An incompetent cervix is just what it sounds like: a cervix that doesn’t know how to do its job well. Its job, during pregnancy, is holding the baby in for 9.5 month, and then opening and allowing the baby to exit. The incompetent ones could really be called impatient ones. They like to dilate early – way early.
We found out my wife suffered from this condition pretty early on. I believe it was about 10 weeks in. Moderate bed-rest was prescribed, meaning that she was not supposed to do much other than rest in bed (no lifting, exercising, anything that got her heart rate up).
German women are strong. And stubborn. And have good work ethics. These things are not compatible with “bed rest,” not matter how “moderate.” This was extremely difficult for my wife, and the fact that it happened in the midst of our effort to finally finish unpacking and moving into our first home together made it even harder.
At the 20-week checkup, the Ob/Gyn let us know that the dilation was advancing very quickly, and sent us straight to a surgeon for a consult. He took a look, and sent us straight to a hospital, for a check-in. We drove over to the hospital, worrying over the scenario he shared in which a simple sneeze could be enough to eject the baby through a too-open cervix. After a day of observation, he put a cerclage in – something akin to metal fishing wire looped around the cervix like a draw-string. He mentioned that the dilation had advanced pretty quickly over the last 24 hours, and that he likely caught it just in time.
They don’t like to put in a cerclage without sufficient cause. They just don’t like to operate on pregnant women. It, among other things, introduces great risk of infection, as surgical instruments will be inside the body, and skin-barriers will be broken. So the story above is the normal course of action for someone suffering from incompetent cervix. Once you’ve been diagnosed (and it takes seeing it happen – not losing a baby, necessarily, but seeing the cervix dilate too far), they will preventively install a cerclage in subsequent pregnancies, at the 14-week mark, long before there’s a risk of the baby falling out.
We stayed in the hospital about a week. Oddly, we were kept in rooms in the labor and delivery floor, and even followed the delivery room, postpartum and mother-baby rooms. Recovery was rough. Strict bed-rest (absolutely no unnecessary movement, and no orgasms) for a couple months was even harder. My wife had really looked forward to being a fit mom, working out and eating well. It was very frustrating for her to not be allowed even to walk around the house unless she was headed to the bathroom. Thankfully, her parents are very nearby. We stayed with them for two or three weeks. That way, I could go to work, and someone could be there to get her food, water, etc. when she needed it.
The cerclage held quite well, until some time around 32 weeks. My wife started dilating. It was only a little, and nothing to be concerned about. Many women start dilating weeks before birth. At about 36 and a half weeks, though, my wife’s water broke, and when we arrived at the hospital we found she had also dilated a bit more. We had our son the next day.
That night, though, they had to remove the cerclage. At about 3 AM. They asked, “Are you planning to get an epidural?” My wife told them she was not. Then they jumped right into trying to find and snip the knot in the cerclage wire, without any form of anesthetic, and without really preparing her at all. She said the pain was excruciating, akin to that of a cervical biopsy. After one of her cries startled the on-call doc, causing her to jump, she re-evaluated, got some different instruments, and slowly walked my wife through the procedure, letting her know everything she was doing before she did it. This worked like a charm. We found out later they had never performed this procedure on a woman who had not been given an epidural. If you find yourself in this situation, remember two things: a weighted speculum and a slow, verbose walkthrough can make a world of difference for your wife.