That's all I can really say. Once again, I'm super conflicted and left to sort out the pieces on my own. I said it in one of my other posts, but I'll say it again: I hate that the lives of future children depend on me making the right choice in treatment. This is why we GO to doctors! So they can tell us what to do! I want to blindly be pointed in the right direction, please.
I had the Maternal-Fetal Medicine appointment today and it was a mixed bag. On the plus side, he agreed that the loss could very likely be the result of an incompetent cervix.
On the down side, that's about all he agreed with.
He would place me on progesterone shots, though there's no evidence that they are helpful one way or another with 2nd trimester losses like mine - they're proven to help later in pregnancy, but studies haven't shown they are helpful at 20 weeks. But then, they haven't been shown to NOT be helpful either, so there's no reason not to use them.
Where we really derail is regarding the cerclages. He believes that a TAC - or any cerclage, even - is overkill. He wouldn't place a preventative vaginal cerclage at 12 weeks, but would place an emergency one if the bi-weekly* cervical scans showed funneling or shortening of the cervix. He listed the risks of TVCs as the main argument against using one unless absolutely necessary, such as risk of rupture, infection, the cervix rejecting the stitches, etc. When I brought up TACs, he repeated the conventional wisdom: that they are only used when TVCs fail. He also said if a TVC is overkill, a TAC is beyond overkill; that it's riskier to place a TAC; that you always have to deliver via C-Section (all of which I knew).
I asked if there was a chance that your cervix could go from "okay" to "Houston, we have a problem!" in the two weeks between checks, and he said it's possibly but not likely.
Dude, it wasn't likely that my water would break and I'd lose my son. NOT LIKELY means nothing to me at this point. When you're on the losing side of statistics, numbers are never comforting again. (Ahem...a bit of frustration apparently, there.) I asked if doing weekly checks during the timeframe when my water broke would help at all, and he said it wasn't necessary but if it would make me more comfortable, he'd have no problem doing it.
I wasn't processing very well at the time, so I missed questions that I now want to ask. Like: "If you think it's IC, I don't understand the 'wait and see' approach." Like: "I thought that placing emergency cerclages were riskier than placing preventative cerclages. Is that the case?" And: "If so, why wouldn't you just do a preventative one?" And: "Please can you just give me a magic pill to fix everything?"
So now, I have a consensus on the diagnosis but two very different treatment plans.
If it happens again, would I ever be able to forgive myself for not moving forward with a TAC? Really, that's all it boils down to.
But the idea of going "behind" my doctor's back and doing something he specifically said wasn't needed makes my heart race, like I'm cheating on a test and scared of getting caught. Only this time I'd have to tell the teacher I cheated. How do I even do that, anyway? "Hey, I'm pregnant..and I'd like to be seen by your high-risk group...and, um, I had a TAC placed, despite your recommendations." For a majority of doctors out there, having a TAC placed with just one loss is...I don't know, equivalent to having chemo started with one abnormal pap smear. I'm sure they'd think I was crazy...and probably that Dr. Haney is too. I know he's on a mission to eradicate the TVCs because of the risks associated with them - namely, that they fail up to 25% of the time, and in the 75% of cases where they work, you still end up with premature babies up to 40% of the time. And the skipping the TVC to go straight to the TAC - that's an out there proposition that few doctors prescribe to today. But I get it. I'm on board with it.
Don't get me wrong - I really, really like the doctor that I saw today. I have full confidence in him. If I hadn't talked to Dr. Haney, I'd be all over this treatment plan. But he doesn't have the stake in this that I do.
I suppose the next step is a third opinion. Sigh.
*One of those confusing words with multiple meanings. Here we're looking at every two weeks, although I'm not going to lie - I'd love twice weekly. Or even daily. Hourly, perhaps. Maybe I can just permanently hook an ultrasound machine up to me?