My Experience with an Incompetent Cervix

At 19 weeks and 2 days pregnant, I was making my way to the hospital for my anatomy ultrasound. This usually being a pregnancy milestone, my mind was elsewhere, thinking about my packed schedule of patients. Besides, this wasn't my first rodeo. My first pregnancy was smooth sailing from start to finish. In fact, I was that annoyingly smug pregnant woman who loved every second of it and boasted about how I could do it ten more times (yeah, current me is rolling her eyes so hard they might just stay that way).

So, I figured I knew what to expect today. Spoiler alert: I did not.

I laid in the dim ultrasound room, listening to the click-clack of the tech labeling each part of my baby like she was coding a program. Every now and then, I glanced at the screen to see the usual suspects—10 fingers, 10 toes—everything seemed in order. My eyes kept darting to the clock, though. Forty minutes until my first patient. I was getting restless.

“Was your first child premature?” the tech asked out of nowhere, catching me off guard.

“No, actually, she was nine days late!” I laughed, mentally cursing my daughter's impeccable timing as I snuck another glance at the clock.

The tech smeared more gel on my belly. “Any previous miscarriages?” she asked, still focused on the screen.

“Yes, I had a first-trimester miscarriage before this pregnancy,” I replied. “Nothing in the second trimester?” she asked again. “No. 10 weeks, and I had a D&C at 12,” I answered, probably a little too quickly.

She went back to her screen, expressionless. She’s just confirming my history, I thought, trying to shake off the unease creeping in. 

A few more minutes passed before she finally said, “Okay, you can get dressed.” I hopped off the bed, thinking, great! I’ll grab a coffee before heading to the clinic. Pants half-on, I was already mentally crafting my to-do list, when she spoke again.

“We need you to wait in the waiting area. I need to check something with the radiologist.”

Uh-oh. If you’ve ever had a gynecological ultrasound, you know they don’t keep you waiting unless something is wrong. Still, I convinced myself that it was probably nothing—just a fuzzy image of an organ they needed to re-check.

I updated my husband, and we waited...and waited. Twenty minutes later, the tech returned. I was sure we were about to be sent home, but instead, she looked me in my eyes said, “Sandra, we need you to lay down immediately. Please follow me back to the room.”

Lay. Down. Two words no woman wants to hear at 19 weeks pregnant. My heart started racing. My husband looked at me, worried. “What’s going on?” he asked.

“I don’t know, but it can’t be good,” I replied, trying to keep calm.

We were led into a brightly lit room and I climbed onto the stiff bed. My mind was spinning, but I tried to hold it together. My husband squeezed my foot at the end of the bed. He was trying to stay strong for both of us, but I could tell he was scared.

The tech came back and explained that my cervix was much shorter than expected—less than half the length it should be at this stage. To add to that, it was also "funneling," meaning it was opening at the top, where the baby sat.

“What does that mean?” I asked, suddenly feeling clueless despite being my expertise in the women’s health field. Shouldn't I know this?

“It means you’re at risk of going into labor any day now.”

I felt the ground fall out from under me. After surviving a brutal first trimester with heavy bleeding, a genetic test scare, and nonstop nausea and vomiting, this was the last thing I expected.

From there, I was quickly referred to Mount Sinai’s high-risk pregnancy team and instructed to head there immediately. My husband and I scrambled to find childcare for our daughter, then rushed to Toronto. I’d had given birth to our first daughter at Mount Sinai and  felt a weird sense of comfort when we arrived. But this time was different—really different.

We checked in and waited, surrounded by women about to be induced, happily eating their last meals before baby arrived, and I could feel my stomach grumbling. I was told to not eat or drink anything in case I had to go for surgery. After what seemed like days of waiting, they called me in for another ultrasound. I prayed the first tech had made a mistake and that I would be soon sent home to continue my pregnancy as usual, but to my disappointment (and gratefulness in retrospect), she hadn’t. My cervix was barely 12mm—way below the expected 35mm for my gestational age.

The doctor laid out my options: wait and observe for a week or go for surgery tonight. The surgery - called cervical cerclage - would include suturing up my cervix with the goal of maintaining my pregnancy for as long as possible. The risks? One of them was going into labor with an unviable baby, which also happened to be the risk of not doing the surgery. Yay, motherhood—where all choices seem impossible.

After many tears and desperate Googling, I opted for the surgery. The next few hours felt like an eternity, but eventually, just after midnight, I was wheeled into the OR. The room was ice cold, but I focused on staying positive as the anesthesiologist walked me through the epidural. It was my first, since I’d gone unmedicated with my first daughter. 

With my lower half mercifully numb, the surgery began. I chatted with the anesthesiologist about random and unrelated topics—anything to distract me from the pressure building in my abdomen. About 15-20 minutes later, the surgery was complete and I was rolled back to my room, exhausted but relieved.

Other than suffering a post-epidural headache, the next week was spent in bed, focusing on recovering and processing all that had happened.

The next five months were a blur of weekly ultrasounds, movement restrictions, and constant anxiety. Every bit of pressure felt like the baby might come. I couldn’t lift my 3-year-old, and I had a clinic to run while navigating my own pregnancy struggles.  Physically and emotionally, this was one of my biggest challenges.

At 28 weeks, I hit a huge milestone—the baby’s survival rate shot up to 80-90%. I was discharged from high-risk care and sent back to my midwives. Each week after that felt like a victory.

Finally, at 38 weeks, it was time to remove the cerclage. Though this is normally done at 36 weeks for most patients, we knew that my baby was breech (head up and feet down towards the cervix) and they wanted to give me a couple more weeks to see if the baby flipped to optimal position, but unfortunately, she didn’t. The plan with my midwife was that she would also perform an ECV - a maneuver to attempt to flip the baby by applying pressure and specific movements to my external belly. 

I arrived at the hospital, feeling proud for making it this far. But, as with everything in this pregnancy, there was a twist.  As the OB palpated my cervix, I noticed a look of confusion on her face and ever so slightly panicked again. She then decided to proceed without the speculum and that’s when she discovered the biggest shock in this journey so far: I was already 5cm dilated and in full active labour. To top it off, my baby’s foot had kicked her through my water bag. 

“We need to prep the OR for a C-section,” she said.

Wait, what? I quickly turned to my midwife and she instantly read my face. She followed the OBGYN out of the room, and I could faintly hear her asking if there was anyone on the team qualified to deliver a breech baby. She came back a few minutes later and told me that that the risks were just too high and that she could not perform the ECV since the baby was still breech against an open cervix.

I was devastated. 

After all the preparation for a vaginal birth and the anticipation of a quick labour, I felt robbed of the experience I wanted for myself and my baby.

I remembered all my patients who had gone through a caesarean section and the support and education I provided them. I was in the best position to go through this surgery with all the education I had. I knew I was strong mentally and physically and that I could endure this. I also felt grateful to be in place of well trained medical professionals that would take care of me and my baby. 

The C-section went smoothly, and as I held my baby girl, I realized something: every fear, every hard decision, every tear—it was all worth it. It was all part of her journey to get here.

And I wouldn’t change a thing.