Pregnancy after cervical cancer

[zanelee]

I'm waiting on my first big follow up biopsies to get pregant. A quick overview of what's going on, then my questions.

I was diagnosed with cervical cancer. Had a Leep procedure done, cancer was not all removed. Had a cone biopsy done, got all the cancer. Fast forward to last week-had my first BIG follow up (PAP and colposcopy with biopsies) and I'm waiting on those. But, assuming it's all clear we're really ready to get pregnant.
Now, my question is...anyone else have a cone biopsy done and get pregnant? Did you have a cerclage (suture in cervix to hold it shut while pregnant...to keep the cervix from dialating and expeling the baby too soon) put in as a precaution? Or did you not?
I am having a tough time with deciding what to do, as we do homebirth. If I don't have a precautionary cerclage put in, my ob/gyn would want me to come in weekly for ultra sounds to make sure that my cervix isn't dialating. Well, we can't afford to do that, and especially since my insurance probably won't pay for it. If I don't have one put in as a precaution, if my cervix starts to dilate, then I could possibly loose the baby, as we probably wouldn't know I'm dilating until it's too late. Plus putting in a cerclage in an emergency (which that would be) can cause miscarriage too.
Any advice...anyone?
TIA!

[Nathan1097]

Are you SURE your insurance won't cover it? I would hope they would, considering its related to cancer.

I agree with you- its smart to think ahead, especially if you have a chance of dilating early, because I hear that can be "silent", unlike preterm labor.

[ScootchsMom]

The weekly U/S should be covered by the insurance if they are ordered by the MD. Call you insurance and find out now so you can be prepared when the time comes.

Hugs to you for all you've been through! I had a colposcopy done because of pre-cancerous cells found during a routine pap and I remember the fear. I did a ton of research on it, and found MANY MANY women who successfully went on to healthy PGs. Some needed a cerclage, some didn't, but in the end, it doesn't matter as long as mom and baby are healthy.

I know you said you HB, but do you have a midwife? Have you discussed your options with her? Would the cerclage risk you out of homebirth?

[zanelee]

Are you SURE your insurance won't cover it? I would hope they would, considering its related to cancer.

Well, no. Not positive. I assume they won't as they cover nothing to do with normal pregnancy and delivery. Only if I were to need emergency stuff would they cover. Stupid, huh?
:

[zanelee]

Hugs to you for all you've been through!

Thank you! I need it!

I know you said you HB, but do you have a midwife? Have you discussed your options with her? Would the cerclage risk you out of homebirth?

Yes, I already asked her about it, and she was fine with it. But did want to try and work with my ob/gyn some as she's not had any experience with cerclages.
I keep trying to look on the bright side and hope that this will actually make for a quick labor and delivery next time!

[Pica]

Hi!

I had a leep done, 2 cone biopsies too. That was quite some time ago -- the leep was at the end of 2001. (1 biopsy before & 1 after).

We started ttc at the end of 2002 & got pregnant in 2 cycles.

OB was concerned about early labour or not dilating at all, he mentioned possibility of cerclage.

However, I had absolutely no problems - textbook labour. OB said he could barely see any scarring from the leep/biopsy & this was the key - luck & skill of my surgeon.

I did however get labelled 'high risk' and was closely monitored - 9 ultrasounds during the pregnancy, many of which were to measure the cervix. I also had a hospital birth (my choice).

I'd be happy to try to answer any questions -- Good luck!!

[memz]

I have been wondering about this. I had a colposcopy with a punch biopsy . Now does this mean that my cervix is scarred and I might have trouble dialating, or is it just with cone biopsys?

[Pica]

I *think* scarring is more likely to form from the leep. I have no facts to back this up, it's just the impression I got from my OB that he was more concerned about that than the biopsies

By the time I was at my OB, I was just so happy we'd been able to get pregnant!

I also think the length of time you allow for healing before you get pregnant might be a factor .... I was closely monitored every 3 months for a year after the leep & then given the ok to ttc by my specialist.:

Have hope ladies! The L & D nurses said my labour was incredible - right on schedule, progressing the way they'd been taught "normal" labours can be expected to progress. Absolutely no complications as a result of the leep/biopsies etc.

I carried DD for 41 weeks, had braxton hicks for 2 weeks straight, had my membranes stripped a couple of times, then walked around for a few days at 3 cm, and then had a ~ 9 hour labour. My water broke at home 2 hours before my scheduled induction (via breaking membranes).:

[HappiLeigh]

Originally Posted by Pica

I *think* scarring is more likely to form from the leep. I have no facts to back this up, it's just the impression I got from my OB that he was more concerned about that than the biopsies

That's the impression I had too. I had a cone biopsy and a LEEP. During my pregnancy I was closely monitored and had many ultrasounds to check for problems with cervix, but none appeared. I did get stuck at 5 cm for a LONG time during my labor, which is common when scar tissue is involved. I did make it past, however, and had a normal vaginal birth. My insurance covered all my extra ultrasounds because they were medically necessary.
Good luck to you.

[zanelee]

Hmmm...I apparently have a bit of scarring. My doc mentioned it when I went in for my first followup pap/colposcopy. You know how when they do the colposcopy, they "stain" the cervix with that vinegar-like substance...because of my scarring, she couldn't tell if any of the tissue might have changes.

