“Emergency Cerclage: Jackie Oshry’s Birth Story”

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
All right, Jackie, welcome back to the podcast. In the last podcast, we spoke about Jackie the professional, Jackie the human, Jackie the book writer, podcaster, celebrity, and all of that. But I want you to tell your birth story, because it’s awesome. It is… I’m involved, obviously. This is how we got to know each other. But I think it’s an amazing story. I know that your listeners have had a chance to hear it in several ways, but number one, if they’re listening, they didn’t have a chance to have me ask you about it, which is different.
Jackie: It’s true. It’s true.
Dr. Fox: And also, my listeners, not all of them are yet Toasters.
Jackie: Right.
Dr. Fox: I’m sure they all will become, or are already, but you know, they’ll have a chance to hear your birth story as well. So, you ready?
Jackie: I’m ready.
Dr. Fox: It’s amazing. So take me back to your first pregnancy, right? Let’s start there. Talk to me about that, what was going on, which is when we met for the first time.
Jackie: Yes. We met during my first pregnancy, which as far as pregnancies goes, was probably the most average experience, you know? I had a little bit of everything, a little nausea, heartburn… But everything was very kind of, like, textbook, like a movie. Even the way, like, my water broke when I gave birth, and I gave birth at 39 weeks and 2 days… I didn’t, like, love pregnancy, but I didn’t hate it. I was uncomfortable, but not anything crazy. So I actually thought it was, like, a very…relatively pleasant experience, and I was, like, very grateful for that.
I met you because we did some genetic counseling. Because you’re a high-risk pregnancy doctor.
Dr. Fox: Yes, I am.
Jackie: So considering my experience was so average, we wouldn’t have met otherwise.
Dr. Fox: Right. Right.
Jackie: Except for the fact that, you know, as Ashkenazi Jews, we do genetic testing, Zach and I, like, had to get our results explained to us by a genetic counselor, who was you, who was the best genetic counselor to be like, this is nothing to worry about, move on, enjoy.
But when we did have that meeting, I guess someone who worked in your office was a Toaster…
Dr. Fox: Right.
Jackie: …who told you that I’m a podcaster, that she loves my podcast, and then you told me that you did a podcast, too. So that was just…you know, we connected over that. So that’s what made you different from my other doctors, and maybe me different from your other patients.
Dr. Fox: Right.
Jackie: And you had given me your phone number to, like, if I had any pregnancy questions along the way, I think I texted you a few times, like, could I have a hot dog? Could I have a turkey sandwich?
Dr. Fox: Right. Right. Yes, yes.
Jackie: But beyond that, like, I don’t know that I saw you again in my… I think I saw you one more time in my pregnancy. Oh, and I did have a bigger question for you that we talked about, but that was it.
Dr. Fox: Yeah.
Jackie: And it was really, you know, pleasant.
Dr. Fox: Right.
Dr. Fox: Yeah no, that was my recollection too, that we met, we definitely connected over the podcast thing. I was a new podcaster, so I hit you up for some advice, I think. But I just thought it was cool, like, to meet someone who does this, you know, for a living, basically. And we connected, again, medically. It was pretty straightforward. We spoke about a few things, and then ultimately, I just, I guess, heard from you or from your doctor, whatever, that you delivered, and everything was well, and everything went great, and as you said, pretty straightforward delivery of your son.
Jackie: Yes. Also, your practice wasn’t my primary practice.
Dr. Fox: Right, right. We weren’t your OB, right.
Jackie: You were just my imaging center.
Dr. Fox: Right. Exactly.
Jackie: So my OBs were at a different practice, so I really wasn’t around that much.
Dr. Fox: Right, right. So what happened after that?
Jackie: So after that, I became a mom. Wonderful experience. The first is just, it’s crazy. It’s just trial by fire.
Jackie: It is. It’s a big change.
Jackie: It’s a big change.
Dr. Fox: Yeah.
Jackie: And it was great. Probably when my son was seven months old, we moved to Florida, which was always our plan, and it was nice living there. He’s, you know…
Dr. Fox: Right. Why was that your plan?
Jackie: To get out of the city, we always wanted to do. There are a lot of things about Florida that we really liked.
Dr. Fox: Right.
Jackie: My sister had moved down there, and that was where we were starting our lives.
Dr. Fox: Right. Okay, so you moved to Florida, and now it’s hot, and you’re down there, and it’s all good.
Jackie: It’s hot…it’s all good. And then, once I’m nine months postpartum, like, I want to get pregnant again, so my husband and I get to work on that, and in late November I became pregnant with my second son.
Dr. Fox: Okay.
Jackie: And the beginning of my pregnancy was the same as before, pretty much down to the point that I knew that I was probably having a boy because my symptoms were so similar, like, and the experience of, like, just fatigue, nothing crazy, you know, morning…all day sickness really, but nothing really… It was pretty uneventful. I would just, like, text my mom, like, oh, he’s a blueberry today, you know, he’s a raspberry… Just, like, quiet, whatever.
Dr. Fox: We love comparing things to food, and particularly fruit.
Jackie: Yeah.
Dr. Fox: That’s our thing. We’re big with fruit.
Jackie: I like it.
Dr. Fox: Yeah.
Jackie: It’s always fun to see what fruit you’re going to be this week.
Dr. Fox: Yeah.
Jackie: So then…
Dr. Fox: What was it like just in general, your experience with healthcare in Florida versus what it was like for you in New York City, before it hit the fan?
