Shirodkar cerclage removal success - surgery story

So it seems for now my cerclage debacle may be over. I went in for surgery this morning to get my cerclage removed. When I got in and prepped for surgery - the anesthesiologist asked me if I wanted to do an epidural or general anesthesia. I know my surgeon wanted me to do an epidural so that he could talk me through the surgery - but the anesthesiologist felt my risks were the same. I also hoped to do an epidural for my delivery ( within 2 weeks) so I opted for general.

My surgeon came in and explained the risks of the surgery and honestly he scared me shitless. He wasn't feeling very confident that he would be able to remove it. He discussed the blood flow rates in my veins in the uterus vs how much blood I have in my body and the dangers of nicking a vein. He also explained that if it went sour, I'd be looking at a c section+hysterectomy. Wait whuuuuuut? He kept saying - he was going to go in and look - and if anything looked unfavorable - he would simply abandon the surgery. He also talked to me about choosing which OB would do my c-section if he wasn't successful. We also talked through getting an IUD with the stitch in if it couldn't come out, how it affects fertility and what pregnancy risks it comes with.

After that pep talk (sarcasm), we went into the OR. I dozed off pretty quick once they gave me meds. I'm actually used to falling asleep instantly - this time I drifted off. It was actually kind of weird. When I came to, my surgeon was still around and the first thing I asked was - did you get it out?? And he happily said he was able to! He said I can go ahead and attempt my vaginal delivery. He said the stitch was buried but he was able to find enough of it to remove the entire thing. I'm sure I was loopy because I asked him 3-4 times to be sure I wasn't dreaming. I also noticed that my throat hurt and I had a productive cough. It turns out I was intubated and even aspirated on the table. It's 3 am now and I'm nursing a sore throat from that and painfully coughing up phlegm....

Recovery was pretty straight forward. The general rule applies - if you can piss you can go home. I'm on bed rest for a day, pelvic rest for a week , and now on labor watch!!! I'm so grateful that he was able to undo what that shady OB in South Africa did. I was so scared that the cerclage he put in was something I'd never be able to get out. I haven't had a chance to ask what this means for future pregnancies ( although I never want to be pregnant again LOL). I just don't want anyone making those decisions for me.

On one side I'm very happy that it seems the crisis has been averted. On the other hand I'm feeling very violated. I trusted the OB in South Africa to give me a cerclage that would 1 - save my pregnancy and 2 - not increase my chances of a csection - and 3 be temporary. What I got was 1 but not 2 or 3 and he falsified my medical records too. I just keep thinking - what would have happened if my cervix funneled and opened even with the stitch? What if my waters had broken? What if we were forced to have an emergency cerclage removal if I went into labor? This surgery required 2 surgeons because they realized what they were dealing with - what if in an emergency situation I ended up with a regular OB instead of a pair of specialists? What gave him the right to make those decisions for me and to not even inform me? I still don't want to have more kids but now I fear how this may affect that. I'm just so angry on so many fronts .

Finally - I'm just laying here with a sore throat because of the intubation / aspiration issue. My baby is still kicking so I know the general anesthesia didn't make him too sluggish. I'm on labor watch which is awesome. My son should be here within the next 2 weeks .....

Cerclage removal failure

So I was all excited for my cerclage to come out .... Except it didn't come out! After 3 attempts my doctor was unable to remove it. I'm fact he couldn't even find the stitch. We knew for a fact that it was there because we saw it on the ultrasound. Also I was awake for the procedure to put it in!

So now I have to have a surgery scheduled to remove it. The removal could be risky because there's a chance of me bleeding out. My perinatologist is willing to try and remove it - but he said only if conditions are completely favorable. If he felt there was the slightest risk of me bleeding out - he'd abort the surgery. So now it is a wait and see thing for next week. 

