The Cerclage

A cerclage is a procedure to place a stitch or stitches in the cervix of a pregnant woman to keep the cervix closed as long as possible. This can be done as an emergency procedure if a woman's cervix is found to be opening (or shortening) too early, as long as her water hasn't broken. This can also be done as a preventative measure when there is reason to believe that there may be a problem later in the pregnancy.

Although we don't have an answer as to what went wrong in our last pregnancy, we know that the cervix opened too early. That early opening may have perpetuated everything else that happened, or some other culprit may have caused the cervix to open early. Either way, my doctor recommended we have the procedure done. He said if we agreed, it would be done around 13 weeks, once the risk of spontaneous miscarriage was significantly decreased.

The benefits of the procedure include: strengthening the cervix, keeping the cervix closed beyond when it may have opened on its own, and providing piece of mind to couples who have experienced a previous loss. The risks include: all the normal risks that come with any surgery with anesthesia (infection, permanent injury, death, etc.), and also the risk of disrupting the pregnancy, causing miscarriage.

My husband was on board with the procedure from the beginning, but I was less sure. For one, I hated to admit that there might be something wrong with me that had caused our loss. Second, it made me nervous to interfere with nature, especially considering the risks. In the end, I decided that we could either worry about the procedure and, as long as it went well, be somewhat more relaxed for the rest of the pregnancy, or we could worry for the whole pregnancy. I decided the former would be a little easier.

After our trip to the ER the Sunday before the surgery, when I was convinced my cervix might be opening already (and everyone in the ER looked at us like we were crazy), it became clear that this was a very good idea. (The outcome of the ER visit was that everything was fine, and when we explained our history to the ER doctors and nurses, they were much more understanding of why we were so crazy).

We went in for the surgery on Wednesday, January 11th. We were very nervous. The nerves were made worse when, before the surgery, the nurse could not find the baby's heartbeat, nor could my doctor. After many nerve racking minutes, the nurse brought an ultrasound machine. The baby quickly appeared on the ultrasound screen, with a strong heartbeat (150bpm). Apparently the labor floor (which is where they performed the surgery) is not well equipped to hear tiny babies' hearts. The nurse assured us that their Doppler equipment was not as sophisticated as the equipment at my doctor's office. After the surgery, they again could not find the heartbeat with the Doppler, so they again used the ultrasound machine to confirm that the baby was fine.

Before the surgery, they gave me a spinal (like an epidural, but the medicine goes into the spinal space instead of the epidural space - that's how the nurse described it). I was already in the OR and couldn't hold my husband's hand as I had hoped, so my nurse held my hand. The nurse anesthetist had warned me that my blood pressure could drop which could cause me to vomit or faint. Plus I had heard that the needle for an epidural was painful. I was most concerned about the consequences of the anesthesia, rather than the surgery itself. The needle was painful, but not unbearable and I had no problems after the medicine went in. The hardest part after that was throwing modesty to the wind while wide awake in a room with about 10 people in it!

Once the surgery was over, I went to a recovery room for an hour and then back to a regular room until I could be released. The only hiccup in the recovery was that I couldn't pee until several hours after the surgery because the numbness had not subsided enough. While I was recovering, one of our wonderful nurses from our stay in April stopped in to say hello. She said she had tried to change her schedule when she heard that we would be there, but she wasn't able to make it work. However, she had to come in for a meeting, so she stopped in to say hello to us.

When I was finally able to leave, I went home to rest with my feet up for a few days. The doctor said everything went very well, and I got the thumbs up to return to normal activities at my follow up appointment the next week. Hopefully this procedure will give us the peace of mind we hoped for in this rollercoaster ride.

