Tuesday, July 21, 2015

No dignity here

We've had a few new developments since Friday. My followup check at Maternal Fetal Medicine on Monday didn't go so well. My cervix had gone back to tunneling pretty severely, leaving only 3mm closed. Just for reference anything under 25mm is considered not good, and when you start considering a cerclage. On Friday I had 24mm at my second check, so really borderline. 3mm, not so good.
A "be cautious and see" approach is no longer safe or reasonable at that point and we decided it's absolutely necessary to go ahead and do he cerclage, that the risks are indeed high, and the success rates this late aren't nearly as impressive as we wish they were, but it's the only thing we could do at this point and the alternative was looking more and more like Max isn't going to stay put on his own until the magical week 24- widely accepted as when a baby is viable outside the womb. So, cerclage it is.
My appointment was made for this morning. I was not allowed to eat or drink anything after midnight which sounds like no big deal but at about 12:17am I was pretty convinced I was going to starve or dehydrate to death, or both. Funny how that works considering I don't usually eat that late anyway. Until someone tells me I can't, apparently.
My mom watched Chase for me, and Jon took most of the day off of work to come be at the hospital. I got checked in and taken off to prep for the procedure. I have zero fear of surgery under general anesthesia. Man, knock me the heck out and do whatever needs to be done, nooooo problem. Doesn't stress me out one bit. Being awake for surgery? Oh. Hell. No. I was, admittedly, quite nervous.... not only for the possibility of something going wrong, but just the procedure itself.
Once wheeled into the OR they prepped me for an epidural- which is really the only option for total numbing, as general was not an option for Max's sake. The nurses were all incredibly friendly and really did their best to make me as comfortable as possible. They mentioned several times it really was unfair I had to be aware and alert for all this and validated the fact though I was keeping my cool and refusing to break down, I was so nervous my legs were trembling. They warned me that the first shot would burn- and they weren't lying, but I knew that's what was supposed to stand between me feeling the giant needle headed towards my spine in a few moments, soooooo I will take a little burning. Except it didn't work the way it was supposed to. I felt the weird pressure of the epidural needle and then was caught completely off guard by what I can only explain as an overwhelming searing pain that shot up my spine to my neck, and radiated through my hips. I yelped fairly loudly, having been caught off guard. "You can feel that?!" Um, yes, I felt that. It knocked the breath out of me. They gave me another numbing shot, ow, and went for it again. Same thing. By this time my body was shaking uncontrollably from the searing pain and they couldn't proceed for several moments until I was able to relax. They poked around my lower back asking me if I could feel it, and gave me a third numbing shot- which I didn't feel nearly as much as the first two. Epidural successful, finally! I felt my feet and legs start to feel heavy and numb about the time my OB's partner- who is just a little more experienced in this procedure- came in to assist. He introduced himself to me though we've met once before (he was brought in Friday when the group of specialists were trying to figure out my case) and said he was just there to be an extra set of hands and direct/ assist. I said "Great, I love extra sets of hands on my cervix!" The room of nurses laughed and I was relieved they weren't too uptight to appreciate some comical relief unlike to folks in Provo Friday who seemed offended that I would even make jokes.
Having a  cerclage put in place is a procedure that strips you of any last shred of dignity that you may have woken up with that morning. Skip this paragraph if you'd prefer not to have the description. While awake and aware (but numb) of everything going on, my feet were placed in stirrups set far above me and wide apart. Unlike a normal pelvic exam where you can kind of close your knees in on each other while they aren't actively doing anything, this left no room to have any bit of decency. Then a device is used to hold the vaginal canal open and give the OB access to the cervix, and the bed is tilted to an angle to use gravity to encourage baby and membranes to move away from the cervix. A single long stitch, weaving in and out of the cervix in a circle is put in place, and then pulled shut. Imagine the drawstring on a bag that can be cinched closed. Well, that's how it was SUPPOSED to go. Except, to the surprise of everyone, I was already dilated to 2-3cm. A cerclage is considered much higher risk, and much less effective when the cervix has already began dilating and though that amount is not very much, it's a lot for being 21weeks along, and it's a lot of space to force closed. I was asked to give permission for photos and video to be taken to send to the specialist in provo to see if it was in our best interest to even proceed. After a mortifying 10 minutes of just hanging out in ALLLL my glory, it was explained to me that the risk of pROM, infection, preterm labor, fetal distress, and bleeding were much higher, and that the effectiveness of the procedure were much lower, BUT still our best and really only option to keep Max baking. If we do nothing, he was on his way. It was in my favor that my cervix had not thinned, they were confident they could perform a good stitch, and it is in my favor that I am not experiencing any contractions. (If I were, they couldn't do it) I was overwhelmed with emotions, and didn't know what to think or feel. I started crying, and not just kind of misty-eyed crying.... I'm talking full on, platypus lipped, ugly face, snot nosed crying. (Mind you, I'm still hanging at a solid 45 degree angle completely exposed. I'm sure I was super, super attractive.) We decided to proceed. The alternative was a whole lot scarier, and I am not ready to throw in the towel.
They had to tilt the bed nearly a full 90degrees to get the membranes to fall back into place, as they had hourglassed outside of the now-open cervix, and use a balloon catheter to push and hold them out of the funnel they were stitching closed. Once they got started it didn't take long.
In recovery, I was feeling quite a bit of cramping, which is normal. However, my back pain was intense, when it should have been mild. It was intense enough I had a hard time talking through it. They kept me for a while to make sure it wasn't the onset of labor and determined it was likely from the rough epidural. I had NO contractions while waiting.
I'm on very strict bed rest. The next three weeks are fragile. But all that can be done is done, and now.... we wait. And hopefully we wait for a long time. 

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