Wednesday, February 07, 2007

Second-guessing fancy doc

After reading lagiulia’s comments and question, I really got to thinking (as if I haven’t been overthinking this whole thing from the get-go). Basically she asked if I’ve considered putting myself on bedrest at least until 28 weeks or so. I’ve been so worried about my doctor’s seemingly cavalier approach to my situation. I know that he is the best around with cerclages and he probably knows exactly what he is doing but I haven’t been able to stop worrying. Looking back, I wish I had done a little more second-guessing of doctors so I am inclined to keep on questioning him.

I put myself on light duty and decided to have my dad come out to help with the kids because I couldn’t stand the idea of carrying on with a normal activity level. I was way to stressed out about having a normal activity level caring for two kids while having a cerclage and contractions. He agreed that light duty is a good idea but I don’t think he would have suggested it himself.

He said the other day that my history and the B-H contractions that I’ve been having put me at increased risk for pre-term labor. The contractions could start to put too much pressure on the cervix and cause it to shorten or dilate. He said that checking my cervix every two weeks is sufficient to monitor any changes. He said that the cervix changes very slowly, but two weeks sounds like a long time to me. Does anybody know anything about this?

This part bugs me: it seems that fancy doc isn’t completely convinced that I am having contractions. He asked where I felt the tightening and said that the whole uterus should feel tight and that he wanted to be “sure that we are communicating clearly” regarding the contractions.

The crazy thing is that I actually started to doubt myself after he said that. But then when I got home and was on the couch having several contractions, I felt my uterus like he showed me and the whole thing felt hard. It’s easy to feel the bottom half but harder to feel the top because I have more abdomen and intestines and fat in the way. I know what contractions feel like, both B-H and labor ones. I don’t like that I doubted myself and I don’t like that he seems to be doubting me. I hope that he isn’t making decisions based on a belief that I’m not really having contractions.

So the answer to lagiulia’s question is yes, I have been considering putting myself on not bedrest but extra-light duty. My dad is here to help us and he can do everything if need be so he can certainly do more. I think I will take it especially easy for the next two weeks and then I’ll be 24 weeks and we’ll do the fetal fibronectin test.

Does anybody have any experience with these things, i.e. incompetent cervix, cerclage, bedrest vs. no bedrest, fetal fibronectin? I looked at the babycenter message board but it seems to be all questions and no answers. Are message boards a bad idea? Are some better than others? Will I just freak myself out even more by going there?

By the way lagiulia, did the magnesium burn like a mo’fo? I think that’s the “big gun” they used to stop my contractions before we knew I had the infection. I SO do not want to end up in a bad situation like you did where the cervix becomes dangerously short. That’s why I wish fancy doc would be a little more proactive and conservative and prevention-minded. At least I can reduce my activity level myself so I know that I am following my gut and doing some of what I can do to keep this baby in there.

I continue to be awed by your responses to the BFN. I really enjoy (is enjoy the right word?) hearing your personal experiences and reactions to my story. I really encourage the questions. I’m glad lagiulia asked hers because it helped me to clarify some thoughts that I had percolating. The interaction really provides a rich experience that leads to reflection and questioning and ultimately growth. I appreciate the de-lurking and the people who may feel like they are sticking their necks out with their responses. Thanks for engaging, all of you.

By the way, those were real questions about the message boards. I’d really like to hear if anybody thinks they are worthwhile. I’m especially curious about experiences with medical issues similar to mine.

14 Comments:

Blogger delphi said...

Hi - I haven't had time to read your posts this week, will do ASAP. Just wanted you to know that we just got your package and I am so touched by your gift. I will send a photo of BB in it, ASAP.

Thank you, a thousand times.

9:11 PM  
Blogger bleu said...

Hi,
I wanted to first say I have NOT read the BFN posts. I cannot bring myself to just yet. I am still in fear of this pregnancy (under 10 weeks yet) and cannot bring myself to read your painful story. I read everything else and send so much good energy your way. I am sure when I finally do I will comment.

