My Incompetent Cervix Pregnancy Journey

I’m so glad you are here! I’ve started this blog mainly as a way to sort of journal my way through the second half of my pregnancy. This first post will be on the longer side as I catch up with everything that has happened so far. Exactly two weeks ago, at my 20 week anatomy scan, we discovered that I have a borderline-short cervix. I have anxiety, so I called my Maternal Fetal Medicine doctor straight away to see if I could get an appointment to confirm.

But before I get to that, let me catch you up on myself and my pregnancy thus far: I am 39 years old (40 in November!) and I live in Canada. In 2021 it was discovered that I had a full septate uterus (turns out it was a complicated one as it took three surgical attempts to remove it!), during one of those attempts my doctor saw abnormal cells in my uterus so he sent me off for a cone biopsy to rule out cancer (it came back negative, thank goodness). So all in all I have had three hysteroscopic attempts to remove my stubborn septum, and a cone biopsy to rule out cancer. This pregnancy is very much wanted, and after three failed rounds of IUI, we moved on to IVF. Our first transfer stuck! I was in disbelief, I’d never had a positive pregnancy test before in my life. My default feeling in most situations like this is anxiety…always worrying about the worst possible outcome (something I have been working on in therapy). As excited as I was, there was always that worry hanging about in the background. Honestly the first couple of weeks were smooth…I took my 162mg of asprin each night, my progesterone suppositories 3x a day, and changed my estrogen patch weekly (ah the joys of an IVF pregnancy). I started spotting around 4 weeks, which set alarm bells off, but I quickly learned that this is actually quite normal in early pregnancy. Then at almost 5 weeks pregnant, still spotting every day, I started bleeding bright red and heavy. Of course my partner and I were away for the weekend in a different province, so we went straight to the emergency room. I was panicking because we hadn’t had an ultrasound yet and I was so worried about an ectopic pregnancy. After hours of waiting, the doctor wheeled in the portable ultrasound and that was the first glimpse we had of our tiny bean. It was there, hanging out in my uterus. After that the spotting continued, and I started bleeding every 8-9 days (passing one large clot each time). My fertility clinic did a 6 week and 7 week ultrasound, and each time tiny bean looked great. There was no explanation for the bleeding aside from maybe the progesterone suppositories were irritating my cervix. Nevertheless with each passing day I was terrified I was going to lose the baby. I was afraid to get excited about the pregnancy and the future to come. Each ultrasound or OB appointment made me anxious, worried I was going to be given bad news. The spotting and bouts of bleeding stopped at 9 weeks, and I stopped progesterone at 10 weeks. It wasn’t until my 13 week ultrasound with my Maternal Fetal Medicine doctor (because I’m over 35) that I finally began to relax. That ultrasound went great, baby was great, I began feeling great. I got excited, I started planning the nursery, made my baby shower registry, started shopping for maternity clothes. This is it, it’s actually happening!

Fast forward to 20 weeks pregnant: The Anatomy Scan. I was a little worried they would find something wrong with baby, but I was mostly excited to finally find out the gender! In Canada, the ultrasound tech is not allowed to share any information with you, aside from gender. We found out it is a boy! She then said that my cervix looks borderline-short so she wanted to do a transvaginal ultrasound to get a better picture for my MFM and OB to analyze. I had never heard of a short cervix before, and at first I wasn’t to concerned. Of course I started Googling it as soon as I got home and learned that it can put you at risk of preterm labour or miscarriage/late term loss. Change in length can happen rapidly…you can go from having a normal length cervix one day to being dangerously short a few days later…or it can happen gradually. I began to panic, though she had said mine seemed borderline, I felt that time was of the essence and immediately called my MFM doctor to see if I could get an appointment with him ASAP. He said that looking at my scans, it looks like my cervix is about 2.6cm, with some mild funnelling. When pregnant, a good cervical length is between 3cm-5cm, anything lower then that is an issue and anything shorter than 2.5cm is a bigger issue, and I was 2.6cm…

In my excessive googling I learned that there is nothing to do to re-lengthen the cervix, but there are measures that can be taken. Progesterone suppositories (usually 200mg taken before bed) are proven to help stabilize the cervix and prevent preterm birth. Another option is a cervical cerclage- basically a stitch to hold the cervix closed until about 36-ish weeks when it is removed in preparation for birth. I also learned that funnelling means that your cervix is starting to open up from the inside, and at 20 weeks it is far too soon for that to be happening. When I heard my doctor say ‘and mild funnelling’ the panic began to rise. He said he would be able to see me in a week, he wanted to have some time in between ultrasounds to see if there is any change in length. I asked him if he could immediately put me on progesterone- he said that usually he waits until the ultrasound, but being on it wouldn’t harm anything. That night I started 200mg progesterone suppositories.

