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…

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

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Until next week,

Thanks for joining me!

Blessings,

Andrea

*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.

http://health.clevelandclinic.org/2013/10/full-term-pregnancy-newly-defined/?utm_campaign=paid+syndication&utm_medium=link&utm_source=outbrain&utm_content=mobile&dynid=outbrain-_-%20paid+syndication%20-_-link-_-%20outbrain-_-mobile

Twenty-four Hours Post-Cerclage

            I opened my eyelids the following morning. The ceiling tiles hadn’t moved. I blinked several times and focused on the sensations in my nether parts. Nothing unusual. No pain. No discharge. Had the cerclage done the job?

           

            Dr. Landry made an early visit to check his handiwork then waved goodbye. Soon after, a nurse bounced into the room to tell me Dr. Landry was allowing me to get out of bed to take a shower, and go home.

           

            “Stand up…and walk around?” I wondered if she’d received the correct orders for the right patient.

           

            “Yes, he’s going to allow you to walk around—only when you need to—and stand for a shower. And sit up in bed!” She sounded almost giddy.

           

            My mouth gaped. After all we’d been through the last forty-eight hours? First, I’d entered the hospital in premature labor, and then Dr. Landry abruptly gathers my cervix together with some measly surgical thread, and, voila, suddenly I get permission to return to near-normal activity?

           

            He’d even suggested that I might be allowed to perform light house cleaning and drive Parker to school, if everything looked good by the week’s end.

           

            His hopeful prescription didn’t stop me from tippy-toeing gingerly to the shower and enjoying only a brief cascade of warm water down my very stiff back. In spite of what he said, I wasn’t going to take any chances. Following my shower, Chris and my mother helped me gather my belongings, and we awaited the mandatory, chauffeured wheelchair ride to the car.

           

            “Get some rest,” the nurses waved to me, happy smiles decorating their faces. “Good luck! We’ll see you back when you’re ready to deliver in four months!”

           

            Four months of rest and feet-up posture. I assumed that particular prescription would put me right back on state disability for four additional weeks. Certainly my health insurance will cover limited home health care.

           

            It would be a matter of days before we’d know just how well my body responded to the cerclage, though. To know if it was really going to work.

oOo

           

            I arrived home with mixed feelings, my head in turmoil. How was I going to care for Parker? How was he going to get to school? What if I went into labor while I was alone in the house and unable to reach anyone? We lived in the country, on four acres, pre-cell phone era.

           

            After several minutes of exhausting my brain with questions, I lay down. Sitting and thinking made me physically uncomfortable and stressed and sapped my energy.

           

            Chris had made a decision to purchase a beeper, so I wouldn’t have difficulty contacting him, at least, although he was forty-five minutes to an hour away—on a good traffic day. My mother decided to stay a week longer than planned, having said good-bye to my father who had driven to the Los Angeles airport that morning to take his scheduled flight home. She’d rejoin him five days later, when they would immediately prepare for their special Christmas trip to Germany.

           

            My mother shuttled Parker to and from school, cleaned the house and did the laundry. Chris returned to his long work routine hours, and Parker continued his pre-school schedule. I set up “house” on the sofa sleeper in our guest bedroom and awaited the arrival of meals from my mother, three or four times a day. Chris prepared one side of the bed with the egg-crate padding brought from the hospital, and I located a comfortable position on the bed, hips tilted as high as I could manage to position them with pillows. Videos played non-stop on the small television set for entertainment, and I gathered several paperback books in a tower next to my new bed. No reason to get too settled in down here, though, I thought. Dr. Landry will probably give me the thumbs up in a few days anyway, to get up and walk around, and return to relative normal. Maybe I will actually enjoy the rest of my pregnancy.

           

            I even rather confidently explained to my pastor and other church members who called—graciously offering to help with picking up Parker from school and delivering hot meals—that by the end of the week, I would almost certainly be allowed quite a bit of freedom, and probably wouldn’t need assistance. With great anticipation, I awaited the Big Day—when I’d return to Dr. Landry’s office to receive the positive prognosis.

           

            This had all been so much easier than I’d expected. Things were really looking up! God was answering my prayers.

           

            What could possibly go wrong now?

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NEXT WEEK: The prognosis…

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Until next week,

Thanks for joining me!

Blessings,

Andrea

Cerclage, Epidurals and a Nurse’s Divine Intervention

            Mayo Clinic defines a cerclage as: a procedure in which sutures are used to close the cervix — the lower part of the uterus that opens to the vagina — during pregnancy to help prevent premature birth.

           

            The best way I can describe it: turning your cervix into something resembling a marble bag opening.

           

            And my cervix was about to be turned into a marble bag clone.

           

            They scheduled surgery for the afternoon, since a heart surgery patient took priority over me. Dr. Landry arrived in my room prior to scrubbing to say, “Hi,” and discuss the procedure with me again, now that the muscle relaxants had worn off. During the go-through, he mentioned that an epidural would be administered for anesthesia. May eyes widened in terror as he talked, and I chewed my lip.

