The best thing to come home to....

Thank you all for the good thoughts and wishes for my surgery.  Everything went according to plan and I left New Jersey more confident than ever that I made the right decision.   Recovery, as to be expected, has been uncomfortable but definitely easier than my c-section.  

Surgery was around 11 am on Friday and lasted about an hour.  In addition to placing the TAC, Dr. Davis was able to remove quite a bit of scar tissue from the large hematoma that I had after my c-section.  I was up in my room by 3pm and by 7am Saturday morning they had removed my IV, catheter, and oxygen and I was up and moving around.  I was discharged around 3pm and was home just in time to see Ginny before she went to bed.   Boy, it feels good to be home :)

It feels especially good to come home to this!

And then we celebrated :)

Our Little Bunny

Happy Easter from our family to yours.  Once again we are reminded how blessed we are.

Transabdominal Cerclage

I'm not usually one to publicly talk about my reproductive organs.  If words like uterus, cervix, transvaginal ultrasound, and dilation make you twitch, you may just want to skip this post ;)  My hope is that this information helps other women navigate their choices for family planning after their preemie or loss.  

On Friday I will be taking the first step in doing everything possible to a full term or nearly full term healthy baby.

No, I am not pregnant.

No, We aren't planning a second baby in the immediate future.

Yes, we would like to eventually have another child.

Tomorrow I am traveling to New Jersey and on Friday I will be getting an Transabdominal Cerclage (TAC) by one of the best and most experienced doctors in the TAC world.  The transabdominal cerclage is a procedure where they open the abdomen in a similar fashion to a c-section and place a strong fabric band around the top of the cervix, just under the uterus.  It essentially keeps the cervix from effacing and dilating and is especially effective because it is placed at the very top of the cervix, eliminating any dilating force or funneling.  The decision to have this surgery has not been an easy one.  There have been many consultations with many doctors with many different opinions to get to this point.

Almost all of the doctors agreed that I had a congenitally weak cervix.  In addition to having a previously diagnosed uterine septum and surgery to remove it, I also showed all of the classic signs of cervical incompetence: I was fully effaced at 22 weeks and had painless dilation thereafter.  There was no sign of infection, my membranes did not rupture, and Virginia was completely perfect- all things that could have made the diagnosis of cervical incompetence a little more hazy.  I did not have a single uncomfortable contraction until I was over 7 cm dilated.  Even then I could have convinced myself that the aches were something other than impending birth.

Some doctors suggested a "wait and see" approach to a future pregnancy.  Umm ... no thanks, we were all shocked at how quickly my cervix changed then stabilized and then changed again. I am not willing to risk that approach.

Some doctors suggested a Transvaginal Cerclage (TVC) at 12 weeks into a future pregnancy.  I very seriously considered this option.  The problem in my case is that I had severe funneling (opening at the top of the cervix) weeks before I had any cervical dilation (opening at the bottom of the cervix). I honestly think a TVC could be successful for me, but not without a whole lot of angst, bedrest and hospitalization.  I have no doubt that if I were to get a TVC that I would be funneled to the stitch by 20-22 weeks.  Cue... lots of panic.  I simply cant do that to myself, my husband, my family, and most importantly Virginia.

I don't think anyone would have even mentioned a TAC none the less suggested the procedure if I had not asked about it.  There are only a handful of doctors in the US that do these procedures regularly.  Unfortunately this leads to a lack of statistics and awareness among the obstetrics and patient community.

I was completely shocked when I read the statistics - A TAC has a success rate of over 95%** for bringing pregnancies to term (37 weeks gestation).  A preventative (as opposed to a rescue) TVC has less than a 75%** success rate.  Most obstetricians and Maternal Fetal Medicine (MFM) specialists view the TAC as an extreme measure saved for people that have had 3 or more 2nd trimester losses.  The all too common complacency to intervene earlier in the wake of of 2nd trimester loss or extreme prematurity when the cause is clearly cervical incompetence is completely baffling and appalling to me.  No one should have to lose 3 or more babies to be at least be presented with all of the options for intervention.  

The TAC is certainly  more invasive than the other options.   It is an open abdominal surgery (open in my case but it can also be done laproscopically).  The TAC eliminates the possibility for delivering a baby vaginally.  For me, a vaginal delivery is not an option because I had a classic c-section with a vertical incision to my uterus.  There is a higher risk of uterine rupture with a classic incision, so laboring and vaginal deliveries are definitely not recommended.  This made my decision for a TAC much easier.