I'm very angry because it appears that the surgeon in South Africa put I'm a shirodkar suture even though on my medical records he said he put in a macdonald stitch. The shirodkar is considerably more difficult to take out and often requires a surgery to do so. I remember taking explicit time to discuss the two stitches, my goals for a vaginal delivery and our expectation that this stitch could be taken out in a doctor's office. Yet here I am with a shirodkar and facing a surgery where this stitch might be permanent ! I won't go into a rant on health care in SA - but I'm over this on so many levels.

Cerclage comes out today!

Im almost 37 weeks and it's time for my stitches to come out!! Will update when it's out this afternoon.

Can't believe I made it this far with no bedrest !

My second cerclage story

So I got my cerclage done right at the end of 13 weeks. This was the first time I've done a surgery in South Africa. Strangely enough - I wasn't terribly concerned for the surgery as such. But hey - it is what it is!

So DH and I arrived early. I had to fast so I was already hungry. The prep up to the surgery was pretty uneventful. I laid in bed and watched bad television, sat on my phone, and actually napped quite a bit since pregnancy fatigue was still reigning supreme. Then it was time to fill out paperwork and to talk to the anesthesiologist. He came in, asked me questions, and then was about to walk out. I stopped him and asked him if he wanted to discuss what he was going to do. He explained he wanted to general anesthesia. I declined. He sort of seemed taken aback. I explained I'd rather do a spinal or an epidural because I don't want general anesthesia since I'm pregnant. I'd rather not do it unless there's an immediate need to do so.  After going back and forth a bit he agreed.

Another hour passed or so, and I was wheeled down to pre-op. There was a guy there waiting to do some kind of surgery that involved his colon. Needless to say his anxiety was hard to miss. I tried to give him some reassuring words - since I've gone under the knife several times. He was shocked that I chose a spinal. It seems people in South Africa don't like to be awake for surgeries hehe. When it was my turn - I was wheeled in, moved onto the table, and they did the spinal. I really hate how you can still feel tugging or pressure when you do one. However, it isn't really painful at all. The procedure was pretty quick. This time they did a Shirodkar suture instead of the MacDonald stitch for my cerclage - which is a little more involved. But I swear this one seemed quicker than the last time I did one of these. Then they brought me back to recovery - easy peasy!

When I was back in the ward - I learned why they prefer general anesthesia - it's because people recover faster. Since I had a spinal of course it would take hours for me to recover. After a while I was the last woman in the ward - and the nurses started pushing me to recover faster ( as if I could do that). They tried to make me drink  6 liters of water but my lower half was still numb. After a while the water was making me hurt so I stopped and decided to walk around to help my legs wake up. Eventually I was able to take a piss  - but they were just pushing me because they wanted to get off of shift at 6 pm. All I could think was - hospital's don't close - if you need to go home - put someone else on shift! Finally my piss was a sad piss - it was more like water just leaking out of me - but that was enough for them and they sent me home.

I have to be honest - I sort of expected a scan afterwards or a doppler or something to monitor the baby  - but nothing. The doc came by - said everything looks great and we'll see you in 4 weeks. Needless to say - that experience sort of sealed my decision to move back. Because I had to think - if I was going to end up in hospital - where would I want to do it....

But my baby is still kicking - so it was worth it after all.

Surgeries , international moves and stress!

So I've been quiet lately so this post is SO overdue. To start - I had my cerclage put in a few weeks ago. It was a shirodkar suture and it went fine. I wasn't so scared for the surgery - not as much as I'm scared of my cervix turning incompetent out here. I can't remember if I posted about this but - I've learned some very hard lessons about living out here. After my last pregnancy I've come to understand that the trick with dealing with incompetent cervix is constant monitoring, vigilance and medical intervention as soon as possible. That's fine and dandy - but out here doctor's still want to follow the same protocol they do with low risk patients - until something bad happens.

