For a few weeks, I have had writer’s block. I haven’t been able to bring myself to pen anything. And the reason is crystal clear to me. As a number of people in this community already know, one of my closest friends recently suffered a miscarriage…at 17 weeks. That loss devastated me more than almost anything I have ever experienced.
Anyone who knows me knows I have 2 best friends (they used to be 3, but that’s a story for another day). We are a tag team, and I have written about them often on this blog. One of them, I’ll call her Mrs. G, has been my best friend for 22 years, and the one I wrote about in My Sister’s Keeper. She is my absolute ride or die, and knows me better than anyone. She is also super duper fertile, and has 2 gorgeous kids. The other one, Mrs. S, has been my best friend for 11 years, and is the most studious and efficient person you can imagine. They both have hearts of gold!
Mrs. S got married a little later, about four years ago, and unfortunately didn’t conceive right away. Last year, she had a myomectomy to remove huge fibroids, which had been disturbing for a while. With the fibroids gone, she was now able to really try for a baby. Alas, they got hit with yet another stumbling block. Her husband was diagnosed with low sperm count. They then decided to give IVF a go. Before she tried, whilst I urged her on, I was also quick to to tell her there were no guarantees, and that there was the possibility of failure, so she was able to manage her expectations. Then she took her first pregnancy test, and neither of us could see a second line. We immediately assumed it had failed, and I proceeded to console her, give her pep talk, and encourage her to try again. But, as our God would have it, she e-mailed the same picture to her IVF Doctor (whom she had formed a close friendship with), who just happened to open it on her laptop and, through the much larger screen, she could see a faint line. When I expanded the picture on my phone, there it was! A gorgeous line! It was a BFP after all! We were so over the moon for this miraculous baby!
At 12 weeks, her IVF clinic handed her over to the Ob/Gyn of her choice, to see her through the remainder of her pregnancy. For some reason, Mrs. S took an instant dislike to my own beloved, longtime doctor, so that ruled him out. She then opted for a very popular clinic in Victoria Island. For a lot of reasons, neither Mrs. G nor I were pleased with this decision. In 2007, we had lost a very dear person in that hospital…someone very close to the 3 of us…largely as a result of their carelessness. So, since that time, that place has always gotten a thumbs down from me. But Mrs. S seemed happy with her choice, and we respected it.
Then came the decision of whether to have a cerclage (cervical stitch) or not. If you have been reading my articles long enough, you’ll know that I am a confirmed apostle of this procedure. Even though I don’t know, and probably will never know, if I have an incompetent cervix (because if I get pregnant again, I’m definitely going to have it placed again), for the mere fact that my Mother did have one, and had to have the stitch placed when she was pregnant with me, as well as the fact that I was carrying twins, it was a foregone conclusion that I would also get one. And I did. And I have no regrets. Thankfully, I wasn’t the only one who thought she should get one. Her new Ob/Gyn strongly recommended it, and so did her older sister who, even though she hadn’t had it with any of her kids, didn’t want her to take any chances with the pregnancy. So, she underwent the procedure.
Fast forward 5 weeks later, on a Thursday afternoon at work, my friend felt a gush of liquid rush down her legs. In a panic, she went to the hospital, and there, the worst was confirmed. She had lost all her amniotic fluid, without which the baby the couldn’t survive. As of the time of the scan, the baby was still alive. As the pregnancy had progressed too far for an evacuation, she was induced the following Friday morning. After a long and difficult labour, she gave birth at noon the next day, Saturday. By this time, the baby, a boy, was already dead.
Understandably, she wanted answers. Why had it happened? What had caused her water to break so early? The only answer she got was that it was caused by an infection. An infection from where? Her doctor’s answers were vague and non-committal. She was discharged with the plan to return to the clinic for a full 24-week bed rest, with her next pregnancy.
She wasn’t satisfied with this explanation at all, and, after speaking with a close relative in the States, chose to take advantage of the time off her employers benevolently gave her, and travelled to see this doctor in Houston, a Nigerian, who proceeded to run extensive tests on her, and he also concluded that it was caused by an infection. But he also pointed a more damning finger, pin-pointing the cerclage she’d had as the culprit. He was furious that her doctor had recommended it, and lamented how so many Nigerian women he met got this when they really didn’t need to. He too proposed that she return to the States as early as she could, with her next pregnancy, where he would help her monitor it, without the need for a cerclage.
When she told me this, I was floored! Was it this same cerclage that had helped me? This same cerclage I know had also helped a lot of other women carry their babies to term? Yes, one of the common side effects of the cerclage is an increased risk of infection, and I got a few towards the end of my pregnancy. But these infections were mild, and my doctor had been able to control them. Also, I have two other close friends who had suffered this same type of miscarriage, one at 19 weeks and the other at 23 weeks, neither of whom had gotten the cerclage. Was it possible that this Nigerian doctor in Houston was just trying to sell his market? It got me thinking…and reading.
I found out that infections are one of the common causes of this kind of Preterm Premature Rupture of the Membranes (PPROM), but not the only one. Heavy smoking (more than 10 cigarettes a day) has also been known to cause it. However, none of the women I know that had it, smokes at all.
According to my research, the womb, the amniotic fluid and the environment in which the baby develops is supposed to be sterile, but sometimes micro-organisms find their way into this environment. These are usually harmless natural bacteria, but have migrated to parts of the body where they shouldn’t be. The most common cause of this intrauterine infection is through the vagina and cervix, but it can also come through the placenta, through the fallopian tubes or through invasive procedures (amniocentesis, cervical stitch, etc.). Infections that could ascend to the womb include E-Coli and Group B Streptococcus (GBS), Bacterial Vaginosis, Chlamydia, Trichomona, Gonorrhoea, Syphilis and HIV (but not thrush). If the infection reaches the womb, it could cause the fetal membranes (membrane of the sac that surrounds your baby in the womb) to become inflamed and infected. This is called Chorioamnionitis, which is an infection of the membranes of the sac that holds the baby. It causes the membranes to become inflamed and this may in itself trigger preterm contractions. It could also cause the waters to break early, leading to a PPROM. When an infection causes PPROM, the waters are no longer sterile, and the baby may need to be born soon, to prevent a more serious infection.
So, I guess it is true that the cerclage could have been a trigger for this after all. But I also realised that there are a plethora of other ways this could still happen. My friend who lost her baby at 23 weeks, and her husband, were diagnosed with a serious infection after this loss, and were placed on a heavy course of antibiotics afterwards. Luckily, she conceived shortly after, and has a son today.
My dear friend, Mrs. S., is back in the country now, and has even resumed work. As she works towards another IVF cycle, and as we pray that she is also successful with it, we are now left wondering what she should do then. Get the cerclage and go on the 24-week bed rest with the Lagos hospital? Or hop on a plane as soon as she can manage it, and be managed by the Houston guy? Left to me, I would have preferred the first option, except for the fact that I can’t shake my distrust of the Lagos hospital she used. If they were careless enough to kill my friend in 2007, who knows if it was their carelessness at the point of the placement of the cerclage that is to blame for her miscarriage?!
But it doesn’t appear that she will go the cerclage line with the next pregnancy and, given her experience, I can’t really blame her. She has been beating herself up with so many ‘if only’s’, that even I feel guilty for encouraging it…even though I probably still won’t stop recommending it to people. Maybe she was just unlucky? Maybe her body is way too sensitive? Maybe the hospital was careless? Who knows? We’ll just have to pray, and hold on to God, and trust Him to guide her path, while doing everything she can to stay as healthy and infection-free as possible.
God help us all!
With References from: http://www.tommys.org