix from dilating beyond its normal state. The TAC is always meant to be permanent, and can be used through multiple pregnancies without being redone. Also, a TAC can be placed laparoscopically, either by hand or by DaVinci robot. Outcomes vary from doctor to doctor, but in general, laparoscopic TACs have had slightly worse outcomes. The surgeons with whom I’ve spoken feel that that is because it’s hard to see and feel the exact place and the correct tension in the band. I think the DaVinci robot, in skilled hands, improves outcomes, but it still hasn’t been as well-tested as the traditional open placement. I will be having a traditional TAC, but here is a very succint discussion of the laparoscopic approach: Prophylactic laparoscopic abdominal cerclage: Tips for success

TAC copy

So those are your three basic options.

TAC, TVC, TVCIC copy

Edit: Dr. Davis, my surgeon, drew a much better diagram and has given me permission to share it here:

Dr. D

Pros and Cons

I think it’s pretty obvious how I’ve come down on this issue, but let me just lay out some of the basics.

My doctors didn’t give me any statistics about the TVC, so I went searching on my own. Statistics vary of course, but what I found is that they have a 75-85% chance of success. Sounds pretty good, right? But there are a few problems. The first is that those numbers very possibly include a lot of women who never would have had a problem a second time. Say you lost a baby in the second trimester because you developed an infection. That infection could have been caused by an opening cervix, or it could have been a complete fluke. If it was a fluke, you may very well not have any problems in the future, but you may receive a TVC nonetheless. The second, and much bigger, problem is that success for a TVC means getting a woman to viability, or 24 weeks. That’s right, let that sink in. So basically, if you really do have an incompetent cervix, your doctors are aiming for 24 weeks (or more, obviously, but 24 weeks is a success, remember), and you have a 3-in-4 or a 4-in-5 chance of getting there. I am here to tell you, having a baby at 24 weeks is NOT a successful pregnancy. Lucy was born at 23 weeks, but her case would not have been substantially different if she’d made it to 24. A baby is not meant to be born at 24 weeks. In the very best case, you’re looking at months in the NICU with the very real possibility of cerebral palsy, vision problems, breathing problems, and developmental delays. But that’s the BEST case at 24 weeks. Viability is no guarantee. Even with all the amazing medicine happening in NICUs, a 24 week baby has less than a 50% chance of living.

Whew, gotta catch my breath. There are benefits to TVCs, of course. They are the least invasive option – one quick outpatient procedure, and you’re done. Also important is that they are easily removed for a vaginal delivery. They do have to be redone for each pregnancy, but no big deal there. Overall, the biggest benefit is that they’re not very invasive. See here to read about the different types of TVC, and to see the difference between the Shirodkar and McDonald stitches. Also see here.

There are other important cons to consider about a TVC, though. Due to their placement in the part of the cervix inside the vagina, some believe that they can have a wicking effect, actually causing ascending infections that endanger a pregnancy. Also, for how simple the procedure, TVCs require a lot of a woman afterward. For example, my doctors wanted to place my prophylactic TVC at 11 weeks. Thereafter, I was to be on complete bed rest. Yep, you read that right. Complete bed rest from 11 weeks until I have the baby. IF I were to make it full-term, that means 29 weeks in bed. That wreaks complete havoc on your body, and I’m not sure why doctors don’t take that into account. I’m already overweight and at higher risk for embolisms and blood clots, and bed rest makes that risk so much higher. So that is definitely something I considered. Complete bed rest isn’t good for anybody.

But I truly believe that I wouldn’t make it full term with a TVC. As I said, success is measured by getting to 24 weeks, and you have a 75-85% chance of that. But one study I read suggested that you actually only have a 20% chance of carrying to term. Those are not good odds. As far as I can tell, this is because the cerclage is too low on the cervix. This means that if you have IC, your cervix can still funnel open from the top to the stitch. That means the baby, the amniotic sac, the umbilical cord – whatever – can sink down into the cervix, putting pressure on the cerclage. This is a problem for two reasons: 1) it makes your cervix functionally shorter, so you are more likely to lose your mucous plug and get an infection, and 2) the pressure, an infection, or a problem with the baby (say an umbilical cord prolapse, where the cord is pushed out ahead of the baby) can cause you to go into labor anyway. Once you’re in labor, it either has to be stopped or you have to deliver. In many cases I’ve read about, women with TVCs went into labor early, their stitch was not removed quickly enough, and the baby was delivered through the stitch. If this happens, it is very likely to tear or otherwise damage the cervix, making it even less likely to work in the future. Also, I know of at least one instance where a baby was delivered through a stitch and suffered severe head trauma because of it. These are real worries. I can’t count how many women I’ve talked to who have had failed TVCs that resulted in the loss of a baby and usually some damage to their bodies. And according to one surgeon I talked to, if you have true IC, it’s not a matter of if your cervix will funnel to the stitch, but when it will funnel, regardless of bed rest.

