What is an incompetent cervix? A mom shares her story
After Geraldine Monaheng* was diagnosed with an incompetent cervix, she received a cervical stitch and was put on bed rest to try to save her baby’s life. But it’s been a far from easy road for her...
“I was 14 years old when I was diagnosed with polycystic ovary syndrome (PCOS) and a prolapsed uterus. Pain was a part of my life,” 27-year-old trained nurse Geraldine remembers. “At 21, I was operated on to remove a cyst in my womb and was told I had severe endometriosis (a painful condition where the lining of your womb grows outside your womb) and would struggle to fall pregnant.”
When Geraldine got married, she wanted to have a baby, so she sought help from a fertility centre. She was given the hormone progesterone to help – and she became pregnant almost immediately.
Geraldine’s job as a student nurse involved heavy lifting and pushing of people and machinery. “At 22 weeks, at home in bed, my membranes ruptured. At first I thought my bladder was leaking, but I actually knew something was wrong. Still, I went to work, where one of the sisters told me to go to my gynae immediately.”
Geraldine was 4cm dilated. Her doctor diagnosed an incompetent cervix, which means that her cervix was too weak to hold the baby inside her. The baby was coming out.
In cases such as these, doctors can sometimes put a stitch in the cervix to sew it closed in order to try to save the baby’s life.
But because her waters had already broken many hours before and he didn’t know how much amniotic fluid had been lost, the doctor advised Geraldine that he could not do a cervical cerclage on her, as the foetus may already have suffered too severe an injury. “I delivered the baby normally,” remembers Geraldine. “I held her in my arms until she passed on.”
- Also see: Know your uterus
But there were more hardships to come for this devastated young woman. In two weeks she was facing nursing exams. When her sister gave birth, she found herself unable to hold or look at her nephew. But worst was the rejection closest to home: “My husband couldn’t understand why I lost the baby. I would greet him in the morning and he would ignore me. As I had failed to give him a child, he impregnated someone else.”
Geraldine’s mother-in-law told her that her son should marry someone else, because it was clear Geraldine didn’t want children. As an orphan, Geraldine doesn’t have a mother or grandmother to take her side and support her.
Zamo Mbele, a clinical psychologist in Johannesburg, empathises with Geraldine’s experience:
“Geraldine has had to endure poor family, societal and professional support. It is common in South Africa to underemphasise the psychological damage of such ordeals. This may have not always been the case. Under the age-old (and possibly clichéd) practice of Ubuntu, such young mothers would have received the necessary support from their family and community. But Geraldine’s experience is a devastating consequence of the erosion of the former ideal.”
Still, Geraldine found her resilience – by herself. “I attended counselling, alone. After being advised by an old tannie nursing sister at the hospital where I work, I went to work in NICU to lose my fear of babies, especially preemies. I held those little bodies, I cried and I celebrated with the mothers because I had my own experiences to remember.”
- Also see: Maternity jargon explained
Just in time
By last year, Geraldine was ready to try to conceive again. Using the fertility medications, she once again fell pregnant quickly – and this time, she was ready.
After some misdiagnoses and changing gynaes twice, Geraldine began treatment with a doctor she trusted, who knew she would have to have a stitch in her cervix in order to keep this pregnancy. Although the usual time for the procedure is at the end of the first trimester, the doctor suggested Geraldine aim for 16 weeks.
But when Geraldine emerged from the procedure, her doc told her he had managed to do the stitch just in time – her membranes were already protruding through her cervix.
Geraldine is now on bed rest and well into her third trimester. She’s finding it heavy going: she’s worried, in pain and her movements are restricted. But her discomforts are once again not just physical.
“Most people in my community attach a stigma to this condition, and people don’t understand it,” she explains. “Sometimes the woman is blamed – why is she like this? My visitors wonder why my husband must make my food and do the laundry in my house.
“I can’t have sex or risk losing the baby, and I have seen my husband looking up the numbers of singles and escorts on his phone,” she continues. “I have spoken to his brother about this, who promised to address it with the elders – nothing came of it.”
- Also see: Rheumatoid arthritis in pregnancy
Yet another failure
Geraldine’s gynaecologist lives far from her, and she was concerned about not being able to get to him in time, should she suddenly go into labour. So Geraldine took the responsible step of signing up at her local government clinic for antenatal care. “The sisters asked me about my stitch. ‘How many babies have you lost?’ they asked. ‘One,’ I said. They told me I am not supposed to get the stitch until I have lost three babies.”
Stories about uncompassionate treatment from nurses in South Africa’s healthcare services are legion. For the record, there’s no official Department of Health policy stating that three miscarriages must be recorded before a woman will qualify for a cervical cerclage.
However, according to a 2013 article by EC van Niekerk et al in the South African Journal of Obstetrics and Gynaecology, “the American Society for Reproductive Medicine defines recurrent pregnancy loss as two or more failed pregnancies.[...] They suggest that some investigation must be done after each miscarriage, with a thorough evaluation after three or more losses.”
But the cumulative effect of all these failings have taken their toll on Geraldine: “Wherever I look I see no love and no support, not from our men, not from our families, not from our health services.”
The treatment of women in our society too often falls short of even basic decency. As Zamo says, “Geraldine’s trials are an injustice in many ways, including constitutionally and ethically, and at the same time, we know there are many Geraldines with similarly horrendous experiences living among us. These victims are left with many different sorts of scars, and some of the most difficult to confront and deal with are the scars on the inside.”
“When an individual experiences this level of trauma, loss and rejection, attempting to heal their psychological wounds is often overlooked,” says Zamo.
But he advises Geraldine nevertheless to seek support wherever she may find it:
“It may be important to focus on what support you need, who can give you that support, and why support is so important during these times.”
Zamo suggests that you continue to seek help if for your trauma. Family, friends, a counsellor, a social worker, or a state hospital psychologist and psychiatrist are a good place to start if you can’t afford to pay private healthcare rates. FAMSA, SADAG and LifeLine will help you find help.
- SA Depression & Anxiety Group (SADAG) 0800 20 50 26, www.sadag.org
- Families South Africa (Famsa) 011 975 7106/7 (phone for an office near you), www.famsaorg.mzansiitsolutions.co.za
- LifeLine, 021 461 1113, www.lifelinewc.org.za
*Name has been changed
- Also see: An incompetent cervix
What is cervical cerclage?
If you have a history of late spontaneous miscarriages, a weakness in your cervix might be the cause. Since 1957, though, doctors have been inserting a strong suture (or stitch) into the cervix to artificially keep it closed and unable to dilate until the end of pregnancy.
There are three types of cervical cerclage. The McDonald cerclage is a purse-string stitch which is usually removed again before delivery. A Shirodkar stitch might mean that you have to have a c-section as the cervix is permanently stitched. A last option is to place a band or tape around the cervix inside the abdomen. The procedure can be done under general or spinal anaesthesia.
You may be placed on bed rest and be booked off work for the rest of your pregnancy, and you won’t be allowed to have sexual intercourse.
Cervical cerclage has a success rate of allowing up to 90 percent of women (whose cerclages were not performed as emergencies) to carry to term (in this case, term is considered to be 37 weeks).
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