It’s complicated

I’ve been doing a terrible job keeping this blog updated at regular intervals. I think I’ll just have to accept that and do the best I can. But, part of the explanation is below.

I’m 20 weeks today. Technically just about halfway there. The babies are doing quite well. Both are healthy sizes and weights and, while they are starting to differ in size, their sizes are still close enough to one another that it’s not an issue.

However, around 16.5 weeks I learned that my cervix had become short. Very short. As in .6cm short, when it should be 3cm or above. At that point the MFM doctor who oversees my ultrasounds (since I was seeing midwives) said she was very concerned, but that, at the end of the day, there was nothing they could do, so I’d have to see what happens. She said if it was a singleton pregnancy they could have placed a cerclage (a stitch in the cervix to keep it closed) but that it was not recommended for twin pregnancies. (I later did some research and ultimately agreed with that assessment, as the risks outweighed the benefits.)

I was pretty devastated, especially because no one really seemed optimistic. The common refrain was wait and see. They did put me on pelvic rest and reduced activities, but there was not much else. They don’t prescribe bed rest much anymore, or rather, doctors are moving away from that unless the situation is extreme because bed rest itself can cause a slew of problems. Granted, once I got to the point where I could do some research, I was seeing that people with my cervix length were being put on hospital bed rest, yet my doctors were not recommending it. The discrepancy in recommendations was disconcerting.

One of my best friends did some research after I called her in tears and found women who’d had cerclage pessaries placed instead of the cerclage. The pessary is essentially a silicone ring placed around the cervix to help hold up the uterus and/or alleviate pressure on the cervix caused by the pregnancy. It is also non-invasive; the cerclage stitch is a minor surgery (and runs the risk of infection), whereas the pessary is just inserted like a diaphragm. So at the next emergency appointment I had less than a week later, I asked one OB about it and he didn’t think it would help, but referred me back to the MFM and she not only thought it was a good idea worth trying, but went ahead and placed it. It was painful to me, as the actual pessary is large, but you don’t really feel it once it’s in.

Emotionally, all of this has been very hard. Learning that there is something wrong, something that you can do very little about, is very hard. Learning that my risk of losing the babies is around 80% given my particular cervix length, is very hard. I try to be as positive as I can, but the reality of the situation is too heavy sometimes. When I told my mother, one of the things she said was that I can’t live in fear, that I can’t live in the fear of it. That has been helpful, but again, I still have my moments. The few people I have told all say some version of needing to be positive and then talk about normal pregnancy things. I appreciate that, but sometimes those conversations are difficult. I know they are trying to make me feel better, but I can’t ignore the reality of the situation.

At my latest appointment three days ago, I learned that my cervix is at about 1.2cm. So the pessary has helped a little. The cervix is still quite short, but it is something, and at this point I will take anything I can get. I am still on pelvic rest and significantly reduced activities. No prolonged standing, no lifting. I can walk around the house, but need to sit as much as I can, laying down is better (though not for too long). They also put me on vaginal progesterone when this started (to support the uterus and prevent contractions), and I still take that.

At those last appointments (I meet with a regular OB and an MFM, no midwives anymore, which is another story) both doctors said that the goal right now is to make it to 24 weeks because that is the point of viability. There were lots of “if we can make it to 24…”, “we want to get to 24…” etc. That hit me really hard. That, and how one of the doctors felt almost 100% certain these babies would be born quite early, again, if I made it to 24 weeks. It’s one of those things where, I recognize the reality of the situation, but hearing it put so plainly struck me, and I’m still dealing with the impact. There is so much uncertainty on whether I will even make it to 24 weeks. With each week that goes by, another hope, dream, and desire for this pregnancy goes out of the window. No homebirth, no midwives, dwindling chances of natural delivery, no normal. At this point I just want the babies to stay in, but instead of hoping for 39-40 weeks, I’m at “let’s just get to 24, anything past that will be a bonus.” The NICU is now very likely to be in my future, and, realistically, it’s likely to be a long stay for the babies, which comes with it’s own risks and consequences, health-wise and developmentally. I just want two healthy babies and it’s not clear whether that will be the case.

