Information from SHARE Atlanta Moms about the medical procedure, Cerclage
The cerclage placement (a stitch--literally one stitch--that is placed at the half way point of the length of the cervix to keep it closed...Angela
Medical disclaimer:
These thoughts and facts are based on SHARE Atlanta moms' experiences of having a cerclage. None of us our medical doctors or nurses and present this information as personal guidelines for other parents. Please ask your specialist or ob all the questions you have, etc.
Entries on this page....
"I am grateful beyond words that this procedure is available to women like me." by Angela (10/04)
"..One small stich literally made the difference between life and death." by Leah (10/04)
"I would love to let you know about my first thoughts on this pregnancy, and how I ended up with the cerclage that I felt I had needed." by Crystal (8/29/05)
"All in all, the cerclage was an easy procedure and very quick. I am grateful that my surgeon was both skilled and caring." by a SA Mom (12/06)
September 2004...Angela Johnson's thoughts...after having two cerclages.
I am grateful beyond words that this procedure is available to women like me.
When I found out I was in labor and had dilated at 21 weeks with Gwendolyn, my first question was, "can't you sew me up?" Of course it was too late at that point, but the fact that it was available for me with Johari and this pregnancy is a blessing from God.
When I had the cerclage placement (a stitch--literally one stitch--that is placed at the half way point of the length of the cervix to keep it closed) with Johari I was petrified. I wasn't sure if it would work. I didn't know if it would hurt and I had tons of questions.
It actually turned out to be a great experience (both times); I think primarily because of my doctors, but also because it is a rather simple procedure. Interesting considering it saves so many babies.
My OB/GYN was very proactive with my care. That was the first step. Because of my history there was no question that I would have the cerclage with any of my subsequent pregnancies. She sent me to the perinatologist very early on so I could be familiar with the person actually performing the cerclage (she chooses to let the perinatalogist handle that end because they perform several of these a day). She sent me to Atlanta Perinatal Associates.
Possible Questions to ask;
The doctors there were extremely friendly (not cold and impersonal) and informative. I was able to ask all kinds of questions, like:
Hey, this is your body and your baby and you need to feel comfortable with the person's hands you and your baby are in.
The procedure...
When you go in for the procedure you are given either an epidural or a spinal block. I had the epidural with the first and a spinal with this last one. You are awake the whole time, but you don't feel a thing.
I had a different doctor perform each (from the same practice) and each talked to me during the procedure. They let me know step by step what they were doing and in between they made me laugh. That also make me calm down especially during the first one.
This is an out patient procedure. The procedure is about 15 minutes--amazing I know. However, you will be at the hospital for several hours doing pre-operative things and then in recovery while the epidural or spinal wears off.
You should be on bed rest afterwards for 2-3 weeks (the first time it was three weeks and this time it was two) or longer if your cervix was "short" before the cerclage. I was blessed to have a normal cervix when the procedure was done both times so my bed rest was minimal.
In your preliminary meeting with the doctor ask how long you will be on best rest. If they say anything less than two weeks, I'd be concerned. Your body needs time to rest and to make sure the cerclage is doing its job.
Also, your doctor should give you an antibiotic and an anti-cramping medication (you get an anti biotic with dental surgery...you should definitely have one with this. Infections can cause problems!). Again, in your preliminary ask if they are going to give you an antibiotic. If they say no need, RUN (smile), just kidding. Ask why and then ask for one--smile.
After your recovery time on bed rest, you will be seen every two or three weeks to have an ultrasound to make sure your cervix hasn't changed. The great thing about this is you get to see your baby more often than a usual (normally its only once during the pregnancy) and watch him or her grow during the entire pregnancy or at least until 32 weeks.
This is all based on my experience with Atlanta Perinatal Associates. Every practice is different, however I know they are great and what they have done has worked for me (and others I know--including SHARE Atlanta moms) so far.
Activities after the cerclage...
