Preterm births stemming from cervical insufficiency can often be prevented with screening that insurance companies are not required to cover. Now, a clinical psychologist and New York lawmaker have joined forces to spread the word and create change.

Advertisement
An image of a gynecologist looking at a woman's cervix.
Credit: Getty Images.

From the time you find out you're pregnant, you want to believe that your care providers and health insurance will have both you and your child's best interests in mind as medical decisions are made. But when it comes to a condition called incompetent cervix or cervical insufficiency, all too many parents-to-be are learning they may not receive a standard of care consistent with what modern medicine has to offer.

Now, a petition on Change.org petition and bill in the New York state legislature—and the two women behind the campaign—are calling attention to the fact that most insurance companies will not cover an important scan between 16-20 weeks that could preempt pregnancy loss, deeming it "unnecessary."

What Incompetent Cervix Is

Cervical insufficiency happens when the cervix, or the lower end of the uterus, opens too early under the weight of the developing baby, potentially leading to pregnancy loss and premature birth. The condition is estimated to occur in 1 in 100 pregnancies, according to the Cleveland Clinic. It is also the cause for as many as 20 percent of mid-second trimester spontaneous pregnancy losses.

Risk factors for the condition include but are not limited to:

  • Prior procedures associated with abnormal Pap smears like a LEEP or conization or other cervix surgery.
  • A history of uterine or cervix anomalies.
  • Exposure to diethylstilbestrol (DES), a synthetic hormone.
  • Damage to the uterus or cervix from previous labor, miscarriage, stillbirth, or abortion.

A scan done between weeks 16-20, which costs no more than a few hundred dollars, could potentially preempt the condition from leading to a pregnancy loss. However, because many insurance companies won't foot the bill, many low-to-middle income women don't get it at all, leading to an increased risk of pregnancy loss and preterm birth. This is especially concerning for pregnant Black and brown people with the disparities that exist in health care.

If cervical insufficiency is detected, doctors may address it with progesterone shots, cervical cerclage (a surgical procedure involving sutures that aim to keep the cervix closed), or a pessary that's designed to hold the uterus in place and can help reduce pressure on the cervix.

How Two Women Joined Forces to Address the Issue

After facing their own devastating losses due to IC, clinical psychologist Carolyn Spiro-Levitt and New York Assemblymember Rodneyse Bichotte Hermelyn joined forces to create change.

Spiro-Levitt, who shared her heartbreaking story in a Washington Post op-ed last summer, lost her son, Eli Levitt, when he was born prematurely at just 23 weeks old on July 5, 2020.

Around that time, Assemblymember Bichotte had opened up about losing her son Jonah when she was 5-and-a-half months pregnant in 2016. To add insult to injury, the hospital affiliated with Bichotte's doctor's office turned her away when she went into labor. It took her hours to get to a new hospital, where her son was born and passed away that same day.

In the wake of losing Eli, Spiro-Levitt read Assemblywoman Bichotte's story.

"When I read about her experience losing her beautiful son Jonah, I was so heartbroken; our stories had so many similarities," Spiro-Levitt tells Parents.com. "I was so inspired that she had worked to pass a bill in Jonah's honor, and I reached out to her to connect. I was touched that she not only responded but wanted to find a time to meet to share our experiences and talk about our boys."

The clinical psychologist recalls having an "immediate bond" with Bichotte over their shared grief. "We both felt so passionately about wanting to prevent other families from experiencing the loss and trauma that we both had, and we talked about working on legislation in Eli's memory to try to do just that," recalls Spiro-Levitt.

Their Change.org petition, which has currently racked up over 43,000 signatures, the women call for support for a bill introduced by Bichotte in the New York state legislature. The Eli Parker Levitt Law, or NY A08048, if passed, would require insurance policies to provide coverage for screening for IC in New York state.

Assemblymember Bichotte also introduced and sponsored the Jonah Bichotte Cowan Law, or NY A7741, passed last year, which requires hospitals to develop their own protocols in line with already existing federal and state requirements for admitting, diagnosing, and treating expectant mothers experiencing an emergency medical condition.

"The most rewarding part has been fighting in Eli's memory for legislation that we hope will save many lives," says Spiro-Levitt. "Losing Eli is the most painful thing my husband and I have ever experienced. We were robbed of a life with Eli, and he was robbed of a lifetime of experiences and opportunities. We want to do everything we can to have his life and legacy leave a positive impact on the world, as we're confident he would have."

While there currently isn't legislation that addresses this issue on the federal level, Spiro-Levitt and Assemblywoman Bichotte hope that the Eli Parker Levitt Bill might become a model for other states.

"Assemblymember Valerie Huttle is introducing a matching bill in New Jersey," explains Bichotte. "California recently passed a 'Momnibus Act' to reduce maternal health care disparities."

Ultimately, they hope raising awareness will mobilize people to contact their local lawmakers and to find champions for nationwide health care access and a reduction of inequity in maternal health care.

What Expectant Parents Need to Know

While developing NY A08048, Spiro-Levitt and Assemblymember Bichotte consulted Dr. James Sumners, a senior faculty member at the Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, Texas and an expert on IC.

"Based on his research and clinical expertise, he recommended that all women should have a transvaginal ultrasound during weeks 16-20 to check on the cervix in a first pregnancy," says Spiro-Levitt. "For women who have risk factors for IC, he recommended that women have biweekly transvaginal ultrasounds during weeks 16-24, which is considered the 'danger zone' for IC."

She adds that since sharing her story publicly, she's heard from multiple women who said that when they asked for the scan, they found out that their cervix was shortening in time for successful intervention.

"Some women shared that they had LEEP or other procedures done but were never warned about the risk of IC," she notes. "While not every case of IC can be caught in time, as the cervix can change quickly, it is possible that many cases could be found in time to save babies' lives."

The bottom line: Spiro-Levitt and Assemblymember Bichotte urge anyone who's newly pregnant to find a doctor and a care team who they trust and who listens to their concerns.

"Know your medical history, and if you don't feel like you're getting the attention you deserve from your provider, don't be afraid to find someone who's a better fit," says Bichotte. "If you're a woman of color, your risks of preterm labor are exponentially greater. Therefore, it's even more necessary to prepare yourself with information, ask your doctor questions."

Spiro-Levitt says she'd also advise pregnant people to trust their intuitions and gut, concluding, "And if something doesn't feel right, ask to be seen."