QuestionHello, I'm currently pregnant with my second child and wondering if I am doing the right thing. With my first child, I went to a doctor who was very... lets just say he didnt want to take ANY risks about ANYTHING, his first response to any little problem was immediate hospiptalization and surgery. When I was 16 weeks along, my cervix was 2.5 cm, exactly the "limit" for being considered too short. I was monitored for about a week, and there was no change for the better or worse. He recommended hospitalized bedrest, which I refused to do because I couldnt afford it (he said worse case scenario he would keep me there for the rest of the pregnancy... to quit my job AND pay for the hospital fees would have wiped us out and then some), I said I would gladly do home bedrest and he said that was no good, it was hospitalized bedrest or cerclage. After doing my research, I didn't want to do the cerclage. I have never had a miscariage and I didnt feel that I had been observed long enough to conclude whether it was actually necessary. My husband threw things at me and said if I didn't do it, we were through. So I did it, basically to save my marriage. They kept me in the hospital for a week (I'm not in the US, I know that is not typical) even though the surgeon said she had never seen such a fast recovery "just to see." After the cerclage, there was no change. I went back to work, which involved performing (singing and dancing) and playing with children, I picked them up and swung them around as always, and other than the cerclage had a model pregnancy. I kept working until the 8th month. I never had any premature contractions or bleeding. In the end I was induced. Needless to say, I do not feel that the cerclage was necessary and deeply regret having made that choice. I am of course glad that my son is fine, and in the end I did manage to have a vaginal birth sans painkillers, but I wish I had done things more "naturally" up until then, too.
Now I am going to another doctor who encourages freestyle labor and delivery and even says on his webpage that he treats cervical incompetence with bedrest first, surgery as a last resort. I showed him the record of the first pregnancy and he kind of glanced at it, seemed more interested in the fact that there were no actual problems with the delivery than anything else. I am not sure that I DID have cervical incompetence the first time, but it concerns me a little that he hasn't even checked yet. I really DONT want to go through the same experience again... but I am a little worried that, whatever the problems were or weren't last time, that the cerclace may ahve CAUSED problems that he isnt checking for? Or does the fact that my first baby was born vaginally with no complications mean that whatever scarring might have occurred wasnt unusual or excessive?
I don't want to go back to the same doctor or give birth at that hospital again (there were other issues too, one of the nurses made racist remarks about me and my baby in front of us, they discouraged breastfeeding, etc... so regardless of the creclage issue going back there is not an option) But really... this sort of scenario seems to be undocumented. In all of the reading I've done on the web, it seems that in the Western world a doctor wouldnt have DONE a cerclage on me with no history of miscarriage or stillbirth and a cervix that was borderline and not getting any shorter that we knew of... if I had had a couple of miscarriages like most of the women I read about I would be insisting on a second cerclage... as it is I dont think the first was necessary, but there dont seem to be any cases like me documented out there... so I dont know what the complications could be with or without this time. My WISH is to never go through that again... but obviously the baby is first priority.
I am not working anymore and more than willing to do as much bedrest as necessary.... but the doctor hasnt recommended that either. Should I just trust that no news is good news? Or ask him to check every time even though he's the doctor, and I know nothing? Any thoughts or opinions are welcomed! Thanks, and sorry for the long question.
AnswerKatie,
I completely agree that it's entirely possible you did not have an incompetent cervix with your first pregnancy, and that your treatment was much too aggressive. It definitely sounds like you were bullied into that decision rather than being presented with evidence-based options. In cases of true IC, labor usually begins within days of having the stitch removed, not with an induction weeks later.
I completely agree that you should not go back to the first doctor. Period.
The second doctor does sound like a much better fit for you. If you have had an ultrasound, he should have been able to tell the length of your cervix from its results. He is most likely unconcerned because you exhibited no true symptoms of cervical incompetence with your first pregnancy, no preterm delivery, or any other complications at birth.
Also, he is probably aware that there is no true evidence-based information to show that cerclage improves outcomes in cases such as yours (see http://www.cochrane.org/reviews/en/ab003253.html for a meta analysis of cerclage effectiveness).
He also knows that vaginal exams yield little useful information and can cause harm by irritating the cervix, which can lead to contractions or dilation as well as introducing bacteria that can cause infection, so performing one to check your cervical length still wouldn't bring much benefit.
Now, the most common cerclage is cervical scarring, which doesn't typically impact the pregnancy, but can interfere with delivery if the scar tissue makes it difficult for the cervix to dilate efficiently.
If your cerclage removal was fairly easy, then you probably don't have a lot of scarring. Your first doctor would probably have mentioned it had there been a great deal of scarring. The scarring would also be somewhat visible and palpable on a vaginal exam if it were extensive. Unfortunately, there is no way to reliably determine how much scarring is too much or how your cervix will respond until you are laboring. In all probability, the odds are with you that everything will be fine.
So, at this point, I think your doctor is following the evidence and isn't overtly concerned because you are not exhibiting signs that there is a true problem. Bed rest would be the first course of action.
You should always address your concerns with your doctor. Remember, he is working for you. You are not at the mercy of his decisions. He must present your options and discuss the risks and benefits of each.
If you still have questions and concerns, then ask him what he thinks of your history, if there are any signs of IC present and what his recommended course of action would be. Also, ask him if he anticipates any problems with delivery, what they are, and how he would address them.
There is no need to live in doubt and just "hope" things are OK. Take the time to talk these issues over with him so you feel comfortable with your care. If your appointments are typically rushed, you can ask for a longer appointment when scheduling so you have the time you need to get your questions answered and have peace of mind. You may also want to write down your questions so you don't forget once you're there.
Best,
Catherine
