Monday, March 2, 2009

On Injections and Being 16 weeks Pregnant

I'm now 16 weeks pregnant (17 weeks tomorrow), and am still as shocked as ever that this is my life. Please enjoy (if you can) a very rare profile picture of my ever-expanding midsection. Moving on...

I saw the doctor a couple of days ago, and while my MFM does an ultrasound at every visit, the OB didn't plan to scan me at every visit until 18 weeks. With all the early complications, I had scans at every visit, but the 16 week appointment was scheduled to be routine. Instead, I came to the appointment just sure that there had to be something wrong with my cervix. I had no actual proof that there would be anything wrong -- just an overwhelming sense of dread. 16 weeks is the magic number for a lot of people with cervical incompetence to begin having problems, and while I now have the transabdominal cerclage that should make IC irrelevant in this pregnancy, it's difficult to move out of that old mindset. This is my first second-trimester on the TAC -- I'm not used to this new normal.

When I had the TAC placed, I was the only person my OB knew who'd undergone the procedure. Nearly two years later, he has another TAC patient who is just as pregnant as I am. He didn't bat an eye when I asked to have my cervix scanned because evidently the other patient is freaking out in the same way I am. He indulged her a few days before, and he indulged me right away.

As I might have known, my cervix was fine and has lengthened even more. The baby, since she's bigger, is closer to the cerclage, but there's plenty of length on the internal os, as well as on the cervix below the cerclage. From now on, even despite the positive report, I'll be scanned at every visit. Not only is it important to continue watching the cervix and how it may or may not change as the baby gets heavier, it's also important to stay on top of potential complications that may lead to uterine rupture. The risk of uterine rupture is the primary complication with the TAC, but with close monitoring, the overall risk is actually quite minimal. And for someone like me whose cervix will not stay closed even with a cerclage, it's a risk worth taking.

Another milestone this week is the beginning of my 17P Hydroxyprogesterone injections. Progesterone injections are routinely given to women who have a short cervix or a history of cervical incompetence. They're also part of routine care in more than 60% of women with the TAC.


According to medical studies, 17P injections significantly reduce the rate of preterm delivery at less than 37 weeks' gestation, and since both children I've birthed were born before then, I'm a candidate on that basis alone. I also have a naturally short cervix, a history of cervical incompetence, and a TAC in place, and with all of that, there's no avoiding the shots.

The medication is compounded and then overnighted to me once a month. I store it and a home health care nurse comes once weekly to administer the injections. The nurse and I connected by phone today, and after talking for a bit, we both realized she's the nurse who gave me the injections for six weeks of my pregnancy with Zachary. It was so hard to hear her voice on the phone today and to schedule her for Thursdays, the same day she always gave me the shots before. So much of this current pregnancy mimics my pregnancy with Zachary, and that's just one more thing on the pile of pregnancy stress. When I hung up with the nurse, I called James to cry.

I know this pregnancy is not Zachary's pregnancy, and I know that even with some similarities, they're not necessarily destined to end the same way. I'm still struggling to determine if this current course of events is a happy coincidence or not. No matter what, it's quite hard. Obviously, I'm in the season where I'd normally begin to think about the last days before my loss. In just a few days, we'd remember the anniversary of moving into this house -- the house we bought because we were having a baby. We'd remember hearing, "It's a girl -- No wait, it's a boy!" We'd remember painting rooms and hanging baby clothes. We'd remember Easter and that dreaded, dreaded cough. In April, we'd remember going Galveston for one last getaway. We'd remember an appointment that was supposed to be uneventful and some really bad news. We'd remember attempts at salvation that didn't work out, and we'd remember that Zachary lived and then died.

Instead of having time to dwell on all those things, I'm busy being pregnant once again. I'm sleeping and eating and hunting for a heartbeat. I'm going to doctor's appointments and scheduling sibling classes and talking about baby showers with dear, dear friends. I'm growing bigger and more uncomfortable and feeling movement from time to time, and even if I somehow go all the way to my due date with this little baby, I'll face Zachary's birthday and dying day with newly-filled arms. I certainly couldn't be happier about that.



cross-posted on About the Baby

9 comments:

  • Sara

    Amanda,

    Of course there are no competent words. I just wanted you to know that your post touched me. I'm so happy for you - for this new baby girl!...and so sad for you as you suffer such pain - in the past and currently. I can't imagine! Yet you are so wonderful and such an amazing friend and so inspirational to so many. And I say none of that for any other reason but that I know Amy thinks all of those things of you. And if she thinks those things, then I know it's true! I'm really excited about Saturday! I'm so glad you're coming with her! Maybe we'll all be INSPIRED by the FlyLady!!! =) See you then!

  • Emily

    i love you and your honesty. i hate that you have had so many bumps in the road of your life and i wish there was something i could do to take away the uncertainty and stress. there are no right words to make it better, but please know that i am praying for you and this little girl. i will also be praying for you and your family as you go through these next weeks that bring back bittersweet and sad memories.

  • Leslie Hargus

    Oh Amanda, you filled my head with memories of little tiny Zachary. I will never forget him, you know. My heart still aches as I think about it now. I will pray for you and for peace and joy for the family.

  • Randi

    I wish I could fast forward you through the remainder of this pregnancy and just get to the part where you're holding Little Miss Huggins in your arms and all is well. I think of you and Zachary every time I cough during this pregnancy so I can only imagine what it's like for you. Praying for a restful mind for you as you continue through this pregnancy.

  • Christy

    Absolutely adora-belly! :-)

  • amy

    Love you... Thanks, as always, for being so open & transparent.

  • In His Grip

    Amanda, Thanks for sharing the lastest update. I am so thrilled all is well so far. Sorry about the similarities. I am praying the Lord keeps you at peace.

  • heidi @ ggip

    I hope that your blogging about this helps you therapeudically through this difficult time.

    Thank you for sharing about all the injections and other medical procedures you are having. I pray that your anxiety will be eased a bit.

  • Daiquiri

    It's not often that a stranger can bring me to tears in the space of one page of text.

    Your little Zachary...I can't help but think that part of his life's purpose was to help this little one. You and your doctor learned things from your experience with him that will help this little one you carry now. I imagine Zachary watching from Heaven and taking great joy in watching your belly grow, knowing that he is a part of this new life.

    I pray for peace and a healthy pregnancy for you today.

    PS. I had that exact maternity shirt!

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