Hmmm.
HMMMMM.
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?
Do what YOU feel is right. It's your body. Your family. No one should judge you on what you and your husband feel is right in this situation. Take a little time and the right thing will come to you. Always expect your Dr.'s to be aggressive with whatever you choose. If that means weekly appointments to make sure everything is going smoothly, then demand that.
ReplyDeleteYou are so deserving of a healthy pregnancy and Baby...
I ruptured at 23w5d pregnant with my second pregnancy, after a completely normal, over due pregnancy nearly 3 years prior. My OB was not keen on doing anything different for subsequent pregnancies, but I felt that it wasn't enough. I knew the risks of pPROM occurring again, and I knew that the risks including rupturing even earlier in subsequent pregnancies. Especially since there does not seem to be any cause or reason to explain why I pPROMd.
ReplyDeleteI also sought out a MFM doctor. The plan of action we agreed on was bi-weekly u/s to check cervical length and fetal growth. At 16 weeks I began p17. We also agreed to "near" bed rest. I don't life anything over 5 lbs, rest a lot and make sure that I don't over exert myself. After 3 miscarriages last year, we're now getting close to 27 weeks :) I do believe that the progesterone made a huge difference.
At the end of the day, you have to do what you feel is the best plan for you. All plans have some risk to them and even with every best laid out plan, a pregnancy after pPROM is absolutely terrifying and I can't say that I don't run to the bathroom at least once per day to verify that I'm not "leaking," but so far so good.
Here's hoping you decide what feels good to you and your family :)
Wow, I know that's not the answer you were expecting. You have to do what's best for you and your family. I know you will make the right decision.
ReplyDeleteSo here's what I think you should do. Remember, not a dr just a baby loss momma terrified of it happening again. I think you should get the TAC placed if you're okay with the idea of always having a c/s. You don't want to go through another loss just because your MFM thinks it's overkill. This is YOUR body and if you want the TAC you should get it. Just let your dr know before you do it instead of hey I'm pregnant oh and I had the procedure done. Just my 2 cents, but you need to do what's best for you and your family.
ReplyDeleteJust because the MFM is your doctor, does not mean he has to be your *only* doctor and that you have to do everything he says. You are not 5 and he is not your dad :) That is just his opinion, it's not the law you follow it. Do what YOU feel is most comfortable! It sounds like that is the TAC, based on the excitement of your last post and how deflated you sound now. If you don't do what you are most comfortable with, you will be so stressed and unhappy. And God forbid something does happen again (which it won't!!), the "what-ifs" would be so much worse if you did *not* do the TAC than if you did (in my opinion anyway- that is how I would be, at least). Well, I just wanted to give you some support and back you up that you need to do what you feel is best for you and your family. :)
ReplyDeleteOh boy. I told myself that when I went to see my MFM, if he wasn't on board with me getting the TAC I was going to walk out the door and find a MFM that was on the same page. I know for a fact that had I lost the twins to IC, I would have done my research just like I did after losing Wyatt and would have asked to have the TAC done too.
ReplyDeleteMy MFM was on board with me, like I mentioned before he has done TAC's but only has done 16 of them and two of them ended badly.
Putting myself in your shoes and with everything that was said to you, I would move on and find another MFM who agrees with you. I really do have full confidence in this TAC and am so ready to have it done.
*hugs* my friend. Wish you all the best.
Wish I had the answers, I'm dreading my MFM in a few weeks because with only one loss I'm afraid they'll have the same opinion about the TAC. So far in my research, I just cannot imagine why you wouldn't get it if you could even if it's overkill. IMO, losing another baby is way too much to justify if we know one procedure works better than another. I think a lot of Docs, even MFM's are just uneducated and inexperienced with TACs. Follow your heart, and get another opinion while you take some time to make your decision.
ReplyDeleteYour story is so similar to mine. I lost my son at 24 weeks and have loosely been diagnosed with IC (my cervix is permanently dilated, even when not pregnant). My new OB (post loss) will agree to a prophylactic TVC in the 16 week but says TAC is for when a TVC fails (and you lose your baby, again) - and wants to "wait and see." I am researching TAC and want to move forward with the surgery. I am on the West Coast but unsure how to reach out to Dr. Haney. Any advice would be so, so appreciated. Thanks!
ReplyDeleteSorry this is such a late reply - but for anyone else who might see it - you can email him through here:
Deletehttp://www.uchospitals.edu/physicians/arthur-haney.html