AN incompetent cervix, also called cervical insufficiency, occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.

Before pregnancy, the cervix — the lower part of the uterus that opens to the vagina — is normally closed and firm. As pregnancy progresses and you prepare to give birth, the cervix gradually softens, decreases in length (effaces) and opens (dilates). If you have an incompetent cervix, your cervix might begin to open too soon — causing you to give birth too early.

According to Mayo Clinic, an incompetent cervix can be difficult to diagnose and treat. If your cervix begins to open early, or you have a history of cervical insufficiency, your doctor might recommend preventive medication during pregnancy, frequent ultrasounds or a procedure that closes the cervix with strong sutures (cervical cerclage).

If you have an incompetent cervix, you may not have any signs or symptoms during early pregnancy. Some women have mild discomfort or spotting over the course of several days or weeks starting between 14 and 20 weeks of pregnancy.

There is no “cure” for cervical incompetence, but to lower the chances of the cervix opening too early a cervical cerclage was recommended for my second pregnancy after my previous experience with pregnancy loss at 22 weeks.

A cerclage is when a strong suture (stitch) is sewn into and around the cervix at around 14 to 16 weeks of pregnancy to keep the baby inside the womb to prevent preterm labour. In addition to the cerclage, taking progesterone was also recommended. It is administered vaginally and taken at the eighth week to the 36th week of pregnancy. He explained that this was to “keep the uterus quiet” while the baby develops. I felt overwhelmed even though I had read about cervical incompetence and knew that this was the best way to bring the baby to term. It was frightening to hear, still, but the unconditional love I had for my baby conquered my fears; I was ready to do whatever it took to bring her to viability.

An incompetent cervix poses risks for your pregnancy — particularly during the second trimester — including, premature birth, pregnancy loss.

After my first ultrasound at six weeks, I experienced light bleeding at eight weeks. This happened at 2:00 am and I was terrified that this pregnancy would end way sooner than the previous one. I wasn’t experiencing cramping and the bleeding was extremely minor, but the sight of blood while pregnant (especially after losing a baby) caused instant panic. I called my doctor immediately and he assured me that this is normal, but knowing I have a problematic cervix kept me up all night so he advised me to do an emergency ultrasound. The sun slept in that morning, because it felt like 2:00 am would not move.

The ultrasound appointment concluded that it was implantation bleeding which is completely normal. Not all women will actively notice this or even experience implantation bleeding (another scare that happens to the minority). I was eager to have the procedure done. I anxiously counted the weeks so I could have it done to lessen my worrying and anxiety. All my fears of getting the procedure done moved swiftly to the background and impatience stepped in.

I had the cervical cerclage procedure done at the Victoria Jubilee Hospital in October 2020 by an amazing doctor and a very patient and understanding anaesthesiologist. The entire medical team in the room during the procedure was surprisingly pleasant and professional. However, I had to wait a week in the hospital to have it done since there’s not enough theatres to facilitate surgical procedures in a timely manner. Emergencies are top priority, naturally, but you can imagine how frustrating it was to wait with uncertainty — especially since we are only allowed to eat the food they provide while pregnant with raging hormones and sporadic cravings. I admit I grew impatient, as no official update was ever provided, I had to keep asking the nurses who directed me to the doctors who never really gave me any answers regarding a date. The reality was that I just had to wait because it was a preventative cerclage rather than an emergency one.

When it was finally time to have it done, my impatience was replaced by nervousness. Even though mentally I was ready, my body is never informed ahead of time so everything I went through physically during this pregnancy came fast and sudden for my body. The room felt like the first day of winter (you’re expecting a change in temperature, but it’s still shocking when the cold breeze touches your skin). The anaesthesiologist entered the room first and explained that she’d administer an injection that would make me numb from the waist down (spinal epidural). She also injected fluids in my access (or more drugs) and assisted with finding a comfortable position for me. The surgeon entered shortly after, introduced himself and proceeded. The procedure was done trans-vaginally and even though I was numb on the outside, I felt tucks and pulls and it certainly was not pain free. The anaesthesiologist coached me along and was very supportive throughout the entire procedure. I was grateful that I was finally able to get the needed support in a challenging and scary time at the Jubilee Hospital; because in reality the procedure lasted a half hour, but I felt like I was laying with my legs hoisted in the air for hours.

