My official follow-up

Today I had my official follow-up appointment with the specialist at the women's clinic. Before I talk about the appointment I did have, I want to talk about the one that I didn't. This appointment was originally scheduled for two days ago (Tuesday). Tuesday was when we had a ton of snow on the ground so the streets were awful and it was freezing. That turns a 20 minute drive into a 30 minute drive (with me going as slow as an old lady) and doesn't make a great start to the day.

Once I get there at 8:40 am there aren't that many people and I get checked in and back to the exam room pretty quick. They take my weight, blood pressure, etc. Then they leave and ask me to take my bottoms off, cover with the sheet, and the doctor will be in. So I sit there...aaaand sit there. It's starting to get a wee bit chilly with nothing but my socks and a paper sheet to keep my bottom half warm. I think it was 15 minutes later when the nurse came in to tell me that the doctor is in surgery and it's taking longer than expected; it'll be another hour. So I can go run errands, which it would probably take an hour just to drive somewhere and back, or I can get dressed and wait in the waiting room. So I go sit in the waiting room.

Never has waiting in a waiting room been so horribly depressing and the name been so appropriate. I tried to occupy my time by going through facebook and email on my phone and avoiding the magazines provided, most of which are pregnancy and family related, the last thing I need to look at right now. I got to see pregnant women going in and out, women and couples with their infants, and whole families with adorable little toddlers in toe. I must keep looking at my phone. After about 45 minutes they called me back to the exam room to wait some more until the doctor arrived. It was now two hours after I arrived and the nurse came in telling me that there were complications so they were having to reschedule all of the doctor's appointments for this afternoon. I was going to have to come back at 3:00 pm.

As soon as I got in my car I had the uncontrollable urge to cry. Tears were streaming down my face thinking of all the beautiful happy pregnant women and the cute little babies. It's not fair. I want that. When I got home it was 11:00 am. Almost half the day wasted waiting around. Skip to 2:00 pm where I recieve a call from the nurse asking if I can come in at 3:30 instead of 3:00? Sure. Skip to 2:50 pm where I recieve a call from the nurse telling me the doctor won't be in today so they will have to reschedule me for Thursday morning. Pain in the ass.

Now back to today's appointment. I got there at 11:30 am and had the same nurse. She didn't bother to weigh me again, thank goodness. (Somebody at work went to Hawaii and brought back chocolate covered macademia nuts and shortbread cookies. They're sitting on the cabinets between mine and Roselyn's half cubes and all I have to do is turn around to eat them. I'm sure I've gained at least a pound). She does the whole blood pressure and question and answer thing, then leaves me alone with the dreaded paper sheet again. I'm pretty sure I was waiting for at least 20 minutes this time with nothing but the sound of badly sung Christmas songs to keep my brain some-what occupied. At least it wasn't as chilly this time.

Finally the doctor comes in. "Sorry about all this...am I in the right room?" He trails off, mumbling to himself and trying to get the laptop started up. Then he asked what happened between when he saw me and....even he doesn't say it out loud. "So you had ruptured membranes?" Yep, my water broke Wednesday night. He asked me about what the doctors saw when they did an exam. I told him they said I was effaced and slightly dilated but didn't say how much, though I got the feeling it wasn't very much. He asks if they said anything about the polyp. They hadn't mentioned it to me. He had talked to the doctor from labor and delivery that night and she hadn't mentioned anything to him either. This is when he told me he thought that maybe it wasn't a polyp after all. If it wasn't a polyp, what was it? Pregnancy tissue. What this means is that it wasn't the polyp causing my bleeding. I was in the early stages of an impending and inevitable miscarriage. "Is this something that can happen fast? Because we saw you on Tuesday when you saw it but at the urgent care on the Sunday before they didn't see it." That's the thing, polyps don't just pop up suddenly like that and they are usually very easy to spot on the ultrasound. He did a quick pelvic exam and there was no polyp there. It's not there now and knowing how big it was, how difficult it was to find on ultrasound, and someone not seeing it two days before, it sounded like it was definitely pregnancy tissue. I have an imcompetent cervix.

I already knew that's what it was; I had done my research, which is why I never understood why my doctor never seemed to be concerned about that being an issue. With an incompetent cervix it doesn't have to be very dilated for bad things to happen. The amniotic sac can start falling through and it's like an hourglass effect on the inside and outside of the cervix, or as my normal physician said, like a balloon that is trying to squeeze through a small space and then "pops." If that was the case then the cerclage wouldn't have helped. Like he said, it was inevitable. As sad as it was to hear that nothing would have saved the baby at that point, it was such an emotional relief. I can quit blaming myself for thinking it was something I did and quit thinking of the what-ifs. Coming in a couple of days earlier wouldn't have changed a thing. They would have had to catch the incompetence when it very first started, which was somewhere between our perfectly normal 11 week ultrasound  and just prior to 14 weeks after I started bleeding and they found the effacement at the urgent care. Maybe if they had done the surgery the day they saw my cervix shortening they could have saved the pregnancy, but that is a pretty big maybe and it would have been impossible to schedule at that time when they didn't know definitively what was happening. It's better to put the stitch in before any effacement occurs anyway.

During the pelvic exam he said everything was looking pretty normal but my "cervix is looking pretty incompetent still." It almost sounds like an insult, doesn't it? He said what this means for future pregnancies is putting in the cerclage earlier, before any changes take place in my cervix. 14 weeks usually is the standard for early incompetence cases, with most women exhibiting my degree of incompetence between 16 and 20 weeks. This just means my cervix is more imcompetent. Cervix fail. Next time we will be stitching it up at 12 and a half weeks when we're out of the realm of normal, natural first trimester miscarriage and it shouldn't irritate my cervix too much. He asked about when we were thinking of trying again. I told him we would like to try as soon as we can, maybe in January or February after I have a period. He said that he recommends two cycles but there is no reason to wait any longer than that. Timing is going to be very important next time so it's crucial to have reliable and accurate dates. He has to be notified right away when we get pregnant again so we can get things set in motion.

Finally, there is some hope for the future. It's hard to have hope again but it feels good. Even though we lost our first little one, it doesn't have to happen again. I have confidence that with accurate dates and frequent, careful monitoring that they can prevent another tragedy. I know we will have a beautful baby to hold in our arms one day. Maybe this time next year we will be celebrating the holidays with a little addition to our family. That's a nice thought.