Jackie: So I had heard, and from you, that healthcare in Florida was very different, and way less personal than it is in New York, so I kind of had that expectation going in. But the OBGYN that I was going to, she seemed really nice, but also, because I had, like, a previous pregnancy, and I kind of knew how to feel and what to expect, I didn’t have, like, a ton of questions.
Dr. Fox: Right. Right.
Jackie: I didn’t really need much other than, like, you know, vitals, weight.
Dr. Fox: Right, yeah. You’re like an OB’s dream, like someone who had…second pregnancy, where the first one was uneventful, you’re like a piece of cake.
Jackie: Yeah.
Dr. Fox: When like, they see a hundred of you a day, it’s the greatest. Yeah.
Jackie: Yeah. And like, every appointment was, you know, just routine.
Dr. Fox: Yeah. Yeah.
Jackie: And then I had my 20-week scan, so it’s a growth scan, and when I got… I went to an MFM, which was my first time…
Dr. Fox: Right.. Probably anatomy. Yeah.
Jackie: Yeah. It was my first… You’re right, it was an anatomy scan.
Dr. Fox: Yeah. Yeah.
Jackie: It was my first time going to that MFM office in Florida, because…
Dr. Fox: Right. Right, to get the ultrasound.
Jackie: To get the ultrasound. And I remember when I used to come to your MFM, they just used to look at my belly.
Dr. Fox: Right.
Jackie: So when I got there, she was like, “We’re going to do transvaginal first to check your cervix.” I was like, I don’t remember ever taking my pants off at the MFM in New York, and I was, like, “Oh, why?” and she was like, “Check your cervix,” and I was, like, okay, sure, whatever. And so she goes in, and like, it’s really quiet, and…
Dr. Fox: That’s never good.
Jackie: I didn’t know what the cervix really did at that point.
Dr. Fox: Okay.
Jackie: So I wasn’t really alarmed.
Dr. Fox: Fair.
Jackie: She’s, you know, looking around, like double-checking what she’s seeing, blah, blah, blah, she has to, like, go and get… Actually, no, she went to go tell the doctor something. She’s like, “I’m just going to tell the doctor,” and then she came back in and did the rest of my scan, the anatomy scan, which takes, like, 20…
Dr. Fox: Abdominally.
Jackie: Yeah, abdominally, which took about, like, 20, 30 minutes.
Dr. Fox: Yeah. Yeah.
Jackie: So I’m laying there, wondering, like, what was it about my cervix, but really… And I got a little worried, of course, and your mind goes to, like, the worst place, but I couldn’t conceive of what it could be that would be, like, really… Maybe if something was ab-…
Dr. Fox: Right.
Jackie: But there are plenty of things that go wrong in pregnancy that aren’t a big deal, it’s just, like, something to note.
Dr. Fox: Right. Right. Were you there alone?
Jackie: I was with my husband.
Dr. Fox: Okay.
Jackie: So I’m just sort of laying there, I don’t… I’m not a big, like, talker, so I’m just in my…
Dr. Fox: You’re not a big talker?
Jackie: No. Oh, I know, I talk for a living. But it’s funny, it’s like sometimes I’m just, like, so…
Dr. Fox: Yeah.
Jackie: Especially when I’m doing stuff like that, I just kind of, like, retreat into myself, and think, and…
Dr. Fox: Yeah. Yeah.
Jackie: So I was getting, like, worried, letting myself, like, think the worst, but… I actually think she said, “Your cervix is short,” but I didn’t know what that meant either. So I’m like…
Dr. Fox: Right. You’re like, well, I’m short… Yeah.
Jackie: Right. So I’m sitting on the table, she’s doing the rest, I’m like, cervix short? Hmm. I guess that’s not good, but I didn’t know what it actually meant.
Dr. Fox: Right.
Jackie: So I’m worried, and I’m anxious, and then she, like, starts, like, huffing and puffing while she’s doing the scan, and she said it’s, like, because she’s wearing a mask, and I was like, oh, just take it off. Like…
Dr. Fox: Right. You’re like, dude, we’re in Florida. Take it off.
Jackie: Yeah. In hindsight, I think she was getting, like, stressed out for me. She’s doing this scan, and like…
Dr. Fox: Worried. Okay.
Jackie: Worried for me. So then we finish the scan, and then the doctor comes in, and she’s telling me how my cervix is short, and that I should get on progesterone, and that I’m going to need a pessary, and that I’m probably in labor. And everyone at the office was really nice, but I think they thought I knew more about what it meant to have a short cervix than I did, because I didn’t know anything. I’m like… So I was, like, “Oh, okay, I’ll think about those things. Thank you,” because I’m not a really huge…like, I don’t want to take medication when I’m pregnant, and what’s a pessary?
Dr. Fox: Yeah. Yeah.
Jackie: Like, no thanks. But I’ll think about it, you know.
Dr. Fox: Right.
Jackie: She was like, “No, you need to do those things today. Like, you’re at three millimeters.” And I was like, “Well, how could my cervix be so short?” And her theory was that I was already in labor, and that I had put myself in to labor by doing too much with my son. Which I really was doing a lot. So of course, I was… And I had just had that thought two days before. I was like, he’s big, and I was like, picking him up a lot… And you know, you can do some of that when you’re pregnant, but like, not…you shouldn’t really exert yourself in such a way. So I was thinking, oh, wow, maybe that tracks, because I’ve been doing a lot, and now I’m in labor?
Dr. Fox: You know, I never knew that part of the story. So she told you not only that your cervix is short, but that it was your fault your cervix was short?