           

            The epidural I received when delivering Parker had failed to anesthetize my lower parts properly. After I explained that to Dr. Landry, he promised me an “audience” with the anesthesiologist to discuss my concerns. An anesthesiologist, he pointed out, that he highly regarded, and with whom he appeared pleased to be working. Lucky me.

           

            Surgery time arrived, and they prepared me for transport to the operating room. After being carefully, gingerly re-positioned on a gurney, Dr. Landry leaned over and asked, “Are you ready?”

           

            “Are you?” I questioned a bit too sarcastically I guess, because the nurses sucked in their collective breaths when I said it. I could almost imagine the “impertinent patient” discussion they’d soon be having at the nurses’ station down the hall after they wheeled me away.

           

            But Dr. Landry merely smiled and nodded before he and Chris maneuvered me to the operating room check-in area. I watched the ceiling tiles zip by as I cruised along. Chris then smooched me goodbye and said he’d return after going home to see Parker and take a shower.

           

            In the hallway outside the operating room, Dr. Landry officially checked me in himself at the window, and the anesthesiologist maneuvered to my bedside. Following a preliminary introduction and brief diagnostic back-and-forth with Dr. Landry—who firmly emphasized that he’d like to do an epidural—I interrupted by blurting out my experience with the relatively unsuccessful epidural during Parker’s delivery. I had a sense of urgency about her knowing it. I couldn’t dispel the feeling that an epidural would lead to catastrophe.

           

            She shifted her attention to me and carefully explained why epidurals sometimes don’t work. Dr. Landry hung over the bed, listening intently before again interjecting that he’d prefer an epidural. But she gave me one last look, turned to Dr. Landry and unequivocally declared, “No. I will do a saddle block so we can ensure complete anesthetizing of the area.” 

           

            I’d won! I couldn’t help but break out in a victory smile. Four eyes turned to look at Dr. Landry.

           

            “I guess that is better,” he agreed with a nod. “I can’t afford to have you wiggling around on the table. I might end up puncturing the amniotic sac during the procedure.” I breathed a sigh of relief at his change of heart.

           

            It would be the first of many God moments that day.

           

            The anesthesiologist left, cheerfully saying that she’d see me in just a few minutes. “You’re in my hands, now,” Dr. Landry said, gently patting my leg.

           

            Not entirely, I thought. Your hands and God’s. “I wouldn’t have it any other way,” I said with a grin.

           

            “I’ll see you inside. I need to go scrub.”

           

oOo

           

            From the anesthesiologist to the operating-room assistants, the process was a picture of precise efficiency. Within minutes, someone arrived to wheel my gurney into the operating room to quickly prepare me for surgery. Together, they carefully transferred me to the table and quickly strapped my arm down for an IV and then draped my body with warm blankets to prevent my shivering in the cold, sterile room. Instructing me to roll onto my left side, the anesthesiologist deftly inserted the necessary equipment into my back to obstruct sensation in my abdomen, hips and legs. Then she promptly returned me to my face-up position. Dr. Landry suddenly appeared, spoke briefly with her, and then turned his attention to me.

           

            He repeated the expectation scenario again, along with the expected thirty-minute surgery time. Then he positioned himself in an optimal viewing position at the end of the table and prepared to weave surgical thread through my cervix to draw it closed. All I could see at the end of the table was the green surgical cap on his head. The assistants threaded my legs through little stirrups and gently cranked up my pelvis with a pulley to a more acceptable, and operable, viewing level. A butcher shop picture floated through my mind: pig and bovine carcasses hanging by meat hooks from a ceiling.

           

           

            The glare of the operating room lights illuminating the room assaulted my eyes, so I closed them and communicated by nodding or wiggling my fingers at Dr. Landry.

           

            It seemed as though the process had only just begun when he roused me to announce he was finished. “Everything went well,” he smiled. “What we have to worry about now is labor starting because I was irritating the cervix. The recovery room nurse will keep an eye on the fetal monitor and start magnesium sulfate if that should happen, and I will be into check on you after I change. I may release you tonight if everything goes well.
           

            Release me tonight! Is he nuts? I don’t want to go home! I want to stay right here, to be observed 24/7, precisely where intervention will be immediate should anything go wrong. I had no intention of leaving the hospital that night. 

           

            I was briskly wheeled into the recovery room area and parked in a stall along the wall where a nurse busied herself taking and recording my vitals, making me comfortable, and observing my recovery from the anesthetic. What she was not doing, however, was keeping a watchful eye on the fetal monitor, regurgitating a stream of paper indicating stronger and stronger and closer and closer contractions. All of which I couldn’t detect because I’d been temporarily paralyzed from the belly button down. As far as I knew, everything was going like clockwork. Just peachy.

