Transabdominal Cerclage Surgery

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Of all the posts i’ve written, this is one of the most vital ones.   It is very lenghthy and chockful of detail on purpose.  There are increasingly a lot of people finding me due to goo.gle searches for information on on the TAC, and I want to offer all the information I can.  This does not take the place of medical advice, but it is my experience and I want it to help you.  If you have lost your baby(s) due to cervical incompetence I am so deeply sorry.  I hope you continue to pursue your dream and to gain knowledge.  Additionaly,  I am more than happy to answer any questions you may have,  just email me as follows: jaded_me0223(at)yahoo(dot)(com)!
 
The Background

Following the loss of Daniella, I left the hospital empty-handed, but also with the knowledge that I would need a Transabdominal Cerclage or TAC to bring a future baby home.   Dr. Goo.gle dissapointed me; the internet offered very little info on the TAC.  Thankfully, I found a group called AbbyLoopers on yah.oo and through this group several doctors that were well recommended by members including Dr. George Davis.  Beefcake and I met Dr. Davis and came up with a plan that I would have a post-pregnancy cerclage placed at 14 weeks (pre-pregnancy is another option).  I continued to read the experiences of AbbyLoopers members and after a self-imposed break from TTC we were ready to try last fall.  We conceived shortly after and when my first trimester screen revealed a healthy pregnancy I got in contact with Dr.  Davis.  He and his staff had great follow up in scheduling and getting paperwork in order.  I knew I was dealing with a special doctor when he called me one night just after 10pm.  He apologized profusely for calling so late but he wanted me to know that he finally had my operating room booked and that surgery was all set for December 28th, 2009.

Surgery Prep

As planned my husband and I arrived at the hospital where I was registered and prepped for surgery.  Beefcake and I chatted and watched t.v. while we waited for Dr. Davis.  He came by rolling over the sonogram machine, which caused his diet co.ke to fall on the floor andd spill, and then he could not find towels and then he couldn’t get the machine to work.  He wasn’t smiling and it was all Beefcake and I could do not to laugh out loud.  Finally, he did a quick sonogram to check on baby and all was well.

Dr. Davis:  How old are you, again?

Jaded: 27

Dr. Davis: A teenager…Do you have any questions before surgery?

Due to nerves, I completely missed the question.

Beefcake:  Babe, do you have any questions?

Jaded:  Huh?  Oh!  Sorry Dr. Davis, I’m just so suddenly nervous. 

Dr. Davis: I’m not.

Jaded: If anyone should be nervous, I’d rather it be me.

Dr. Davis left to prep while the anestesiologist and his assistant came by to talk to us.  The plan was to give me a spinal, so that I would be conscious and just slightly whoozy.  I asked if I could bring my ip.od into surgery and they were fine with that.  I set up a playlist of Mich.ael Jack.son’s greatest hits, kissed and hugged my husband goodbye and was wheeled into surgery.

The Surgery

Upon entering the operating room the flood gates gave way.  I mean I was BAWLING – the bright lights and the cold sterility of the room with the surgical tools out brought back memories of my daughters.  Tears just kept coming without ceasing.  I reasoned with myself: I was now in a position of knowledge, power and preparation.   This was not a reactive attempt to save this baby, but a proactive one – BIG difference.  Compassionate hands cradled mine as compassionate words soothed my spirit.   I was then given more paperwork stipulating that I understood that I was about to undergo abdominal cerclage sugery and that I was agreeing to in-surgery ultrasounds to monitor the baby’s heartbeat.   I signed the paperwork and thought to myself: Wow, after all the research, blood, sweat and tears I am here and this is really about to happen.  The spinal was administered, and we waited for its effect as more lights were switcched on,  doctors strolled in including Dr. Davis and nurses and the anestisiologist monitored my vitals.  So i’m there, spread-eagle, legs strapped, arms strapped and naked from the waist down.  At this point I hear the familiar sound of an electrical razor as Dr. Davis shaves off about an inch of my pubic hair just below my abdomen,  I cringe as he places this sticky material over the shaved area and prepares to pull it off (i’m thinking a salon wax here) –  luckily I did not feel a thing.  Whew. Vulnerable does not capture how i’m feeling.  By now, the spinal should have taken effect, so they decided to put me to sleep.  A mask is placed over my mouth and nose as i’m instructed to breathe in deeply.  I remember my first breath…my second…and my third when I suddenly get this funny taste in my mouth. 

