Dealing with Fears
My biggest fear in second trimester has been incompetent cervix. Because I had a uterine septum, I am at slightly higher risk for incompetent cervix (IC).
What is IC?: Basically, your cervix doesn’t function right, either because of a birth defect (hence the connection to a uterine anomaly) or previous trauma to your cervix. A normal cervix should stay tightly closed & long until you are ready to deliver in the third trimester. An incompetent cervix will give way under the weight of a growing baby, much, much earlier than it should. Most cases of incompetent cervix occur between 16-24 weeks. Which is terrifying – because your baby has little to no chance of surviving if born this early. Even more terrifying: IC often has no symptoms until it is too late. The cervix just dilates silently, and women often won’t realize there is a problem until they are in active labor and/or their water has broken.
So what are we going to do about it?: I don’t want to be a drama queen here. The good news is, we are just at slightly higher risk, so there isn’t THAT much to be done. The key for us is frequent monitoring: cervical checks every 2 weeks during the high risk period.
If a woman has previously lost a baby/babies to IC, she will often have a preventative cerclage placed early in her pregnancy (sewing closed the cervix). Cerclage, along with bed rest and/or progesterone suppositories, is often very successful in preventing preterm birth. Some women will also have a trans-abdominal cerclage (TAC) placed before they become pregnant again. TAC requires a more extensive surgery, done before a woman becomes pregnant again. It is also permanent (unlike a cervical cerclage, which has to be removed before a woman delivers). However, TACs have the highest success rate.
Cervical Checks & Doctor Drama:
So, we’ve been going to bi-monthly cervical length checks since 16 weeks. My cervix has looked normal (closed & long) at all of these checks, so my doctor actually wanted to stop at 20 weeks.
This is where shit started to get tricky. As far as I understand, cervical length checks are effective because they are done frequently. Your cervix can change a lot in a month. So, by checking every two weeks, the doctor should be able to catch any potential changes & intervene before your cervix fully opens. We just weren’t sure why our doctor wanted to cease cervical length checks smack in the middle of the high-risk period (16-24 weeks).
To make a long story short, we sent a few questions to our doctor, trying to understand her rationale. We just weren’t on board with the way our cervical length checks were panning out. We had two main concerns.
1 -Why are we stopping cervical length checks so early?
2 – Why were our cervical length scans being done abdominally, and not transvaginally? (Every source we’ve read suggests transvaginal is more accurate, and is generally the standard for cervical screening).
We tried to ask these questions as politely and respectfully as possible. We realize how obnoxious it can be to question a doctor’s judgement, and we didn’t want to be “those patients.” Unfortunately, we may have been too chill in our approach. Because our doctor never really answered our questions clearly, and brushed off our concerns. She had never been great about answering our questions in detail. But, at this point, we were really starting to feel rushed and written off by her responses to us.
Eventually, we took the attitude of “This is our baby’s life. We are not going to worry if our doctor thinks we are crazy.” We let our OB know that we valued her expert opinion and have been very happy with our care, but that our history of infertility and loss causes us to be extra cautious. We then requested to schedule an extra scan at 22 weeks for peace of mind.
False Alarm: Pre-term labor scare
Okay. So you can imagine my shock when I showed up for that 22 week appointment and was told I may be going into preterm labor.
Turns out I wasn’t actually going into preterm labor, but I spent a good 15-20 minutes panicking and believing I might lose the baby.
I laid down for the scan, expecting business as usual. Instead, the tech immediately began telling and showing me that my cervix was significantly open. She explained this in great detail, and even pushed down on my stomach to mimic what happened when I stood – as in, showing me it opened even FURTHER. She then told me in no uncertain terms that I may be going into preterm labor. She said they’d have to do a fFn swab. They would then do a transvaginal ultrasound for greater accuracy. There was a chance that the abdominal ultrasound was wrong, in which case they said they’d throw out the swab and send me home. However, the tech seemed pretty damn concerned. Despite the doctor being right outside, in the same office, she never came in to explain ANY of this.
They sent me to the bathroom and had me get changed for the transvaginal ultrasound. Then I just sat alone in a room, wondering WTF was happening, and contemplated losing our baby this far along. Because I knew that if I went into labor now, our baby had no chance of surviving. And I had no idea what “significantly open” meant. Was my cervix shortening, funneling, dilated, fully dilated? I wasn’t sure if I should text Alex, because I didn’t want to freak him out if it was a false alarm. But I was freaked out. Eventually, I did text him.
The tech came back about ten minutes later, and made an offhand comment that it was too early to do the fFn swab. No explanation offered. Eventually she started the transvaginal ultrasound. The doctor came in, GLANCED at the screen for all of 30 seconds, and quickly deemed that my cervix was closed. There was no funneling. False alarm.
