Before we get started with this next chapter, I want to note that I have added simplified medical terminology to help you follow along. I wanted to lay this all out with the information as we received it.
What is a short cervix?
The cervix is the opening to the uterus at the top of the birth canal. It is like a hallway stretching the distance between where you house your little one in the womb and the place of their great escape. The cervix opens, shortens and gets thinner and softer nearing the end of your pregnancy so your baby can travel the birth canal during labour and birth.
A short cervix is quite literally when that canal is shorter in length than the average woman. This can cause complications in a pregnancy, the greatest complications of all being miscarriage and pre-term labour.
What is an insufficient cervix?
Where a short cervix is when the canal is short, an insufficient cervix (or incompetent cervix) is when your cervix dilates and opens (funnels) too early on in the pregnancy, resulting in pre-term labour or miscarriage.
At this point, this is about the just of our understanding going into this appointment.
The morning after our hospital visit, we prepped ourselves to return to the high-risk clinic. I was anxious but hopeful. While being assessed in the emergency room, there was no sign of funnelling, which made this the best of a bad scenario. The doctor felt comfortable sending me home that night and I was grasping to find any reason to feel less urgency.
Upon arrival at the hospital, Josh and I were called into a room where I was poked and prodded further but we got to spend a little more face-time with our girl. The technician was checking to ensure how Liliana was developing and that she was in good health while she worked hard to get an accurate measurement of my cervix for the doctor.
When the doctor entered the room she was warm and kind. She took her time and through all of my inquisition, I never felt rushed. She kindly explained that given my medical history and the results of the ultrasound she felt that I did not require an emergency cerclage at that time. She would start me on progesterone and have me back the following week for another ultrasound to ensure that my cervix was not shrinking any further. I was also put on restricted duties and asked to stay home, avoid lifting, minimize physical activity and avoid any sexual activity.
What is progesterone?
Progesterone is a hormone that helps your uterus grow and keeps it from funnelling. Progesterone suppositories are used to help prevent pre-term labour and are generally used when a woman is pregnant with one child and has a short cervix.
I am eternally grateful that my employer allowed me to work from home during this time. I can not imagine my stress level had I not been so supported by my place of work. Still, despite my best efforts, when we returned to the hospital the following week, we were given more bad news. At 20 weeks, my cervix had shrunken further under the pressure of my growing pregnancy. Josh and I waited in the empty office of the doctor for an excruciatingly long time. When she entered, she explained that I would require an emergency cerclage and I was scheduled for the procedure the following morning. My heart sunk, but whatever it took, I would do it.
Josh and I returned home to rest up and prepare ourselves for the challenges ahead. I packed us some clothes, charged the iPad and got the headphone splitter and headphones that my dad and I would use to watch Animal Kingdom and Peaky Blinders when we would go to chemo. I packed us a lunch with plenty of snacks and we were ready for the morning drive.
What is a cerclage?
A cervical cerclage is when the cervix is stitched closed to prevent funnelling or any further shortening of the cervix which can lead to pre-term labour.
Josh and I arrived at the hospital, bags packed. We made our way to the 8th floor of the general to check-in for the procedure. I can not tell you how terrified I was, but I did my best not to show it. I wanted to show Josh the same strength that he showed me. I shakily slid my health card to the clerk and we were escorted to another room. We spent some time in a room with a dedicated nurse while we waited for the anesthesiologist to be available.
When it was time, I was rolled into the surgery room. The room itself was cold, clean and overwhelmingly medical. At that moment, the reality of what was happening hit me. My breathing shallowed, my stomach turned and I felt a warm tingling run through my entire body. But I placed my hand on my stomach, took a deep breath and calmed myself. Whatever it took, I would do it. I sat up on the operating table and was held by the nurse while the anesthesiologist readied the needle for my spine. I remember the terror I felt. I recall the urgency that I felt to ask them to stop and beg them to knock me out. But I just kept reminding myself over and over that this was for her. This was the more safe option for her, so I am going to do it.
A few moments after I had been given the needle, they laid me down, placed my feet up in stirrups and put up a sheet to block my view. The anesthesiologist stood next to me and held my hand, making small-talk while the doctor and nurses did their best to secure the cerclage. I am so grateful that I had her there, it really did help to have the distraction of conversation and the comfort of a hand to hold. I would occasionally get pulled out of that moment because the doctors would be tugging so hard to stitch me that it shook me on the table. I only felt a mild pressure, no pain.
I had very minimal funnelling but my cervix was extremely short so there was some concern that they could break my water during this procedure and send me into labour. But everything went well and I was sent to the recovery room where I would spend the next few hours as I waited to regain feeling in my lower half. It felt like forever but Josh and I found humour in all of this because for the first time in my life I remained still and unexpressive as he tickled my feet.
