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.
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?
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.
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.
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.
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 patients 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.