And that was about it. They sent me to another room for weight and blood pressure. The doctor popped in briefly to ask if I had any questions. I was so freaked out, I had trouble getting my thoughts together. But I did ask what my actual length was on the transvaginal ultrasound. The doctor gave an extremely brief/vague response: it was “totally normal” and “just below 3cm.” She did not take any extra time to explain to me what had happened, or ask how I was doing. I felt like they rushed me out of the office, business as usual.
WTF Questions & Follow-Up
When I got home that day, I was really upset. I didn’t understand how my doctor could have told me a 22 week scan wasn’t necessary, and then have THIS happen. I also didn’t understand how my cervix looked so drastically different on the abdominal vs. transvaginal ultrasound. Not to mention that I was baffled about why the tech told me so much scary info, with little to no involvement from the doctor. The whole situation didn’t make sense.
Alex and I compiled a list of follow-up questions for our doctor, and called to speak to a receptionist. Our doctor took her sweet time in calling us back, and was actually kind of defensive on the phone. Our questions were pretty straight-forward, and very warranted (I think!) after what had happened in their office that day. Like –
1- How does our current cervical length compare to our measurement at 20 weeks?
2 – What caused my cervix to look open on the abdominal ultrasound?
We were not thrilled with our doctor’s answers. When pushed, she said my cervix was measuring “just under 3” compared to “3.7” at twenty weeks. She was clear that she would not consider any interventions or extra monitoring until my cervix was at or below 1.5cm.
Attitude aside, the numbers she was giving us just don’t gel with anything I’ve read online. I know – this is tricky territory. I am well aware that Dr. Google is not always accurate, and can be a seriously fucked-up rabbit hole to go down. However, every reputable source we’ve checked suggests that average cervical length for 24-28 weeks is 3.5-4cm. My cervix was on the low end of normal. Okay, fine. I could understand how that might not merit any immediate action.
However, her definition of anything above 1.5cm as normal seems way too low to us. Everything else we’ve read suggests that 2-2.5 is considered short, and possibly worthy of interventions like extra monitoring or modified activity restrictions. By the time you get to 1.5cm, there is already a serious risk. But, our doctor stuck to her guns and brushed off our questions about my activity level as a teacher. Clearly, she thought we were nuts.
Breaking up with our Doctor
After all of this, Alex and I no longer feel comfortable with our OB. We’re not saying that her judgement is necessarily wrong. However, we would like to get a second opinion.
Our doctor’s behavior, and the behavior of her staff, have caused us to feel uncomfortable in their judgements and lose faith in her treatment plans for us. So, we requested that our medical records be sent for a consult with another OBGYN that was highly recommended by our fertility specialist. We did not complain to the office, we simply called the receptionist, had a polite conversation, and filled out the necessary paperwork.
The icing on the cake was when our doctor called to scold us for asking to see another OBGYN. Thank god I was teaching and she got Alex. Because I’m sure he stayed a lot calmer than I would have. She nastily told him that she could not write a “referral” to another OBGYN and would not send our records over. Alex very nicely informed her that we weren’t asking for a referral, nor did we need one. He reiterated that we had simply requested that our records be released, and were seeking a second opinion. The doctor huffily said “fine” and that was that. Alex was seriously floored that after her lethargic response times on everything else, NOW she calls us ASAP just to bitch us out. Like, I get it, you aren’t thrilled we questioned you and are now potentially leaving your office. But, grow up! Be a professional to our faces, and then bitch about us later, like a normal person.
I think I have every right to be royally freaked out after what happened this week. But it’s difficult for me to find the right balance between self-advocacy and irrational anxiety. I am having trouble trusting my doctor’s judgement, and even the tech’s measurements, from the appointment this past week. So, I have been freaking out a bit, imagining my cervix opening over the next few days and losing the baby. However, I know that this is highly unlikely. Our current doctor isn’t incompetent. In fact, the practice she works at is pretty well regarded. I still think that she exhibited a bizarre lack of sensitivity to our situation, seems to resent answering patient questions, and may be too lax in her monitoring for incompetent cervix. These are all excellent reasons to look for a new care provider. However, I am trying to remember that it is highly unlikely that her staff sent me home if there was any significant risk to the baby.
Moving to a New Practice & Covering all of our Bases
Alex and I spent Thursday and Friday creating a game plan for next week.
(1) Fetal Echocardiogram: This was already scheduled weeks ago. It’s standard for IVF babies, since they have a very, very slight increased risk of birth defects.
(2) Follow-Up Cervical Length Check with the MFM Specialists at our Hospital – This might be overkill, but my therapist highly recommended them. We asked for a referral from our current doctor, figuring the worst she could do was say “no.” Plus, she already thinks we’re nuts, so whatever.
(3) Consult with New OB: Alex spoke at length with the receptionist, who really seemed to know her shit. It’s a single doctor practice, and she’s been working with him for many years. She said that our previous practice’s decisions seemed a bit off to her, and explained how our concerns would be handled in the new office.