The Two Week Wait
10 Questions To Ask Your Care Provider
Pregnancy After Miscarriage: How Long to Wait Before Trying Again
Bleeding In Pregnancy
Birthing Your Placenta : Active Management versus Physiological Management
5 Common Postpartum Experiences
In today’s episode I chat to Nikki about her life in East Arnhem Land, her unexpected third pregnancy and the steps she took to actively prepare for her birth. You can hear the story of Nikki’s first two births in episode #113 but she also briefly talks about her second birth in this episode and details the challenge of shoulder dystocia, retained placenta and a postpartum hemorrhage. Her experience definitely dictated her pregnancy care and birth plans but she was also fiercely proactive in getting informed, advocating for herself and rallying a supportive care team. Nikki is incredibly articulate and her story will give you the encouragement to prepare and plan, regardless of your fears.
In 2011 Nikki’s husband James was diagnosed with testicular cancer and underwent treatment which was successful. Consequently, he was left with one percent fertility so they conceived their first two children – Tilly and Henry – through IVF. After a big move from Adelaide to remote East Arnhem Land, they thought their family was complete but baby Edie had other plans.
“Tilly is now six and her birth was pretty straightforward. I was on bed rest for part of it, she stopped putting on weight towards the end so I was induced at 40+1. It was an intense but manageable labour and her delivery was assisted by the vacuum.
“I was induced with Henry as well and it felt as natural as possible…it was long but a really good one, it had a nice progression. But when I tried to deliver him he got stuck. The vacuum failed and they had to use the forceps for his head and then again with his body and it turns out that he had shoulder dystocia; his shoulder was wedged into my pubic bone. He was born flat, his apgar scores were really low and he needed resus. Unfortunately the placenta didn’t come out so I ended up losing more than 2.5L of blood and I had to go to surgery to get it removed.”
Despite the immense difficulty of Nikki’s experience, she doesn’t view it as fear or grief-filled. “It was such a gift to go through something like that…I just feel so proud of going through it and coming out the other side and feeling empowered. It didn’t take anything away from the birth itself and while I don’t want to dismiss anyone else’s birth fear, I can’t deny that I still think of it as a good experience even though it was hard.”
In remote East Arnhem Land, Nikki and James are surrounded by a close-knit community that is always willing to help. They’re most definitely living the village life and it proves to be so beneficial to growing and raising a family.
“We’ve got a wonderful support network up here, a real village of people ready and willing to help and I couldn’t have done pregnancy or the early newborn days without them. They really rallied. The mums and I have a messenger chat and we’ll chat all day; someone will duck in to pick up Tilly for school, everyone is two minutes away from each other so it makes it so easy to help out.”
Nikki discovered she was pregnant at the hospital when she presumed she had an infection in her arm. She navigated almost 20 weeks of nausea, vomiting and fatigue but despite it all, she set about advocating for herself really early on.
“The first thing I did was arrange continuity of care and that was a big turning point for me. My OB made the call that I was too high risk for the local hospital and I needed to give birth in Darwin.I felt good about it because I had a plan and this was at 25 weeks. I need to feel safe and making plans late in my third trimester wasn’t going to suit me. The next thing I did was get a student midwife, again for continuity of care…she was local to me but she was also going to be on placement in Darwin when I was due so she was wit me throughout my pregnancy and at my birth…she actually caught Edie! I linked in with a psychologist too…leading up to Edie’s birth I wanted to connect with someone just to make sure I was in a good headspace. I did it through a zoom session and she emphasised the importance of making time for myself and connecting with my baby. There is a high chance of having another shoulder dystocia birth and it’s not as if I have big babies but they did suggest the shape of my pelvis was a cause so I was really mindful of that.
“I was strongly advised to have an induction at 39 weeks so my labour was controlled and the baby would be a bit smaller. I had a couple of appointments in Darwin and at 36 weeks there was a shift. I met with the head of OB, he was working here in Gove, he recommended that I wasn’t induced….he thought an induction would speed up labour and my body wouldn’t encourage the baby into a good position. I felt really confident in that decision even though I liked the safety net of an induction. That same week I was accepted into the Midwifery Group Practice in Darwin and I was delighted about that…they also supported my choice to not be induced.”
Nikki and James decided to go to Darwin at 37 weeks and spend a few weeks in family holiday mode before they turned their attention to birth preparation. I revisited The Birth Class towards the end and every night I was getting tightenings for hours and I just focussed on my breathing, my movement and I found the optimal maternal positioning episode really helpful. Every night I used the tightenings as a practice run which really helped me connect to my baby, to the pregnancy and put my energy into what my body was preparing to do.
“I was 40+5 and I’d lost my mucous plug that morning which was exciting. I was hopeful. That afternoon I was so cranky with everybody and once everyone was in bed I stayed up watching crappy tv and relaxing. At 10:30 I decided to go to bed and I started to get small tightenings, they were niggly and they kept coming on and off more frequently. I started timing them and around midnight I called the hospital to give them a heads up.I couldn’t be in bed and I knew at 1:30am that things were ramping up…I could barely speak to the midwife at the hospital and they told us to come straight in. Even though I’d done so much work going into this birth the anxiety still got in…but it was all happening so quickly I just needed to let my body do what it needed to do. We were in the car and I felt like I was at that transition point, I used my breath, and when we got to ED I fell to the floor with a huge contraction and it felt like she dropped and she was coming. I was making this animalistic noise so they put me in a wheelchair and wheeled me up to the delivery suite. None of my midwives made it but I had Kylie, my student midwife. I had a few big contractions and then I got on the bed and they checked her heart rate and it was a bit low and they were a bit worried. They laid me down and put the fetal scalp monitor on and she was doing better…they must have broken my waters to put that on…soon after they noticed that she was going into distress.
“They suggested an episiotomy and vacuum and while she was getting close she wasn’t progressing quite in time with how quickly my body was working. For me I felt that she needed to come out and my body wasn’t doing it. They did the episiotomy and all of a sudden I was birthing her…her head was coming and everyone was cheering. Kylie encouraged me to reach down and feel her head and it got really exciting. I can’t even remember how many pushes…but her head came. I heard the midwife say McRoberts which is a manouvre used to prevent or assist a shoulder dystocia presentation. They pulled my legs back and she was born. She cried, I cried, everyone cried. There was a sense of relief that she was there, she was safe and we’d done it. As they were pulling her out they gave me a syntocinon injection…my biggest fear was waiting for the placenta and then I’d lose blood and have to go to theatre. The option I chose was providing active management and I delivered the placenta within twenty minutes.
“The obstetrician came back to stitch me up and I unraveled a bit then….the after birth pains were intense and things were raw, being in that similar situation with Henry…it took me back and I remember saying I felt scared and unsafe. I sucked on the gas and I had a local anesthetic but it was hard…I wasn’t expecting it at that moment but thankfully it passed and soon after she latched on and the room was calm and we snuggled and took in all in.
“When she was being born, the head midwife heard a pop and I’ve watched the video a thousand times and I couldn’t hear it. The midwife wanted the pediatrician to look over her and he said it was probably fine but we should do an x-ray just to be sure. We were moved to the ward, they did the x-ray about 10am and it was very obviously broken but it healed itself…when babies break their clavicles they just fuse back together. I’m monitoring her arm movements and pain and her skin….initially she wouldn’t move that arm above her shoulder but now she is moving it just as much as the other arm so that’s encouraging.”
Postpartum haemorrhage (PPH), Shoulder dystocia, McRoberts maneuver, Student midwife, Three vaginal births, MGP
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