So on to BBS. Whenever I am looking for good info on med questions I go to Mothering.com boards. I have always found the most thorough info there that seems to cut through bullshit and get down to science and facts. That said I did a search for fibronectin under their advanced search option and hit the "show posts" button and came back with 10 pages of posts talking about it specifically. I am not sure what you want to know, here is a link.
http://www.mothering.com/discussions/search.php?searchid=3967072
I hope it works but if not you can do that search. I hope it helps.

10:25 PM  
Blogger bleu said...

http://www.mothering.com/discussions
/search.php?searchid=3967072

I cannot seem to master linking, here is the entire link in 2 rows

10:28 PM  
Blogger AJW5403 said...

I also had a cerclage and tons of contractions really early on. My Doctors were also not very worried about the contractions. They did not put me on bed rest or tell me to slow down until my cervix went below 2.7. That is what they considered the danger range. They also only checked me every two weeks. They told me that as long as I was not having really bad contractions (which I thought they were some pretty bad ones, some I would have to sit and breathe though) or more then 10 an hour I was ok. At 23 weeks my Cervix came in at 2.8 and they still did not put me on bed rest at that point. It was not until 2 weeks later when it measured 2 that they put me to bed. Needless to say I also was feeling like they were being very laxed about the whole thing. All I can say is you do what you feel is right. With me I had to have Dr. orders to go on bed rest because I work and needed that doctors order to get out of work. But if you don’t work and you can put yourself on bed rest. Then I say go ahead and do it. What is it going to hurt?

I also wanted to let you know I did not comment on your BFN post because it hits close to home with me. Our situations were different but I had to let me baby die also. I don’t wish that on my worst enemy.

2:58 AM  
Blogger lagiulia said...

Hi again, WTF,
I am a little sorry that my question got you thinking so much. Sorry, because you don't need any more stress than you already have. I don't want to add to your stress.
Since I already brought it up, though, I guess I will go ahead and tell you what I know about some of the things you asked in your post.
If you think you are having contractions, you probably are. They may not be strong, and some docs may consider it "irritability," which is like tightness for less than 40 seconds. But you are your best guide. I had so many contractions from about 25 weeks on, that I couldn't even tell for sure when I'd gone into labor. Could they hook you up to a monitor for a hour or two and see more definitively if you are having contractions? My insurance covered a home monitor. It was like a belt you put on for an hour twice a day which resting. It would detect contractions. Then you would fax part of the device via this little machine and get a call back from a nurse telling you how many you'd had (this was in relation to me being on terbutaline, which was helping to control the number of contractions). You're right that contractions can cause changes in the cervix (although some debate this cause and effect). In my case, it shortened from about 4.5 to about 2.2 (I was wrong when I told you 1...I went back and checked) in a matter of 2 weeks. My doc said that was a rapid rate of shortening, which is why I was sent to the hospital. According to my doctors (maternal-fetal medicine specialists), the cervix can change quickly as pregnancy progresses. I don't know if this means it only changes quickly later in pregnancy or what. And remember, I was having twins and was BIG from say 24 weeks. Strangers kept saying "Any day now, huh." Checking your cervix every 2 weeks is important, I'm glad they're doing that. The FFN is good too. Like I said, when my cervix shortened, I also had a positive FFN, which helped to land me in the hospital. And yes, the magnesium burned like hell. And it made me really hot and shaky. They put ice bags all over me. But I guess it REALLY gives some women the shakes and makes them feel just horrible, so it sounds like I got off easy. I have heard awful things about it from other women and the nurses who were there.
Some people think bedrest is BS. I only know that the more I did (walking, doing dishes, even riding in a bumpy car), the more tightness I would feel, and that disturbed me. I guess I would say just follow your gut (heh) as much as you can and err on the side of caution. The reason I mentioned bedrest to 28 weeks is because it is not uncommon in twin pregnancies for docs to suggest bedrest until then, because at 28 weeks gestation the survival rate jumps up to 90% or something like that. This is not how my docs handled my pregnancy, but I've heard that from other women.
No matter what you do, I know you are trying to do the best for your baby. You really are doing great, WTF. I admire your strength and courage very much.
ps- Mothering.com is about "natural" parenting, so they *may* lean toward low-intervention pregnancy advice.

