Monday, June 9, 2014

The Post-Cerclage Prognosis: Not What I Hoped

            The go-to-the-doctor-to-see-if-the-cerclage-worked day arrived.
            My mother chauffeured me to the doctor’s while I tried to relax in the front passenger seat. It was the first time I’d sat upright in a car since coming home from the hospital the week before, and I reclined the seat as far as it would recline. Chris had already gone to work and planned to meet us there. I still felt uncomfortable walking around, even though I’d enjoyed several showers and carefully shuffled across our expansive tile entry for my once-a-day—doctor’s limit—kitchen visit.
            Even as my heart sparkled with hope, it spasmed a little with trepidation.
            Upon arrival at Dr. Landry’s, Chris and I were quickly escorted to a room where I was prepared for another ultrasound. Dr. Landry entered, offered friendly, distracting conversation, and then flicked on the monitor screen. The amniotic sac no longer funneled into the canal, and the baby’s head was disengaged from the cervix, although it was still resting as far down as it possibly could in my pelvis.
            Everything looked good to me, and my heart flip-flopped with excitement. Until I examined Dr. Landry’s strained face and then turned my head to survey the top of the cervix to which he was now pointing.
            “Normally after this procedure, the cervix will close and lengthen again, return to a more normal position.” He took a very noticeable, almost anguished pause. “Yours has not.”
            My flip-flopping heart slammed into a wall and lay quivering inside my chest. In fact, my entire gut sank like an anchored weight. “You are still seventy-five percent effaced, with just the amniotic sac and the sutures keeping this thing closed,” he continued. “And since you were three-plus centimeters dilated in the hospital, the amount of cervix I had available to sew together was about the thickness of a thin piece of cloth.” He held up a paper towel to visually accentuate his words. To give me a word picture.
            Carefully laying down the ultrasound head, which caused the screen to go abruptly blank and my baby to disappear from view, he turned, carefully placed his hands next to me on the table, slowly leaned toward me, and established intense, unwavering eye contact with me. After a deep, prolonged breath, he continued. “This pregnancy…is, at best…” He seemed to grope for the right word, or to even utter a word. He stared at me, agonizing frustration contorting his face. Fear. It was written all over his countenance and in his eyes. My doctor was afraid, and he knew there was nothing he could do to make everything easier or better for me. For any of us. That wordless conversation that passed between us happened in just a nanosecond.
            “This pregnancy…is, at best…”
            “Tenuous,” I completed his sentence for him as reality clobbered my conscience, and my heart burrowed itself even deeper somewhere in my body, to hide from the truth.
            Exactly,” he nodded vigorously. “That is the perfect word for it.” Another brief, thick moment of silence passed. “You are hanging by a thread! Our biggest concern now is the possible rupturing of the amniotic sac, particularly with the increase in pressure as the baby develops and grows. You will be completely confined to bed, not even allowed to sit up. If we make it until the end of the month, (I winced at the accentuated “if”), we will be lucky. Every week will be critical, but at this stage—if it were my baby—I would not have any life-saving intervention, should delivery ensue before twenty-eight weeks.” Did he have to mention that now? I thought. He thinks we’ve already lost.
            He then examined me internally to check the strength of the sutures. Why did he have to do that? I blinked at him. Then he firmly told me that he did not know when—if ever—I’d be able to return to light housework. “If you make it to thirty-six weeks, I will cut the sutures and let whatever happens, happen.” Why does he have to say “if” so many times? I understood his point all too well, and painfully.
            Thirty-six weeks of gestation. Almost eighteen weeks away. Eighteen weeks of complete bed confinement. No showers. No standing for more time than it took to use the bathroom. No going to the kitchen. No sitting up. No holding Chris. No holding Parker. No…anything! I listened intently to his additional instructions and concerns and felt the familiar survivalist, competitive armor begin to rise up and encase my body, mind and soul. That familiar, invisible protective gear I slapped on when I knew I couldn’t afford to let anything in, and I couldn’t afford to let anything out. And I couldn’t afford to feel. When any type of emotion is too costly. When any type of emotion might compromise survival.
            I think that was the precise moment I attempted to divest myself of the love and longing I had for my unborn child. It was too painful to bear or think about. Oh, yes, I wanted this baby, but I felt as if the battle cry for war was trumpeted, and I had convinced myself that excessive emotional involvement—including love—would weaken our chances of survival. Though determined to go the distance, to do whatever it took to succeed—without overwrought sentimental investment cluttering the effort—it was easier to be analytical and calculated about the situation and emotionally dead to the horrible realities.
            “I’ll do whatever it takes, Dr. Landry. I know it’s going to be hell, but I will not look back on this as a missed opportunity, with a lot of “what if’s” nagging me the rest of my life. This is our last chance. This is our last child. I won’t jeopardize it.”
            Dr. Landry nodded, like a knowing father, who has more information than he’s willing to unload, wordlessly nods to a young child in order to not upset her. Then he prescribed cream antibiotics indefinitely, since the cervix’s protective mucous plug seal had been lost. He also gave me a prescription for Terbutaline, (the drug most commonly prescribed to arrest labor), with strict orders not to take it unless I had continuous, consistent contractions for more than two hours, and then not without calling him first.
            My head spun. How could I keep track of all of those instructions?
            Chris spoke further with Dr. Landry in the hallway while I padded guardedly to the waiting room, eased myself—half-reclining— into a chair next to my mother, and heaved a disheartened sigh. “It doesn’t look good,” I mumbled, my eyes fixated on my toes stretched out in front of me. My shoulders sagged as my head drooped in defeat.
            “Oh, no!” she replied, and then grilled me about what Dr. Landry had said.
            “He’s going to try to receive authorization for home health care to prepare meals and take care of my needs. He doesn’t even want me taking care of Parker.” My eyes remained focused on my toes.
            “You mean he wants some strange person to come into your house!?” What if they thieve something!?”
            You’ve got to be kidding me! My baby's life—your grandchild—is literally hanging by a thread, and that’s all you can think about? “That’s the least of my worries right now. I have a baby to hang onto,” I said and then turned slowly to stare at her, to pierce through her eyes and brain with a penetrating, don’t-utter-another-foolish-comment-like-that-again gaze.
            She didn’t offer a reply.
            I was too tired, distraught, and scared to orally rehash the conversation with Dr. Landry. And I internally wrestled with a sense that something was trying to beat me into submission, something was trying to force me to condescend and abandon the fight, right there, and right now.
            From where is the energy going to miraculously emerge to see this ordeal through until the end? I felt like an arid well without any available water to reclaim, completely void of enough energy to raise a cup to my parched lips and soul.
            Only God knew where I could get the water, and what Water had to be got. He knew precisely where I’d have to dip my empty vessel—if my baby and I were to survive, emotionally, physically and spiritually.  
            He was going to take me to that well, whether I wanted to go there or not…


NEXT WEEK: Embarking on my new, hanging-by-a-thread life….

Until next week,

Thanks for joining me!



*For those of you who are still in the childbearing years and plan to have more children, or those of you whose children or grandchildren are expecting or planning to have children, this is a must-read article for you, outlining the new guidelines on what doctors now consider to be “full-term” pregnancies.