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What is Informed Choice?
What To Expect in the Fourth Trimester
How to Plan for Postpartum
In today’s episode Madi shares her very interesting story and talks at length about her experience with postnatal depression. After her first positive vaginal birth, she was diagnosed with chiari malformation type 1 where part of the brain at the back of her skull bulges and puts pressure on the spinal column. Her neurologist confirmed that she could birth vaginally but she wouldn’t be able to have an epidural or spinal block if an emergency situation arose. Madi accessed all the evidence she could relating to chiari malformation and vaginal birth yet she couldn’t find any information on the ongoing effects after birth. Subsequently, she made the informed choice to plan a caesarean birth under general anaesthetic.
“I had a miscarriage and that really confirmed that I was ready to have a baby. Miscarriage isn’t talked about enough and I didn’t know anyone who had been through it so we kept to ourselves when it happened. I told our friends and family that I wasn’t ready to talk about it and we weren’t really sure how to deal with it. There was no heartbeat on my eight week scan and by twelve weeks I felt like a pincushion as I’d had regular blood tests to check that my hCG levels were going down.
“We kept our pregnancy news with Oakley to ourselves and to be honest, it didn’t feel real until I started feeling her move at about 22 weeks. I was definitely reassured by her movements and we just hoped that there was a happy and healthy baby in there. I booked into midwifery care at my local low-risk hospital but I had to give birth at the primary hospital where there was more medical support if I needed it.
“I woke up one morning and had a bloody show. I was still quite comfortable and I knew that you could have a show and it may be days or weeks till labour started. I went to breakfast with work colleagues and by then I’d started to have some niggles so I messaged Nick just to let him know that things may have started. I had a midwife appointment that afternoon and Nick met me there. The contractions had started to intensify but they were still pretty manageable. My midwife confirmed that I was in labour and encouraged me to go to the primary hospital soon after as she was convinced I was going to have my baby that day. I wasn’t so sure, I was happy to stay at home because I didn’t feel ready to go to the hospital. After walking around the backyard and eating something, I felt ready to go but it wasn’t fitting the guide; my contractions were six minutes apart but very, very intense.
“We got to the hospital just after 6pm and Nick got me in a wheelchair and took me up to the birthing suite. They offered me a vaginal examination because I wanted to know where I was at and I also wanted an epidural; in retrospect I now know I was in transition. I was 7cm and they told me they wouldn’t be able to get me the epidural. They encouraged me to get in the shower and I just swayed in there. Before long I felt like I was going to vomit again but then the energy channelled down and I realised I wanted to push. I got out of the shower and they put the bed up and I leaned against it and started pushing. I remember thinking No one told me I had to push for this long!
“I got on the bed on all fours and the front of the bed was lifted so I could lean my upper body on it. I pushed for almost two hours and then that moment when I felt the ring of fire, I pushed and got half her head out and the midwives encouraged me to hold her there. It was such a good feeling when the rest of her head was out and then one more contraction and she was born.
“Everyone talks about the love you have for their baby when they’re born and I absolutely didn’t have that. I just felt relief, not love and connection, and I did feel guilty for that. I didn’t verbalise that at all; I do now because I know it’s completely normal. It took a very long time for me to feel that connection. We had a lot of trouble with latching, feeding and sleeping; being a first time mum wasn’t what I thought it would be and I was diagnosed with postnatal depression. I’ve had mental health concerns in the past and as soon as Nick asked me if I was okay, I told him that I really wasn’t. It was a long time till I felt connected to her…about nine or ten months.”
Maddi got a mental health care plan through her GP and reconnected with her psychologist. She went back to work a few days a week earlier than she intended, which was a practical way for her to re-establish her identity and a positive step forward for her. She was sure she was happy with one baby but she just woke up one morning and felt like she was ready to have another baby. She fell pregnant with Harlow on her second month of trying.
“I was diagnosed with chiari malformation type 1 so basically after I had Oakley I had a lot of symptoms that were concerning; I was vomiting a lot, I’d get neck pain and migraines, I would lie on the floor and not be able to move. I’d been through so many different tests and I persisted and found a great doctor so he gave me a referral for an MRI. I went to a neurosurgeon who specialised in my condition and he ruled out surgery which was a relief. He told me that if I was ready to have another baby, he supported that but warned me that I couldn’t have an epidural.
“I was weighing up my options and what would be best for me at birth. I had continuity of care with a beautiful midwife and she was there for every decision I made, she was like my cheerleader. I had a lack of confidence when I spoke to my neurologist which is very unlike me and he encouraged me to continue with my birth plan and reminded me that I couldn’t have an epidural or spinal block. There was a lot of evidence that women with chiari can birth vaginally but not much evidence regarding the pushing stage or what symptoms are like postnatally. And there may have been repercussions for me and my long-term health.
“I made the decision that I didn’t want to have to make – to have a caesarean birth under general anaesthetic. This was during the height of covid as well. I haven’t stopped seeing my psychologist and she was helpful with recommendations for brain specialists, too.
“I stayed with my continuity of care midwife and booked my caesarean for 39 weeks. But then I woke up one morning and had a show and soon after I started feeling niggles. I called my midwife and told her I was in labour and she told me she’d been at the hospital for 23 hours and she wouldn’t be able to be at the birth with me. I was so comforted by the fact that I was in labour and she was ready to come. I’d completely prepared myself for a caesarean and at that stage my labour was really ramping up. I was 5cm so the team was really prompt with getting me to the theatre.
“The obstetrician came and told me that if I got to the theatre and I was 10cm, I would have to birth vaginally. My jaw just dropped. I finally got to theatre and they did all the prep first – catheter in, pelvis tilted – before they gave me the general so the baby got the smallest amount of anaesthetic. Nick said he heard me talking and laughing and the next minute he heard Harlow cry. We had planned for Nick to have skin to skin in the nursery with Harlow while I was in recovery.
“It was really strange when I woke up. It was like I’d had the best sleep of my life but I was still tired. I eventually went back to maternity and they wheeled her in and she was so smooshy with dark hair. Holding her for the first time and I got all the feels; we had skin to skin and it was just so nice. There was three hours between her birth and getting to hold her. She was similar to Oakley with feeding; she didn’t latch well but she was safe and healthy and that was the best feeling ever.”
Chiari malformation type 1, Two births, PND, Vaginal birth, MGP, Miscarriage, Caesarean
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