Marking days (and knowing your risks for PTL)

The kids are 8 1/2 months old (nearly eight adjusted) and have surpassed their time inside, 36w4d, with their time outside, 37w2d, and today is the one year anniversary of the surgery that kept them cooking past 21w4d and saved their lives. 

After losing my mucus plug last 8/19 @ 19w (and then having an OB clear me w/a long and closed cervix as we were heading OOT on vaca) and then six days later discovering my funneling cervix at our anatomy scan (which put me on bed rest), I quickly found an MFM that ordered that I be monitored more closely (and put me back on P4).  After a week of twice weekly checks showed that my cervix was stable and then much improved/normal, the third showed that I was beginning to dilate.  By the time I got into surgery that afternoon, I was already two cm dilated (with four cm being the limit for being able to be sewn shut).  It was one of our very worst and (in the end) best days...

Every day now, I look at the babies and know how lucky we were that my appointment just happened to be on that day and that my body failed so slowly.  We've just passed what would have been the first birthday of our first baby who we lost.  I am a very emotionally resilient person, as is DH, but I'm just not sure that I would have been able to cope very well with birthing three lost babies.  There is a limit to how much you can even imagine bouncing back from...

In an attempt to hopefully save others from a similar situation, I wanted to share the risk factors that I had (and should have put me on a short list for closer monitoring) and all the many others, so you can advocate for yourself and your babies.

According to the March of Dimes, I had all three of the greatest risks of having a preterm birth:

A uterine septum (or other uterine/cervical irregularity) can cause problems, even after removed.  In our attempts to get pg, I'd also had several surgeries (three over the course of 16 months) to address my septum and a polyp, which involved dilating my cervix (any D&C-type procedure increases the risk of having cervical problems or adhesions).  I'd also had a cervical cone biopsy in my 20s after an irregular Pap, which thankfully was benign, but left me with a little piece of my cervix missing, which also weakens it.

Though I was carrying multiples, a major risk factor, just having done IVF and being pg with one baby is sadly also a risk factor for preterm labor.

Since my first pregnancy ended in a spontaneous loss, this also put me at higher risk for another preterm loss (since the root causes, including low P4, were likely the same).  First trimester losses sadly garner little serious attention, so it was not considered a risk at the time.  Though if it had been several weeks later, it would have raised more red flags and I would have been a candidate for a preventative cerclage, rather than needing a rescue cerclage.  How sad is it that you not only have to lose babies to be treated proactively, they must be farther along...

Though I was nearly 35 when all this occurred and age (high or low) is a risk factor, I was very healthy and didn't have any of the other health related risk factors (preeclampsia, high blood pressure, diabetes, under/overweight, clotting disorders, other disease/infections/birth defects, etc.)

All the other/lifestyle risk factors actually ran counter to my situation.  These include race, socioeconomic status, marital status, working status, access to prenatal care, unintended pregnancy, smoking, alcohol/drug use, lack of social support, stress, domestic violence, and exposure to environmental pollutants.

If you are TTC or newly pg, please check out the list of risk factors (there are so many, but some intersect w/those causing IF, like PCOS) and see if any of them apply to you and discuss with your physicians.

And so it is finally September, when we also mark two years since we lost my FIL and my sister was dx w/cancer.  Those were some dark days...  Thankfully, my MIL is bolstered now by having my BIL back in India, a new DIL, and of course new grandbabies (which she'll be back to see in the new year).  And my sister is so far cancer free since her surgery and chemo last year.  Thanks to those who sent her cards and/or added her to your prayers.  We also get to mark another year of marriage (6!) and life (36!), opportunities that we cherish.  We know just how lucky we are and are very thankful, every single day.

If you are going through hell, keep going... -Eleanor Roosevelt

What's old is new again

Just when I thought I was never going back to the now months past vag cam visits and Crinone, here we go again...  We went to the MFM this morning and thankfully my cervix funneling hasn't changed since Thursday, and she also doesn't think a cerclage is a good idea at this point.  The risk of breaking my water during the procedure and of infection apparently outweigh the benefits, though I must admit part of me (and DH) wanted her to say they would just stitch me up so we could relax a little.  The babies are both still looking great.

After the dx on Thursday and hospital trip on Friday and a very rough weekend, where I was almost entirely on bed rest fearing that my cervix was ready to give out while we had family visiting, we are both ready for a break.  But at least we have a more proactive plan.  In addition to the progesterone, she wants me to be monitored twice a week to see if/how my cervix changes.  She said if/when I dilate too early, they will stitch me up.  She said she didn't think all the pain and discomfort I'm having is related to the cervical changes, and that strict bed rest is unlikely to prevent any changes that could happen.  She said I should take it easy, which I thought I already was, and get a support band to help me as I continue to grow.

The nursery is now a new room, though we (by which I mean DH) still have quite a bit of work to do to finish the wall and paint, so we can move everything in.  I can't wait to get it all put together, but honestly given all the craziness of the last few days, I guess we aren't in that big a hurry since we've already past into what I thought would be the post-24 week lockdown and we won't be housing babies for some time even if they come early.  We now have both the cribs, mattresses, bedding, rugs, dresser, topper, shelves, art, etc. and it will be fun to see it all come together.  We still have to finalize the chair decision and get that ordered.

Bed Rest Day #1

After spending the entire day yesterday in the city at our anatomy scan and then OB appt., we finally came home and I went to bed.  Though sleeping wasn't really on the docket.  I got a few hours all night, as I was having all sorts of pain and pressure.  I paged the OB early this morning as she said this is the only indication I'd have of something changing and she told me to go to the hospital, so off we went again.

We spent several hours at Prentice, where they confirmed that my cervix is still closed and I was not contracting (and the babies are still fine).  They talked to the OB, who we are meeting with again on Monday.  We stopped by the MFM practice before we left to get an appt., but they just took my info and told me they'd call me back.  Thankfully, they called back this afternoon and I have a 9am u/s for Monday with an MFM who specializes in multiples, high risk pregnancies and pregnancy loss.  We are very happy to get in with a specialist who can potentially give us additional options rather than just lay on my back for the next four months in hopes of keeping the babies in and that it is up to me to know if my cervix starts dilating between appts., at which point they could try to intervene.

We are very thankful that this cervical issue was discovered when we can still potentially do something to bring the babies closer to term, as many people just go into preterm labor and lose their babies before they ever know something is amiss.  Being on bed rest before 24 weeks wasn't really something I had considered, but we will figure it out.  Thankful again that I am not working and that our travel is done.  DH is amazing at taking care of me, as always.  My dad and step mom are coming tomorrow for a quick visit, when DH and dad will put up the nursery wall.

Whether it's a cerclage and/or bed rest that gets us there, we are fighting for these babies. 

If you've been on bed rest, what did you do?  I'm thinking over four months, I could write a book, or two... ;)