I feel them move often. It used to fill me with excitement, but now it is mixed with a bit of anxiety. The lowest baby, Baby A, is very low, and their head is constantly rubbing against what is now the open funnel of the top of my cervix. I was told that the bigger they get and the more they move up against it that the more stress there will be on the cervix. I want moving, active babies, but every time Baby A is very active it makes me nervous. I hate feeling that way.

The rest/reduced activities is hard too, especially because it is just me. I have to rely on others so much more now, and I realize I don’t have as many people as I thought I did. Or maybe I do and I just can’t see it. I don’t know. But simple things like washing dishes, making food for myself, picking up something I dropped, I can’t really do. Cleaning is not often. Laundry is not often. I know in normal pregnancies these actions can become hard, but they are especially hard in this case because of the added stress they place on the cervix. I have to be strategic about which days I shower (since daily is too much) and when I wash my hair because of the prolonged standing. I order food far more often than I used to, which helps in terms of staying off my feet, but doesn’t help my budget that is getting tighter and tighter as I’m still in the process of closing on a condo (which has hit another delay).

I had a fleeting moment where I wondered if I’d made a mistake in not waiting to do this with a partner. The moment was in passing, but it was very real. When you think about having a baby on your own, you know that there’s a chance things might not go smoothly, but I don’t think you think about it seriously, or you do and think you can handle it. I knew there was a possibility things could not go smoothly, but I assumed the chances were small. But here I am.

I’m actually still staying with friends at the moment because of the last-minute condo debacle from two months ago when the last one fell through at the very last minute, leaving me homeless. They have been helping me a lot, but that is not forever. They’re actually out of town currently and all the things I can’t do or need help with seem magnified, and representative of what it will be like once I move into my new place.

I’m fighting the urge to just withdraw from everything and everyone because this situation feels so isolating. I don’t feel like I can talk to a lot of people about it, for the aforementioned reasons. Telling people about the situation also takes an emotional toll on me, constantly recounting the issue. That and, on the flip side, it feels like I’m being a burden when I express concerns about the realistic aspects of this. Some days I’ve considered joining an online forum, but some days I have a hard time reading other people’s experiences. It’s a mix of hope and heavy that I’m not ready for yet, though I feel I would find support there. I’ve read that working on your registry or continuing with baby planning can really help during this time, as it gives you something positive to focus on. I’d started working on my baby registry and buying some clothes around 16 weeks, but both of those have been on hold because they are emotionally taxing right now.

On the flip side of all of this, I am happy that I have made it this far. I’m 20 weeks. A little less than 3 weeks past when I first learned about the short cervix. I’ve made some progress. The babies are healthy. I’m committed to doing whatever I need to maximize my chances. Their chances. Every morning I tell myself that I can do this. Every morning I say out loud that we are all going to make it through this. Sometimes my resolve is shaken and my faith in those statements is thin, but I say them anyway.

So that’s where I am now. Just counting every day that goes by as a success and one step closer to my first goal of 24 weeks.

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3 thoughts on “It’s complicated

  1. I’m sorry to hear you are going through this. The self doubt of having chosen to do this on your own will always creep in when you are stressed out. I’m 5 years into this on my own and it still happens sometimes. Since early seems inevitable, please look up the preemie growth project and reach out to Ida or myself if you need. My son was not born early but for some reason he has hypotonia which contributed to his weight gain and development issues. The trace minerals prevented a CP diagnoses (though I still wonder what caused it. Pitocin? Genetics?). Hang in there and I will have you in my thoughts.

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    • Thank you for your response. Yeah, it’s when things are abundantly difficult or stressful that I think “what if,” and I suspect it will occasionally be the case. And thank you for letting me know about the preemie growth project – this is really useful information.

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      • I read an article once about how children need to bond to three adults and beat myself up for a week over this one opinion. Turns out he has bonded to three adults and I know he would be just fine even if he hadn’t.

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