Pregnancy

What Is An 'Incompetent Cervix,' And Can We Please Stop Calling It That?

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James Van Der Beek, best known for his roles in Dawson’s Creek and Varsity Blues, recently posted about the birth of his son, Jeremiah. In it, the 44-year-old actor and writer expressed his joy at his new son’s arrival, sharing that he and his wife Kimberly had suffered through back-to-back late-term pregnancy losses.

Fearing another loss, the couple chose to keep the new pregnancy quiet and found a doctor near their Texas home who could help Kimberly get through her pregnancy. Van Der Beek wrote that the doctor “diagnosed the last two as having been caused by an: ‘incompetent cervix.’” He pointed out what a misogynistic term that is, and the doctor laughed, which Van Der Beek said made him like the doctor more.

What Is An “Incompetent Cervix” Anyway?

First of all, good for Van Der Beek for calling out the misogyny inherent in calling a woman’s body part “incompetent” after she’s suffered through the horror of a pregnancy loss. To be clear, transgender and nonbinary people can also get pregnant, but the “incompetent cervix” label reeks of the archaic misogynistic assumption about the fault for any failure to procreate always lying solely with the woman, and never the man. Other terms that are starting to gain traction to replace “incompetent cervix” are “weakened cervix” and “cervical insufficiency.”

So what is a weakened cervix, then, and why is it so dangerous for a pregnancy? The term “weakened” is apt, because that’s exactly what it is — cervical tissue that is too weak to support the weight of the expanding uterus. According to the Mayo Clinic, this “causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.”

Prior to pregnancy, the cervix is typically closed and firm. But over the course of a pregnancy, the cervix begins to soften, shorten (efface), and open (dilate). A weakened cervix softens and opens too much, too soon, resulting in premature birth or a lost pregnancy.

How Do You Diagnose A Weakened Cervix?

It can be tricky to diagnose a weakened cervix, because often there’s no way of knowing it exists until after you’ve experienced a loss. However, some signs to look out for are spotting between 14 and 20 weeks of pregnancy, as well as new sensations of pelvic pressure or backache, cramping, a change in vaginal discharge, or vaginal bleeding.

Risk factors aren’t always apparent, either. Cervical trauma, such as prior treatments following an abnormal Pap smear, D&Cs, or a cervical tear from a prior labor and delivery, could lead to cervical insufficiency. It isn’t known why, but Black women tend to be at higher risk of having a weakened cervix. Congenital conditions like uterine abnormalities or certain genetic disorders impacting connective tissue can also contribute to a weakened cervix.

But again, despite knowing some of the risk factors, the diagnosis typically doesn’t happen until after at least one pregnancy loss.

Can You Prevent Or Treat A Weakened Cervix?

Unfortunately, there is no way to prevent a weakened cervix. If you experience a premature birth or late-term pregnancy due to a weakened cervix, it is absolutely not your fault. That said, it’s always a good idea to make as many healthy choices as possible to promote a healthy pregnancy, from getting regular prenatal care, eating nutritious foods, and steering clear of dangerous substances like tobacco and alcohol.

Though you can’t prevent a weakened cervix, once you know about it, there are ways to treat it. If you know or suspect you have a weakened cervix and you are pregnant or are hoping to become pregnant soon, talk with your doctor and find out what steps you can take to increase your odds of a healthy, full-term pregnancy. Your doctor may prescribe medications during pregnancy to stave off the softening of your cervix, or they may recommend more frequent ultrasounds.

Your doctor can also perform a procedure called cervical cerclage, which literally sutures the cervix closed to keep your baby safely ensconced in their cozy uterine home until it’s time to come out. This is how the Van Der Beeks were able to get through a full-term pregnancy after suffering through two losses. As Van Der Beek noted, though, some doctors will wait until three losses have occurred before performing a cervical cerclage.

Anyone who has suffered through a pregnancy loss knows how absolutely devastating and traumatic this is. One loss is bad enough; hopeful parents should not be suffering through multiple losses just to get confirmation on a suspected diagnosis. Here’s hoping more doctors will be proactive in recommending cervical cerclage after a single loss. And here’s to spreading the word to those wanting to become pregnant that they do not have to suffer through numerous losses when there is a procedure that can dramatically increase the odds of their having a pregnancy that ends in what every expectant parent wants most: a healthy baby.

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