Jackie: That was one theory. Everyone also said a theory is that my pregnancies were close together, but they all said that’s probably not it.
Dr. Fox: Okay. Fair enough.
Jackie: So, yeah, that it was pretty much, like, my fault. I just had, like, pushed myself too far, and put myself into…
Dr. Fox: Terrific. That’s just terrific.
Jackie: …put myself into labor, which shortened my cervix.
So on the one hand, I’m trying to absorb all the information, but I really…it took me a while to realize, like, how dire the situation was. Like, a short cervix means that it’s about to open, and I’m about to give birth if it doesn’t stop opening.
Dr. Fox: Right. That’s what you’re…that’s the impression they left you with.
Jackie: Yes.
Dr. Fox: Right.
Jackie: And I’m 20 weeks along, so if I give birth, like, yeah, it’s a disaster.
Dr. Fox: Yeah, it’s a miscarriage. Right.
Jackie: Right. So she had said, you know, “Sometimes for situations like this we put a stitch in, but you’re too far along. And you know, considering you’re, like, in labor, and probably having contractions…” I was like, I don’t feel contractions. And I had horrible contractions when I gave birth to Harry, so I was like, I think I would know if I’m having a contraction. She said I probably wouldn’t feel it, they might be, like, mini-contractions, but I’m likely in labor, so for that…
Dr. Fox: Micro-contractions?
Jackie: Micro-contractions. So for that reason, I’m not a candidate for a stitch.
Dr. Fox: Okay.
Jackie: I still hadn’t, like, heard more about this stitch, and I was kind of glad to not be a candidate because I didn’t want to have surgery.
Dr. Fox: Right. Yeah, sure.
Jackie: So I’m like, on the phone with my mom in the office, like, crying, trying to understand what this means. She also called my OBGYN, to have the OBGYN say to me, like, no, you need to do those things today.
Dr. Fox: She, the doctor, not she, your mom.
Jackie: She, the doctor, the MFN called my doctor.
Dr. Fox: Right, okay. Yeah.
Jackie: Because I had met my doctor a bunch of times before at that point, so I trusted what she said, and she was like, no, you can’t go home and think about it. Like, you have to get the pessary today.
Dr. Fox: Right. Right.
Jackie: You have to get on progesterone.
Dr. Fox: Right.
Jackie: And the doctor in the MFM office was pretty optimistic, which to her credit, like, she was optimistic about my odds doing pessary and progesterone.
Dr. Fox: Right.
Jackie: And she was sharing, like, a couple, like, hopeful stories for me.
Dr. Fox: Okay.
Jackie: And she was letting me know, like, all the milestones that I would have to hit, but she was like, total bed rest for you, you know, you can’t pick up your son anymore… Like, you can’t get out of the bed. Just kind of like, go home, close your legs, do your progesterone, keep your pessary in, say a prayer…
Dr. Fox: Right, and hope for the best.
Jackie: …and stay in bed for the next five months. So like, I was shook, and I went home to do that. And throughout the course of the day, I’m just, like, replaying the events in my head, I’m on the phone with my mom, trying to understand what this means to, like, not have a cervix, like, how quickly does it dilate? How much time might I have? Like, even if I give birth early, like, how early…what are my chances? So we’re doing as much research as we can.
Dr. Fox: Right. And your mom is your medical spiritual advisor.
Jackie: She’s my advisor for everything.
Dr. Fox: Right. Got it.
Jackie: So…
Dr. Fox: She’s your consigliere.
Jackie: Yeah.
Dr. Fox: Got it.
Jackie: So we’re trying to, like, piece it all together, together.
Dr. Fox: Right.
Jackie: But I start the progesterone, and I have a pessary in… She also prescribed me a medication to stop my contractions.
Dr. Fox: Right.
Jackie: But she had mentioned that the medication was, like, not as routine as progesterone, and I didn’t like that.
Dr. Fox: Right.
Jackie: So I was like, you know what? I’m not going to take this until I feel a contraction, and she was fine with that, so I never took that medication.
Dr. Fox: Right. Got it.
Jackie: And then that night… Actually, it’s to their credit again, the place emailed me my images from the day. Because I’m sure, usually, people are excited to get those pictures.
Dr. Fox: Right.
Jackie: And I saw the picture that raised the alarm bell of my cervix, and I was just like, I wish I had someone who understood these sorts of things that I could send this to. And I do have two aunts that are doctors, and I ask them for medical advice all the time, and when I had sent it to them, they were like…it was kind of out of their wheelhouse. They’re not OBGYNs. But they were like, a three-millimeter cervix? That’s zero. You have no cervix. So I was like, yeah, okay… So then I’m like, you know, I wish I knew an OBGYN, and then I realized, like, I have your number, Dr. Fox, who I met in my first pregnancy with Harry. Like, maybe I could ask him to just take a look at these pictures, and tell me what he sees.
So I texted you, and called you, and I, like, briefly explained the situation, and you said that you would look at it, and you were like, whoa, you need a cerclage. So from there, you were helping me find a doctor in Florida who would see the situation, and give me a cerclage, because you were like, “It doesn’t make…” I was like, “I’ll come to New York,” you’re like, “It doesn’t make sense, because then you would need the rest of your pregnancy care in New York, and it would be better if you find someone in Florida.”
Dr. Fox: Right.
Jackie: So that night you found me, like, a really good doctor through the grapevine, who got me in the next day to not see him, but someone in his office. And so I went, and I’m still at my 20-week anatomy scan phase, so they do the transvaginal and the whole scan again.
