Our
Story
5/7/04
We found out
in February that we are expecting our first baby. We are very excited,
but also very apprehensive, because I am considered to be "high risk." I
was born with two openings on my cervix, and (most likely), a condition called
"uterus didelphys," which means that my uterus actually has two "horns" instead
of one. This condition can cause a multitude of different problems, or the
pregnancy could be completely "normal."
One
complication that can arise from having the two openings on the cervix is what
is called "incompetent cervix," in which the cervix opens prematurely, causing
the baby to be born prematurely. Since this is a first pregnancy, there is
no past history from which to draw. However, because of other cases seen
by my doctor (Dr. Clapp), she felt that it was appropriate to keep a close eye
on the pregnancy and on the length of my cervix (with visits to the doctor every
2 weeks, starting at week 14), and if it appeared that it was becoming
incompetent, there were procedures that could be done to attempt to keep it
closed so that the baby could be carried to term. The "simplest" of these
procedures is a stitch (called a cerclage) put in the cervix to keep it closed
and reinforce it.
I had an
ultrasound at 14 weeks to get a "baseline" reading of my cervical length.
I was to come back in 2 weeks (at week 16) to be measured again, and would be
measured every 2 weeks until week 24 (when the highest risk of cervical
incompetence should be past). At week 16 (April 29), I saw Dr. Sadek,
another doctor in the practice (I'm supposed to rotate through all the doctors
so that they are all familiar with my history). Chris had a class at work,
so I went to the appointment by myself. I had my ultrasound done, then
went to Dr. Sadek's exam room to wait. I waited for over 30 minutes, and
she finally came in. She introduced herself and said that she had been
talking with Dr. Clapp about my situation and that was what took her so long to
get in to see me. She then told me that last time I was in, my cervix was
4.5 cm, and this time it was 3.2 cm, which indicated that it was possibly
thinning and becoming incompetent.
She
thought that I should have a cervical cerclage put in immediately, then start
progesterone shots once a week for the next 20 weeks, and have a steroid shot
immediately to boost the baby's lung function in case of preterm delivery.
She also referred me to Dr. Dennis, a specialist at Community Hospital, to
confirm the diagnosis, as well as to confirm the treatment options, but
indicated that if I couldn't see him first thing the following week, I should
have the cerclage done regardless.
I was
blindsided, to say the least. I didn't even know what to say, what to ask,
or what to do. I told her that I wanted to talk everything over with
Chris, but that I'd go ahead and make the appointment with Dr. Dennis (it never
hurts to have a second opinion).
I saw Dr.
Dennis on Monday, May 3, and based on his assessment and my doctor's assessment,
the decision was made to go forward with having the cerclage done. I also
asked him about the progesterone and steroid shots, and while he didn't
"strenuously oppose" (his words) them, and could understand why they were
recommended, he would not necessarily have recommended them to me based on my
situation. Based on that, Chris and I decided that it was probably best to
have the cerclage done, but that we were going to pass on the progesterone and
steroid shots, since there wasn't really anything strongly indicating their
need, and there are alternative treatments should I go into preterm labor.
Things happened very quickly from there, and I was at the hospital for surgery on Wednesday morning, May 5 (I was approximately 17 weeks pregnant at the time). What an awful experience. I will be the first to admit that I am a terrible patient -- I hate the lack of control over my own body, and I hate the lack of privacy and modesty afforded to a hospital patient. I understand that the doctors, nurses, and rest of the hospital staff deal with the everyday ins and outs of hospital stays and surgeries regularly, but I do not, and it can be very upsetting and frustrating when there are so many things that they just take for granted that "everyone" knows. Everyone keeps telling me that by the time I go through labor and delivery, I'm not going to care who sees my body, what they do to it, or how much I get poked and prodded; however, at this point in my life, I still feel very uncomfortable being on display like that. But, be that as it may, I guess I have to take the good with the bad and just keep in mind that there is a purpose behind all this. The ultimate outcome is that Dr. Clapp was pleased with the surgery and said that things had gone well. I am off work for the rest of the week, but go back to work and to my "regular" life on Monday (May 10).
Sonograms
from my big "20 week" appointment (which happened to be on May 28, my
29th birthday -- what a gift to be able to see my little one!!)!