She also knows of our desire to have another baby, soon. I must say, I (personally) would be too afraid to wait a year. Mostly because I'm scared I won't have the chance if we wait, (cancer returning and subsequent hysterectomy) and also we are both not the youngest ones...
So, she told us to wait at least 3 months from my cone biopsty. So, now it's been those three months and we're getting ready to work on that next baby.

[Pica]

Good luck Zanelee -

I just wanted to add I wasn't told to wait, we just weren't ready until a year later. (The Dr wasn't telling me to wait or anything - the first time I brought it up to him was at 1 year post-leep & he said go for it. Maybe if I'd asked him earlier it would have been ok.)

I hope it works out for you, just keep thinking positively!

[zanelee]

Results are in...

My pap came back abnormal, which isn't unexpected being I've had a lot of healing going on in that area.
My biopsies came back inflammatory, which is, again, most likely from the healing process.
The HPV part is still out, but my ob/gyn is expecting it to be ok too.

So, we have the go ahead to work on our next little one! I'm waiting to pounce on dh when he walks in the door!
I asked about the cerclage again, and her recommendation is that once I do get pregnant, we'll do a vaginal ultrasound to see how much cervix I actually have left. If it's over 4cm, she thinks I probably won't need one. If it's under 4cm, then she recommends one. So, I will cross that bridge when we get there.

You guys talked about calling the ins. company to see if u/s in this case is covered....how do I go about that? Do I just call and ask the first person to answer the phone, or do I need to speak with a particular dept.?
I've never called them to ask about something being covered before.
Thanks ya'll!

[oliviagoddess]

Ask to speak with pre-authorization. Your pregnancy is NOT a "normal" pregnancy - you might get stiched up, you might end up on bed rest, you might end up in the hospital with early labor at 24 weeks or you might not. These are just some of the fun possibilities with "high risk" pregnancies. "High risk" does not always mean problems, but even people who have reported textbook pregnancies have been closely monitored by their doctors, just to make sure - because you may not you your are miscarrying until it's too late.

If your doctor is worth her degree, she will call, write and tear them a new one until your are completley covered. One of the things that good doctors do is advocate for their patients. I remember getting a "we won't cover XYZ" letter from the PPO insurance company and showing it to my doctor and she flipped out! Started raving about how insurance companies want to do masectomies out patient. Took the letter and immediately called, with me right there. She also worte a letter and everything related to the pregnancy was covered.

I went into labor at 38 weeks and dialeted quickly (6 hours from 0 to 10) and my water broke, my problem was the the contractions would happen at 2 minutes and then at 45. I labored for another 4 hours until my doctor could get in and gave me petocin, I delivered 1:57 minutes later.

Our daughter had the umbilival cord wrapped around her neck and an Apgar of 4 and stayed in NICU for 4 days and since it wasn't busy, the hopital let me stay, saying insurance may or may not pay. My doctor told me not to worry, she would take care of it.

So my advice is to find out how will your doctor advocate for you with the insurance company? I think my insurance company was actually afraidof my doctor!

Originally Posted by zanelee

Results are in...
You guys talked about calling the ins. company to see if u/s in this case is covered....how do I go about that? Do I just call and ask the first person to answer the phone, or do I need to speak with a particular dept.?
I've never called them to ask about something being covered before.
Thanks ya'll!

[TheHealingRoomChir]

For what it's worth, my history sounds almost exactly like yours. I am also a DES daughter on top of all this. I had no problems with first pregnancy after the cancer. My cervix was stubborn about dilating, but eventually it did, and I had a home water birth... all was well.

I wish you a quick conception, easy pregnancy, and joyful delivery!

:-)Carolin

[zanelee]

Thank you guys sooooo much for your wisdom and wishes. Dh and I are just waiting now....
I'll post an update soon. We should have our first update within a couple of weeks....
:

[Doodlebugsmom]

I had a LEEP done in '95, and got pg with dd in '01. I got pg during the first cycle with both pregnancies. My mw said I did have scarring on my cervix from the LEEP, but I had two incredibly easy labor and deliveries. I swear they were both very fast, and as close to painless as you can get!

[indieand]

If it helps, I had biopsies including a cone biopsy in 1998, and went on to have two normal healthy pregnancies starting in 2003. I dilated normally and on time during both. That is a lot more than 3 months though...it does take a long time for the cervix to regenerate as much as it's going to. As long as you and your doctor keep a close watch on it, you should be fine without intervention.

[knittinmomma]

I had a cone bipsy in 2000 and got pregnant in 2005. Pregnancy went great, no cerclage needed. All my ultrasounds (about 5 total) were covered by insurance. I was induced at two weeks overdue and my labor stalled at 1cm dialated - they believed due to the scar tissue. I had a great doctor who "mucked" with my cervix and got me to 3 cm in about a minute. Progressed normally from there and had a vaginal delivery. I think this is really common and not a big issue for most. My doctors also felt that by 16 weeks if my cervix wasn't looking weak it probably wouldn't need to be stitched and my last ultrasound was at 20 weeks. Good luck!