Dr. Fox: Right.
Jackie: And the transvaginal, they couldn’t see that much, because I had the pessary in already.
Dr. Fox: Right.
Jackie: And she had wanted to maybe take the pessary out, but the practice doesn’t…they don’t really, like, do pessaries at that practice, so she didn’t have a fresh one to put in.
Dr. Fox: Right. Right.
Jackie: She was like, “I could put the old one back in.” Like, “We could clean it and put it back in,” and I’m like, “I don’t love that.”
Dr. Fox: Yeah.
Jackie: It seemed like a lot of mutzgaring, which is a word, it’s a medical word in my family, which means, like, futzing around with things. I just don’t know, like, how many times you want to go in there, and…
Dr. Fox: Right.
Jackie: It’s mutzgaring.
Dr. Fox: Right, because mutzgaring is a lot less precise than futzing.
Jackie: Yeah. Yeah, it’s different. Mutzgaring is like, more futzy than futzing.
Dr. Fox: Got it, got it. Understood. On the futzy scale, it’s higher…yeah.
Jackie: Yeah.
Dr. Fox: No, I get you. I get you, yeah.
Jackie: So also, so I didn’t really want her to take out the pessary because they didn’t have fresh ones, and you had said the night before, like, “Did the doctor at the other practice, like, look with her eye, and if you’re dilated?”
Dr. Fox: Right.
Jackie: And I was like, no. So we were going to this doctor for her to look with her eye so that she could give me, like, kind of the go ahead to get the cerclage.
Dr. Fox: Right.
Jackie: And this doctor, like, felt with her hand my cervix, and then she…like, we went into her office, and she was like, “I can feel the amniotic sac,” like, and basically preparing me for, like, what was going to happen next.
Dr. Fox: Right.
Jackie: There was nothing she could do for me, I’m not a candidate for a cerclage.
Dr. Fox: Because your cervix was open.
Jackie: Because my cervix was open. It was her theory that I was two to three centimeters dilated already, and so, like, now I need to go home and prepare myself, like, mentally to give birth very early, you know? She was saying how 24 weeks is viable, there are hospitals in Florida that will…that 22 weeks is where you have to get to, and they will, like, help your baby. So she was like, if you…
Dr. Fox: They’ll try.
Jackie: They’ll try. So she was like, “If you want to, like, drive up to Jacksonville…” But her whole… Like, it was just bad news. So at a certain point, I couldn’t hear anything else. It’s like, if this is going to end terribly, I just want to be home.
Dr. Fox: Right.
Jackie: Like, I understand. Like, so I’m so beside myself because I’m not a candidate for the surgery, it’s actually worse than the doctor yesterday said it was… Because yesterday she told me three millimeters, and that pessary and progesterone could get me somewhere. And today she’s telling me I’m already dilated, and there’s, like, no help for me.
Dr. Fox: Right. And again, it probably was the same cervix. Meaning when I saw that picture of three millimeters and said, okay, when you put an ultrasound probe and take a picture, it might look like three millimeters, but if you put in a speculum and look with your eyeballs, you’re probably already dilated, which is why I said I think you’re probably already dilated, and you need a cerclage. And so when you went the next day, they confirmed that you were dilated, but then they said because of that, you can’t get a cerclage.
Jackie: Right. Right.
Dr. Fox: Yeah. So…
Jackie: That’s when, like, just, you know, in their medical opinion, I’m not a candidate.
Dr. Fox: Right.
Jackie: She also said, you know, I could get the surgery, and then if you get infected, and I could get sepsis, and be in the ICU and die.
Dr. Fox: That’s pretty pessimistic. Yeah.
Jackie: Yeah. No, yeah. That was rough.
Dr. Fox: Yeah.
Jackie: So I go home, I didn’t really…I don’t know that I called you immediately because I was just like, this is it, you know?
Dr. Fox: It’s over.
Jackie: This was Dr. Fox’s doctor, and he said this, and two people are kind of saying the same thing, like, just go home, and cross your legs, and stay in bed… So then you followed up, and you’re like, “What did they say,” and I told you, I was like, “I’m two to three centimeters, so I’m not a candidate,” and you we’re like, “You’re two to three centimeters, so you are a candidate.”
Dr. Fox: Right.
Jackie: Like, “We do this surgery all the time.”
Dr. Fox: Right.
Jackie: And you called the other doctor who would have done the surgery if I had gotten the green light, and you guys just had a difference of, like, medical opinion, and just do things differently.
Dr. Fox: Right.
Jackie: And so I don’t know if it was your idea or my idea, that you were like, if you come, we’ll do it tonight.
Dr. Fox: Right. I mean, I basically said I’m sure there’s someone in the state of Florida who is good at this, and would do it, and will do it, and will do a good job, but I don’t know who they are.
Jackie: Yeah, we don’t know that.
Dr. Fox: And it may take days to get in to see them, and this is a serious situation here.
Jackie: Yeah.
Dr. Fox: So I said, you know, if you were in New York, I’d be doing it tonight.
Jackie: Right.
Dr. Fox: And so you’re like, I’m coming.
Jackie: And so I was like, I’m coming, you know? I pack up… I thought about it for maybe, like, 30 more minutes, weighing, like, pros and cons of, you know, not doing anything, and trusting, like, the pessary, and…or going to New York, getting the surgery, which is also a risk because there are risks involved with, like, it could rupture my sac, I could be too far gone…
Dr. Fox: Yeah. Yeah. No, it’s not risk-free. I mean, it’s not like unicorns and rainbows. I mean, it’s a serious situation. It’s an operation, it’s a lot of skill, and it’s hard, and it doesn’t always work out. It doesn’t work out for everyone. But you have two options. You either place it, or you don’t place it, right. That’s it, right? And most of the evidence shows that if you don’t place it, you’re probably going to either lose the baby entirely, or deliver a very premature, very sick baby.