7:04 AM  
Anonymous jenny said...

wWTF - I just wanted to let you know that I am still around reading and thinking of you. I don't really have any advice because I am never been in the same situation, but I did want to say that I think message boards are really a mixed bag because people have really different experiences and situations. Also, I think that anything you can do to reduce your stress level is a good thing. If that means self-prescribed bedrest than do it without hesitation. It can't hurt, KWIM?

I haven't been commenting much anywhere lately because this IVF cycle is kicking my ass.

7:30 AM  
Blogger Jade said...

I read the whole BFN - and I have been reading your blog for a while. I admire your courage to attempt another pregnancy after having to go through such a horrible loss. I am not sure how people recover from such an experience. Reading the BFN also helped me really really understand where you are coming from in a way that I don't think I did before.

I have to admit reading the BFN made me queazy. I am older and not even a candidate for IVF with my own eggs and will be embarking on DE/IVF in another month and just pray that things go well because I'm not sure how much I can really handle if they don't.

thanks for your brutal honesty and putting yourself out there - it helps to know the awful truth - it's the bitter reality that we often choose to ignore or pretend doesn't exist.

7:33 AM  
Blogger Amber Kelly said...

Another lurker commenting for the first time...

First I have to confess that I have been unable to bring myself to comment on the BFN posts. I don't know what to say except that really fucking sucks. You must be wicked strong to have come through this and doing what you're doing. I don't think I could.

But for some reason I felt compelled to comment re. your concerns about bedrest - ridiculous really since I have zero experience with anything you have - but I really believe, very very strongly, that YOU SHOULD FOLLOW YOUR INSTINCTS. If you didn't need bedrest but take it anyway, who's it going to hurt? I think you will feel better if you are doing everything you possibly can for your baby, even if it is way more than you need to do. It's only for another few weeks anyway. Also, if you're uncomfortable with your doctor, FIND ANOTHER ONE. Really. One of the best pieces of medical advice I ever got was "your doctor should be your advisor, but it is up to you to heal yourself". You know your own body better than he does, do what you feel it needs. And if you go overboard, who the fuck cares? It won't hurt anyone.

Anyway. I don't know you but I am sending good thoughts your way...

Amber

10:00 AM  
Blogger Aurelia said...

WTF,

Just a question, has your doctor mentioned doing medroxyprogesterone shots once a week during the second or third trimester to prevent preterm labour? It's the plan my high-risk doc suggested to maintain my pregnancy.
If I can ever get pregnant again, which is no sure bet, I'll try it, but you may want to ask.
Most Docs never insist because they don't view progesterone as useful except during first trimester, and there is a persistent myth about it affecting the gen!tals of babies. Untrue, but still...here's link

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15684151

If that doesn't come through google the drug name and preterm labour.

10:11 AM  
Blogger three minute palaver said...

My OB also says the cervix changes very slowly, so I am getting my cervix checked and measured every 2 weeks to see if I need a cerclage or not because I've also had a LEEP (Lletz) procedure and we don't know how my cervix is going to hold up this time around. Anyway, thinking of you and also think putting yourself on bedrest until 28 weeks would probably be a good idea even if your OB is not recommending it yet.

4:04 PM  
Anonymous Meri-ann said...

Hi love,

I was told that the cervix would change slowly as well, but as you know mine went from 4cm or so long, to open and dilating in 22 hours. My rescue cerclage obviously didn't work, and I only wish now that I'd had it early on.

My assvice is to trust your instincts, sit on your butt as much as you can, and maybe get monitored weekly if it would make you feel any more confident.

Hope I haven't terrified the crap out of you! Take care babe x

Meri-ann
www.impatientpatient.wordpress.com

3:24 AM  
Blogger K77 said...

Cervix checks every 2 weeks seems to be pretty standard from what I've seen for those with cerclages and others with MAs who are prone to IC.

2:30 AM  
Blogger Dee said...

I don't have much to give. I don't know anything about message boards and have no past frame of reference for your situation. BUT, I believe light, light duty could definitely help!!!

8:36 AM  
Anonymous steph said...

Definitely bedrest - why the hell not? That's what your dad is there for, and you want to do everything you can to help this baby get here. If you don't listen to your inner voice, and something goes wrong. . .

7:45 AM  

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