This year has been an exercise in finding our new normal. I have had a hard time accepting that all my days of actively being a mother are behind me. I have researched alternative ways to have a pregnancy with a positive outcome based on my diagnosis of incompetent cervix and a failed cerclage. I didn’t know what to do for a long time, but in the spring, David and I met with my family doctor to get a referral to a TAC surgeon. In July we had our first meeting with one of the Maternal Fetal Medical (MFM) doctors who work with that surgeon. The surgeon would take me on as a patient if the MFM, Dr. C, determined that I was a candidate for the procedure.
David and I both went into that appointment with guarded high hopes. The Dr C had spent quite a bit of time gathering our history and getting a detailed picture of what went wrong in Lily and Anika’s pregnancies. She asked a few questions and then told us her opinions and concerns.
Firstly, the fact that there had been infection in both pregnancies worried her and could be an indication of a chronic infection in my uterus, that had been dormant outside of pregnancy, but that ran rampant with my immune system suppressed by pregnancy hormones. She was also concerned that with the tearing that happened with my cerclage for Anika that the structure of my cervix had been damaged. With all of that she didn’t feel confident in a diagnosis of incompetent cervix and wanted to run some tests. Overall she put our odds at having a successful, healthy pregnancy at 60-70% and said she was not confident that a TAC would help, and that if there was an underlying issue that the TAC might make it worse.
David and I felt deflated after that appointment, but we were also glad to be getting some sort of answers. If nothing else, answers would at least make us stop asking “why”.
We went back in August for the tests, I had a uterine biopsy done as well as a cervical examination and swab. It took a month to get the results. So that appointment didn’t really give us any information. I was a bit uncomfortable afterwards, but given the other procedures I’ve had it really wasn’t that bad at all.
We went back for the test results on September 18, the day after Anika would have turned 1. We were once again guardedly optimistic. Dr C led us through the test results and it started off looking good. The external OS of my cervix looked alright, no abnormal cultures, this looked good, that looked healthy… But then in my uterus was something not good. There was evidence of a chronic bacterial infection, and I had a +1 white blood cell count. Dr C said that I’m the patient that has been weighing heaviest on her mind, and that she doesn’t know what course of action would be best for me. For sure if I got pregnant again I’d be on antibiotics and progesterone from pretty much day 1, and I’d need some sort of stitch. A classic TVC (like I had with Anika) would work, if the last one didn’t leave permanent damage, but considering how it tore out there’s a 50/50 chance that the internal portion of my cervix is pretty much Swiss cheese, and if that turned out to be the case a TVC would fail. A TAC would hold, but if the ureaplasma isn’t controlled by antibiotics I could end up needing to have a C-Section to remove the baby and infection before viability to prevent me dying. Or I could end up having the stitch rupture or having my uterus rupture. Those are unlikely, but worst case outcomes with the TAC, but considering that we live in Kingston, and the TAC is a relatively obscure treatment, it is something to consider as the hospital there may not best understand how to treat a TAC pregnancy, and I might not have time to get to Toronto for proper treatment if an infection is raging. As it was with Anika’s delivery I was hours away from dying due to infection when she was born.
Even with all of that, the doctor suggested that we take time to think, and process everything and that we set up a meeting with the surgeon, because if we do decide to move forward she would want me to get a TAC instead of a TVC if I got pregnant again. With a TAC in place she would give us about a 70% likelihood of a successful and healthy pregnancy and delivery, with a TAC and all possible intervention. A TAC is most often successful if placed while you’re not pregnant, but it can be placed during a small window of time during pregnancy.
So, David and I left that appointment feeling pretty devastated. But in the time since, I did what I do… I started learning what I could given this new diagnosis. Ureaplasma is one of the smallest free-living organisms, and it doesn’t have a cell wall which makes it hard to treat because most antimicrobial agents attack the cell wall. The bacteria is hard to culture and not often tested for, so many people who have it don’t know about it. Ureaplasma exists in the lower reproductive tracts of many people, male and female, and it is usually benign, but it causes issues when it moves into the uterus. If left untreated, the bacteria can infect the baby, and cause low birth weight, breathing problems, premature delivery, or labour and delivery before viability. That is why having a TAC and the bacteria can be dangerous, as the body would try and get rid of the infection by starting labour, and the TAC would prevent dilation and delivery. Up to 45% of ureaplasma is resistant to the antibiotics in the tetracycline family, so other drugs like ciprofloxin or metronidazole are used.
I have also connected with other people around the world who have been diagnosed with this bacteria, and found that many were successfully treated for it. The bacteria can be passed back and forth between partners, so both people have to be treated with the antibiotic. Through the magic of the Internet I have met moms who were treated with antibiotics throughout pregnancy and had healthy babies, and I have met people who were able to get rid of the bacteria after detection and before a subsequent pregnancy.
The potential for complications, and the unknown long term effects of prolonged use of antibiotics while pregnant really make me leery about any future pregnancies. Unless we end up being able to eradicate the bacteria, I don’t see us actively trying to have another baby. But even if we’re careful, it’s not unheard of for a surprise to happen. I have irregular periods because of my PCOS, and I get nervous every month or so and feel the need to do pee-stick pregnancy tests almost every day until my next period starts. I get so scared about missing the window for intervention and losing another otherwise healthy baby because I didn’t know soon enough that I was pregnant. In my mind, I kind of see getting the TAC like wearing a life jacket on a dock, it’s probably not necessary, but if I accidentally fell in the water I’d be happy that I’m wearing it.
We have our appointment with the TAC surgeon next month, and we will hopefully receive enough information from her to be able to decide whether or not to proceed with a TAC surgery, and then after that we will have to have another conversation with Dr C to discuss what next steps to take.
I really don’t know what the journey in front of David and I will look like, but I’m glad I know about this bacteria. I am so glad this doctor tested for it. I can’t imagine getting a TAC without knowing about the bacteria and being blindsided by having another raging infection while pregnant and this time having to undergo surgery. Well, actually, I can imagine it, and I don’t want to live it. I am so glad that we are able to gather information and make plans so that hopefully David and I will never have to relive the trauma of losing another baby, and hopefully David and I will never have to experience a fate worse than that either.