Jackie: Yeah.
Dr. Fox: That’s… Again, not definitively, right? We’re not gods, like, we can’t tell the future. But that’s what the likelihood is. And if you place the stitch, it’s possible you’ll lose the baby, but the odds are much better of you getting further along. And I think we spoke about it at the time, that in our experience, and a lot of the literature, the odds are pretty high you’re going to get at least past 32 weeks, which is premature, but they typically do fine, and hopefully even better.
Jackie: Yeah.
Dr. Fox: And so at that situation, unless someone just says, like, I’m out, like, I didn’t sign up for this, I don’t want the pregnancy anymore, your best option is a cerclage. That’s really it.
Jackie: Yeah.
Dr. Fox: Yeah.
Jackie: So that’s where I was headed. I wound up, I called…like, I asked a couple people from their opinion, including that original MFM doctor, I was like, “By the way, I went…” And they put me on a contraction monitor at the second doctor, to confirm that I’m not in labor.
Dr. Fox: Right. Right.
Jackie: So I was like, “By the way, I’m not in labor.” Like, “I was on a contraction monitor… And there’s a doctor in New York who says, like, I’m a candidate for this surgery, like, do you think I should go?” Because she was a nice lady, and like…you know?
Dr. Fox: Yeah.
Jackie: And she said no, that… I was like, “And why?” and she said, “Because I don’t think it will work.” So, okay, I had that in my head…
Dr. Fox: I can’t… That’s so strange to me. But okay. I mean, whatever. Whatever. Okay.
Jackie: Yeah. So I had a couple people, like, saying, you know, just take it easy, stay in bed, and you know, trust the process. But I’m just a crazy bitch, and I was like…like, when I get something in my head, and there’s like…I just have to do it. So I packed up my family. At that point, they’re… Still I’m on bed rest, so I can’t be like, you know, running through the airport, trying to catch flights. It’s very stressful, like, you know? So I’m trying to find, like, a seat on a private plane that would go, but there’s not enough seats for, like, my whole… Actually, there was only one flight, like, out from South Florida to New York, because by that point it was, like, 4:00.
Dr. Fox: Yeah.
Jackie: And there was only one flight out, and there was only one seat, and it’s like, well, what if I go into labor on the plane, and I don’t have my husband with me? Like, I can’t do that either.
Dr. Fox: Yeah. Yeah.
Jackie: So then I’m trying to find a whole plane.
Dr. Fox: Right.
Jackie: And my sister and her husband had already been in Florida because it was Passover, and they were at my house for Passover.
Dr. Fox: Right.
Jackie: And her husband found a plane that could take off 30 minutes later, like, so close to our house, straight to Teterboro, and we all packed up and we went.
Dr. Fox: Yeah.
Jackie: So I landed at Teterboro probably, like, 8:00, 8:30, I was texting you, like, the whole time because I was going right from Teterboro to Mount Sinai for the surgery. I was still, like, not even sure, you know? I might show up, and I might be too far gone, you had said, if I was, like, really, like, dilating still.
Dr. Fox: Yeah. Yeah.
Jackie: So it wasn’t given that it was going to happen for me.
Dr. Fox: Right.
Jackie: And checked in, triage, all that jazz, finally get on the table probably, like, midnight is when we did the surgery?
Dr. Fox: Yeah. I mean, we wanted to make sure that there was no signs of an infection…
Jackie: Right.
Dr. Fox: …we wanted to make sure we could confirm you weren’t in labor, like, you know we have to, like we said, make sure everything’s okay. And then we said, you know, we’re just going to give you a spinal, an epidural, so that way we can do an exam that’s thorough, and really… Because I didn’t want to start mucking around…or what was the word?
Jackie: Mutzgaring.
Dr. Fox: I didn’t want to mutzgar around in triage, and you’re going to be in pain, there’s no… Like, let’s just do this right.
Jackie: Yeah.
Dr. Fox: And then, yeah, it was like midnight, go to the OR, and then…tell me what it was like on your end. I know what it was like on my end.
Jackie: Oh, my… Okay, so we go into the OR, we’re waiting…
Dr. Fox: This is your story, not mine.
Jackie: Yeah, no, but I like hearing from your perspective.
Dr. Fox: Yeah.
Jackie: And you also, like, probably remember some things more clearly, because it was very emotional for me, and you know how memories could be warped. So I’m, like, on the table, you know, back-style, legs up…
Dr. Fox: Yeah, yeah, yeah.
Jackie: I’ve had the anesthesia and everything, and we’re just sort of waiting to see what you see, like, how dilated am I? Like, is this a possibility?
Dr. Fox: Yeah. Yeah.
Jackie: And then you said I’m one to two centimeters dilated, and it was such a relief. So then you guys…
Dr. Fox: Right. And also, it was…you were dilated, but I remember vividly, I was like, we can do this. Like, this is not going to be a technically complicated procedure to do. Sometimes it’s very, very technically complicated, but for you, I was like, I was… And I remember saying, like, we’re going to do this. Like, this will not be a problem.
Man: Jackie: Yeah. Yeah.