Hospital Recovery

The next thing I remember was waking up in the operating room and being told the surgery was over and that I was headed to a recovery area.  I’m very whoozy and so I’m ‘in’ and ‘out’ and don’t remember being wheeled over.  Once in recovery, I ask how my surgery went and the nurse smiles and says very well.  Dr.  Davis strolls over and I ask if surgery went well.  (I think I asked anything that blinked how it went).  He patted my leg and said very well.   My husband is soon by my side and he gave me this loving gaze and told me he almost cried when he saw the doctor heading his way immediately after surgery.   “Dr. Davis said you and the baby did very well and that he’s happy with surgery – there were no complications and everything went as planned, the surgery was over  in under an hour.  Thank God for that, because I could hardly stand waiting to know if my baby and wife were ok.”   Some time later I was wheeled to a private ‘mother-baby’ room.  My vitals continued to be monitored the rest of that day and through the next day.  On day 2 the strong meds were discontinued and I was told that I needed to start walking later that day.  Say what?  The meds had already started to wear off and the pain was creeping in.  The nurse laughed when she saw my face and said it helps with gas.  Huh?  What’s wrong with some gas?, I thought.  Ha!  Who knew gas could be so evil and so painful?  So I took my first step with her assistance and let me tell you  warn you – the pain WILL take your breath away.  I’ll fast-forward through the rest of my time there: I was there 3 nights in total, my husband helped give me a sponge bath and I progressed to taking showers on my own with him standing by.  The nurses were wonderful and I walked every day, despite the pain to encourage healing and help with gas as recommended.  On my last day there, the doctor performed one last sonogram to look over the baby, the TAC and to take my now-improved cervical length measurement.  The doctor was happy with how my incision healed and so he removed the bandage and staples and placed steri-st.rips over the incision.  As he filled out paperwork, I realized he was wearing a Cowbo.ys football team tie.  My husband and I are all about the NY Gi.ants, but I smiled and said that it seemed we were all Cowbo.ys fans that day.  Before leaving, I gave Dr. Davis another of many hugs during my stay and a very teary-eyed, heartfelt thank you.

At-home Recovery

We left the hospital on strict orders to drink water as if it were ‘going out of style’, move a little every day, take it easy, and to have s.ex when ready but on the condition of using condoms until after delivery.  Beefcake tried to drive home slowly, but every bump in the road was agony for me.  Once home, he took care of all meals, assisted with bathing and drying me when neeeded, he took care of Peaches, ran my errands, faxed paperwork to my job, helped with my grandmother who is still with us and at the time was still healing a broken ankle and much more.  We ran him ragged.  I returned to work 3 weeks post surgery.  I was still slightly sore for about a week after.  Now at 20+ weeks I feel fine, although the baby is now kicking me and occasionally making me feel soar above the incision.  However, every kick is like a breath of fresh air.

What is the TAC?

Again, it is always best to talk with a doctor, preferably a perinatologist but… There are 2 approaches to dealing with cervical incompetence.  A vaginal cerclage entails a stitching of the cervix at the site of the external os (the lower part of the cervix that a gynecologist views/’handles’ during a pelvic exam).  It is removed shortly before delivery and is therefore not permanent.  It has a good success rate, but does not compare with that of the TAC.  The vagina naturally has more bacteria than the abdomen, therefore the risk of infection is much higher when done vaginally.  For most women a vaginal cerclage will do the trick – but it can fail and some women are just not good candidates due to factors such as cervical trauma due to a previous birth, cervical surgeries, a congenitaly short cervix and i’m sure a host of other issues.   Ideally you want to get the stitch as high up on the cervix as possible to prevent funneling and the progress of pre-term labor.  This is where the transabdominal cerclage comes in.  To get it higher you have to go through the abdomen and the ideal placement is where the lower uterine segment and the internal os meet.  In other words, you want to get the cerclage at the exact juncture of where the uterus ends and the cervix begins.  Additionally, to my knowledge, abdominal cerclages are not stitched into the cervix, but rather very strong thread is wrapped around said juncture.   Make no mistake about it – this is major surgery and is a painful recovery especially when done post pregnancy, as I did.  In addition, due to the nature and placement you are FULLY committed to cesarean sections for all future deliveries.

However, the physical pain pales in comparison to the agony of losing a very beloved and desired child.

Unfortunately, some O/B’s are ignorant of this procedure or not even aware of it, and they do discourage many patiens from pursuing TAC’s when they are clearly indicated.  This is why I always suggest that you also consult with a perinatologist as difficult and complicated pregnancies are an everyday occurence for them and they are usualy up to date on new procedures and technologies.  I was lucky, in the sense that the peri that placed my ill-fated vaginal cerclage was the first one to tell me about the abdominal approach and give me hope.

Sometimes the situation is not black and white and you might be a good candidate for either approach.  What do you do?  In your shoes, I would take the more agressive approach – but that’s easy for me to conclude.  I don’t know your circumstances and i’m certain that there are many variables that you will thoughtfully consider.

Good luck to you if you are considering the TAC or another approach, I hope more than anything that you get your baby.  Remember knowledge is power, please make a well-informed decision.

A smile before surgery

With Dr. Davis before surgery - I look like a dork b/c my eyes are closed.

