QuestionHello,
First and foremost thanks for doing this, it's a great service. I have read a lot of your posts on the topic (and others) already. I have also done a lot of research on cervical length, etc. already. I have read med journals, research studies, simple anecdotes from other pregnant women, and general info.
So I know my question is really more a matter of opinion. I need to hear an opinion from someone who isn't concerned with the opinion of his or her colleagues in the least, and also to know a little bit how great you consider my risk to be. My reason for confusion and frustration with many opinions is this: I am a patient of a group of CNM with a university hospital. I love them and had my first daughter with them. However, when you have an ultrasound, a tech performs the sono, then a regular OB/GYN reviews it and speaks to you if there is any concern - not your midwife. There are three such doctors that I have met, and each has had a different reaction to my situation. Also, each seems to be trying to not offend or contradict what the previous doctors have said, even though it's obvious that they don't agree.
I am currently at 28 weeks with my second pregnancy, at age 25. I was told I had a short cervix (2.6) at 18 1/2 weeks.
Relevant History: At 17, I had a cone biopsy. No other procedures/pregnancies until, at 22, I had my daughter after a completely normal pregnancy, zero complications, at 40 wks 5 days. At 6 weeks, 12 weeks and 20 weeks, my CL was measured via TVU and was about 2.5/2.6 each time. After that no one was concerned and I didn't have any more ultrasounds. Labor was natural, went well, but I did end up having an IV, a pitocin injection and lots of pounding and scooping after the placenta delivered as my uterus was "boggy." Labor was normal length (13 hrs) but all the dilation occurred in the last hour and a half or so. I only mention because I don't know if such an intense labor could possibly compromise the cervix in future pregnancies? It certainly seems to indicate it may have already been shortened at time of delivery.
This time, I was flagged for a short cervix and had a follow up ultrasound at 21 1/2 wks. Length was 2.0. Now they considered this substantial risk and rechecked in 1 week, telling me only to take it easy. After 1 week, length was 2.37. I got a 2 week reprieve, then length was 1.7. At that point I was put on complete bedrest and had to take a leave from work. I'm a teacher and I had to call and tell my principal I was on bed rest the day before students came back - the first day of school. I followed complete bedrest as best I could until a recheck 3 days later. Cervix was 2.2. They also did the fFn test. It came back positive. However, a different doctor called me with results and was quite annoyed the test had been ordered, because I was asymptomatic. He told me he recommended that I ignore the results and refuse any more fFn tests unless I developed contractions/cramping/funneling. I was also back to modified bed rest or reduced physical activity in his opinion.
After two weeks, I was rechecked by TVU and, at 27 wks 1 day, the cervix was 2.2. Unfortunately, then while checking on the baby during regular (on the belly) ultrasound, I had a BH contraction. The cervix then showed dynamic change and shortened to .78, but within a minute climbed back to .98.
So then I got a 3rd doctor for consult, and he was quite relaxed about the whole thing. He seemed unaware I had ever been on complete bedrest, seemed to think the bedrest would be irrelevant and that reduced physical activity was sufficient, and was significantly convinced by my prior full term baby that this pregnancy would have a good outcome.
He said if I'd like I could recheck in one week. I said yes please, that sounded good.
So there is, in a nutshell (well actually that was quite a drawn out question) my question.
My own personal feelings vary: initially, I felt that that was simply how my body was, that I was fine, and that it was unnecessary; then I became scared, and then I recovered and felt once again that I was going to be fine; I read a lot about cervixes (cervices, I suppose) online and have found there is limited knowledge to show how a "normal" cervix behaves. A couple of very small studies in Norway and Sweden indicate that a large majority of women's cervices begin to shorten after 24 weeks or so, gradually (19 women) while others shorten at an accelerated rate in the few weeks prior to delivery (5 women) and just 2 women maintained cervical length until just before labor. Also, in a chart, it was clear that all of these women's cervixes varied in length from week to week, going up and down, and that the rate of change was actually 2 - 3x the rate of change I've been experiencing. So I was reassured, but now I'm scared again, because if one BH contraction could do that, what could three or four do when I get into the early 30's (weeks pregnant, I mean, not age. After this extremely stressful experience I think we'll be a family of four.). I am wondering if it might have been more appropriate to give me something to reduce contractions? I have another appt. tomorrow and will ask whomever I happen to see their opinion on that.
Anyway sorry for the long, rambling novel, I'm just very confused and frustrated with the differences of opinion provided by all these providers - it ranges from one midwife (my favorite) thinking I'm fine and should perhaps forget the ultrasounds, practice pelvic rest and take it easy, and be alert to contractions/pains, fluids leaking, to the Dr. who put me on the complete bed rest and caused extreme upheaval to our lives, and who shall be dubbed Dr. Chicken Little because her colleague actually stated that she has a habit of thinking the sky is falling over everything.
Anyway. This is probably amongst the longest questions ever, but any suggestions and your personal opinion are welcome.
AnswerDear Arica,
Well, alrighty then..... :-)
As with our unfortunate situation in Washington, I'm thinking there may be too many cooks in the kitchen. You have obviously done your homework, so I'm going to skip giving you all the actual data and explanations of this. You already know it and I won't presume to talk down to a teacher who obviously knows knowledge is power. What I am gathering that you are looking for is simply an objective opinion from outside the "group". Politics be damned, so to speak...
OK - you need to keep in mind that all I have to go on is the information you share. I do not have the advantage (as your medical team does) of having your complete medical record to evaluate. You also need to realize that I don't give out diagnoses or medical opinions per se - as a nurse. I can, however, let you know what I would tell my sister or best friend if she were giving me this same information... I agree that #1- all women are absolutely different physiologically and will progress in their pregnancies differently as well; #2- It would seem a natural occurrence for the cervix of a pregnant woman (short, long, or average) to lengthen and shorten in varying degrees during the pregnancy, and especially in the last trimester, in preparation for delivery; #3- BH contractions are not thought to cause cervical dilatation, but it would not be out of the realm of possibility for the cervix to begin the process of effacement or shortening with BH but, #4- It would be rare for a medication such as Brethine to be ordered for BH contractions only.
At this point, my expectations of orders for a friend or sister in this situation at 28 weeks would be: pelvic rest, very limited physical activity, obvious heightened awareness of any cramping/contractions or unusual vaginal discharge and immediate reporting of those, but also monitoring of the CL every 2-4 weeks. I'm sure your CNM wants to start to ease your stress level about this after all of the upheaval, but the fact that there is a diagnosed short cervix cannot be ignored and should be monitored. Part of the reason you need to be aware of any unusual discharge is the correlation of funneling to PROM (premature rupture of membranes). So doing the scans at least every 2-4 weeks would enable your medical team to make sure there was no cervical funneling starting which might require further intervention.
I hope what I have shared has actually helped you. After all, it is another cook's thoughts - even though it's from a far away kitchen.
:-) Be well!
Brenda
