"When a soul recognises the will of God and shows a readiness to submit to it entirely, then God gives Himself to such a soul and renders it most powerful succour under all circumstances." - Rev. Jean-Pierre de Caussade

Tuesday, January 5, 2016

"You need a what?" {getting a cerclage}

First off, thank you so, so much for all of the prayers for baby and me. The cerclage went well, we heard the baby's heart tones a few times throughout the day, and although it wasn't my easiest cerclage thus far...I can't complain because baby is alive and well, and we avoided major complications. And I'm totally overwhelmed by all of the prayers and messages I received! You all are awesome.

Even though I've done this whole cerclage thing THREE TIMES now, I'm still amazed at how much I don't remember. So I wanted to post a "day in the life" type post explaining exactly what it involves. Partly for my benefit (because my memory stinks) and partly for those of you who are curious. Many of my friends know I get a cerclage and that it holds my cervix together...but that's about it. And when a new friend finds out I need a cerclage every pregnancy, they're like, "You need a what?"

So here we go. Hopefully you will never find yourself in the position of needing a cerclage, but if you do - or someone you know does - I hope this post is at least somewhat helpful in knowing what to expect.

I guess I should start off with some basics...

And this is where I say I'm not a doctor, just sharing my experiences! I really didn't know what to expect for my first cerclage, and I still got nervous for this 3rd one because we're dealing with a tiny baby in utero and as with all procedures, there are risks.

After we lost Levi, my doctors suspected an incompetent cervix but couldn't verify it until my cervix started funneling with Landon at only 11 weeks. Even though my cervix seemed fine with Chase and this baby, I still get a cerclage because of my history, and in the words of Dr. H (my primary OB), "I don't want to find out what happens if we don't put one in." I totally agree!

So! Doctors typically don't place a cerclage until the end of the first trimester because they want the baby to be fully formed, as well as to make sure a natural miscarriage doesn't happen (since most happen during the first trimester). That's why I was put on strict bedrest for 2 weeks with Landon before they put in a cerclage.

The main risks with a cerclage are causing preterm labor and breaking the water bag (that one freaks me out!). My doctor, thankfully, has never broken a water bag and he's been doing this forever. You also get spinal anesthesia right before the cerclage, which has its own risks.

Okay, now for the actual day of the cerclage!

5:30am - Logan and I arrive to Labor and Delivery 2 hours before the cerclage is scheduled as instructed. I'm starving and thirsty because I had to fast overnight. I sign a few papers, a nurse brings us to a triage room (it was actually the room I was in when I unexpectedly had Chase!), and I change into a lovely (ahem) gown that is completely huge on me.

Once I'm changed, the nurse comes back in, listens to my baby's heart tones via Doppler, and attempts to start an IV. It doesn't work so she gets the charge nurse to come try. Success! They take vials of blood before hooking me up to receive 2 liters of fluid.

6:00 - The nurses leave us for a little bit, so I take out my Kindle to read. Logan is on his phone as usual.
I've never taken a picture during the whole cerclage process until now, but there's a first for everything. I'm sure I'll cherish it forever. ;)

6:20 - Nurse comes back in to take my temperature and blood pressure. Logan decides to go for a walk since he was getting sleepy. (Turns out he just wanted some food.)

6:40 - I get up to pee, dragging the IV pole behind me. I have to pee in a cup for the lab too. Not long after I get back to bed, the second nurse comes back in saying the lab needs more blood. So she has to stick me for a third time. Feeling a little like a pincushion and it's not even 7am!

7:00 - The CRNA (AKA nurse anesthetist) comes in to tell me how things are going to go down with the spinal anesthesia. He and Logan notice they have the same exact shoes. Funny. My nurse comes back in to change my IV bag, and put SCDs on my legs (but doesn't hook them up to the machine yet...they will squeeze my legs after the procedure since I won't be able to move them). Once everyone leaves I get up to pee again. Darn fluids.

7:20 - It's shift change so a new nurse comes in to take my temp and BP again, as well as to go over everything that will happen. She also asks some questions about my history. At some point, she puts Zantac into my IV (to keep my stomach acid from coming up), but I don't remember if was at this point or if she had already done it already.

7:30 - Dr. H comes into the room to see if I'm ready. He says we're just waiting on results of my bloodwork.

7:40 - Oh, fluids, how I hate thee. Off to the bathroom again.

7:45 - Finally time for the cerclage! I put on one of those fancy hair nets and walk with the nurse to the Operating Room as she holds the bag of IV fluids. Once I'm in the OR, it's a whirlwind of people asking me questions, hooking things up to me, and getting me in position to get the spinal anesthesia. I have a pulse oximeter on one of my left fingers (to measure O2 saturation) and a blood pressure cuff on my right arm. It's absolutely FREEZING, so they drape a couple of those warm blankets on me to try to get me to stop shivering. It doesn't really work.

The nurse gets me to sit on the side of the table, with my feet dangling, as she stands in front of me, holding me. I have to lean forward to curve my back and drop my shoulders down for the spinal (which is kind of similar to an epidural, by the way). The anesthesiologist is behind me, feeling my spine. Then he starts cleaning my back with a cold solution. Which is great considering I'm already shivering like crazy. Ha.