So what's wrong you ask? When I lost my first pregnancy - I walked into a routine monthly appointment and my cervix was 4 cm dilated - membranes bulging. Pretty much too late to save my pregnancy . For the second pregnancy we did a cerclage and had biweekly ultrasounds. Well needless to say - at about the same time - my cervix shortened down to the stitch as tried to funnel. So we intervened and 15 weeks of injections , bedrest and a bout of preterm labor later - we delivered a healthy baby girl! So of course when I explained this to numerous doctors here - I was baffled that they felt all I needed was the stitch and they could treat me normally. Oh did I mention my chronic UTis and gestational diabetes and that I'm over 35 now too? This is not a recipe for a normal pregnancy! 

So am I just paranoid? Well before my suture - my cervix was 6.6 cm. I basically demanded another appointment several weeks later - and now my cervix is 4.5 cm. So that's 2 cm loss or 30 percent in 2.5 weeks or so. So fine ..... I'm still within a wonderfully healthy range - but my cervix has shortened some. In fact quite a bit - but I'm the only person who thinks this is at least slightly concerning as I approach the 20 week mark - where my cervix goes nuts. Maybe it is just warming up? Maybe we should check it again in maybe 2 weeks to see if it is still changing? Not what my doctor thinks! So if I followed my doctor's lead - my next appt would be at 20 weeks and we'd walk in and pray the stitch held. If not then eeeek! 

All of this weighed in on our decision to return to the States. I've spent too much time nagging doctors out here about tests and labwork I want done. Too many times I've had to ask over and over for what my actual labs / numbers / results  were. I also had to nag for supplemental progesterone in the first trimester. I want to have some proactive care for my perilous pregnancy. Is that so much to ask for?

So here we are - organizing an international move in the space of 4 weeks. When you have a kid and pets it takes on a whole new dimension. Fortunately most stuff could be done remotely and we have knocked almost all of it out. My husband and I are exhausted - We look haggard - we've actually gained more white hairs over this! My toddler is clearly bewildered at the abandonment of her lovely routine - and is clingy and now refuses to sleep on her own. Not that I blame her! When some men take all your toys , put them in boxes, everything you've known is hauled off and you're now hanging out at the grandparents house all the time - you get suspicious that something is amiss. 

On a side note I think she's beginning to understand there's a baby coming. She actualy asked me to use the Doppler . She smiled when she heard her baby brothers heartbeat and said baby. It's a lot to hope a 2.5 year old understands but I'll take  what I can get. 

So I hope this does justice and gives a decent update as to where things are . I still need to write my surgery story .... But that will have to wait for another night of insomnia.

The Shirodkar Cerclage in 2 days

So here we go again... it's time to stitch this baby up! Let me take a step back before I get to this. So we saw the OB today and got a final OK for the cerclage. Our baby boy (yeah he thinks we're having one too ), is holding on nice and strong. So here's something interesting - he said my cervix is 6 cm!! I have to admit that's ridiculously long. I don't think mine reached over 4 cm last time. But I guess this is a good thing. Of course I've been Dr. Googling to see if it's an indication of perhaps reduced cervical incompetence but I can't find anything.  I even wondered if having only one ovary has reduced my PCOS and therefore my body's ability to suppress my progesterone? Anyway - I'm just glad he has plenty of cervix to work with.
So I'm scheduled to do my cerclage on Monday.  One thing that stands out is how much cheaper medical care is here. This whole procedure is coming to $1400 on the high end. My ultrasounds used to cost $1200 in the states...  and my cerclage came to $9000 in the states. Oh well! So the doctor is doing a Shirodkar stitch. I had a McDonald stitch last time. I had to ask the nurse 3 times to confirm that this wasn't a permanent. Doctors out here LOVE c-sections - so I wanted to make sure he wasn't setting me up for one. Anyway - from what I've Dr. Googled, the two are pretty equivalent and both can be taken out in a doctor's office - however, the Shirodkar is placed higher up and is harder to remove. Sometimes you have to get a spinal to remove it  ... and sometimes it's done in an operating theater. The idea of doing a second surgery to remove this stitch does not appeal to me. However, that's roughly 15 weeks from now - so we'll cross that bridge when it comes to it. Oh how I envy women who can have normal pregnancies. Instead ours is filled with endless online research about medical procedures, risk factors, and constantly watching for signs of negative changes. Anyway that's all I have for tonight. I'm still battling pregnancy insomnia - can't wait for this to pass!

