Hope in the Fog

Fog is strange…every morning over the last few days there has been a dense fog as we woke. You can see, but not very far. There is light and at times extremely bright…it can almost blind you. And often times its grey and ominous. As you look ahead it looks so dense that it can be frighting…it causes you to pause…slow down…but as you approach that dense area it suddenly becomes clear. Life lately feels like that, especially now…

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Mason and I return to work this week…I wouldn’t say back to normal, because life will never be back to what it once was. But we’re looking forward to approaching our work lives with fresh eyes and new perspectives…we’re ready to get back to our new normal.

Over the weekend, our foggy path seemed to have shifted some after doing additional research on my pregnancy history. I posted our story on a uterine anomaly support website in hopes to find other women who may have had a similar experience to me. Several women responded and shared their stories. Many began recommending that I look into a special type of cervical cerclage called a transabdominal cerclage (TAC). There are only about 100 doctors in the country that will perform these and there are only three doctors that actually specialize in this procedure. With one of those three doctors in hand based in Chicago I pulled him up online, found his email address, and wrote him an email on Saturday morning sharing our story, my pregnancy history, and asked for his thoughts…within two hours he responded…

His email took my breath away and brought me to tears. His confidence in diagnosing my case within minutes was encouraging, yet heartbreaking at the same time. Could this all have been prevented? I don’t dare dwell on that reality, but focus on hope…

Dear Ms. John,

I am sorry to hear of your preterm delivery and subsequent loss and am sure these were very difficult for you and your entire family.

From your history, there is no doubt that you have an incompetent cervix (IC) as there is virtually no other way you could present with your cervix 4 cm dilated at 22 weeks in your second pregnancy without funneling from an IC.  I suspect IC was also the cause of your extreme preterm 1st delivery as well but your cervical support at that time allowed you to get further in pregnancy.  Once you have had a delivery of any kind, it is not uncommon to have the same pattern occur earlier in your next pregnancy.  While you have a bicornuate uterus (a common uterine anomaly), a bicornuate uterus does not result in second trimester losses so this is clearly IC.

Without treatment, you are likely to have a similar pattern of cervical change and loss in any subsequent pregnancies.  You have two basic treatment options, a transvaginal cerclage (TVC) as your doctor recommended or a transabdominal cerclage (TAC) and they are very different.  The TVC is placed around 12 weeks, generally requires bed rest, allows you to have a vaginal delivery, results in living children approximately 75% of the time but with a high rate of preterm delivery often with long and risky NICU stays as you previously experienced.

The TAC is easily placed prior to pregnancy as an outpatient, does not need bed rest, requires a C-section (you need one regardless) but virtually assures you a term delivery (> 36 weeks).  I have placed TACs in many women with anomalies of the uterus and they respond just like women with normal uterine configurations with IC. Additionally, you simply leave the TAC in place at the time of the C-section and it will work just as well in any subsequent pregnancies.  I am currently placing over 200 TACs per year in women with histories like yours.

I am happy to discuss your situation with you on the phone to answer all of your questions and make your options clear.  You can arrange that by contacting my assistant Gina Williams at 773-702-6127 and she can find a mutually convenient time.  I look forward to speaking with you.  Good luck.

A.F. Haney

We ask for your prayers.

Specifically as we meet with Dr. Haney. We have a scheduled phone consult with him on Thursday morning. We pray for wisdom for the doctor as he assesses my history and we pray for discernment for us. xo

Small Answers

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I had my consultation with Women’s Institute – Maternal and Fetal Medicine today. It was an appointment we hoped would bring some clarity and answer some of the “why’s”…it did.

It was also an appointment that allowed us to talk through what other medical considerations would be added to our “plan” regarding monitoring and preventing preterm complications of any future pregnancies should we decide to try again…there were a few.

Mason and I knew going in that we wouldn’t be handed a silver bullet. Our expectations were realistic. We knew that there will always be a risk of an early deliver…how early? We will never know. We prayed that we’d walk out encouraged…we did. But also knew this wouldn’t make our decision any easier…it doesn’t.

I have a follow-up appointment with my primary OB next week and expect some additional tests to be performed over the next weeks/months to ensure we’re not missing anything else that may have gone undiagnosed or not considered…

My dad shared the above verse as he was helping me pull together some medically specific questions in preparation for my appointment. Clearly, I take after him in our need to read and pour over information…but it was this scripture that puts into perspective that as much as we want to know and understand, our trust is ultimately in the LORD – not medicine, doctors, statistics, or any earthly knowledge.

We ask for continued prayers over the next several months as we pray, process, and make decisions regarding the future of our family. xo