When we returned home I spent a considerable amount of time in bed or sitting at my kitchen table working. The recovery was a piece of cake. I was not in a lot of pain - just mild discomfort. But being bound to my home was a little trying. Again, I am so grateful to my employers for accommodating me during this time. Work was a very welcome distraction to what I was going on in my personal life.
My mom came to my aid and cleaned my house, my aunt Anna brought Josh and me TONS of food, friends and select family came to keep me company. The list of people in-the-know was very short. In the weeks that progressed while I remained on restricted duties, Josh and I focused on keeping a positive outlook.
Every week that passed was a small victory. We never took a day for granted. Every morning Josh would kiss me goodbye and kiss my belly before exclaiming loudly "I love my girls!". I hummed and sang to Lily all day long while I ran my hands over my tummy. Josh and I read to her at night and on Saturday and Sunday mornings, Josh would play her music in bed to see what she would react to. I marvelled at every movement she made. Lily and I would often press our hands against one another from either side of my growing belly. I would place my hand there and she would press her hand against it with all of her might. Nothing made me smile more than that. I could not believe her strength. Whenever I felt scared, whenever I doubted myself I pressed my hand against hers and I was immediately calmed and completely assured that nobody was going to take her from me. She was strong like her mommy. "We got this" I would whisper to her.
Josh dedicated his time to make sure that I felt supported and never let me doubt that we would be bringing our girl home. I only left the house on two occasions in the time between the discovery of my short cervix and Lily's arrival. Josh and I decided one day that we would do our registry. By doing our registry we were announcing to the universe that she was ours and would be coming home with us - there would be no alternative to this narrative. We did most of our planning by asking my mommy friends and a lot of Googling and YouTube reviews. We arrived at Buy Buy Baby with a list, we completed our registry with ease and in record time.
We had been keeping the gender of our baby secret so everything that we were picking was gender-neutral to allow for reuse when it was time for baby number two. While we travelled the isles scanning just the essentials Josh and I would occasionally get side-tracked by adorable girly attire. Josh and I fell madly in love with two little outfits in particular. Josh looked at me and he said: "I am buying these for my little girl". My heart was full. I did a pretty good job of hiding her clothes but one of the days that my mom came to help us clean she found the bag with her outfits. To my surprise, she didn't take a good look because she mistook them for boy clothes and promptly texted Josh. Josh and I had a really good laugh with one another while he played along.
On the morning of Lily's arrival, I felt something strange in my belly. I knew that it was not her moving, that feeling was all too familiar to me. It was not painful, it felt like the rumbling of an upset tummy. As the day progressed that feeling evolved. I was sitting at the counter cutting up veggies and prepping dinner - I was making chilli. Josh had been held up in the house with me for weeks and was heading out to see a friend. He asked me if he should stay but I assured him that I was fine. I just told him to keep his phone on him, I would call the midwife and let him know if we needed to go to the hospital. But as I sat there cutting up my veggies the faint rumbling turned to a very mild tightening. I spoke to my midwife for a while, describing what I was feeling and counting the length and distance between what I prayed were Braxton Hicks. She advised me to go to the high-risk clinic where I could be assessed. So I texted Josh and let him know that we should head to the hospital.
I hadn't been clear with Josh about whether he should come and pick me up, or if I would meet him there. In a panic, he went directly to the hospital. So when I called him to clarify, I let him know that I would be fine to drive and I would meet him there. I knew somewhere deep down that there was some urgency here, deep deep down beneath my denial, I knew I needed to leave now. I got in my car and drove. All of the while talking to our daughter, singing to her, telling her that I was excited to meet her too but that Mommy needed her to hang in there at least a few weeks longer. I spoke to my dad and with one hand on the wheel and the other on my belly, I pulled into a parking space and whispered to myself, "We got this."
As I walked up to the hospital, I locked eyes with Josh and I could see how scared he was. But I smiled and kept reassuring him it was going to be ok. "It doesn't hurt, we are going to be ok. We are just being cautious." I said. I sat in a wheelchair and Josh rolled me up to the reception desk where we checked in and were promptly brought to an examination room. I laid there on the bed while they monitored Lily's heart and my contractions. Still, I would not accept what was really happening. I kept looking at Josh, holding his hand and telling him we were going to be alright.
The nurse left the room to page the doctor and just moments after she left the room, my water broke. My heart shattered. This can't be happening. I can't lose her too. I can't. I turned to Josh and said with urgency, "Get the nurse".
