In this the second part in this brief series on cervical insufficieny/incompetent cervix, Bedrest Coach Darline Turner offers another potential cause of CI/IC- inflammation-and discusses the role of 17 Alpha-hydroxyprogesterone caproate (17P).
The incompetent cervix is far and away the most common reason that the mamas in our community are on bed rest. Some come with shortened cervices. Others come with funneling. Many mamas have both cervical conditions. In this video blog, I try to give a little insight into just what is going on with your cervix-demonstrating with clay models. I’m no Michelangelo, but I think you’ll get the point. Be sure to check back for our follow up post on the effect of inflammation on the cervix.
There are a myriad of reasons why mamas are prescribed bed rest during pregnancy. However, in the Mamas on Bedrest & Beyond community, having an incompetent cervix is by far the most common indication.
What is an incompetent cervix exactly? An incompetent cervix (or cervical insufficiency) is when the cervix does not remain closed and elongated during pregnancy, resulting in or putting a mama at risk for preterm labor.
So the first question a mama asks when she is diagnosed with an incompetent cervix is, “Why won’t my cervix stay closed? An incompetent cervix may be the result of,
- Previous surgery on the cervix
- Damage during a difficult/traumatic birth
- Malformed cervix or uterus from a birth defect
- Previous trauma to the cervix, such as a D&C (dilation and curettage) from a termination or a miscarriage
- DES (Diethylstilbestrol) exposure
But in a large number of situations, there is no readily identifiable reason for the incompetent cervix.
Kathleen Kendall Tackett, Ph.D., IBCLC, FAPAand her colleagues have indicated another reason for the incompetent cervix-inflammation. As a result of the inflammatory response, chemicals released into the bloodstream act on the cervix to soften it, cause it to shrink and essentially “ripen” in much the same way it would at term in response to the initiation of labor. But of course, cervical ripening in the second or third trimester before 37 weeks gestation has undesirable effects, mainly preterm labor, premature delivery or, sadly, miscarriage.
Why is the inflammatory response activated in pregnant women? The main reason that the inflammatory response is activated is stress. Stress or the “Fight or Flight” response prepares the body for battle, activating a series of physiologic changes that will aid the body in the event of trauma or injury. While the “Fight or Flight” Response is completely appropriate in the face of trauma or injury helping to mitigate the damage to the body’s cells, it is an excessive response to stress and/or depression, the common psychological reasons for stress.
Now many of you reading this may be saying, “I’m not stressed. I’m busy, I have a lot on my plate.” Exactly! “Having a lot on your plate”, excessive worry…They can all illicit a stress response and start what is called the inflammatory cascade- Neurochemicals released in response to stress, acting on the cervix to ripen it. When the cervix opens, shortens and thins before 37 weeks gestation, then preterm labor is the risk.
Treatments for incompetent cervix are bed rest, a cerclage (surgically stitching the cervix closed) and progesterone supplementation. The goals of the therapies are to relieve pressure on the cervix (bed rest), keep it closed (the cerclage) and to maintain cervical integrity and relieve inflammation (progesterone). Mamas may be prescribed any one, combination or all of the therapies for incompetent cervix.
I want to add one more vital therapy to the management of incompetent cervix-stress reduction! While bed rest may initially (and over the long term) actually exacerbate a mama’s stress, it is important that mamas do all that they can to keep their stress levels low. Low or no stress shuts down the inflammatory response and as a result, the neuro-chemicals released as part of the inflammatory response are no longer released and available to act to soften the cervix.
So what are the best ways to reduce stress? According to Mamas on Bedrest:
- Watching TV/movies
- Participating in community forums
- Talking with family and friends.
Mamas, do all that you can to reduce your stress. If you are put on bed rest, it may seem next to impossible not to worry. But worry, stress and anxiety work against you and your baby. Do what you can to calm your mind, open your heart and relax.
How are you staying calm while on Bed rest? Share your insights in the comments section below.