           

            While I lay there, immovable, my overactive imagination kicked into high gear. I entertained morbid thoughts of what it would like if the anesthesia never wore off, and considered what it must be like for paraplegics. The more I thought about it, the more I convinced myself that I’d never walk out of the hospital on my own power. Worse, I’d never walk again!

           

            It didn’t help that every couple of minutes the nurse asked if I had any sensation or could wiggle my toes. Mustering great will and determination, I attempted to move the leaded weights extending from my trunk to the end of the table. I was unable to wave even a big toe in her direction. I’d just look at her apologetically and shake my head.          

           

            Then try to keep from hyperventilating in panic.

           

            How utterly frightening, to realize that you’d be spending the rest of your life in that condition—with dead limbs hanging limply, uncontrollably from your body. My mind raced backwards ten years to the University of Wisconsin Hospitals physical therapy department, where I’d been volunteering as a physical therapy aide. No wonder those paraplegic patients—grown men and women, in the acute stage of their rehabilitation—spent so much time in fits of anger and tears, consumed with frustration about the unfairness of life and the futility of their condition. The physical therapist would get them on the floor and make them stand up, or get back in their wheelchairs on their own, using only their crutches or their arms and upper bodies for support and leverage.

           

            After long, drawn out minutes, they’d usually slump into a quivering heap on the floor, unconcerned about the other patients watching their meltdowns. Day after day after day of repeating the same procedure, the same instructions, the same exercises, they’d eventually emerge victorious. And then they’d weep over their success.  

           

            In an instant, my appreciation for quad and paraplegics deepened.

           

            This would be horrific.

           

            While I was mentally entertaining myself, and attempting every fifteen seconds to feel my toes, the double doors were thrust open and in walked Vera, looking determined and projecting a huge smile. My morbid thoughts abruptly disintegrated as I smiled back.

           

            “I just felt like I needed to come and see how you were doing, “ she said in her authoritative, yet soothing voice as she walked toward me. “How are you?”

           

            Before I could answer, she stopped abruptly, quit looking at me and scrutinized the fetal monitor paper ream rolling from the machine beside me.

           

            “Fine,” I replied, instantly calmed by her warm, hopeful presence.

           

            “You’re not keeping an eye on this monitor at all, are you!?” Vera shot at the recovering room nurse. “She’s having spikes of contractions all over the place, every three minutes! You’ve got to give her magnesium sulfate, right now!” she finished hotly as the nurse snapped to attention and, without a word of response to Vera, rapidly prepared the injection for insertion into my IV line. With visible disgust, Vera reiterated the need for attention to the monitor.

           

            I swiveled my head right to look at the recovery nurse, who busied herself preparing the injection. She refused to raise her eyes to meet Vera’s lethal gaze. Then I swiveled my head left to look at Vera, whose blazing eyes indicated she wanted to reach across the bed to slap her. Instead, she shook her head and told me she’d see me later. Then she pivoted on her white nurse’s shoes and strode back across the floor and through the double doors.

           

            I blinked. What just happened? If it weren’t for Vera… Within seconds, the magnesium sulfate flooded my body, bringing with it the familiar, scorching sensations. At precisely the moment the nurse injected the mag sulfate into the line, I requested two cold washcloths for my chest and face and reminded her of the drug’s other unpleasant side effects: nausea and vomiting.  She smilingly reassured me that Dr. Langford had ordered an anti-nausea drug to combat the problem. My eyelids slid shut in thankfulness, and I relaxed enough to momentarily withstand the hot flashes roaring across my face, shoulders and chest. Within minutes, the burning receded, the labor contraction waves quieted to just occasional blips of baby wiggles, and blessed sensation crept into my lower extremities to awaken my feet. All ten toes gestured ecstatically at their liberation. And I breathed a gargantuan relief sigh.

           

            Dr. Landry also arrived for a quick check—I didn’t blab on the recovery room nurse—and reported that everything looked good, although he reiterated that the next twenty-four to seventy-two hours would be critical. Fortunately, he had decided to extend my stay overnight in order to keep a close eye on me. Smiling, I wordlessly nodded my head. Good decision, doctor! I concur completely.

           

            They wheeled me back to my room and re-positioned me into the head-tilted-south position. And, once again, I inspected the ceiling tiles as we cruised along. Chris, Parker and my mother arrived to check me out and offer encouragement. Then I was left alone to fill the silence with television and any sleep I managed to self-induce. Seventy-two hours sounded like such a turtle race, especially when every minute hung in the balance.

           

            And I had plenty of time to think about what might have happened if the anesthesiologist had sided with Dr. Landry, and Vera had not responded to the “felt need” to vacate her post and make a quick trip to the recovery room, just “to check on me.” 

            Maybe God wasn’t so silent, and He hadn’t yet uttered, “No.”

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NEXT WEEK: I get to go home, and hope sparks my heart…

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Until next week,

Thanks for joining me!

Blessings,

Andrea