6/25/04
We went to an appointment on Friday, June 11 (over a month out from my surgery), and saw one of the other doctors in the practice. He said that it felt like one of the stitches (my doctor did 2, because of the two openings on my cervix) had pulled loose, but since I hadn't seen him before, he wanted me to see Dr. Clapp for confirmation. I saw her on June 16, and she confirmed that one of the stitches had pulled out. The good news was that my cervix was still closed up tight; the bad news was that the stitch wasn't doing exactly what it was supposed to (since it was loose on one side). She sent me back to the specialist for another consultation, to see if he felt we should put the stitch back in, and if not, what he felt the appropriate next step would be.
We saw Dr.
Dennis again today, and after examining me, he determined that the stitch had
definitely come loose on one side. I am about 25 weeks along at this point, and
he said that they usually don't do a cerclage beyond 26 weeks. He also
confirmed that my cervix is still closed up tight, and that it doesn't show any
signs of being incompetent. He thinks that at this point, I should wait it out
and not go back into surgery to repair the stitch (thank goodness!!!). He also
recommended pelvic rest (no intercourse, no "trauma" to the pelvic or vaginal
region), and also recommended increased bed rest (which he defined as no
strenuous activity and resting in a reclined position as much as possible). I
explained to him that I am a teacher and off for the summer, so I'm
automatically on increased rest (I'm not on my feet 4-5 hours a day teaching),
and that I've already modified my gym and outdoor workouts from 1-2 hours of
strenuous workouts per day to 30-60 minutes of "easy" workouts several times a
week. I also explained that I'd go completely stir crazy and climb the walls if
I couldn't get some kind of exercise (I'm already having enough trouble sleeping
because I'm up to the bathroom a hundred times a night and I'm not sleeping well
because I'm not tiring myself out with exercise). He did indicate that if I cut
back and do this "bed rest" for about a month, then I could start doing a little
more after that, and that it would be fine to go back to work in August. I
understand why he wants me to do this, but I also think that a lot of it is
being overly cautious. In addition to the increased rest, he wants me to see
Dr. Clapp (or others at the practice) twice a week for the next 4-6 weeks to
check my cervix (why it's not OK to have sex, but it's fine to have someone open
me up twice a week to check my cervix is beyond me).
So, that's where we are for now. I'm really stressed out about this whole thing, and feel like on top of everything, the doctors are taking away my "outlet" (exercise). Chris and I have talked things over, and have decided that we're going to be as realistic as possible about this whole thing. Basically, everything that's being done is precautionary, and everyone is operating on "what ifs." We've gotten (and will continue to get) plenty of medical opinions and advice, and are going to take it all as exactly that. I'm going to continue to live my life, being cautious and listening to my body. I think that getting zero exercise and being completely miserable has got to be more harmful than helpful to both me and the baby. I'm going to rest as much as possible, but I'm still going to go to the gym a couple days a week for light workouts (if I feel like it) or take short walks in the evening. I'll listen to my body and stop if it says stop, but I'm not going to just quit living my life. All I want is to be a "happy pregnant person" and to deliver a healthy baby, and I think that good mental and emotional health goes a long way toward making that happen. I don't know if we've made the right decision...only time will tell, but based on all the information I've gathered and the discussions Chris and I have had, it's the best way we've come up with to balance my physical, mental, and emotional health, and we're going to stick with it for now. I see Dr. Clapp on Tuesday, June 29, so I'll get her take on everything then, and we'll see where that leads us as well.
7/1/04
I went for my second appointment of the week today. Saw Dr. Clapp for the second time this week, and all looks good. I talked with her on Tuesday to get her take on things, and realized again just why I like her so much. She and I seem to have a similar outlook on things -- moderation in all things.
I asked her about the things that Dr. Dennis told me: 1) he wants me on increased/modified bed rest (meaning no gym, no exercise, and resting in a reclined position whenever possible), 2) he wants me on pelvic rest (no intercourse, no douche, no tampons...in other words, no "pelvic trauma"), and 3) he wants me to see a doctor at my practice two times a week for the next 6 weeks or so to have my cervix checked to make sure it is staying closed.