My Epic De-Cerclaging

Oh my gosh - boy I didn't know what I was in for. I admit, I read tons of blogs online about the cerclage removal process. I read the horror stories. I heard about cerclage removals gone wrong - but I had no idea that my experience would fit right in with those. Now I should start by saying - I'm not angry at my doctor. I don't feel like he did anything wrong - but this was a painful experience. It also sucked that there was no anesthesia for this whole procedure.

When I arrived at the peri, the nurse offered to do one last abdominal ultrasound. It was great to see our little baby and to get another confirmation that she's doing fine. When the peri came in, we settled down to get it out. First he tried the plastic speculum. I've always hated the clicking sound they make.  I felt pinching pains here and there but it was bearable. He finally said - I can't reach the stitches, I need to go in manually and pull the thread down. He pulled it down - OUCH - and put the speculum in. That didn't work. He tried again. No luck. This went on for about 20 minutes, and then he said - I think I need a metal speculum. It will open everything wider and won't pinch as much. 

Now with the metal speculum in, I'm wincing and blurting Owww over and over. After another 15 minutes of trying - he explains that my cervix has grown over the stitches and he needs to basically go in deeper, push the cervix back and then access the stitch. He goes on to explain that it's going to put me in more pain and I have the option to leave the stitch in until I deliver - then the OB can remove the stitch when I'm in labor. 

I'm sorry that idea simply didn't work for me. I had a vision of an OB desperately trying to remove a stitch he wasn't familiar with. I had a vision of my stitches tearing into my cervix. NO THANKS! I told the peri, "here's the deal - I'll stop complaining about the pain - and you just get this thing out of me. I am not leaving here with a stitch in me." He said, "OK" and went to work. DH stood next to me and gave me his hand to hold. I kept up my end of the bargain, I didn't complain one more time. I simply squeezed DH's hand harder and harder and dug my nails into his hand. I also started having contractions while this was going on - so I was trying to breathe through them. 

This went on for another hour!! I have to admit - it hurt like all hell.  This wasn't the 10 minute nip and tuck that women talk about with their cerclages. This was someone clawing at my insides trying to find stitches that were so high up inside of me - my cervix grew over them. Add the pain of my baby sending lightning crotch sensations down - and ugh - it was hell. Eventually the peri  looked up and said  - all done! He held up the stitch and said - Got it!!! It was a dark green mass of thread with blood all over it. Gross I know - but I have never been so happy to see a bloody piece of string! The nurse congratulated me on how well I was doing. The peri pulled the speculum out and told me he was going to check me to see how I was doing. He reached in there and gave me a quick cervical exam. He announced, "You're 3 cm dilated and 80 percent effaced." Just like that - I realized - my body was getting ready to drop this baby. He suggested that I maybe have a week or so left before labor settles in.

After all was said and done and cleaned up, I hobbled to the bathroom, put my clothes on and made my way to the nurses' station to get my last 17p injection. I don't know why but the shot burned like hell today! Ugh - I can't win today! Anyway - I said my goodbyes, hugged the nurse, promised to send pictures and said my goodbyes. The peri asked me to bring the baby in when she was born. 

I won't say this is the most painful thing I've ever endured - but it was an hour and a half or so of some seriously excruciating pain. My lower half feels crampy and definitely feels different - but I feel a serious sense of achievement. I have been wishing for the day that my cerclage gets removed for months and that day came. I was not about to be a failure and leave with the stitches inside of me. I'm glad I did this because without a cerclage I'm convinced I would have lost this pregnancy. Now we're taking bets on when labor will come. I'm kind of excited to see when she will make her appearance. 