I don't remember exactly how it went down (partly because it is the worst part of the whole thing, I think, so I probably blocked it out), but I get stuck with one needle and can feel burning as the anesthesiologist injects what I think is a local anesthetic. Then I get stuck with another needle that hurts worse than the first (not sure how that happens), and I'm in that uncomfortable position for several long minutes as it seems like he's trying to find the right spot. I don't remember the spinal taking that long any other time (and I've had 2 other cerclages AND 2 C-sections), and I really don't know if he was having trouble because he didn't tell me. But it hurt like heck and I'm even dealing with a really sore back now because of it. (This is totally a first for me though, so I guess it's not common!)

Well, the dreadful spinal is finally done, and my booty starts feeling warm and my legs start getting tingly. Everyone comments, "You're so tiny!" (this seriously happens every.single.time.) as they get me into the lithotomy position. Dr. H walks in. The CRNA puts a nasal cannula (oxygen) on me and someone else covers my top half with warm blankets.

8:05 - The actual procedure begins. People are occasionally asking me if I'm doing okay, to which I say yes. I pray a rosary on my fingers to get my mind off everything. (I'm still freezing! Things are hooked to me everywhere. I can't feel from my belly down. It was kind of perfect that it's Tuesday and I had to think about the Sorrowful Mysteries...)

I get a glimpse of the proline, which is the material used to stitch the cervix (they do have other materials to use, but this is what my doctor likes to use because it's sturdy...just makes it harder to get out). It looks like blue fishing line. And according to Dr. H, it's like putting in barbed wire! Lovely though, eh? Now I know why I was in so much pain at the end of Chase's pregnancy!

8:25 - I didn't even finish a rosary and the cerclage is already done! Dr. H says it went fine and that he'll come back later to check on me. The surgical tech, nurse, and CRNA are about to slide me over into a bed to roll me back to my room when I start feeling nauseated. I warn the surgical tech next to me, who grabs some gauze (desperate times call for desperate measures) and well, I kind of throw up (spit? fluid?), if you can call it that when on an empty stomach, for about 10 minutes. This is the first time it's happened to me, out of all the things I've gotten done, and I wonder if it's because of the cold I've been having and how the snot drained into my throat (sorry, TMI maybe?) since my head was lower than my legs. The CRNA puts some Zofran into my IV. 

8:35 - I start feeling much better so they slide me from the table to the bed (once again commenting how tiny I am, thank you) and I'm rolled back to my room where the nurse takes my vitals again and checks my baby's HR again with the Doppler. I'm still freezing so she brings yet another warm blanket, and I probably had about 5-6 on me and I was still shivering like crazy.

9:35 - The nurse brings me ice! Yay! They want to make sure I tolerate liquids before eating a meal, which can be frustrating since it's been so long since I had anything to eat or drink, but at this point I just wanted to lie down. I think I doze off at some point.

10:10 - The nurse brings me a small cup of ice water, which is heavenly. Logan and I just watch TV, and I read a little bit. I'm having some cramping (which is normal).

11:20 - Even though I can't fully feel my legs yet, my bladder is feeling REALLY full and I kind of feel like I need to pee. So the nurse helps me get on a bedpan. 20 minutes later...nothing. Ugh. I'm feeling pretty uncomfortable, so the nurse gets a catheter to drain my bladder. It takes 15 minutes because of how much urine! 1100mls. Over a liter, people. I ask how much a bladder is supposed to hold, and the nurse says only 500ml. No wonder I was hurting! (The same thing happened with Chase's cerclage. Eh.) Turns out my full bladder was making the cramping much worse, so thankfully that got better for the most part.

12:00 - The lunch trays haven't arrived yet, so a nurse brings me juice and crackers. I'm not a big juice drinker (especially apple juice, bleh), but I down it because I'm starving. Dr. H pops in just then. He says the 2 stitches went in fine, and there was a little extra bleeding so he had to put in another dissolvable stitch to stop the bleeding. I am spotting a little, but that's normal and might continue for a couple days. He also said I could go as soon as I was ready - but I have to pee on my own first.

12:10 - Nurse comes in with my lunch tray and checks the baby's HR again. 
I know you're totally jealous of my lunch. (Kidding, of course. Because what the heck is that?!) But thankfully for me, anything would taste good at this point! Over 14 hours since I last ate and all...

12:30 - I feel like I need to pee, so the nurse helps me walk to the bathroom. I'm still a little tingly and unsteady so she doesn't let me go for a second! I sit for 10-15 minutes....nothing. Ugh. It's so frustrating to feel like you need to go to the bathroom and then not be able to.

1:40 - I can finally feel my legs completely at this point, so the nurse accompanies me to the bathroom again. And I pee!! Happy dance. The nurse takes out my IV and I change back into my clothes. Nurse checks the baby's heart tones one last time. She says she's working on the discharge paperwork.

2:00 - I sign a couple papers, the nurse gives me some discharge instructions, and I'm wheeled to the parking garage! Yet another cerclage is finished. 

I've been chilling in the recliner for the rest of the day, trying to only get up to use the bathroom. I'm going to try to do the same for at least another day or two to make sure my uterus stays calm. My mom is staying for a few days to help with the boys since Logan is going back to work tomorrow. (She's the best, just so you know!) I'm barely spotting now and having some occasional cramping. The worst thing I'm dealing with at this point is my back, which is still really sore, and I even have a knot from the spinal needle. It's making it hard to move much. But in the big picture, I know it could have been much worse, and for that, I am grateful. 

My next appointment is next week, so I'll be taking it pretty easy until then! Thanks again for the prayers!!

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