Her response was: 1) it can't hurt to rest up whenever possible, and I'm going to have to "ease up" on my exercise as the baby grows because it will demand more of my body and I'll have less stamina and strength left over for exercise after diverting what is needed to the baby; but she doesn't really see how sitting on a bike spinning my legs around and getting my heart rate up a little is going to do me any harm. I should listen to my body and not overdo it, and certainly if I have bleeding, contractions, or pain, stop immediately and see the doctor, but if I need to do some light exercise to feel human, it certainly shouldn't be a big deal. 2) If I'm supposed to stay away from "pelvic trauma," then (her words), "I probably shouldn't be sticking that probe into you twice a week, then." She said this with a laugh (speaking of the ultrasound probe she uses to check my cervix length), and said that while there is probably a slight risk, again, it's a matter of being careful, listening to my body, and doing what feels right (and not doing what doesn't). And 3) while twice a week might be being a little bit over-cautious, things can change very quickly, and until I'm to the point where the risk to the baby drops if I were to deliver early, she'd rather have me in twice a week and err on the side of caution. She said that even if the baby is born early, after 31 weeks, a lot of the risk level drops considerably and the chance of survival with no ill effects increases considerably. So, until then, it's twice a week (good thing I'm off work for the summer!).
I told her what Chris and I had talked about after meeting with Dr. Dennis, and how we had decided to take all the different opinions and then make a personal decision based on what we felt was the best plan after all the considerations. I explained that we have decided that I need to balance my physical, mental, and emotional health, and feel that a good balance of all three will be the best for both me and the baby. While she didn't jump up and down with excitement, she did not seem opposed to that, and seemed to approve of our approach. She acknowledged that the recommendations they (her, Dr. Dennis, and all the other doctors involved in my care) made were all based on prior cases that weren't exactly the same as mine, and that's why it's called the "practice" of medicine -- they give me the best advice they can based on what they know about me and how that fits with what they know about medicine. I certainly feel much better after talking with her, and I truly believe that if my approach and my decisions were a threat to me or the baby, she would tell me that and "strongly recommend" the best course of action.
So, for now, we're keeping on keeping on. I'm finally getting to the point that I feel somewhat comfortable with being pregnant and getting excited about it. I'm trying to focus on the good and the fun, and trying to take all the doctor's appointments and other unfortunate side effects in stride. I really want to be a happy pregnant person, and I think that the balance of being able to keep living my life but knowing that the doctors are keeping a close eye on me and will catch any problems early on will help me to do that. Now the real fun gets to start...shopping, preparing, planning. Chris and I are going to be parents...how scary is that!?!
7/05/04 - 7/10/04
This week was rather uneventful. Went for my first appointment of the week on Monday. Saw Dr. Kelly this time. I kind of feel like the appointment was a waste...we went in, he used the ultrasound machine to try to get a measurement on my cervix, but didn't seem to think it was doing the job (couldn't have been the user, could it have?!?). Went ahead and did a "manual" exam (which was very painful, and he made the comment while I was "ouching" and squirming on the table that he didn't know how I was going to deliver this baby...what a vote of confidence) and said that my cervix was still closed up tight. He didn't seem to think that I needed to be coming in twice a week, but since Dr. Dennis and Dr. Clapp both recommended it, I'm going to continue with it (as much as I'd like to cut back). He commented that he thinks that I'm fine, and that I have nothing to worry about with my cervix...that it's doing exactly what it's supposed to, and will continue to do the same. Hopefully he's right!