Now, the TVCIC. This one is tricky, as it’s not often done. The goal with a TVCIC is to get the band as close to the level of a TAC as possible while still going through the vagina for minimum invasiveness. If I understand it correctly, though, it’s otherwise like a TAC and not a TVC, in that the band is placed around the cervix, rather than a stitch being placed through the flesh of the cervix. I spoke with one well-known surgeon who thinks the TVCIC is not really an option. He thinks it is impossible to get the band as high on the cervix as the TAC. This is important because, as I mentioned above, the cervix will still funnel as much as it can. Any funneling at all can cause problems, although the less, the better. He also pointed out that during a TVCIC, the surgeon goes in blind essentially, and there are important things going on in that area (like your urethra and big blood vessels). So you would definitely want to make sure you were in the hands of a very skilled and experienced surgeon. That criticism makes sense to me, but it would be much less of an ordeal if the procedure could be done through the vagina (rather than through the abdomen, like a TAC). It would also be fantastic if it could be removed for a vaginal delivery, although this would mean that it would have to be redone for each subsequent pregnancy. The critical surgeon I talked to did not think it should be removed, but I spoke to another well-known surgeon who has done the procedure very successfully and who does think it’s a valid option. According to the somewhat limited data available on TVCIC, women with proven IC were able to carry their babies to term with the TVCIC about 90% of the time. That is a much better figure than for TVCs.

We’ve opted to go with the traditional TAC. The surgery can be done either during pregnancy or before pregnancy (something neither my OB nor my RE – reproductive endocrinologist – were aware of). Some surgeons will only do it during pregnancy, but the most experienced surgeons in the country (both of whom I’ve talked to by email and by phone) prefer to do it pre-pregnancy if at all possible, because there is no risk to the baby (as there is no baby, of course), it requires a smaller incision, and the recovery is faster. However, some insurance companies will not cover it prior to pregnancy (ugh, the insurance is another issue entirely – some insurances will not cover a TAC unless you’ve had TWO or MORE failed TVCs, meaning you’ve lost at least two babies.) Anyway, when the TAC is performed prior to pregnancy, it does not interfere with any attempts to get pregnant, or with IUI or IVF. As far as I know, the surgeons say you can start trying to conceive as soon as you’ve had one period.

Pros:

  • It’s permanent, and you should never have to worry about your cervix opening up again (although you will anyway). It shouldn’t get in the way of anything else, so even when you’re done having kids, you shouldn’t have to worry about it.
  • No bed rest is required by the surgeons, although your particular case may warrant some degree of bed rest. They do recommend taking it easy.
  • No pelvic rest necessary, unlike a TVC, unless your situation warrants. Have as much sex as you want, or don’t.
  • Since the TAC is placed just at the cervico-isthmic junction just below the internal os, if it is placed correctly, your cervix can’t really funnel at all.
  • If you are prone to premature labor for reasons other than IC (as many women with IC are), the TAC improves your chances regardless by improving the functionality of your cervix.
  • Again, statistics vary, and some doctors are better than others. But with a well-placed TAC, you have a 95-98% chance of carrying to term. I like those odds.

Cons:

  • It’s definitely a surgery. It’s pretty straightforward as surgeries go, but it has all the same risks as any other abdominal surgery: adhesions, blood loss, mistakes, etc.
  • If you have the TAC while you’re pregnant, there is a small risk to the baby. The surgeons I’ve talked with haven’t really had any losses to speak of, but there is something like a 1-2% chance of loss. It’s hard to determine what might be caused by the surgery and what might have been a first trimester miscarriage anyway.
  • Longer recovery.
  • Required C-section. The cut is made through the same incision (unless you’ve had your TAC placed laparoscopically, in which case you’ll have several small incisions, and a new larger one for the C-section).
  • No labor/chance of uterine/cervical rupture. If you are allowed to labor hard for a long time, there is a chance that your uterus or cervix could rupture. Some might see the fact that you aren’t allowed to labor as a pro, I guess. This small risk is the reason they usually schedule the C-section a week or two early.
  • You may have issues getting your insurance to cover the procedure. I didn’t, but if your insurance isn’t that great, you might have to fight them for it.
  • The TAC can be placed incorrectly, in which case it could fail. Research your doctor carefully.
  • Not that many doctors do it, and your OB may very well not support your decision.
  • It’s not a 100% guarantee. Women have lost babies with TACs in place, either because they had a badly placed TAC or because they had some other, unrelated problem. If you do go into labor early with the TAC, and the labor can’t be stopped, you will probably have to have an emergency C-section to deliver.

I feel like I’m forgetting a lot of stuff, so I may come back and add more information, but I think I’ve hit the main points. I’m really not looking forward to having the surgery. I’ve had surgery a couple times before, and it’s no fun. But losing my little girl was the worst thing that’s ever happened to me, and I could not bear a repeat of that. I listed more cons than pros for the TAC, but it’s the 95-98% chance of carrying to term that outweighs all the cons for me.

Again, I’m not a doctor. If you’re considering these options, I advise you to do your own research. The important thing is that you feel comfortable about your decision and you know why you made it. Don’t let doctors push you into any particular course of action, because they get it wrong, and the stakes just aren’t as high for them. You have to be an advocate for yourself, your baby, and your family. If you’d like to learn more, or hear from the doctors doing the TAC, or talk to a lot of women who have suffered losses like this (and have or would like to have a TAC), I’d suggest you head over to Abbyloopers for more info.