The decision was not made lightly but we feel this is the best one for our family.  We believe it gives me the best chance for carrying to term.  We believe it gives me the best chance to avoid bedrest and more importantly hospital bedrest.  Do we think a future pregnancy will be "normal"?  no way.  Will we be scared sh*tless still? Absolutely.

If you have some good thoughts to spare, I'll take them.  I'm hoping that this the dawn of a new day for us and someday helps bring us a big, chubby and healthy baby.

In the meantime things might be a little quiet around here.  Heath is holding down the fort with Virginia at home and Moma will be with me in NJ for a few days.  I'm hoping to be home in time to spend Easter with Virginia.



** These statistics were quoted to me by my physician.  I will add some of the published research that I came across some time in the future.  

peek a boo

A very short video of one of Virginia's favorite games :)

and her favorite baby yoga pose

17 Months

Virginia is 17 months old today.  Goodness, where has my tiny baby gone?  

I was looking through photos last night and realized that my big baby still has the same "looks" as her itty bitty self.  

 

 

 

I can even see alot of Virginia today in this photo of her from week 3 of her life.  Many of her mannerisms are the same today as they were in those first few weeks.  

The way she tucks her arms in to snuggle is the same as the way she did it the first time we did kangaroo care.  

The way she furrows her brow is the exact same.

The way extends her arms and then her fingers out in protest.  The only difference is that she has gotten quicker.  

The way she keeps us on our toes.... I don't think that will ever change.  

marriage and the NICU

When I entered the hospital in the fall of 2011 Heath and I had been married a month shy of 3 short years.  Our relationship was on a pretty predictable path.  We met in college, graduated, traveled, started jobs, traveled more, got engaged, bought a house, got married, traveled even more, adopted a dog and then got pregnant.  In our 6 year relationship our biggest decisions had been where to take vacations and how to make career changes and our biggest challenges had been living far from our families and negotiating holidays.  This all changed in September 2011.

When I entered the hospital at 22 weeks pregnant with our first baby my biggest fear was for the life of our baby.  My second biggest fear was for my marriage.  In the best case scenario we were looking at 2.5-3 month stay on hospital bedrest and worst case we could be leaving the hospital in days without our baby and with only a memory box and heavy hearts.  I truly worried that this situation could literally break our hearts and our marriage.  I later learned that my fear was very much justified, many marriages are tested and break under similar situations.

What transpired were days, weeks, and eventually 5 months of love, patience and faith in one another and in our baby.

Our marriage survived by:

Communicating-   We communicated facts without emotion and emotion with disregard to facts.  We let ourselves get emotional about being in a crappy situation and get teary, irrational, angry and sad but we were sure to make decisions and talk about specifics without emotion when possible.  We also somehow knew when each other needed a break and needed to talk about something ... anything other than medical talk.

Taking the serious seriously and not taking anything else too seriously -  A little humor (at the appropriate times) was truly the best medicine for us.

Engaging our support system - We had so much support.  By being able to talk, vent and get advice from  friends and family  helped accomplish the 2 items above.

Our marriage thrived by:

Despite what seemed like chaotic schedules we had a surprising amount of quality time together - We spent alot of uninterrupted time together in the car and at Virginia's bedside.  There were no phonecalls, computers, ipads, iphones or tv's to distract us from being present with each other and Virginia.  It really was so much quality time, something that is rare these days with so many different screens that can stand between all of us.

Time to ourselves (together) -  Heath and I have always liked to eat out.  We took Virginia's 4 month stay as an opportunity to eat at many of New Havens fabulous restaurants and food carts.  Afterall, we had to eat sometime, so why subject ourselves to bad hospital food?  We ate at dive bars, hole in the walls, and fine dining alike.  We were always anxious to get back to Virginia's bedside, but those dinners became a vital part of working together as a team, communicating, and keeping things in perspective.

This is not to say that the challenges ended when Virginia came home from the hospital.  Like many other parts of our journey the finality of the hospital stage solidified that like parenthood, marriage is a marathon.  We made it through an incredibly challenging time but it was no time to rest.  Our Marriage was tested and certainly isn't perfect but is in a better place because of Virginia.

radio silence

do you hear crickets?  Excuse the quietness lately.   Between some big impending deadlines at work and a busy little Virginia my head has been spinning.  Add in alot of March of Dimes stuff,  medical appointments, and trying to swiffer the floors and pick up pre made meals at whole foods   keep a household, I'm a bit tapped out.

Perhaps I should just drink those bottles to keep them out of her reach.  :)