After surgery & whoozy

Last day in hospital - we are all Cowboys fans!

Ready to go home!

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About Jessica Emilia

Mother, wife, grief survivor, dancer, yogi, feminine, baker, cook, lover, fighter, perfectly imperfect, optimistic, pessimistic, reader, writer, funny, sarcastic, compassionate, emphatic, sympatheric, HR Pro, anxious, confident, supernatural, hocus-pocus, friend, daughter and momma again...

20 responses »

  1. I’m wondering about the sex too ; ) Haha, of the baby that is!

    I was thinking about you today. I think I’ll try to call you later in the week when I get a few moments. This snow is killing us! Well, you too, I’m sure.

    Do you mind if I copy and paste some of this onto my blog? I’ll give you credit and change to my info. I get more and more emails from women who have lost hope too and I wonder what I did because like you said, there was NOTHING out there.

  2. I just want you to know that I absolutely freakin adore you. Really. Like in the why the hell aren’t you my neighbor?!? adore. The we could so hang out adore. And – and this one’s a biggie – I’d not only go to your baby shower, but I’d go broke buying stuff for it adore.

    *hugs*

  3. I’m glad you posted this. I’m a detail oriented person and it’s helpful for me to know all about it. Thank you.

    You are a beautiful person inside and out. Glad to know you and baby are still doing well. Will it be a boy or girl? do tell!

  4. hi, my name is meyeline, you are like an answered prayer to me…
    my first second trimester loss was at 18 weeks. i was having a baby boy, i couldnt be happier, but then one day i went to the bathroom, and saw my amniotic sac literaly coming out of me, it ruptured, i was rushed to the ed, where i then delivered my son, he died 10 min after being born.
    a year later my boyfriend and i decided to try again, this time around we took every precation, and were being seen by a high risk specialist, we couldnt determine why we lost the first pregnancy, but we were careful not to get our hopes up, just bacause we werent sure what caused the first loss. the other day on march 21, 2010, we delivered a premature baby boy at 17 weeks. he was still born. my heart has been breaking.
    my doctor has informed me that i have an incompetent cervix, and has suggested a transabdominal suggery if i decide to have any more children. i am only 20 years old, and i fear if i wait years before i try again, i might not be so lucky at conceiving, cus its another issue i have.
    but reading your story, has given me hope, i may want to try again, in a year or two, but now i know that it is possible.
    thank you…

    • Meyeline, my heart breaks for your losses. I lost Emi and Daniella a year apart and decided to take a 1 year break for my mental sanity and to give my body rest. Only yesterday I was reflecting on the good that waiting a year did for me and my relationship. I am so glad that your perinatologist suggested the TAC and did not wait for you to have more losses to figure it out. As you know, no child is disposable and I hate the fact that some doctors want women to have 2 to 3 losses before even considering the TAC. Thank you for letting me know that this post was helpful for you and I hope that you will consider joining AbbyLoopers – that group was like a lifeline for me.
      My dear you are only days removed from your last loss, please take care of yourself: be gentle and patient with your feelings. There will be rare moments where a laugh or smile escapes from your lips – embrace it. People may ask you what you need – tell them! Also realize that what may have helped you with your first loss, may not be enough now. (For example, with my 1st loss I went to a support group and leaned on my faith; with my 2nd loss I turned to blogging and no longer have a ‘traditional’ sense of faith.)
      Please feel free to email me or leave me comments here. Again, I am sorry for what you are enduring, I understand the magnitude of your loss and I grieve with you.

  5. Please contact me … i want to talk to you! I also had a TAC by DR.Davis!!! Post Pregnancy. I lost my son Matthew at 24 weeks last yr. may2009. PLease contact me!!!

  6. I wish you the best!! If I calculated correctly, you will be seeing your new little one soon!! I have the TAC and got my miracle baby her and he is now 5. Unfortunately I lost 3 babies due to an IC – but finally have my son. I wish you many happy diaper changes!!

    • Yes – I can’t wait!!! Thanks for your good wishes and I’m glad you had your little miracle and am sorry for the losses you endured along the way.

  7. Hello….your story is very inspirational. i have had 5 failed vaginal cerclages and as a result have no children. I have been communicating with a doctor in Chicago and actually have a TAC scheduled in 2 weeks but now the insurance company is giving me a hassle since its out of network. I live in Delaware and didn’t realize that there was an experienced doctor so close that performs this procedure. This may be my only chance at a successful pregnancy. You have given me so much hope. I am going to contact Dr. Davis to see if I can get the procedure done here that way it would be considered in network hopefully with minimal out of pocket expense. I have tons of questions, but dint want to be to personal. Can you email me so we can talk?

