24 weeks today!

I woke up this morning to see this!
Along with quite a few messages of support
and love

So we have made it to 24 weeks today! The past four weeks have been full of lots of fears, tears and hospital appointments. I'm really proud of my little family for what we're managed to get through together and how amazing my other half has been driving me to and from the hospital at all times of the day and putting up with these crazy hormonal mood swings. So it's time to reset the countdown and see if this little nugget will be patient enough to reach the 26 week mark.

In babies born preterm, the chance of survival at less than 23 weeks is close to zero, while at 23 weeks it is 15%, at 24 weeks 55% and at 25 weeks about 80% (Tommy's Organisation). For every week that he decides to stay in there cooking his chances look better and better. So I am quite happy to just try and plump him up as much as possible until then, however much his also impatient daddy wants to meet him (I say this whilst eating a Viennese swirl after finishing a bowl of grapes). I am starting to wonder if I am just producing a new improved version of my other half.

One of the things that has bothered me since having my cervical stitch placed was the fact that they kept referring to a 'miscarriage' if anything were to happen. That means that no birth certificate would be given. Now that we have reached 24 weeks my little one is now considered 'viable'. I know these are technical terms and the reasoning behind them but it is comforting to know that his birth will now be recognised. Not all ladies are this lucky. Scrolling through the internet this morning I did find this petition-

https://www.change.org/p/department-of-health-uk-allow-registered-birth-certificates-for-children-born-from-20-weeks

Even though the likelihood of a baby born before 23 weeks surviving is greatly reduced, I think it is important that these births from 20 weeks are acknowledged. Especially with babies born much earlier than 24 weeks surviving. During week 24, according to the baby center, the little ones taste buds are forming and the brain is growing quickly. So that means whatever I'm eating, those chemicals and theoretically tastes are being passed to the amniotic fluid for the little nugget to take in. Now if my other half figures this out I feel he'll be force feeding me chicken so he can have a food buddy and also an excuse to bring home buckets of chicken wings.

Last night I visited the ladies two or three times... I believe my bladder is now the size of a walnut!

My Incompetent Cervix Symptoms

Considering this is my first pregnancy I didn't really know what to expect in terms of all the changes that were happening. As the Bump website states there aren't many symptoms with an incompetent cervix. I did however question some of these changes- mainly that I did feel a lot of pressure pushing down on my cervix and I did have a lot of very sticky clear discharge which I felt was quite unusual. I had read lots of websites that this type of discharge was completely normal and that you would expect to have an increase in the amount of discharge over the course of pregnancy. Since having the cervical stitch there has been very little of this clear sticky mucous compared to before when it was very noticeable. I didn't experience any bleeding, cramping or back pain.

Date nights have been replaced by giving my pregnancy pillow some serious TLC

The causes of cervical weakness can be put down to having an abnormal smear, cervical trauma with a previous pregnancy, previous operations that require a D&C or congenital conditions. Thankfully none of these apply to me besides the last category. The Mayo Clinic includes a really good connection between genetic conditions and cervical incompetence 'genetic disorders affecting a fibrous type of protein that makes up your body's connective tissues (collagen) might cause an incompetent cervix' which I feel having read a number of websites none really address. Ehlers Danlos Syndrome (EDS) is a condition that affects the production of collagen. It is also the condition my family suffers from.

Some facts about EDS...

I do alternate between feeling quite confident in the stitch to quite angry that my cervical length wasn't monitored as soon as I mentioned my EDS. During my first midwife's appointment it didn't take long before it was decided I needed to see a consultant. To be fair when seeing the consultant they were too preoccupied worrying about a heart condition developing, issues with my kidneys and a history of gestational diabetes in my family. I did raise my concerns of my cervix due to my EDS with the consultant, she said she would liaise with the premature clinic and it wasn't something to worry about until after 6 months. It has now been 17 days since my cervical stitch and I am 22 weeks + 4 days today.

22 weeks + 4 days today!

First Premature Clinic Appointment

Today I am 21 weeks and 4 days! It has been 9 days since the emergency cervical stitch was placed and I just had my first appointment with the premature clinic. I am really happy to say that the funnelling has decreased and the stitch placement is looking good! It has definitely started the week off on a high.