The Birth Certificate

Until a new bill recently passed, New York State did not acknowledge the birth of any baby born still (birth certificates are called "Certificate of Live Birth", not applicable if the baby was born still). In addition, the parents do not receive a copy of the fetal death certificate, unless they request it (not exactly something you are thinking to ask for in the hospital). You can request the certificate after the fact, but must have the request notarized. There is no need for a name of the baby on the death certificate, so they baby remains unacknowledged. As far as New York State is concerned, the baby was never born, so therefore, a baby never actually died; they only acknowledge the termination of the pregnancy.

Thanks to some very dedicated mothers, this will soon change. Beginning in March, New York State will offer Certificates of Stillbirth. The law is retroactive, so anyone who has had a stillbirth (at more than 20 weeks gestation) can request a birth certificate for their baby. (Our stillbirth was at 20 weeks and 4 days, so we cross the required threshold to qualify.)

After coming home from the hospital, it took a while to sink in that we would not receive birth certificates. Once it did, we were very upset, but poured our energy into the March of Dimes. We were so grateful to these wonderfully dedicated mothers for making this happen. We are very excited for March, when we can request the certificates for our babies. We will proudly display them as proof that our babies were, in fact, born.

Trying Again

In an effort to cope with the loss of our twins, my husband announced (to anyone who would listen) that we would be trying again as soon as the doctor gave us the okay. I wasn't sure that I would be ready right away, but I was devastated when the doctor told us at our follow up appointment that he recommended we wait six months before trying again. Our grief over the loss of the twins was three-fold: (1) the loss of Caiden and Kaylie - a pain that would dull with time, but could never go away completely, no matter how many more children we have, (2) the loss of the excitement of twins - this part could be relieved if we have twins again in the future, but my doctor assured me that in all likelihood we will never conceive twins again (what he perceived to be good news, but I took as another devastating blow), and (3) the loss of having a baby, especially while all of our friends were bringing home healthy babies. The last, at least, was something that we could fix by starting to try again. So, although I didn't want to start trying the next week, I thought a month or two would be a good waiting period.

At my follow up appointment to the D&C, the doctor had changed his mind. He said that it was good to wait six months to allow my body to return to normal before getting pregnant again, but since we didn't know that we would be successful on our first try, he thought it was okay for us to start trying sooner. I was ecstatic! Much sooner than I had originally anticipated, I would be able to do something to relieve some of our grief.

However, I did not anticipate the emotional roller coaster that was to come. I knew that when I was pregnant again it would be the craziest roller coaster ride we had ever been on, but I didn't expect the effort to get us there would also be a roller coaster. Over several agonizing months, we experienced the roller coaster - the raw emotions of "moving forward" after our loss (not that we were forgetting or minimizing our loss, but working to move forward nonetheless), the tears with every negative pregnancy test from sadness that we were unsuccessful yet again and frustration about the unfairness that we had to go through the roller coaster again the next month. During this time, I lived my life two weeks at a time: two weeks of doing whatever I wanted: drinking, eating raw cookie dough, getting tattoos (okay only one), and two weeks of being on my best behavior in case we had been successful.

However, thankfully, after these agonizing months, we had a positive pregnancy test! I had expected to be filled with mixed emotions and most likely more scared than happy at the sight of those two little pink lines, but just the opposite happened. I was over the moon! Scared, of course, but that was secondary to my excitement. I took the test on a Sunday morning. I was the lector at church later that morning. At my church, the lector sits all by themselves, to the side of the Altar. It was a good thing I was alone, because during the quiet prayer times, I could barely keep the tears of excitement out of my eyes.

One additional exciting note is that the due date is our wedding anniversary! I fully expect a roller coaster of emotions until then (or whenever the baby decides to arrive), but I hope that I can enjoy every crazy minute of it. I know all too well that things can go terribly wrong in a heartbeat, and then all you have to look back on are the pictures and memories. So my goal is to get as many pictures, videos, audio files of our baby as possible and make as many memories as one small family can manage over the next several months. If anything goes wrong, at least we will have these things to remind us of happier times, and if we end up with a healthy baby, we will have even more to treasure.