  8. Hi Jaded,

    I think by now your little one has arrived? Congrats!
    I just stumbled on your blog while researching on cerclages. I’ve had 2 failed pregnancies both lost at 18/19 weeks. I had a regular vaginal cerclage for the second pregnancy and lost it about 4 weeks after; this was in June 2009. No words can express the pain and distress one goes through when you have a 2nd trimester miscarriage.

    Could you please give me info on Dr Davies, where he is based and the costs involved? I live in Africa so cost would be a major challenge. Both my husband and I have both lived in the US/UK respectively and returned home to Africa about 3 yrs ago; he still has family in the US so we are considering trying the TAC for our next pregnancy hopefully before the year ends. We want to give it our best shot so any info would be appreciated.
    Thanks lots

    • Hi Dede,

      You can contact Dr. Davis at 856-641-7960. He has set up a ‘deal’ of sorts with the hospitals that he works out of that patients without insurance that he accepts will actually pay an ‘at cost’ fee. I hear that it varies from $4,500 – $5,000 U.S. dollars, which is not bad at all. I am not certain of the cost because I had insurance. Best of luck to you in your next pregnancy, although with someone like Dr. Davis on board you are certainly making your own luck!

      Hugs!

  9. Thank you for sharing your story. I am hopeful after losing my baby boy 2 weeks ago because of having no cervix(just a stitch) because I had a radical trachelectomy 11 years ago that I may be a candadate for an abdominal stitch should I become pregnant again. I emailed Dr. Davis and he actually responded and is very willing to speak to me over the phone to find out more about my case. Fingers crossed.
    Again, Thank you for sharing your story and for the information you provided.

    • Hi Doretta, I don’t know specifically what you’d like to know – i tried to put up as much info as possible based on my own experience. I suggest you join the AbbyLoopers group on yahoo or speak to a perinatologist closer to you. Best of luck – jaded.

  10. Hi Jaded,

    Thank you so much for your blog it has so much useful information. Im 26 years old and 6 weeks pregnant and i will be having an TAC very soon and reading your story gave me more information about after the surgery. Im very nervous and scared i’ve had 2 miscarriages due to my incompetent cervix. So i dedcide to get the TAC. In my second miscarriage i had cervical cerclage put in but it failed so they told me in order to get the TAC i had to have the cervical cerclage fail 2 more times. I was like hell no im not going to go through that 2 more times. So i decided to look for a second opinion and i did and i found the perfect doctor to help me his name is Dr. Haney at chicago. I found him on the internet read his profile and he conviced me to be the one to put my TAC he has patients coming in from different states even from Austria, and England. So basically hes really good so if anyone who reads my comment and looking for a doctor Dr. Haney is the one at chicago. Im very scared about the whole procedure i really hope the doctor puts me to sleep i dont want to be awake and hear everything they are going to be doing. I had foot surgery couple a weeks ago before i found out i was pregnant and when i got my stitches removed i fainted that was nothing compared to getting the TAC. I can only imagine how i will be when im in the room getting the TAC i feel like im goin to panic so im hoping to be put to sleep all the way im keeping my fingers cross 🙂 Again thank you so much for your story xoxo take care

    • I am so sorry for your losses. My heart truly goes out to you. Yay for Dr. Haney! I’ve heard wonderful things about him as well. It is a painful recovery but worth it – there are many pain managment options. My advice is to STAY AHEAD of the pain! When the meds start to wear off ask for more immediately. I was put to sleep for my surgery b/c for some reason the spinal did not take effect. If putting you to sleep is not an option ask the anestisiologist (sp) for something to make you ‘whoozy’.

      Good luck to you…if you want to you can follow me at my new blog…I will post the link shortly on here.

      Hugs and cheers to your growing baby!

  11. Hi Jaded, It was so sad for me to read another story about babies passing, you dont empathise you feel it in your heart, anyway congrats on your new child. I too was diagnosed with IC. After having ivf the baby was born at 18wks. For the second ivf in 2009 I had a stitch placed but gave bith again at 22wks. I have now had a natural conception with my husband, its taken 13 years! The next step was the TAC.
    I found your blog about two weeks ago not long after ît had been agreed that my surgery would go ahead. It was brilliant and informitive for myself and husband to read (you never get step by step info like that from the medics). Most importantly you gave some info on the post op expectancy, which once again the medics are very vague about (I didnt have much of a rapure with my surgeon which made me very nervous about the op, in the UK there arent that many surgeons trained and experienced with this op, so it had to be him). Anyway enough of complaining about that. I had my op four days ago. The doc said my fibroids caused a slight complication but he did get the stitch in and that it all should be good. The second day post op I was so mobile it was unbelievable. I had the op on Wednesday evening by Saturday I was able to laugh a little! However, that same evening Î was constipated but took something to help but now maybe five hours later or so my left side is so sore with a slight burning sensation even with the pain killers, before ît was the left side but that has subsided now. Did you experience anything like this at all? …sorry ive really gone on…

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