Lightning Crotch - Why didn't someone warn me about this???

Honestly I feel bamboozled. Everyone knows pregnant women suffer from any number of discomforts. I was prepared for cramps, hot flashes, sore joints, nausea, headaches, constipation etc. But no one warned me that once I reached the third trimester, I'd get a sensation that feels like my baby has been armed with an ice pick and is trying to claw her way out. I had to google this - because although my nurses, OBs, midwives and perinatologist swear it's normal it is the most unholy sensation.

If your'e wondering what it feels like - it's like having a lightning jolt at the top of your vagina or on your cervix. It lasts maybe 2 - 4 seconds at a time. My poor DH has to watch me walk and then start to stagger without warning. Lately I've been having these "lightning crotch" spells in the evenings and they can last an hour or longer. They are so strong I can barely walk or worse they bring me to my knees. I've been terrified that it's my cerclage failing or worse, my cervix trying to dilate through the cerclage. I've got less than 48 hours until the stitch comes out, so I guess there's nothing to do but wait. The last time I've gone in for appointments after having these pains, my cervix has measured fine.

I confess, I've consulted Dr. Google and according to him, there are pretty much 3 reasons this could be happening. #1 - It's the feeling of my cervix trying to dilate.
#2 - It's the baby's head pushing on a nerve
#3 - It's a side effect of a cerclage

Ugh - so of course this is completely inconclusive. I can only hope that it goes away once I have my cerclage removed.

3 days till my cerclage comes out

It's so weird - it's starting to feel real. I went into this pregnancy knowing it would be incredibly difficult to get pregnant and even harder to stay pregnant. I convinced myself that I was going to have a preemie. I remember just wanting to get to 24 weeks so we'd have a chance at viability. Then 26 weeks, 28 weeks, 32 week, and 35 weeks passed and I couldn't believe it! Now DH and I are sitting here installing a car seat, washing baby clothes, packing a hospital bag, packing a take-home outfit, and it seems surreal. Even when I had 15 weeks of bedrest - it never dawned on me that the bedrest would actually work. A friend of mine just gave birth to her baby boy a few days ago - and I'm so jealous. I am so ready to meet our baby. I know I might have up to 4 weeks at most to go, but I'm so ready to see her.

Now this whole pregnancy was a series of hurdles. I wanted to get through the cerclage surgery. I wanted to get through weekly 17p injections in my butt. The second procedure is the removal of the cerclage. I have to admit - I'm a little nervous. It's done with no anesthesia. I am having a hard time believing that stitches put in there from 15 weeks ago can be removed with no pain management. That being said, I'll trust the doctor. The woman who booked my appointment added extra time for complications. I have to admit - that freaked me out a little. Anyway, if it gets bad - they can always do it as a surgery. Ugh.... I'll be sure to write a full post about the cerclage removal procedure. Fingers crossed!

The cerclage surgical procedure - details!

If you've never had a cerclage - all I can say is there's nothing "minor" about it. I think when I miscarried - I was such an emotional wreck that I forgot how hectic it was. I got to the hospital, checked in and they started me on IVs. I remember now how much I hate IVs. They wanted at least a liter in me before we started. It totally chills the whole side of my body. The doc was able to get the epidural in easily - but those medications burn before they take effect. Also - when you're sitting there - back curved, not wanting to move because you don't want to mess up the doctor's aim - your mind is racing. Please don't let this man miss his aim and end up paralyzing me! My dear husband was there and offered a hand for me to squeeze and to help me breathe through the pains. I squeezed the life out of his hand. When they finally got it in, I was able to lie back down and they started numbing me. The numbing went fine.


