I Have to Choose Between a Medically-Necessary Hysterectomy And Having a Second Baby
Illustration by Gwenda Kaczor
My husband and I always considered having multiple children. After my daughter was born in October 2019, we figured we would settle into parenting for a couple of years before discussing when it would be the right time to expand our family. But we may not have that luxury of time. At my six-week postpartum check-up, when I expected to discuss birth control options with my OB, my doctor told me that I either needed to start trying for a second baby soon or have a hysterectomy to protect my health.
For the past nine months, I was so deep in my happy haze of doppler readings, sonograms, and belly measurements that I had nearly forgotten my non-pregnant reality: I had an abnormal Pap test in 2016 with an atypical glandular cells (AGC) result and then subsequently tested positive for human papillomavirus (HPV). The AGC pap result means there are abnormal cell changes in the cervical canal and potentially the uterus. Combining that with a positive HPV test put me at an increased risk for cervical cancer, uterine cancer, fallopian tube cancer, and other types of metastatic cancer to the lower genital tract. The ultimate prevention is having a hysterectomy.
My Abnormal Pap Test
After my Pap test results came back abnormal in 2016, I endured more than a year of invasive and painful cervical examinations. AGC only occurs in less than one percent of all cervical tests and it's associated with significant disease, so a follow-up Pap test is not sufficient. With nothing conclusive found in my first set of cervical biopsies, my doctor decided to perform a cone biopsy to remove large amounts of tissue. This revealed I had what's called adenocarcinoma in situ (AIS), or pre-cancerous cells. Thankfully, the procedure cleared away the bad cells, but my doctor told me it would be best to wait to have a child until I had plenty of clear Pap tests under my belt.
Finally, after two years of testing, my doctor told me it was safe to try for a baby. We were excited, but something else my doctor told me was playing in the back of my mind. The ultimate treatment for AIS is a hysterectomy, preferably as soon as I was done having children. That's because AIS makes it difficult to tell if those bad cells that can cause cancer are actually gone. "When the cervix is removed completely, it allows the processing of the tissue to also completely exclude the malignancy of an invasive cancer," says Andrew Menzin, M.D., the chief of gynecologic oncology for Northwell Health in Manhasset, New York and a professor of obstetrics and gynecology at Hofstra/Northwell.
I still sometimes break into a cold sweat at the thought of more pre-cancerous cells lurking in my cervix, just waiting to attack.
Dealing With a Tough Decision
As I walked out of my doctor’s office at the end of my postpartum appointment, I called my husband. "How do you feel about having a second kid?" I asked, hearing my roly-poly baby screeching in the background, eagerly awaiting my return home.
"Yikes," he said jokingly.
We were so sleep-deprived and overwhelmed that the thought of having a second one of these little creatures seemed unfathomable. Undoubtedly, most parents have to ask themselves some hard questions before having another kid, but because of the unpredictability of the cells in my cervix, we felt like we had a looming deadline to answer them. If we decided to have another child, there's a chance I was gambling with my health.
Even after several clean Pap tests, I sometimes broke into a cold sweat at the thought of more pre-cancerous cells lurking in my cervix, just waiting to attack. Was it just best to take my chips off the table and be satisfied with the one child I have?
Besides the added complications and expenses of another child, the thought of being pregnant again so soon sounded nerve-wracking and not to mention miserable (did I really want to gag again every time I brushed my teeth?). My cervix was slightly shortened from the cone biopsy, and although it held strong for 41 long weeks of my first pregnancy, I wondered if I would be chancing it the next time around.
Living in the Now
When I got home from the doctor's, I could hear my baby crying even before I walked through the door. I had pumped a bottle for my husband before I left, but my tot never seems to be satisfied unless we're skin-to-skin and she's tugging on a strand of my hair. After I plucked her from my husband's arms, she stopped crying. I sat down to feed our healthy, beautiful, wide-eyed baby and remembered a time when I didn't think even she would be possible.
There is so much uncertainty about what the future of our family will look like, and we have a lot of tough decisions to make over the next year about birth control, finances, and my overall health. But for right now, I am taking some time to slow down and enjoy listening to my daughter's breathing in and out as she sleeps on my chest. For now, that sound is all I need to remember that no matter our decision, we have all we need to make it through.