We actually went "shopping" for the first time this week.... Went to Toys-R-Us/Babies-R-Us (I actually succeeded in keeping Chris in the baby section and away from the toys) and looked at a few things...how overwhelming! We don't even know where to start! Went "shopping" again with my mom on Thursday, and looked some more. Got a couple of little things -- a package of little tee-shirts, some diapers (we're doing cloth diapers), some socks, and a little pair of booties (all on clearance...I'm beginning to think we'll have to name the baby Clearance, because that's the only way to manage to buy all the stuff you need to have a baby!). Looked at some furniture, but didn't find anything that just jumped out at me. I guess we've got a little time before we have to worry too much about that. Nevertheless, it was an educational experience. There is so much STUFF out there. To some extent, it makes you want to go in and buy one of everything, but on the other hand, I look at most of it and ask myself "is this REALLY necessary?" and can't figure out a way to justify a "yes" answer to that question. Again, I think we're going to employ the "moderation in all things" motto, and try to be reasonable about things. Went back to Toys-R-Us on Friday and registered for some stuff with Babies-R-Us. The really cool thing is that you can scan an item, then choose "non-specific" and what it will do is put the item on your registry with a note that says (basically), "they would like an item from this category, but you can pick whatever you want from the cheapest to the most expensive." We really liked that idea because it lets people have more of a say in things...and since we're not doing a nursery theme (yellows and greens are about as good as it's gotten so far...will update with more info if we decide on a particular design), we aren't locked in on any one line of baby gear...we're going to just have a mish-mash of all different colors, designs, patterns, etc. It could either be really fun, or look like a tornado went through a paint store, but as long as everything does its job, we'll be in good shape! :-)
Had our second doctor's appointment on Friday...saw Dr. Smith this time. The ultrasound tech did my sonogram first, and said that my cervical length looked good. Dr. Smith confirmed it, and just sat with us and asked and answered questions. She seemed to thing that everything is progressing well, and that I'm pretty much on target with everything. She seems to think that if my uterus is smaller (because of possibly having the two chambers), since the baby is currently turned around breech, unless it does it soon, it very likely will stay that way and I would probably end up having a C-section. It's still early, though, so we'll see how things go over the next several weeks before we deal with any of that. In some ways, it actually makes more sense for me to look into having a C-section...that would avoid the potential problems with my cervix being torn (which would most likely necessitate reparative surgery at some point), and then not functioning properly and making a second pregnancy (yeah, right...after this one, there may not be another one!) significantly higher-risk. But again, we're just going to play things by ear and not worry about them yet. There will be plenty of time for that over the next several weeks (and months, hopefully), and when it gets closer to the due-date, we'll sit down, consider the situation, look at all our options, and make the best decision we can at that time.
I'm trying to continue to be upbeat about everything, and for the most part, it seems to be working (there are still times that I wonder, "why me?" and other times that I look in the mirror and just think that I'm FAT, but those are happening less often, and I'm settling into a little happier state of mind and body). I'm still keeping on keeping on...going to the gym when I feel like it (just light workouts to break a little sweat), walking around, and generally trying not to be a total slug. So far, it feels like we're doing the right things, so I'm going to keep listening to my body -- it seems to be working so far. So many people have been so supportive -- sending emails, cards, and calling, and it means SO MUCH to us! Your interest, love, and concern have really helped me to have a good attitude about things, and have really helped to encourage me and keep me smiling. It may sound corny, but it really is true, and I appreciate all the happy thoughts that have been coming our way!
7/12/04
Saw Dr. Sadek today. This was only the second time I've seen her -- the first being when she told me that I needed the cerclage, and I needed it yesterday! I'm glad to report that things were much calmer this time. Things went well...my cervix is still closed. The ultrasound was really interesting this time around...the way she got things maneuvered, she actually got two completely different measurements, which we're assuming were of the two different openings on my cervix. The one on the right was about 3.6 cm, and the one on the left was almost 5.5 cm. But we talked about it, and it actually made pretty good sense...if I have two openings, we should be able to see both and get two different measurements. The discrepancy in size also makes pretty good sense, because if I'm carrying on the right (which I'm certain I am, because I've never felt any movement to the left of my belly button), then the weight of the baby and the fact that the stitch is loose on the right is consistent with the right side shortening some. Since there's no pressure, and the stitch is still in tight on the left, it should be longer and stronger. Bottom line, it's not shortened to any alarming length, and since it's still closed tight, I'm good to go for now. She did mention that if it continues to thin, I might look into progesterone shots to try to prevent pre-term labor, and to get the steroid shot to boost the baby's lung function should I deliver prematurely. Since I'll be in twice a week to have everything monitored, I'm not jumping on that option right now...I'm going to wait and see what happens, talk to Dr. Clapp, and hold off...if it becomes a necessity, I'll do it, but for right now, I'm going to let nature take its course.