Dr. Fox: Whether it works or not, you know, obviously it’s in God’s hands. But basically, from a surgical standpoint, I was like, thank God. Like, this is not as bad as I thought it might be. Yeah.
Jackie: Right. So that was, like, the first huge relief, that I could get the surgery.
Dr. Fox: Yeah.
Jackie: I remember just, you know… I’m like, when I’m going through something, I’m very, like, quiet and introspective, and I just try and, like, be reflective, and like, not very… There’s times where…for panic, and there’s just times for prayer, and just, like, trusting the process.
Dr. Fox: Right. Yeah.
Jackie: So at that point, like, I just am trying to, like, get through everything. And the surgery was 30 minutes-ish.
Dr. Fox: Yeah.
Jackie: And you said it was a success, and that this…
Dr. Fox: Yeah.
Jackie: Like, as much as I could have, you know, just gotten, like, textbook cerclage, like, it was.
Dr. Fox: Right. Right.
Jackie: So that was the first huge relief, getting it in.
Dr. Fox: Yeah. Oh, we forgot the…besides checking that you were not contracting, checking that you were not infected, I also had to clear it with your mom.
Jackie: Yes, yes.
Dr. Fox: That was the other part of the preoperative checklist, clear it with Jackie’s mom.
Jackie: Yes, of course. Of course.
Dr. Fox: Yeah, she gave me her bracha.
Jackie: She needs the play-by-play. And when I came out of the OR, like, Zach, had Facetimed her immediately, and you told her, like, all is well…
Dr. Fox: Yeah, it’s all good.
Jackie: …you know, we did it, and it’s looking good. So now, after that, then there’s, like, a few, like, kind of checkpoints I have to pass along the way, you know, a few days to see that I don’t get an infection, to see that I don’t go into labor.
Dr. Fox: Right. Right.
Jackie: And then after two weeks, I will have my follow-up appointment where you will look at the stitch, and see how it looks.
Dr. Fox: Right. Right, yeah.
Jackie: So I had to get to that two-week appointment.
Dr. Fox: Right, right.
Jackie: And the recovery from the surgery was, like…it was kind of fine. It reminded me of postpartum recovery, you know, with all the, like…
Dr. Fox: Yeah. Some cramping, some bleeding, yeah.
Jackie: Cramping, and you know, disposable underwear, you use all the same products, the peri bottle…
Dr. Fox: Yeah, yeah, yeah. Sure.
Jackie: But it really, it was pretty fine, and then we’re just, like, waiting to see, waiting to see.
So after two weeks, after the surgery, I came in for my checkup, and you went in there with the transvag, and you know, you’re looking around, and it’s not, like, what you’re…you’re not enthusiastic. And then it’s like, okay, well, why don’t you come into this room? Because we have, like, a better scanner in here.
Dr. Fox: Yeah.
Jackie: And along the way, you were explaining it, “It looks a little, like, off to the side, and I just want to…” First you did a…what’s it called, with…?
Dr. Fox: Speculum?
Jackie: A speculum one.
Dr. Fox: Yeah.
Jackie: And you said it felt great.
Dr. Fox: Yeah.
Jackie: So I was like, okay, so it’s not terrible in there.
Dr. Fox: Right.
Jackie: But then you went in with the transvaginal, and then it was a little bit quiet. But I wasn’t so pessimistic because for the speculum one went well…
Dr. Fox: Yeah. Yeah.
Jackie: So I was like, okay, I can be patient, you know?
Dr. Fox: Yeah.
Jackie: Obviously, I came from, like, such dire circumstances, I can’t expect that it’s all going to be perfect.
Dr. Fox: Yeah.
Jackie: So you then sat Zach and I down, and you explained that the stitch kind of pulled through a little bit on one side of my cervix, and it wasn’t holding the way it should be holding.
Dr. Fox: Right. Your cervix was…felt fine, looked fine, and in fact on the ultrasound, the cervical length was fine, but it was apparent that the cerclage was not in a perfect location, that sort of it… And this happens sometimes, when the cervix is so thin when we place it, it pulls through, like it tears sort of through the cervix, and so it’s not… It’s doing its job temporarily, and maybe it’ll hold the rest of the pregnancy, but…
Jackie: It might not.
Dr. Fox: It might not. And so it’s interesting, because it’s actually…not only is there some controversy about placing the cerclage, there’s a lot of controversy about checking afterwards with ultrasound the placement. We do it because we think it’s a smart thing to do, to make sure that what we placed is where it’s supposed to be. Not everyone does that. And so I was pretty confident that, you know, you’re only 22 or 23 weeks, the cervix looks okay, but let’s redo this, and just go back to the operating room and do it.
And it happens. It’s not…you know, not a lot, but it definitely happens, especially if you’re dilated when we put it in. And then we did it a second time, and then, after that, it was picture-perfect.
Jackie: Yeah. But it was still, like, everything…I could never just, like… For the next five months, like, holding my breath for five months, every appointment.
Dr. Fox: Yeah.
Jackie: I think I was in this office once a week, there was a week I was here five days in a row.
Dr. Fox: Yeah, yeah.
Jackie: Like, literally always here.
Dr. Fox: We’re like “The Toast” for you.
Jackie: Yeah. Even, like, doing the second, it took me a few days to decide to, like, do it again, because that was, like, another decision that I had to make, like do we want to do it again?
Dr. Fox: Yeah.
Jackie: Ultimately, like, I decided yes, and that was also your recommendation. The recovery from the second surgery was the most painful thing. More painful, I think, more painful for sure than birth recovery.