After having/loosing my daughter I was told any other pregnancies would result in bed rest from 4 months on. With my son I worked until the day before I was induced, and he is now an active and amazing 21 month old. I am hopeful the same will be true in this pregnancy.
After the cerclage, your activities are limited. But, depending on your life situation, that can be a good thing. I was told with both...no cooking, cleaning or laundry...what woman doesn't want that option--smile. I am only allowed to stand in 15 minute intervals with no long term walking (which means as I got further along in the last pregnancy--and will get with this one--I used the electric carts in the target and wal-mart and had people drive me around). And people get to pamper you even more than the average pregnant woman...the cerclage has its perks--smile.
Please feel free to ask me any questions. I believe some of us go through experiences so we can help others through the same.
Angela's Diary of her ongoing subsequent pregnancy 2004, a link to her story about Gwendolyn, and pictures of Johari her subsequent cutie - born in 2002 and Ayinde born in 2004.
E-mail Angela
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"..One small stich literally made the difference between life and death." In Nov. 2000, at 25 weeks into my first pregnancy, I was hospitalized at 3 cm. dialated. The OB on call discussed a cerclage with us, but later that evening my water broke, making the cerclage an impossibility. I lay in bed for the next 5 weeks hoping and praying. On Dec. 13, 2000 our son, Cole Alexander was born via emergency c-section. He lived for 35 hours and died on Dec 14, 2000. The Dr's told us I had an incompetent cervix and would need a cerclage with any subsequent pregnancies. It took us 2 1/2 years to get pregnant again and in that time I spoke with many women who had had a cerclage and I 'interviewed' various OB's and Perinatologists. I finally chose the OB and Perinatologist I felt comfortable with. I asked questions such as: I felt a need to control as much of my pregnancy as I could and part of that for me meant being as informed as I could be and choosing my Dr's carefully. After all, this is my child's life we are talking about! The procedure... My OB performed the cerclage at 13 weeks into my pregnancy. I arrived at Emory Eastside Medical center 2 hours before my cerclage was scheduled. I was given a lovely hospital gown, socks, and hat. I had an IV put in and was given an Epidural. The procedure started right on time and lasted 12 minutes, I felt no pain at all. I was very emotional because I was afraid it wouldn't work or that I would miscarry. However, the staff was very kind and my Dr used the doppler before surgery and an US after to check the baby. I stayed for approximately 3 hours until the numbness wore off and then I went home and stayed on bedrest for the next week. I bled for about a week and had lots of cramping, which scared me to death even though the Dr warned it would happen and was normal. The blood was red for the first day and then turned pink and eventually brown. It was also a watery, slimy consistency. I drank tons of water (80-90oz. a day) and took Tylenol every 4 hours. I was also given IV antibiotics while in the hospital but none when I returned home. Activities after the cerclage... I continued to work, but cut it to 32 hours a week. I limited my activites- no sex, no exercise of any kind, no cleaning the house (oh, shoot!!!:)), and I rested alot. I often wonderded if my butt had grown roots to the sofa. I saw my OB every other week and the Perinatologist every 2-3 weeks throughout the pregnancy. The perinatologist checked the baby and looked at the stiches and measured my cervix each visit to make sure it hadn't shortened. I loved having US's so often and even called my OB occasionally to ask if I could come in to hear the baby's heartbeat. He always understood my panic and allowed me to come in whenever I needed to. This is so important!! Make sure you feel comfortable with your OB. At times I actually had a hard time breathing, I was so scared I might loose another baby and knew all I had to do was call and my fears would be relieved. ...One small stich literally made the difference between life and death I worked up until the day before my scheduled c-section. On March 12, 2004 (4 days before my due date) our healthy baby girl, Katherine Nicole was born weighing 7lbs. 3 oz. I still amazes me that one small stich literally made the difference between life and death. In summary... My advice to any woman facing a cerclage is to ask lots of questions of your DR, make sure they follow you closely, pick someone you feel comfortable with, and take it easy. There are not many times in our lives when we actually have a Dr's excuse for house work, take advanatge of it!!
