Q&A: My Cerclage Pregnancies

"I would have never known that I needed a procedure done to keep my babies without first losing a baby halfway through pregnancy, and that brings on so many mixed emotions."

Over the past year, I have had many asking about my cerclage experiences or for advice on whether or not they should consider cerclage. 

I decided to do a simple Q&A to help those who may want to know more about cerclage or just want something to refer to. Also, so I don't have to continue repeating myself because social media has attracted lots of worried and cautious mamas to my inbox.

If there is a question I haven't answered or you would like answered, feel free to comment or send an email, so that I can add it to this already helpful list of questions. Be sure to do your own reading/research, as my experiences are only just a couple out of a million :) but I promise you with my heart that these are all honest answers.

So far, I have had two successful cerclages and had two babies within a year! And I'm sure that both of my cerclage pregnancies are an inspiration or a sign of hope for someone out there.

I know that considering cerclage can be scary and not to be taken lightly (I was there and so, so scared), but I honestly think that if you are here reading this, then it is most likely that you could benefit from cerclage! 

Let me know if this Q&A has helped you! I'd love to be a part of your cerclage journey and provide sister support as much as I can. 

With love x

What is a cerclage?

A cervical cerclage is a procedure where a stitch is made around the cervix to prevent preterm labor. The goal of a cerclage is to keep the cervix closed until removal at around 37 weeks gestation (full term). A good example to picture a cerclage is like a drawstring of a jewelry bag or a ribbon tied at the end of a balloon.

How did you know that you needed cerclage?

We lost our first pregnancy at 20 weeks gestation due to an early rupture (breaking of the sac) or what doctors call Preterm Premature Rupture of Membranes (PPROM). Unfortunately, we were not able to continue the pregnancy because of a complete loss of amniotic fluid. Our first child was stillborn after an early labor and delivery. The cause of the rupture was unclear, but there was a possible (not definitive) reason of infection. The loss was also labeled "spontaneous abortion."

At the beginning of our second pregnancy, my doctor (OB-GYN) had mentioned the option of cerclage because it was uncertain whether or not there would be a subsequent loss. Starting at 16 weeks gestation, my doctor began performing weekly cervical measurements to check for premature cervical dilation. 

Ultimately, the measurements revealed a "dynamic cervix," which was risky of preterm delivery and assumed that I had cervical insufficiency or "incompetent cervix (IC)." At 21 weeks, we had our last cervical measurements with both my doctor and Maternal Fetal Medicine (MFM) before deciding that I was a candidate for an "emergency" cerclage.

For our third pregnancy, since our first cerclage was a success, we opted for an elective or "preventative" cerclage at close to 14 weeks gestation. This was also through the approval of MFM.

What type of cerclage(s) did you have?

For both pregnancies, I had a double McDonald's cervical cerclage where there is one stitch higher than the other.

What kinds of anesthesia did you receive during placement/removal?

During my first placement, I had a "spinal block" or a local anesthetic, which numbs the body from the lower half such as the abdomen, hips, legs, and feet. Unfortunately, my spinal block failed to numb the entire region and worked mainly on my legs and feet. I had a prolonged and painful recovery (procedure and recovery usually takes 2-4 hours) with abdominal cramping, vaginal pain, and had to wait for anesthesia to wear off, which took about 10 hours in the hospital.

*Removals are typically done at the doctor's office without anesthesia.

My first removal was difficult, since I had two stitches. The doctors were unable to successfully remove the first stitch without minimal pain. I was referred to the hospital to have both stitches removed in the OR where I received pain medications to help with the process.

For my second cerclage placement, I decided to use general anesthesia where I was "put under" to prevent another failed spinal. I did not feel any pain and recovery was quick and easy. I was able to leave the hospital within two hours after recovery. The removal for this cerclage was painful, however, it was a success within 30 minutes.

Were you also treated with progesterone? Would or would you not recommend it?

I received my first dose of progesterone the same day as my first cerclage placement at the hospital. I decided not to continue the shots because of the commute and how often I would need to receive them. I also chose not to take progesterone for my second cerclage pregnancy because of how successful the cerclage was the first time without the help of progesterone. 

*MFM recommended progesterone, whereas my doctor personally did not think it would be of any benefit. Many doctors have differing opinions on whether or not progesterone prevents miscarriage or helps prolong pregnancies.

I would personally recommend it for those who are considering progesterone, especially for those who have IC or has had noticeable cervical shortening. 

How did your experiences with cerclage compare/differ after having two cerclage pregnancies?

My first cerclage experience was the hardest because it was also my first pregnancy after loss; I didn't know what to expect and worried about complications. I spent the majority of my pregnancy resting, even though I was told bed rest was not necessary. I did not have a comfortable experience with this cerclage, there was a lot of "pinching" and pressure in the cervix. I was also unable to do certain things for prolonged periods (or for no more than 10-20 minutes at a time) such as sitting, standing, and walking. 

*Removal was at 37 weeks, went into labor and delivered at 39 weeks.

My second cerclage pregnancy was a busy period (I was also caring for another child from previous pregnancy). Before placement, I had already begun feeling pressure in the cervix during the early weeks of pregnancy - the cerclage helped relieved some tension for awhile. Since I had this cerclage placed earlier at 13 weeks, only one cervical measurement was taken before placement (to make sure there was sufficient cervical length for cerclage). Although I was not working outside of home, my daily life as a mother required much of my physical energy. I was unable to have a restful pregnancy and was constantly on the move. I also felt pinching and continued experiencing pelvic pressure in the cervix with this cerclage.

*Removal was at 36 weeks 2 days. Waters broke hours after removal, delivered at 36 weeks 3 days.

Were there any doctor's restrictions or things you had difficulty with while on cerclage?

My doctors did not recommend bed rest (for both pregnancies) as they did not think it was necessary. I was able to continue my normal duties with my own discretion. The only restrictions for my first cerclage were pelvic rest (no sex) and no climbing stairs. I was not on pelvic rest for my second cerclage, however, sex with cerclage was uncomfortable. I chose to abstain from sex as much as possible.

For both cerclage pregnancies, I was not able to continue work because the jobs I had at the time required mainly manual labor (heavy lifting, bending, standing, walking, climbing, reaching, etc), which had put too much pressure on my body (and my cervix). I stopped work at around the end of the first trimester both times. 

Any tips, advice, or a word of caution before getting cerclage?

  • Do your research, know the risks and benefits, and join groups/discussion boards to know what to expect or for support in aftercare.
  • Remember that no two experiences are alike. Someone can have an easy cerclage while someone else may have difficulties or complications. 
  • Remember that cerclage is a treatment, not a solution. Some cerclages fail.
  • Some doctors may also place certain restrictions based on your health and/or history.
  • Consider your job, workload, and daily activities may interfere with your cerclage.

Do you think your cerclage worked and would you recommend it?

Without a doubt, yes! But please also seek the advice from a health professional or your trusted doctor.


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