Dr. Fox: Mm.
Jackie: It was two weeks of, like, abject pain.
Dr. Fox: Yeah, I remember we spoke about that. Yeah.
Jackie: I was like, oh, my… And thank God the first one wasn’t that painful, or else I honestly don’t know if I would have been able to do it again.
Dr. Fox: Yeah. What was it like emotionally, going through the pregnancy? I mean, I could tell you what my perspective was, but I’m curious what yours was.
Jackie: I’m curious what yours was.
Dr. Fox: I’ll tell you after.
Jackie: But it was really just having to take everything one day at a time, holding my breath every single day. Like, you know, those first few days before I got the cerclage were, like, all over, like shock, so never really… And then I had the cerclage, and I could be, I was like, calm waters for two weeks, as long as everything was going ok.
Dr. Fox: Right.
Jackie: And with every day, like, I’m getting closer to viability, so like, every single day is a milestone, every week was a milestone. Even getting to 22 weeks, you know, there was that hospital in Jacksonville that would help me…
Dr. Fox: Yeah. Yeah, yeah.
Jackie: Then getting to 24 weeks, and it’s like, okay, I have a baby now, like, so…
Dr. Fox: Yeah. Right.
Jackie: And then 28 weeks, I know someone, someone who I’m really close with is 28 weeks he was born at, and you would never know.
Dr. Fox: Right.
Jackie: So like, everything was… 32 weeks my niece was born at, 32 or 34 weeks, so like, every single week was, like, a huge milestone, but I never could exhale until cerclage removal day, which was at 37 weeks.
Dr. Fox: Yeah.
Jackie: So it was just, like, living, like, so on edge, you know? Every night going to sleep and being like, am I going to wake up in labor?
Dr. Fox: Right.
Jackie: Especially because then in June, I didn’t share this on the show because… But this added, like, a level of precariousness, because after the second cerclage, and then I came in for my checkup, and it looked gangbusters, like, we have a cerclage… And I was enjoying life, you know? Now I moved to New York, because now you’re my doctor.
Dr. Fox: Yeah.
Jackie: That was another huge…like, there were so many just huge things going on, like finding a place to stay, moving everything. Like, I have one baby already, like, it’s just a lot… And maybe some of that stuff actually distracted me from the medical stuff in a good way, like, just keeping me, like, really busy, and having a lot of things on my mind. But the month of May, like, I really just got to enjoy being pregnant in New York. The whole month of April was like, I’m recovering from surgeries…
So I’m going about my life, I’m doing a little bit here and there, still, like, not lifting my son or anything, but you know, I’ll do my show, because in the studio, and maybe go to lunch, maybe go to a brunch on the weekend, nothing crazy at all. And then in June I came in for one of my checkups, and you guys do that Fetal fibronectin test…
Dr. Fox: And it came back positive, yeah.
Jackie: And it came back positive. And after that, I put myself, like, back on bed rest…
Dr. Fox: Mm-hmm.
Jackie: I’d gotten a little ahead of myself, I felt. And so that sort of, like, set me back a little bit, like, mentally and also in terms of, like, what I could do. And then the next few months were just about, like, waiting, hitting milestone, waiting, you know, fingers crossing, praying, and holding my… Like, I just…holding my breath until I gave birth.
Dr. Fox: Yeah. I mean, from my perspective, you definitely looked a little bit like someone who was holding their breath, you know?
Jackie: Yeah.
Dr. Fox: At every appointment you could sort of see the low level of terror in the eyes.
Jackie: Yeah.
Dr. Fox: Which is fine. I mean, that’s appropriate. It was a scary situation. It was not… You know, it was a rocky pregnancy. There’s no doubt about it. And I felt that you were quite appropriate. I mean, you were both scared, but also not overwhelmed in a certain sense. And you, you know, were very rational, and you always, you know, we’re trying to make good decisions. Sometimes a little emotional, but normal, like, as you should be. This was a very emotional time.
Jackie: Yeah.
Dr. Fox: And I felt that my role was a little bit more to be reassuring, because things were actually going very well, objectively. You’re still pregnant, the cervix still looks good, it’s still closed, the cerclage is in place, we’re going every…like you said, every week, every week, every week. Over the course of those weeks, the mood kept lightning…
Jackie: Yeah.
Dr. Fox: …because the stakes were getting lower each week, because we sort of knew that every week was good. And you know, by the end, we were just sort of, like, pulling out calendars to figure out, like, when to take out the cerclage…
Jackie: Yeah.
Dr. Fox: …and when to deliver the baby and all this stuff, and it got a lot more smiley in a certain sense. But you were always very pleasant, obviously. You’re a very pleasant person. But it was…it’s hard to see someone who’s scared. I mean, that’s what I do every day, you know, but it’s always hard.
But I remember I told you when I came on “The Toast,” that, you know, I thought you were great. I mean, you handled it really, really well, the balance between, like, being scared, but being informed, and asking questions, but not being, like, sort of irrational in a certain… Like, you were very grounded, and I think very focused, which I think was great.
Ultimately, what was… After you delivered, and had this big, fat, healthy baby…yeah.
Jackie: Oh, yeah, that was the plot twist.
Dr. Fox: Yeah.
Jackie: The whole time, I’m like, worried about having this preemie, like, small baby…
Dr. Fox: Preemie, and you get, like, a 16-pound baby.
Jackie: …and I had a baby that was 9 pounds, 5 ounces.
Dr. Fox: Right, and you’r like, 90 pounds, 7 ounces, which is so pretty… I mean, I guess that camp worked that you went to.
