Incompetent Cervix occurs within 1 in 100 pregnancies. A year and a half ago, this condition in pregnancy was just a mere diagnosis briefly discussed and studied during nursing school and again while reviewing for my nursing board examination. It's one thing to learn and read about diagnoses but once you become diagnosed with something, everything changes. This was the exact case for me. During our years of dating, Paul and I always dreamt big - while I was set on wanting three consecutive children the way my parents had my siblings and I (and all in the same birth month!), Paul took it a step further and always said four was his dream. We both agreed we wanted a big family. A dream that was once so easily spoken over, now stings and is painful to openly talk about.
At 24 weeks gestation during my pregnancy with Haven, I heard the words Incompetent Cervix again while Paul was hearing it for the first time ever. If you are new to our story, I was unexpectedly diagnosed with Incompetent Cervix (IC) when I was six months pregnant with our daughter. When this was discovered through a routine cervical exam I asked our perinatologist to perform, things looked bad and seemed too late for intervention. The bag supporting her was bulging out, her limbs were hanging and seen during examination, and there was very little cervix left to work with in order to save Haven.
IC is a condition when weak cervical tissue causes miscarriage, premature birth or loss of an otherwise healthy pregnancy. It is commonly and unfortunately discovered and diagnosed through a second trimester loss; this is exactly what happened to us in our case. Some causes of IC include previous cervical trauma (i.e. a previous cervical tear during labor and delivery, a surgical cervical procedure), dilation and cutterage, and congenital conditions. Since none of these risk factors apply to me, my current specialist put things plainly and explained that I was just born with a weak cervix. As with other conditions that may occur during a woman's pregnancy, IC is just as terrifying, limiting, and life-changing in its' own way. Incompetent Cervix also called Cervical Insufficiency, is a condition that will be present with every pregnancy a woman has.
As pregnancy progresses, the baby grows and gets bigger causing pressure onto the cervix which then causes the cervix to dilate (open) prematurely. Fortunately, there are a few ways to treat IC - a). Transcervical cerclage b). Transabdominal cerclage c). Progesterone supplementation (PO (by mouth) and injections) and d). Frequent Ultrasounds. My first follow up following Haven's passing, our OB already began to discuss the future and what we would be doing differently as a team if Paul and I were to become pregnant again. Fast forward to seven months later, these treatment options became a reality.
After confirming our second and current pregnancy with two ultrasounds that proved a strong heartbeat, a growing baby and increasing hCg (pregnancy hormone) levels, our regular OB handed our care over to one of the best specialists in the nation. We met with him for the first time at 10 weeks and after studying our records and interviewing us, made plans to go ahead and place a Transcervical Cerclage at 14 weeks for preventative/ prophylactic measures. A Transcervical Cerclage is a surgery in which the cervix is stitched closed with the use of strong sutures. The sutures will then be removed during the last month or so of pregnancy to help ensure the safe arrival of the baby and to prevent any risks of preterm labor from reoccuring.
This was the treatment method chosen by our specialist for me. By the grace of God, baby and I reached 14 weeks earlier in May and my cerclage was placed. The procedure lasted for about 1 hour and 15 minutes total, prep time and my epidural placement included. Wonderful nurses and the anesthesiologist guided me through everything and held my hand to help alleviate the very evident anxiety and fear I gave off. Thankfully, I had plenty of cervical tissue left to use to stitch closed and everything else looked good. I stayed overnight to be monitored for bleeding, return of lower extremity function, adequate urine output, and stable vital signs. Days prior to my procedure, I had planned for a maximum of 1 week's worth of recovery with my job. However, upon being discharged from the hospital, my doctor had other plans. The main one being an instruction my family and I didn't think would be given to me.
The following are my discharge instructions for the remainder of my pregnancy (starting at 14 weeks):
- Remain on bedrest until the doctor removes the cerclage at either 36 or 37 weeks of pregnancy.
- Only getting up to shower and fix myself quick meals. * (Max time for getting up/ standing: 10-15 minutes at a time)
- No prolonged sitting or standing to prevent pressure on my cervix. (If I am sitting, I am to assume a comfortable side lying position)
- No driving.
- No strenuous activity / lifting or pushing things 10 pounds or greater.
- No straining, avoiding foods/ medications that can cause constipation.
- Pelvic Rest
- No Travel
I immediately notified my job of my leave of absence due to my condition and am receiving financial support through disability. For an otherwise healthy twenty-eight year old woman, bedrest has become my personal mountain for the past few months. Many would easily believe that bedrest is glamorous, that at least I am free from work and get to relax at home until I deliver. However to be honest, it's been quite the struggle (and blessing) for me. I've spent my days since May being horizontal and have in many ways, both lost and found myself (if that makes any sense).
I have learned to let go of myself, my pride, my ego and to put my child and his needs + safety first. While normally, I am quick to get things done and place others before myself, I repeatedly have to tell myself that it is okay to accept help and be helped. Daily, I have watched my husband Paul, parents, and siblings take care of me and instead do things for me that otherwise, naturally can do for myself. Fixed meals, not being able to perform household chores, declining invitations to hang out, inability to leave the house for leisure, and achingly sitting in a wheelchair while my parents wheel me for bi-weekly doctor appointments are just a few of the things I've had to selflessly accept in order to fight for my child's life.
If you're reading this and have never been on bedrest like I have, I want you to know that bedrest is messy. It is isolating, restricting, depressing, and can leave you thinking and feeling hopeless majority of the time. It is not Netflix and chilling all day, unlimited web browsing, matched PJs, and beautiful weekly bump photos. It is learning to stay and lay down while everyone else you love is up and about, staying indoors when the rest of the world is soaking up the LA summer sun, multiple daily bouts of crying due to fluctuating pregnancy hormones, feelings of depression, and loneliness, and forgetting to love/ care for yourself so a bare face and quick top knot while avoiding the mirror all day is just the shortcut for not bursting into random tears (again, for the millionth time today).
Though bedrest has been far from easy, one thing keeps me going and is what keeps my spirit and faith lifted - everyday that I still remain pregnant is a true blessing. I've been keeping track of baby and I's progress through a calendar that I created on my first full day of bedrest. Commonly one would assume that it is a countdown calendar but to Paul and I, it serves as a count UP calendar. After experiencing preterm labor and delivery and our losing Haven, everyday that I am able to stay pregnant means an extra day for our son to get healthier and grow stronger until my stitch gets removed. We are programmed to see X's and think, "another day over and done with", but to us every X means another day given to us because of God's grace, faithfulness, and visible proof of His hand at work.
Through the extreme highs and lows I've endured during this season of re-teaching and shaping my heart for the best, I know that God has a bigger picture in mind. A picture of better and beautiful things to come than I could ever begin to imagine. To my dancing daughter in heaven and dancing son in the womb - this journey, this season, is for You - Mommy's biggest teachers.
If you stumbled upon this post and are spending your pregnancy on bedrest too, from my bed + couch to you + yours, you are not alone, you are incredible and you and your baby(ies) are worth it.