I was extremely lucky to have my sister, mum and partner all there for support this morning. It is really amazing how reassuring and comforting it is to have family around at these worrying times. I didn't quite know what to expect today but everything does feel a lot tighter and plugged up down there since the stitch and the progesterone (cyclogest) tablets. They really have worked wonders and I now have 15mm of cervix below the stitch and 21mm above the stitch.

Trans-vaginal scan 21 weeks + 4 days

I was quite confused though as the doctor had previously told me when scanning the morning after the operation that there was 24mm below the stitch. This had been done with an abdominal scan, which I know aren't as accurate, and it could have been the whole length of the cervix. I was still quite shell shocked by everything at that point and I can't find his measurements within my notes.

Nevertheless, I am now very proud to say I have a cervix of 36mm overall, which is the ideal length! I just hope it now stays that way. There were lots of thoughts that had gone through my mind with having the stitch and short cervix- the main being infection. Infection can cause premature labour but with a longer cervix it should be more difficult for bacteria to enter.

During the appointment the doctor did the usual check and update on how I have been doing. It was quite crowded with the doctor, midwife, student and my entourage in the room! They also didn't have curtains for you to get changed behind, considering the past couple of weeks I feel there's not much left to hide. My lovely partner kindly came to the rescue and helped cover me with a towel before the trans-vaginal scan began.

Now baby has been doing cartwheels in there since yesterday and he also decided to move feet first. He often takes joy trying to kick his way out through my cervix. So his placement did make it harder to see the degree of funnelling but I felt better that his head wasn't getting ready to pop out. He also thought it would be fun to kick as they tried to do the measurements which did make me laugh. Every sonographer has always remarked on how active he is... hyperactive just like his daddy.

What made me laugh even harder was the doctor broaching the topic of no sex when there's a stitch in there. We had discussed how to prevent infection; don't use soap when cleaning down there, don't try to clean within the vagina and only have showers. When the doctor looked at my caring partner who was just helping me put my shoes back on and muttered the 'no sex' statement. I did have to bite my lip to stop myself from laughing. My partner seems convinced my mum has trained my chihuahua to go for his man area so I don't think that will be an issue.

Face of a little angel!

I still don't think I will be completely content until we do get to the 24 week mark and I have my next premature clinic appointment in two weeks time. I know that my EDS (Ehlers Danlos Syndrome) plays a factor which is often not really considered by doctors but I am feeling a lot more confident in my little nugget.

What is it like to have a cervical stitch?

I still feel I am very much coming to terms with having a cervical stitch. Having it for just over a week, it has still been a rollercoaster and something that is constantly on my mind. The doctors managed to extend my cervix from 4mm to 24mm (with the typical cervix during mid-pregnancy being 35mm). I never thought I would be jealous of another womans cervical length! Scouring forums often leaves me thinking the worst and regularly leaves me in tears, reading about ladies with lengths of 15mm pre-stitch we just have to remember we have all been in this terrifying position.

20 weeks + 1 day cervical scan

So I thought I would put together a list of questions I would have liked to have known the answers to...

1. What was the epidural like?

Talking to my mum about it afterwards we both had completely different experiences with the epidural. It felt like someone had dribbled some warm fluid down one side of my back whereas my mum found it very painful. The epidural was more effective on my left compared to right which was a very interesting experience because when it eventually wore off my left side took much longer to regain sensation. The doctors test to see if it's working by putting a cold spray on you to see where you can feel it, I think I lost all sensation below my belly button. The doctors then cover you up so you can't see whats happening.

2. Is the stitch painful?

I didn't feel the doctors put in the stitch but I could feel it afterwards. I had very sharp pains on my left and right side near my cervix following the operation. This could have been due to the little one lying on my cervix (just for fun!). The pain is quite dull, bearing in mind it is an operation I wouldn't be surprised if there was quite a bit of swelling. The more I move around the more painful it gets, but sometimes the pain only subsides if i get up! It also hurts if I need to visit the toilet for a more lengthy visit.

3. Can you feel the stitch?

I can feel the stitch, at first I really did panic as to whether this was normal. It feels a lot tighter in my lower pelvis compared to before. It almost feels like there is a tampon left in there, so very different to when there wasn't much left of my cervix.

4. What do you need to be careful of?

Keep everything clean! The risk of infection is big in terms of stitches, making sure everything remains clean is all I think about for hours on end. Bacteria from the vagina can enter the cervix and cause the membranes to rupture and just can't be prevented sometimes. I feel better knowing I am doing everything I can... disinfecting the toilet before every use, only having showers, using alcohol hand sanitiser and not using scented shower gels.