"I remember having to stop her periodically to breathe through the pain of another contraction. The pressure that I felt in my lower back was agony, but nothing hurt more than listening to any of this."
Suddenly, our room was overcrowded. My mild contractions intensified and were closer and closer together. The doctor let us know that Lily was coming and that a nurse from the NICU would be joining us to go over the risks. I couldn't breathe. Josh quickly called our midwife, our parents and my brother to let them know that they needed to come right away. The nurse from NICU appeared suddenly with a stack of infographic cards. She proceeded to run through a flurry of statistics. I laid there holding Josh's hand, tears rolling down my cheeks while the nurse flipped through each card illustrating the chances of survival, and if she were to make it, the laundry list of health issues that she might have as a result. I remember having to stop her periodically to breathe through the pain of another contraction. The pressure that I felt in my lower back was agony, but nothing hurt more than listening to any of this. They told Josh and me that we had a decision to make. When Lily arrived, they needed permission to intervene or direction to provide comfort care. They gave us the room for a moment to chat but there was no discussion necessary. We knew we would do whatever it took, I just needed a minute to cry. I remember apologizing to Josh through laboured breathing. It was my body failing them. It was my fault.
I could not tell you how much time passed from the moment that we entered that delivery room to the moment she arrived. It felt like seconds but lasted minutes. There would be no time for the anesthesiologist. My cerclage was removed while I was actively in labour. Our girl was coming now. She was breech and given how far along I was, a C-section was out of the question, it would be too dangerous. They gave me a shot of steroids in a last-ditch effort to help Lily and handed me a gas mask for the pain.
"Without ever having done a Lamaze class and without ever having gotten that far in my pregnancy book, we were completely in-sync with one another. He was an extension of myself."
The mask did not help, the only thing that kept me steady was locking eyes with Josh. When I was looking at him and concentrating on my breathing I felt stronger. He was the anchor I needed. Without ever having done a Lamaze class and without ever having gotten that far in my pregnancy book, we were completely in-sync with one another. He was an extension of myself. I remember the look on his face. I remember staring at the fleck of brown in his left eye. I remember him walking me through my breaths and stroking my hair. I remember him telling me how beautiful I was and how strong I was, over and over.
I had to remove the gas mask because it was time to push. At that very moment, before we were about to start, the doctor told me that Liliana's heartbeat was slowing and they would be limited in what they could do to help her. As he uttered those words and another contraction ramped up, Lily pressed her hand against my belly with incredible force. For one last time, I placed my hand on hers, pressed back and cried hard before pushing. At that moment I felt like she was telling me that she'd fight but somewhere deep down I was terrified that this was her goodbye.
When Lily arrived she was rushed to the NICU where they would do everything in their power to stabilize her. Josh stayed with her and that was around the time that our midwife arrived. It all happened so quickly that she barely made it. When I delivered Lily, the doctor vanished and I don't believe I saw him again. But I was surrounded by nurses and my midwife like angels. They took care of me while I waited for Josh to come back.
When Josh entered the room he looked so defeated. He shook his head and did his best to hold himself together. The look on his face knocked the wind from my lungs and I broke down. She wasn't going to make it.
The nurses brought her to us in a tiny knit outfit with a pink bonnet donated by generous strangers. She was so small. So beautiful. So perfect. As the nurse handed her to me she let us know that there was still a very faint heartbeat. I found a little gratitude in that because if she was going to leave us, she would leave us in my arms under the loving gaze of her mother and father. The hospital let us stay as long as we needed. We had some time alone before inviting our family into the room. Josh and I held her for hours before finally mustering the strength to go home.
Josh went down to bring the truck around and the nurses gave me a moment alone with our girl. I held her one last time. Through tearful hugs and well wishes, our nurses bid me farewell. To those women, I will forever be grateful. My incredible midwife, Brigid grabbed my things and pushed my wheelchair through the halls of the hospital. I can't be too sure what time it was by this point. The sky was black. I remember being rolled through the hallway of the high-risk clinic. Two couples were sitting in the chairs in the hallway waiting to be seen. They looked scared and I wondered if it was obvious to them what had taken place here. If I was a black cat crossing their paths. A looming reminder that sometimes there isn't a happy ending. I turned my head and looked forward as my eyes glossed over in the reality of it all. I still think of them sometimes and hope that their story had a better ending than ours did that day.
Brigid rolled me up to Josh's truck and hugged me goodbye. I climbed into the truck with a plastic bag of my clothes. I stared out the window that whole drive home. All the while, running through memories of the last 23 weeks. All of the memories we had made and had planned to make passed by like street lights as we drove home in the dark of night.