After it was done every discomfort left my body and blended with the numbness of the epidural, and for the first time in my pregnancy I felt like my baby was safe.

I experienced bleeding six times throughout my pregnancy. However, only implantation bleeding at eight weeks could be explained and I was hospitalised for two separate bleeding incidents. At 25 weeks I experienced the biggest scare — blood running down my legs like I had definitely miscarried. My body felt numb and the only feeling I had that secured hope was my baby’s nudges and kicks reminding me that she was going nowhere until my body naturally let her out to meet me. The bleeding gradually got less as I made my way to the hospital. It practically disappeared when I arrived, but I was still kept overnight for observation. All tests performed came back normal and they could not conclude from where the blood came. However, the baby was fine and the doctors saw no cause for concern. At this point, getting off the bed to walk made me nervous. I tiptoed my way through the the second trimester as an even bigger threat awaited — COVID-19.

For the majority of my pregnancy I entertained minimal outdoor activities, but I somehow contracted the virus and had to be hospitalised again. My hospital stay was only for a day because I had trouble breathing and the hospital was not equipped with a CT scan machine to check and see if the breathing problems were as a result of clotting on my lungs. For the 14 days of my quarantine I had to be injected twice daily to prevent further clots, if any existed to begin with. Thankfully, the CT scan came back normal.

My baby girl hung tight in her temporary home, and I had no other complications for the rest of my pregnancy.

I removed the cervical cerclage at 38 weeks. Removing it was more invasive than getting it. There was no anaesthesia involved. It was a matter of the doctor finding the stitch and pulling it loose to remove it. As usual, I was a champ, even though I wanted to close my legs and scream at the top of my lungs. It was a hard 30 minutes. The whole half-hour was filled with me biting my lips to keep in the screams and visibly sweating. But, again, my anxiety of having my baby any day after the cerclage was removed helped me to conquer the pain and any other fears that still loitered.

Of course, I stayed overnight for observation. I began to dilate but it stopped at three centimetres, so I was discharged the following day to go home and wait for her to knock on my cervix and make her way out! Everyday was filled with anticipation, but to everyone’s surprise, she went to 40 weeks. I didn’t feel or see any signs of labour and I became worried that she’d be overdue and I’d have to be induced. I wanted to have her naturally, so I googled ways to help start the labour process, which led me to stretching exercises. I did as many as my body allowed. I cannot confirm that it was the stretches that helped, but I went into labour that same evening, one day after my due date.

The contractions were manageable and I even timed them before leaving for the hospital. Given the nature of my pregnancy, I can attest that giving birth was the easiest part. My water broke, and I only pushed once, and there she was, but with the umbilical cord around her neck. So the nurse advised me to stop pushing and removed it quickly. It may sound super corny but holding her for the first time in all her stickiness and goo was the happiest moment of my entire life. I don’t know how I managed not to cry because she was absolutely perfect, very tiny, yet everything I needed — my perfect little bean that I grew and brought to life.

Further, while you can’t prevent an incompetent cervix, there’s much you can do to promote a healthy, full-term pregnancy. If you’ve had an incompetent cervix during one pregnancy, you’re at risk of premature birth or pregnancy loss in later pregnancies. If you’re considering getting pregnant again, talk with your doctor to understand the risks and what you can do to promote a healthy pregnancy.

Melanie Hanchard is a mother, poet, and blogger committed to educating women on the journey of motherhood and navigating the difficult phases. Her blog posts can be read at https://melaniehanchard.wordpress.com/