Let’s discuss the pessary

As I’ve mentioned, I am using a pessary in this pregnancy.  The specific type of pessary is an Arabin pessary.  This pessary was developed by Dr. Arabin who is a doctor in Germany.  I first heard of pessaries being used in twin pregnancies in my twin loss support group when a girl subsequent to her twin pregnancy became pregnant with twins again, and had a pessary placed in a rescue situation at 19 weeks when her cervix was between 1.7cm and 2.4, depending on pressure being applied or not.  You can read her rollercoaster story here.

https://alexandriakerrigan.wordpress.com/2015/04/10/twin-pregnancy-after-twin-loss-week-21/

Prior to her mentioning it, I had never heard that word, and in fact, didn’t even know how to say it when I began researching it!  There are many different types of pessaries, and the most common use is when the uterus has prolapsed.  This explains why, when I initially mentioned use of a pessary to my doctor’s nurse, she didn’t understand how that would do any good! 

The reasoning behind why the Arabin pessary works is the pessary supports the cervix and causes the cervix to shift slightly, which helps take weight and pressure off of the cervix.  In my own words, it is almost disbursing weight from being directly on the cervix in order to help relieve pressure on the cervix.  It’s been used in Europe, but is still not common in the US.  Here is the website for the doctor who invented this.

http://www.dr-arabin.de/e/cerclage.html

Since learning more about this, and joining an incompetent cervix group on facebook, I’ve since seen women who have contacted Dr. Arabin directly via email and he has helped “size” them for the pessary, and then they have ordered it directly from him and he has provided guidance to their obs for how to place the pessary.  So, that might be an option if any of you are reading this and your ob says they don’t have access to it (like the Tulsa MFM told me).  Remember, be proactive! 

Also, just google “pessary use in twin pregnancy” and you will see lots of links to studies and information about the use of the pessary in twin pregnancies.  It seems to be picking up ground, and I see more and more information about it every time I google it.  I am very encouraged at this increase in information.  There isn’t enough being done for women who find themselves in this situation (pregnant with twins after a pregnancy loss due to pre-term labor or incompetent cervix), and I’m glad to see more proactivity instead of just the wait and see mentality, which honestly just isn’t good enough.

Hopefully the above information is useful to somebody!  Honestly, if this post reaches just one person and helps them be proactive with their ob and helps save their baby’s or babies’ lives, it is so worth it to me! 

I want to share a little more about the placement of the pessary.  So, as I mentioned, we went around 15 weeks to have the pessary placed, which was on November 18.  I was 15 weeks 3 days at that point, to be exact. 

Before we had the pessary, we had an ultrasound.  During the ultrasound, the tech had looked at my chart and noticed I was getting a pessary, or, I guess, asked if I had it already.  I did something stupid and asked her how big the pessary was.  Really, I shouldn’t have.  I had avoided thinking about the actual size for weeks, but, then, I just couldn’t help myself.  When she held up her hand and showed me (slightly bigger than a baseball in diameter), I thought there was no way I could handle that!  I already had so much anxiety going into that appointment.  I honestly was so scared about how much it would hurt, and that did nothing to make me feel better.  The tech told me that it would hurt, that nobody walked out of there saying, that wasn’t that bad.  She wasn’t doing that to be mean, I had asked, and that was the honest answer she gave, which I appreciated.

We left the ultrasound room and went into an exam room to wait for the pessary.  I was kinda surprised, I didn’t have to have my legs up in stirrups, which I honestly think helped my anxiety somewhat.  I hate those things (you’d think I’d be used to them by now)!  Instead, Dr. F just pulled out the table extender and had me bend my knees and rest my feet on that.  Oh!  But first, I should say, before I laid back, I saw the pessary and I’m sure my eyes got huge.  It was a lot bigger than the size I had minimized it to in my mind.  Foolish me!  I went in thinking, ok, surely this thing is about the size of a golf ball.  Nope!

Dr. F checked my cervix before placing the pessary, and said it was good.  It was long and closed, and hard, which is a good thing.  I, of course, winced when she did that and I remember she kinda said something like, oh just hold on if that hurt.  *cry*

So, next, for the fun part.  Thank goodness Dr. F has little hands!  She put some lube on the pessary, folded it in half, and very quickly “shoved it up there”, for lack of a better way to describe it.  It hurt like heck, not going to lie.  However; I’m so glad she’d done it before because it was over in about 10 seconds.  Actually, probably less, but you know, when you’re getting a large ring and somebody’s hand shoved up there, seconds feel like minutes!  And, to be completely honest, although it hurt like crazy, it wasn’t as bad as I had made it out to be in my mind.  I think mostly because it was over so quickly and she got it in the right spot on her first try.

Afterwards, she had me go to the bathroom to make sure I could urinate, which I could, so that was good.  She asked me how I felt, which was a little hard to describe, so she said, full in there?  Yep, exactly, full in there.  It was definitely a different feeling.

 

I asked her if coughing or throwing up could cause it to come out (because that was when I still had my awful cough), and she said no.  In fact, this is hilarious, she said pretty much the only way it could come out is “if it gets stuck on him (and points to Dusty)”.  Dust and I were both like, uh, no!  She went on to say, “which you shouldn’t be doing anyway, don’t be doing that any more” and we were both like, oh!  We aren’t!  Don’t worry!  Lol!  It was a funny moment!

For about a week after having it placed, I finally started to get over the fear of coughing it out, peeing it out, whatever!  It did take about a week before I stopped worrying about it though!  Since then, I really haven’t noticed it too much.  I will say, I think I’ve felt it when I’ve gone to the bathroom at times.  I feel just something that seems like it is pressing on my bladder and causing a change in my ability to potty.  I still can, but not as easy as before.  This, of course, though, could just be pregnancy in general. 

I’ll do another post very soon to catch up on my cervical checks since getting the pessary, and how the visits with the MFM have gone so far!  Please feel free to leave comments with questions and I'll gladly answer them!

(disclaimer - this is all my own opinion, not medical advice, I am by no means a doctor nor do I give this advice as anything except my own personal experience)