Prepare for a positive birth with The Birth Class

Episode 455

Larke – maternal assisted caesarean (MAC), cleft palate

Larke is a midwife and she talks about her primal desire to experience labour and birth. But as she reiterates, there is so much about pregnancy and birth that is beyond our control. She was only 4 weeks pregnant when a scan revealed a significant fibroid at the back of her cervix which dictated her mode of delivery so from very early on she was grieving the loss of the vaginal birth she may never have. Her 20 week scan revealed her baby had a cleft palate and she is transparent with her rollercoaster of emotions following the diagnosis, normalising the confronting thoughts that come up in challenging times. With the support of her beloved midwife and obstetrician, Larke had an empowering maternal assisted caesarean and within minutes of Dolly being born it was confirmed that her palate was intact which meant she could breastfeed.

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“I’m a midwife so I’ve always looked forward to having my own baby. My periods were really regular and I could tell when I was ovulating. I fell pregnant after three cycles which isn’t long at all but at the time it felt like an eternity. I started using ovulation kits and we conceived that month. It was very exciting to get a positive test.

“I live in Coffs Harbour so we only have one maternity hospital. I wanted MGP because I believe it’s the golden standard of care and when I was a student midwife I chose who I wanted; she is amazing, she makes me feel so safe.

“In early pregnancy I had a significant pain in my side and the next day I had pain in my right shoulder tip, too. I knew what that meant so I went to hospital and they took my blood to measure my hCG levels and they did a scan. I was only 4 weeks but they found a fibroid at the back of my cervix that was the size of a 20 week fetus. I felt icky that there was something in me that I didn’t know about. A fibroid is a non-cancerous muscular mass. I was more concerned with my mode of birth than miscarriage. I was so passionate about having a vaginal birth and I wanted to know what labour felt like so when I was guiding women through it, I had an understanding of what they were experiencing.

“I had a lot of scans and from the get-go the local obstetrician admitted that the fibroid was in a tricky spot – right behind my cervix – and would likely inhibit dilation. It’s very vascular so the risk of haemorrhaging and hysterectomy if they remove it is very high. I feel like I’m still processing the fact that I couldn’t have a vaginal birth but I would also not change anything about my birth experience. Nothing was in my control in pregnancy; I felt so blindsided by the universe.

“A maternal assisted caesarean (MAC) was my way of taking control back. It was a really hard day when I surrendered to that. But after I’d booked it in I was less keen to go into labour because my OB explained that I could only have the MAC if it was planned and not if I was already contracting.

“I didn’t notice anything at my 20 week scan but the sonographer was honest with me and she told me that there was a gap in the baby’s lip. I was shocked but not surprised. My first feeling and fear was how my child was going to cope with being bullied and my heart hurt for the potential pain my child would experience. It just felt really unfair and I was bullied myself; I know what it feels like. I knew it wasn’t my fault but it felt like it was my fault. I called my midwife and she referred us to the maternal foetal medicine team for a tertiary scan. As soon as the scan was done by the head doctor he told me that the palate was also involved. I started googling and discovered hearing, speech, teeth and language development issues. I knew I wouldn’t be able to breastfeed, too. The images are confronting and I told Sunny that I wasn’t sure I could do it. He agreed with me and it was a comfort that we were always on the same page. That was a really dark day for us. It wasn’t that I didn’t want my baby but I was so scared for her and I wanted to protect her.

“As soon as we were at John Hunter Hospital and saw our baby on the screen, everything changed. The team were so supportive and were confident in me birthing in Coffs Harbour despite there not being a NICU. I was determined to do antenatal expressing so I went into hospital with 80ml. Towards the end of my third trimester my midwife really encouraged me to start thinking about what I wanted for my birth. A maternal assisted caesarean was booked for 39+6.

“They guided my hands to Dolly and I’ll never forget those squishy little arms in my hands. I brought her up and she let out a cute little squeal and I cried and cried and cried. The paediatrician checked her straight away and Sunny came back to me and told me she was perfect and her palate was intact and it felt like I’d won the lottery because I knew in that moment that I could breastfeed her. She latched in recovery and she’s officially a boobie girl, she loves it.

“Her lip was repaired at six months but she’s also got a gum notch which means she’ll need surgery when she’s ten. Her gum sits up and away from where it should be and there’s a gap to one side. Once she’s 16 she’ll be eligible for a rhinoplasty (reshaping the nose) if that’s something she wants.”

Topics Discussed

cleft palate, fibroid, maternal assisted caesarean (MAC), MGP, One baby

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