Thank you for all of your comments, both publicly and privately. Monday and Tuesday were rough days for me. Even though bed rest was not recommended and even though my MFM didn’t encourage any lifestyle changes, I did freak the fuck out. There just wasn’t a way for me to grasp how I was going to be ok hour by hour trying to get through the next however many weeks. In fact, I was up almost all night Monday night/Tuesday morning ruminating over worst case scenarios, like delivering at 25 weeks and having baby boy not survive, or delivering at 26 weeks with major complications, or, or, or. I am prone to catastrophic thinking which I know stems from the childhood accident that killed my brother. It was a worst case scenario come true and dictated the trajectory of my life going forward.
I voraciously researched ‘shortening cervix with funneling’, ‘pregnancy outcomes shortened cervix’, etc., and I posted to a couple of parenting groups I belong to looking for success stories of those making it to term with a shortened cervix. That turned out to be a mistake. Why can’t people respond to the question at hand without pontificating or inquiring as to why you didn’t do XYZ? Most of the folks who responded encouraged me to get a second opinion, try to find a doc who would place an emergency cerclage now, remand myself to bed rest with feet and hips elevated above my belly. There are so many local, old school OBs who practice under an archaic set of guidelines that have been updated and refuted umpteen times. It was hard feeling like I had to justify prior decisions when that isn’t what I asked for.
I clearly needed more info to set my mind at ease (if that was possible) so I emailed my MFM to express my concern. Below are excerpts from her responses:
“Believe me, I’d have preferred your cervix to stay put where it was too, but after all we know that we do this surveillance because on occasion we still see that some women change. The big thing is not to miss the window of opportunity to intervene, and I’m pretty happy that overall you are asymptomatic and we have already crossed into viability.
It’d be highly unusual to see a significant change within a week, and I do believe that we’ll have a good chance of simply continuing as we have, albeit with a shorter cervix.
Try and lose not too much sleep about it, at least until we have to (which we may not….). The measurement was still normal.
Overall I think taking a step by step approach is healthy regardless. You know yourself best, I’ll tag along.“
I then inquired as to the effectiveness vs. risk of placing a cerclage up to 26 weeks (as some OBs still do):
“The recommendations on cerclage placement are very clear, it is not recommended beyond 24 weeks since the risk of the procedure and the available interventions for a then viable baby stand in no relation. I am sure you have heard of people undertaking cerclage placement all the way up until 28 weeks. Frankly, that stems from outdated recommendations and will universally be offered by older practitioners who were trained during a time when fetal viability began at 26-28 weeks.
There is a brand new summary of recommendations that was just published by the SMFM in the American Journal of Obstetrics and Gynecology in May of 2012. (“Progesterone and preterm birth prevention: translating clinical trials data into clinical practice”) You could probably find it at www.AJOG.org.”
I found and read the abstract which basically summarized what I already know. As anyone who has been through IVF knows, the science is evolving all the time, but there are some ‘gold standards’ that REs still prescribe (like post transfer bed rest) with a ‘it may not help, but probably won’t hurt’ mentality. The more recently someone is out of med school, the more likely they are to follow the newer research. I have found this to be true of virtually all my doctors.
Last night we attended back to school night at our son’s school. I listened to the director’s key note address (she is an articulate and impassioned speaker) and we visited my son’s classroom for his teacher’s presentation. I sat there, like every other parent invested in their child’s educational experience and something clicked. I am 25 weeks pregnant with a little boy. Yes, my cervix has decided to change a bit, but even so it is still within normal limits. There is virtually nothing I can do to affect the outcome of this pregnancy, whether I take to my bed in fear or not. There is not one study that proves or even suggests that bed rest would be ordered at this point. Sure, taking it easy, while pregnant, is prudent. I have a son and husband who need me and lying in bed in fear is bad for my psyche, which in turn is bad for this baby. I am in tune with my body, even though there’s no way I can feel what’s happening with my cervix, so at the first sign of pre-term labor, I will high-tail it to L&D. But, I don’t suspect that I’ll go in to pre-term labor. Instead, my cervix is either going to hold up or its not and there’s nothing I can do beyond what I am doing (progesterone suppositories and taking it easy (not lifting, not doing housework, not doing things that require me to bear down on my cervix)) to effect what’s happening internally.
Things are going to evolve as they are going to. I have to let go of any false perception of control that I think I might have and, as I did during my prolonged bed rest with my son, take things one day at a time. I’ll make it as far as I’m going to make it, which very likely will be full term and all the worry and hand-wringing and doomsday scenario thinking isn’t going to change that one bit.
“Grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
Living one day at a time;
Enjoying one moment at a time;
Accepting hardships as the pathway to peace”
~excerpted from The Serenity Prayer