I would love to let you know about my first thoughts on this pregnancy, and how I ended up with the cerclage that I felt I had needed. I remember how in January, I was really down and depressed over not celebrating New Year's with my little boy, especially since my "friend" came to visit that night. I went and spent some time with my father, who lives in Florida and who had not been able to make it to CJ's funeral, so I was pretty sad to be back in the house where I had found out I was pregnant with my darling boy. After we got back, about a week or so later, I started feeling weird (the only way to describe it). So I scheduled an appointment with the doctor who said I needed to have an endometrial biopsy. Well, three days before it was done, I said that I wanted to make sure I wasn't pregnant because that procedure has the ability to jeopardize a pregnancy. The test came back negative so I had the procedure done on January 24, 2005. Well, I still felt weird for the next week. I was late for my "friend" and I figured that better to be sure. SURPRISE!!! Big FAT POSITIVE!!! As soon as it was confirmed, Al and I cried out of joy. Then the fear set in... We announced it to a few selected people and proceeded with caution... Especially since I was only four weeks along and my progesterone levels were low. *sidenote: to be honest, I don't think he expected me to carry very long.... HA showed him!!!* I had three progesterone level checks performed and slowly but surely the levels climbed to a decent number and the pregnancy progressed. Before I knew it, I was already into my second trimester. Then at 19 weeks, he ordered an ultrasound to redate the pregnancy and to check for the sex of the baby. She refused to show him anything... LOL I didn't feel safe not having the cerclage but I couldn't get him to perform the surgery and I thought it was too late. I was praying with a fervor I had forgotten I had possessed. Well to my surprise he sent me to Atlanta Perinatology and Dr. B. ordered two consecutive ultrasounds within a week. We found out I was having a girl and then he gave me some alarming news... My cervix had shortened in less than a week by almost a full centimeter. His recommendation was to have the cerclage put in ASAP. I thought long and hard about all the risks and weighed the pros and cons with my husband and my mother-in-law and decided "all right, let's do it." After having a successful surgery and recovery, I called my ob/gyn who was FURIOUS with me for having it put in and promptly dropped me as a patient. Well, okay then... I found another doctor who is a female and is WONDERFUL!!!! It has been a blessing especially since she is a devout Christian who completely understands ME. Nothing is too small for her to talk to me about and she addresses all of my fears, reservations, etc. with an open mind as well as heart. So, I guess that my journey has been rough and rocky but still doable. Marcia's thoughts: "Doable" is the key here. Life can be and is often "rough and rocky," and noone promised us roses with no thorns. It is what we do with our walk that is important. Not giving up or in is what it takes. We MUST take care of ourselves and our babies. Sometimes that means finding a doctor that is on the same page as we are. Doctors are human beings..not perfect...and we must never forget that. We must learn all we can about our situation, get different opinions and then "do" what we feel is best for us based on the facts as we see them. That is what you did...that is what many of our SHARE Atlanta parents must do and that is what October Awareness is all about as well. We must have faith in our decisions and our need to protect ourselves and our loved ones...with us it is often our baby-to-be. Memoirs of A Cerclage In my previous pregnancy, I did not have a cerclage, nor did I know that I needed one. After unknowingly dilating 3 centimeters, I delivered my twin sons on May 31, 2004. They were at 21 weeks gestation and too young to survive. They both lived for 1 hour before they passed away. After months of research and consultations with doctors, I knew things would be different with my next pregnancy. I knew a cerclage would be a reality. Little did I know that I would conceive twins again! I arrived at the hospital promptly at 6 a.m. I was a bag of nerves, but I tried desperately to remember why I had to do this procedure. I was 11 weeks pregnant and very nervous. I prayed constantly for a kind nurse, a skilled anesthesiologist, and the steady and knowledgeable hands of my surgeon. My husband whispered positive thoughts and words of encouragement. I knew that this was my best option to help sustain this pregnancy, but it was surgery nonetheless, with many other risks. I happened to be the only patient in pre-op that morning, so I received extra special treatment and attention. My nurse came right over and introduced herself in a deep