But yeah, I mean, what was… I’m just… I really want to hear, like, what was it like afterwards? Because you had such a crazy pregnancy, unexpected, emotional, scary, you’re flying to different states, you’re being told you’re going to lose the baby, all this stuff, operations, and here you are with this big, fat, healthy baby. What was it like for you, sort of looking back on it?
Jackie: The first week of, like, having Charlie was the best week ever. Like, I was so happy to, you know, no longer be pregnant, to have this, like…have my baby with me. Being a mom for the second time came so much easier to me, breastfeeding came so much easier to me. Like, I just, I felt like everything was more intuitive, and I knew what I was doing, and like, couldn’t bring me down.
And then it just became a little stressful because when Charlie was, like, eight days old, my other son got sick with a fever. And we’re in an apartment, and I’m, like, so worried about Charlie getting sick, and I’m like, I just…I just exhaled, and now I’m like… And I’m trying to, like, take care of both of them, and change my clothes in between, and it was, like, not…
Dr. Fox: Yeah.
Jackie: So that kind of brought me back down to Earth. But then, Harry was…you know, he got better, and now I just, like, get to enjoy motherhood, and not have this, like, thing hanging over my head. And doing it for the second time, like, I’ve just found it to be, like…like a dream.
Dr. Fox: Wow. That’s amazing. What do you take away from all this, from your story? Like, what big high-level lessons in your life have you thought about, or learned, or want to impart on others?
Jackie: So I think it’s really important to ask a lot of questions, to get as many opinions as you can. I feel so fortunate that, like, I know…like, that I knew you, and that I had you as a resource. And it makes me, like, sad for other people who just have their doctor, and maybe live, like, somewhere in a smaller town where there’s just one doctor, and this is the opinion, and like, you don’t know where else to go. So just question everything. Even if what you’re being told is 100% correct, and that’s your fate, like, there’s no harm in asking questions, and seeking other advice.
I didn’t really even realize, like, how different medical opinions could be. There is not one way of doing things. So… And I’ve always been that sort of way, like, just very inquisitive, like, okay, I want to know more and more and more, trusting my gut that, like, we’re going to come to New York, and I’m going to give it a shot, and just a lot of prayer. Like, you just can’t… It’s just so crazy, because you have all this going on, and you have to, like, be…you can’t lose yourself. You can’t, like, just sink, you know?
Dr. Fox: Right. Right. That’s amazing. I mean, your story is awesome.
Jackie: I honestly haven’t thought about it since I…I don’t know. I’m also just, like, a weird… Because I’m a very rational person, and of course I feel, and I’m also very emotional sometimes, but I never really make emotional decisions. I really… And it’s not even, like, by…consciously. Like, I just, I’m just a rational thinker, instead of emotional.
Dr. Fox: Right.
Jackie: And sometimes it works to my advantage, and sometimes it doesn’t. And then since, you know, I’ve given birth and everything, I just haven’t really gone back too much and thought about it. Every once in a while I’ll, like, look at Charlie, and be like, oh, my God…like, you know, everything that we went through together. And I really sat home for four months, while everyone else, like, did everything else, and…you know?
Dr. Fox: You uprooted your whole life.
Jackie: Uprooted my whole life. I was on bed rest for… And like, so we’ve just been through so much together, he and I. He was in there, you know, getting mutzgared, and surgeries, and this and that…
Dr. Fox: Yeah.
Jackie: So I’m just, like, I’m so grateful with how it all turned out. There were a million ways it could go. Even if it wasn’t terrible, it could have been, you know, midway, not what I wanted… So for it to have, like, turned out the way that it did, like, I just…it’s a lot.
Dr. Fox: Yeah. Listen, I am so grateful that you texted me that day. I just, I care about you, and I shudder to think what would have happened if you just went home and crossed your legs, and what your life would be like now, and how different it is.
And again, I’m not…this is not tooting my own horn. There’s a lot of people who do what I do. I think I’m good at what I do, I think my practice is good, but there’s a lot of us, and this is… It wasn’t the craziest situation on Earth. We didn’t do anything that hasn’t been done before. People do this. And just to think that just by chance, you were by people who didn’t do do that, and they told you advice that said go home and pray, and it’s not going to end well… Whereas if you’d been somewhere else, they would have put this in, and it would have been, like, a non-issue. Not a non-issue, but it would have been…whatever, a rocky pregnancy that ended well. And it’s just sort of like the sliding doors of your life, you know?
Jackie: Sliding doors, yeah.
Dr. Fox: And just…and how awesome it is, and how beautiful this baby is, and how happy I am for you that it worked out, and that you did decide to text, and come up and have the surgery, and have the second surgery, and do all these things, that it’s just… I mean, it’s amazing. It just, it brings me such joy. I mean…you know?
Jackie: I’m sure, like, it’s so cool… Like, that’s why you do what you do, you know? For stories like this, like…
Dr. Fox: Yeah. That, and not liking to sleep at night.
Jackie: So true. Which is why you’ve also added a podcast to your plate.
Dr. Fox: It’s all good. It’s all good. And no, but listen, people get to hear your story, and people get to learn from it, and people get to enjoy it, and sort of go through with you both the heartache and the joy, and everything… Like you do every day with your podcast, but this is a little bit of a different format, and a little bit of a different audience. But thank you so much. I really appreciate it.
Jackie: Thank you for having me.
Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast, or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.
The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health, and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.
[00:37:27]
♪ [music] ♪