The 8 day wait for my ultrasound with him was torture. I was a wreck. A viable pregnancy is after 24 weeks and I was weeks away from that. Thankfully, for reasons not related to pregnancy, I was already off work on medical leave (which would roll into maternity leave) so I have been able to be on a sort of modified bedrest. No exercise, no long walks, just walking around the house, cooking, light cleaning, short drives. Two days before my ultrasound appointment I woke up at 4:30am and discovered a decent amount of brown spotting. Oddly I didn’t panic, I assumed it was from the progesterone- plus I had been feeling lots of kicks, which was reassuring. I decided to wait a few hours, get more sleep, and call Labour & Delivery when I woke up. Still spotting 4 hours later, that is exactly what I did. They said it couldn’t hurt to get checked out, so off to the hospital we went. A doppler machine showed a strong heartbeat for baby, and an ultrasound showed he was active. Swabs for infection were taken and let me tell you, having a speculum is no fun at any time, but when pregnant it is a WHOLE other level. The pain was excruciating…but nothing prepared me for when the doctor wanted to check my cervix for dilation. That was a whole other level of pain. Then he said it “you seem to have some mild dilation. If you don’t mind, we would like to keep you here for 2 more hours to re-check, this will let us know if you are in active labour.” Two hours, and one hospital meal later, I was re-checked and there was no change. The doctor was not at all concerned, so home we went under the instruction that I should be on even stricter bedrest until my MFM appointment in two days time.

The day of my MFM appointment I was an anxious wreck. Sadly my partner was not able to get the time off work to accompany me (but he has been so good about coming to every appointment possible so far, so I was understanding). The wait in the waiting room was difficult…lots of newborn babies. I felt like I did back when I was going through fertility treatments: jealousy, anger, sadness. They get their babies, and here I am waiting to find out if mine will even make it to viability. The appointment started off by looking at baby with an abdominal ultrasound, still doing amazingly well. The doctor pointed out the funnelling and then started to measure my cervix both with and without pelvic pressure. With no pressure I was measuring at 3.6cm, but with pressure I was back down to 2.6cm. I have a dynamic cervix, the funnelling is still there, as is the dilation. Thankfully the numbers haven’t changed…he said that if things remain stable over the next few weeks then we can breathe a bit easier. I am still not a candidate for a cerclage, especially with the bleeding and spotting I had experienced. There is risk of infection, and that would certainly not be good. I asked about travel: I have plans to travel to see my family (a 2 hour plane ride) in a few weeks for a visit and for my baby shower. He said it likely wasn’t a good idea, not a risk worth taking, but that if things stabilize it may be possible. He told me to put my feet up and rest as much as possible, and to come back next week for another ultrasound. That ultrasound is tomorrow, and I am worried that things will have progressed for the worse.

I am terrified of losing my baby. Each day is torture. I no longer trust my body…it’s job is to keep my baby safe and for reasons beyond my control, it’s just not doing that. All of the joy and excitement about being pregnant are gone. I am mourning the pregnancy I thought I would have. Long summer walks on the beach, baby shower, trips to see family, weekend getaways…everything feels like a risk. Everything is scary. Every cramp, every twinge, every weird feeling makes me worry that this is it, I’m losing my boy. My whole body hurts, logically I think it is because of all of the lying around I have been doing, I’m not used to being so sedentary…but who knows, maybe it means something is wrong. In an effort to be as open and honest as possible I want to share everything, even if it is perhaps TMI: but my outer vagina aches, it aches when I pee, my thighs ache when I walk around. Is this normal for pregnancy? Do I have an infection? Are these somehow related to preterm labour? I have no idea. Everything I have looked up for any symptom I feel says that ‘it’s normal in pregnancy’ but also ‘this is abnormal and should get checked out asap’. Im spiralling, I have no idea what is normal and what isn’t, and I can’t live at the MFM office so I just have to tough it out unless I am in unbearable pain or start bleeding (hopefully neither of which ever ends up happening). I think once I hit viability at 24 weeks, I will be able to breathe a little. That is two weeks away. As busy as I try to keep myself, the days go by painfully slow. Once I hit 24 weeks, the next goal will be 28 weeks…and then 32 weeks…and finally 36 weeks…anything after that will be a bonus in my eyes. At this point that all seems unattainable. No matter how many positive stories I read, I am SO worried that I won’t get to be one of them. I’m terrified we will never get to bring our baby boy home. I’ve stopped buying baby items, maternity clothes, planning the nursery. I’m worried we will have all of this stuff and never get to use it. I’m angry at my body for taking away what should be a special time in my life and replacing it with worry and anxiety, causing me to live day to day with fear always hanging about.

I’ll update after every appointment, and any time I have a lot of feelings I just need to get out. I’ve always found it’s better to get things out rather than to keep them in. I don’t personally know anyone who has had to deal with an incompetent cervix before. I do have a good support system, but until you have actually gone through it, there really is no way to fully understand what it is like. I figured through this blog I can share every feeling and milestone and maybe someone out there will feel less alone as they navigate the shitstorm that is IC.

This is my story so far…