Southern accent and told me what would happen later that the morning. She asked a series of questions concerning my medical history and told me to change into that wonderful hospital gown and matching socks. My IV was started promptly, as surgery was scheduled for 7:30 a.m. The IV was a Gatorade mixture…no antibiotics. Blood was also drawn for the lab to check for any signs of pre-existing infection. Next, my anesthesiologist came by and introduced himself and asked more medical questions. He seemed very kind and knowledgeable and then I asked him questions! He answered all of them from what exact function an epidural performs, how it works in the body, to whether he had actually had an epidural himself as part of his training! He answered all of my questions with a genuine smile. And no, he had never had an epidural himself! Then the epidural was prepared and the nurse came over to help me lean forward for the injection. The anesthesiologist talked me through the entire procedure and told me what sensations I would feel at each step of the way. It wasn’t bad at all and I attribute that to the skill of the doctor. He then stayed with me throughout the morning as part of the monitoring, and told me that I should expect the same thing at delivery. I hope to see him at that time, when I’m full term and ready to go! Shortly thereafter, the nurses came by with the ultrasound machine to check the babies’ heartbeats. Once they were located, I was wheeled into the OR and by that time, my legs were warm, tingly, and nearly impossible for me to move. My doctor/surgeon came in and the procedure began promptly at 7:30 a.m.. My surgeon told me that he decided to place 2 cerclages due to my history and the fact that I was carrying twins again. Fine! In the OR, I felt the nurse prepping me and then I felt the doctor touching my legs. Beyond that, I did not feel a thing. No pain. The doctor told me when he had finished my first stitch and I was surprised because it took about 5 minutes. Then the second stitch was finished in about 10 minutes and I was on my way to recovery. I happened to be the only patient in post-op as well, so I got special attention from my new nurse. After about 2 hours, my legs came back and I was able to walk. Shortly thereafter, I was released from the hospital. That day, I experienced a small amount of discomfort in my back from the epidural. Later in the day, I had light spotting from the stitches, but it cleared up by the end of the next week. Not a lot of cramping and no real need to take the pain killers that were prescribed. The spotting was very light and I only used one pad and a few liners the entire time. I do not feel the stitches that were placed in my cervix. I was instructed to take antibiotics for the next 7 days and stay on bedrest for 2 days; although, I stayed off my feet for the next 2 weeks!! I also drank tons of water (80-90 oz.) per day. The following Friday, I went in for my one week post-operative check-up and I was told that the stitches were healing nicely, my cervix was closed, and bedrest was not necessary at that time. My cervix would be monitored throughout my pregnancy and bedrest could be a possibility in the future. The twins were also doing fine and growing right along. I was glad to hear it, but I knew that things could change in the blink of an eye, so I continued to limit my daily activity and worked only 4 hours per week in the office. Thank goodness my office allowed me this privilege. I worked the other 36 hours from home using my laptop. No unnecessary bending or squatting. Also, no lifting, housework, cooking, or sex! No problem! I also limited my trips on the stairs in our house to 1-2 times up and down per day. I was told that I could take my dog for a short, slow stroll in the evenings, but I refused; my husband will take him, or he will just have to play in the backyard as his exercise for a few months!! My days after the cerclage consisted mostly of going downstairs in the mornings and staying all day, resting on the couch, working from the couch, going to the restrooms, taking quick meal breaks, and going to my doctor appointments. All in all, the cerclage was an easy procedure and very quick. I am grateful that my surgeon was both skilled and caring. It was a positive experience, and not one to be feared. However, it is important to do a lot of research before the procedure, find the right surgeon (one who does the procedure very, very often and one with a high success rate), and ask many questions before and after the procedure. You are your own advocate and real professionals will respect the fact that you ask many questions and have done your homework.
"Remembering Cole..." by Leah (12/14/04)E-mail Leah
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Click here for Crystal's Online Subsequent Pregnancy DiaryE-mail Crystal.
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