When I was pretty numbed up, they moved me into the operating room. It always feels weird to lie there with your arms crossed as 3 people haul you onto an operating table. They strapped my arms down, put a big sheet to block me from seeing anything and put my legs in a crazy harness. I wish I had a diagram to show what it looks like - but basically, my ankles were in a harness and I was lifted in the air from the hips down. Way to feel exposed!!!! The anesthesiologist's assistant gave me some oxygen with something in it to help me calm down. He also put some drug - Propyphyl in my IV. OMG - it burned like a fire. You know when they ask you how bad your pain was on a scale of 1 - 10. It was a friggin 15. It burned like fire and my arm ached and felt like someone was trying to pull it off. I started yelping and moaning and the guy put an antidote in my IV. Ugh!!!!! After that, I started getting loopy. I was aware, but I was babbling constantly during the procedure. I was talking about the weather, pain tolerance, favorite foods, music I like, etc. It was nuts. Then they told me I was done. The wheeled me back and I went into the recovery room. It took about 3 hours for my recovery. My legs were still wobbly - and I got another 3 IV bags to help me go to the bathroom. I finally tried to go to the bathroom and I sat there for five minutes and out came a trickle. Two minutes later another pitiful trickle. That went on for another 15 minutes but I was able to empty my bladder. After that - they helped me get dressed, took out my IV and helped me get dressed.


I was discharged and halfway through the drive home with my dear husband- the pain started. OMG it felt like bad contractions! So that's what the epidural was saving me from! When we got home, I ate, and took the meds (Indocin) the doc gave me. It's basically a drug to stop cramps and prevent / stop me from going into labor. I thought i'd have 2 - 3 days of bed rest. The doctor decided to put me on 7 days bed rest and I'll be reassessed in a week. Wow.... So they put me on modified bed rest for a few weeks. No walking, no stairs, no driving, no leaving the house, and I couldn't stand up for more than 20 minutes at a time. I could take short showers, but since my shower was upstairs... it was reduced to a big bowl of hot water and soap for a while Wow..... I wondered if I could do this for months!

All in all I lived to tell the story - I thought I'd go ahead and fully describe the experience for anyone who has never gone through a cerclage - just to give some perspective. They will keep it in until 36 weeks as long as we can keep pre-term labor away that long.

I'm just an infertile turkey stitched shut

So 16 days into bedrest and it's just me and my thoughts! My cerclage seems to be holding just nicely. I feel like a turkey. Well - I mean - I have a cerclage. It's holding my cervix shut for now. I'm doing my part - resting every single day to make sure I don't aggravate it. However, with my cervix shortened right down to the stitches, I really do feel like the cerclage really is the only thing holding this baby in. I've been quoted to say things like - I'll sit with my legs in the air for 6 months if I have to - to bring this baby into the world. So much easier said than done. Yet if I have to do it - I'll do it.

The hidden stressor with all of this - especially with bedrest is that you simply can't relax ever. Every twinge, every low baby kick, every bit of discharge - just scares me. I don't know if that's the twinge that signifies if something's wrong. Worse yet - if it is the twinge and I ignore it - will it be the one sign that something was wrong - that I ignored - and therefore didn't get medical help in time? I don't want to be THAT woman who is always in the Labor and Delivery Ward for monitoring at the hospital because she has symptoms that medical science will prove weren't really the case. Also, will my doctor's take me as serious if I'm always calling with false claims? It's oh so strange - what to do what to do.

I decided that I'd wait for an undeniable symptom. A serious cramp that won't go away....a gush of fluid... some yellow discharge (what happened with my last pregnancy / miscarriage).... or some spotting. Other than that... I'll just lie here and assess how things are going. My only consolation is that I see my doctors often with roughly 8 appointments with a medical practitioner per month. If that's not close monitoring - I don't know what is. Of course 4 of those are just with nurses, but at least I can ask them questions if I feel strange.

So all that's left is to sit here and contemplate that my stitches need to hold until this baby is fully cooked! It amuses me to think of what my battle to have a baby has reduced me to!