5. How often should you have checkups?

This was the first question on my mind. The doctor scanned me the next morning to check on the baby and stitch but after that it is up to the premature clinic to see you. Do not leave the hospital without that appointment! They don't like repetitive scanning so we'll only find out what is happening on monday during our first premature clinic appointment where I am hoping they will scan.

Cervical Stitch - 21 weeks and 2 days pregnant

It has now been a week since my emergency cerclage, also known as a cervical stitch, and I am still resting in bed. With another 19 days to go until our viability aim it looks like bedrest is the main thing on my agenda. I currently have three different countdown timers on my mobile including tickers, days until due date and the 24 week mark, it is quite reassuring seeing each day pass but I do feel incredibly lucky just to have these days with my little one.

The little one at 3 months

Like most of the ladies I have read about on countless forums I had gone in for my routine 20 week anomaly scan. Thinking that everything would be quite straight forward I brought my younger sister as well as my partner. Even though the sonographer seemed to be muttering the measurements of the baby to herself, everything was perfect with our little one kicking away. That was until something didn't look quite right on the screen.

My cervix was measuring 4mm with funneling, at the time we thought she had said 4cm and didn't quite see what the fuss was about. Now for those who do their research you'll find-

At 24 weeks gestation, the average cervical length is 3.5 cm. When cervical length is less than 2.2 cm, women face a 20 percent probability of preterm delivery. (Source: The Length of the Cervix and the Risk of Spontaneous Premature Delivery. New England Journal of Medicine; February 29, 1996; Vol. 334, Number 9: 567-572.)

So we were rushed up to the labour ward where my mum soon joined us. I did not expect to see the inside of those rooms for a good few months yet. By the constant rush of doctors and midwives coming in and out of the room it started to dawn on me how serious the situation was. It was then that they gave us three options: 

1. Leave everything as it is. I could have been walking around with a short cervix for a while without noticing- I had been feeling increasing pressure on my cervix the past few weeks.
2. Progesterone. This was offered to help reduce the funneling and encourage the cervix to close.
3. Cervical cerclage. This involved putting a stitch in the cervix to regain as much of the cervix as possible. The issue here was that there was a 30% chance of miscarriage due to the membranes rupturing or manipulation of the cervix causing contractions.

So naturally we wanted to go for the safer low risk option, the progesterone. It was only when we saw the doctors face that we realised we didn't really have an option. When my partner heard the words 'hormones would be too little too late', our decision was made. Before I knew it I had signed some forms and was in a hospital gown.

In all honesty the worst part was actually having the cannula put in. Anyone who knows me well can explain my severe aversion to needles. Now this is with good reason, it was only on the third attempt that they managed to find a vein. I just wanted to get into the theatre at this point. There were so many people in the theatre I could not remember all of their names, I can hardly remember what I spoke about in there- I think I was talking about my college and students.

One week later and still feeling very bruised

The whole procedure lasted about 50mins, that included putting in the epidural and waiting for it to start to work. I think I should mention at this point my partner had ordered pizza (someone has been comfort eating and it's not the pregnant lady) so my entourage was missing when I came out of surgery. On the plus side when they were found I had a whole tuna pizza and found out my partner had somehow managed to eat 14 chicken wings.

I stayed in hospital overnight with my partner watching over me, no one tells you how hard it is to actually urinate after an epidural and stitch by the way. The amazing news was that the doctor managed to regain another 2cm of cervix so it now measures 2.4cm but still with funneling. After another night of monitoring I was discharged.

I was probably only home for two hours before I was back in maternity triage with active bleeding from my cervix. Did you know that emptying your bowels could irritate your cervix? Another night of observation with the love of my life sleeping in a very uncomfortable chair next to me I was then ready to go home.

... and here I am now. I have heard a number of different doctors state a number of different weeks the stitch could make it to but it seems 24/25 weeks seems most realistic due to my ehlers danlos syndrome (collagen deficiency so everything is more stretchy). Every day really is a gift and I'm hoping to see him on monday during our premature clinic appointment. Each hour my little baby keeps getting stronger and I feel so lucky to even get this far.

Mummy, daddy and bump at the Baby Show 4th March 2017