Baby is still breech...since we (actually, I should revise that to "I" not "we") don't want to know the gender, they have to be careful not to get a crotch shot with the sonograms...that little butt is just right there, and Chris keeps hoping that it'll open its legs enough for him to get a glimpse of a penis (or lack thereof). I have a feeling that with as many ultrasounds as I'm getting, and as many different people involved, there's going to be an inadvertent slip-up, and we'll end up finding out. Not that it's a big deal...there's no changing it anyway...but I'd like to be surprised in the delivery room with an "it's a ....!" There's still time for the baby to turn, but if I'm built like they think and my uterus is smaller than most, the longer it stays breech, the greater the chance is that it'll stay that way, simply because of lack of room to turn as it gets bigger. Dr. Sadek seemed to agree with what Dr. Smith said the other day about keeping an open mind about possibly scheduling a C-section, considering the risks to me and my cervix of trying a vaginal delivery. Dr. Clapp is out of town right now, but both Dr. Smith and Dr. Sadek encouraged me to discuss my options with Dr. Clapp so that we can make a plan and a decision after weighing all the risks and benefits of both types of delivery.
I'm learning so much from this whole process -- not only about my body and anatomy in general, but about the practice of medicine (I'm definitely learning that it's just that...practice!). It's becoming more and more clear that while the doctors know what they're doing from a medical standpoint, I am a "medical anomaly" and they're having to do a lot of educated guessing using their existing knowledge and twisting it to try to fit my situation. I guess I'm pretty lucky, though, because (for the most part) my experiences with the doctors in this practice has been good -- they're all very open-minded, and seem to want to learn, but also listen to my questions, thoughts, and opinions, and consider them (or at least make me feel like they consider them) as they're making recommendations.
7/14/04
Had our second "Prepared Childbirth" class tonight. It wasn't quite as bad as last week, but still wasn't anything to jump up and down about. We watched a video of two different births, one with medication and one without. It didn't seem to me that there was much difference (the lady who didn't use any medication was having her third child, and barely made any noise...just some "I'm in pain" faces). Although I know how it all works, I think this was the first time I've actually seen a birth, and it definitely reinforced for me that if I have a vaginal delivery, they'd better give me all the drugs available! In both cases in the video, the baby's head came out, and then the doctor just stopped for awhile, baby's head out and shoulders still lodged in, took his time suctioning out the baby's mouth and nose, commenting on how big it or its head was, and then, (oh, by the way), I guess you should push it the rest of the way out. If I were either of those women, I'd be pushing the whole thing out and giving the doctor a quite a few choice words!! It was interesting, though, and actually wasn't as messy and gross as I expected (you still won't see any pictures until everything is all nice and cleaned up!).
7/15/04
I had a "big" appointment today. I couldn't eat or drink anything but water for 2 hours before it because they did my glucose screening (to check for gestational diabetes). I had to drink this (NASTY) orange soda stuff when I got there, then wait an hour and have blood drawn (YUCK!). In the meantime, I had my sonogram done, and met with Dr. Smith. All looked good...Jeri, the ultrasound technician, tried to duplicate Dr. Sadek's look at my cervix, and took several different measurements. The smallest (on the right, again) was 3.3 cm, and Dr. Smith said that as long as it's longer than 2.5 cm, there's nothing to worry about. Since it seems to fluctuate between about 3.3 and 4.5, I think everything is holding strong for the time being. I'm back in on Monday for Dr. Smith to do another ultrasound, so we'll see what changes (if any) there are between now and then. My blood pressure was good (98/64, or something similar), and Dr. Smith measured my belly and said that I'm measuring exactly right for where I am (she mentioned "28", but I don't know if that was length across my belly or weeks). She seemed very pleased with where I was, told me to keep on doing what I've been doing. After that, I waited out the rest of the hour, then went and had blood drawn (I SO hate having blood drawn...needles and I just don't get along!). It was relatively uneventful, though (no passing out or throwing up). They check for glucose and for iron levels, and said that they would call if there is any problem with either. They're closed for the day now, and I haven't heard anything, so I'm taking that as a good sign. I'm hoping that maybe there is some justice in the world and that since I'm having to go through all this other stuff, I'll be spared from having to deal with gestational diabetes and/or anemia!
Anyway, that's about it for this week. I have appointments on Monday and Thursday of next week, then Chris and I will be going to Northern VA to visit his family next weekend, so I'll hopefully get updates done before we leave on Friday. If not, keep an eye out...they should be up early the following week.
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