Anybody have any advice for pregnancy and delivery with Chiari? I am pregnant and have Chiari type 1… My dr at The Chiari Institute said it would be safe to do a vaginal delivery but I heard mixed opinions elsewhere. . Any advice would be helpful
Congratulations on your pregnancy, Melissa!
I'm sure you have many questions regarding pregnancy and chiari: how they'll work together and what's best for you and your baby.
I was not diagnosed before my two vag deliveries of my oldest daughters. (Our youngest daughter was adopted.) I had excruciating headaches with both pregnancies-they were chalked up to pregnancy induced migraines. My daughters have chosen not to find out if they have a chiari even though I have greatly encouraged it especially before starting a family because I would definitely advise them to have a scheduled C/Section to possibly prevent the many problems pushing can have on chiari and iih. I did not experience it personally, but have talked to way too many people who have told me that their problems did not start until after the vaginal birth of a child.
I am an OB/GYN RNP and I definitely would not recommend a vaginal delivery if you have a chiari malformation of any type. I'm sure everyone is going to have a different opinion and recommendation, but I say why mess with it if there is another way.
Wishing you the best in your pregnancy, delivery and becoming a new mom! It's the best job on Earth!
I have a chiari I malformation. I became symptomatic after I had my daughter, 7 years ago. I became pregnant again and my neurologist, Dr Frim, University of Chicago, strongly advised a csection under general anastesia. My OBGYN monitored me and decided that was the safest way for me to deliver. My symptoms became worse during the end of my pregnancy. I had the csection in December and am feeling back to normal. My OBGYN said every Chiari delivery is different. It just depends on the situation.
Hi Melissa,
Thanks for posting this as I am curious about this as well. I am not pregnant, but am considering in the near future. My doctors say that I will (obviously) have to deal with natural pain management because of not being able to take pain medicine during the pregnancy. I was already preparing myself for that anyways, but I was more concerned about after birth symptoms getting worse from over-pushing/straining. Since my surgery my valsalva headaches have gotten better, but the chronic neck pain and surgery pain is still very much an issue with me. I was decompressed in 2010 and I will say that my improvement has been a very slow road, I am still dependent on pain medicine. This makes for a difficult decision on my end.
Any information from others is helpful and thanks for the responses so far. Much appreciated and hope today is a good one for you.
Patricia
Hi Melissa!
Congratulations! Pregnancy can be exciting and terrifying, even if you don't have a rare disease. I have been part of the birthing community for years and when I was diagnosed with Chiari, having kids was the first thing I questioned.
There have been other moms on the boards who have gotten misinformation about Chiari and pregnancy. If this is your first baby, the best thing you can do is take a childbirth education class. That will give you information about your birth options. (For natural childbirth I lean toward Lamaze/Passion for Birth, Birthing As Nature Intended, or Hypnobirthing/Mongan Method.) Figure out what kind of birth YOU want and then find a doctor who supports you best. A vaginal delivery IS possible. I asked this question to an OBGYN who us doulas have worked closely with. His response was:
"The short answer to your question is that, yes, most MFM (maternal fetal medicine "perinatologists") will recommend a cesarean to avoid intracranial pressures during 2nd stage and hopeful avoidance of increasing any brain herniation. That said, there are a number of non-ACM conditions where this is the goal, and sometimes you can find an MFM who works with an OB/GYN that will allow a "low-pressure" vaginal delivery. This usually includes an "assisted" 2nd stage, meaning letting the uterus doing most of the work (getting the baby's head really really close to crowning all by itself, without pushing), and then using either a vacuum or forceps for the final push. I've done this with certain cardiac and spinal-cord injury patients with great success."
A low pressure second stage is also known as "laboring down." It means you don't start pushing just because you reach 10cm. I won't go over all the details as they're available via a simple Google search, but it is a great way to avoid a valsalva headache during labor.
Phew what a long post. One more thing and I'll stop, I swear. :) This is useful for pregnancy or any other doctor's appointment. If they are talking about a procedure or medication you're not sure about, ask these questions (I bring a printed copy with me to every appointment!):
B - Benefits - what are the benefits of this medication/procedure?
R - Risks - what are the risks?
A - Alternatives - are there any less invasive alternatives?
I - Intuition - what does your gut say about this?
N - Nothing - what happens if we wait an hour? A day? A week? More?
B.R.A.I.N. :)
Let me know if you've got any other questions!
Katrina W.
I have chiari type one and three babies. I had number one using plain old labor methods. Number two I used the hypno birthing method and number three was fairly complicated but I still went Ua natural I would say that I agree with Katrina. Get as much info as possible and get second, third and twentieth opinions. I would not suggest that what I did was the right way, just what worked for me. I think that number one and all the bearing down was not wise and may have caused some of the problems I have now. Number two was peaceful and I was only “in labor” for 43 minutes. She nearly fell out on the way to the hospital. Number three was “sunny side up” and face first (not back of head first). Very complicated but I had skilled midwives who allowed me to labor and deliver her vaginally. It all worked out in the end. Spend time learning and do what’s right for you and your family.
Thank you so much to everyone who replied! I guess I should have explained my situation a bit mote. This is my 2nd pregnancy and I believe my Chiari was aquired due tova bad epidural which caused me to have intacranial hypotension… There is no way to bee absolutely positive but my dr at the chiari institute agreed. I had a wonderful first pregnancy and had no symptoms all my life until after my son was born. I have 7mm herniation on the left and 5mm herniation on the right. I never had any surgery but I do suffer with a lot of symptoms. Very bad Short term memory, brain fog, very bad anxiety, neck pain, I can go on and on. I am just scared and don’t want my symptoms to get worse. My dr told me my chiari is very slight I have nothing to worry about and that he didn’t recommend surgery. He believes that I have chronic fatigue syndrome and fibramyalgia and that could be causing a lot of the symptoms. For my delivery options I just want to make the best ddecision with the best outcome… I am just afraid…
I have not been officially dx with CM yet, but I have all the symptoms. I recall when I delivering my last child, that was 26 years ago, after the delivery I developed severe pain in the back of my head that last over 20 days. The labor was extreme as my baby was over nine pounds and got stuck - they had to use forsips. Looking back on it now, I know it was CM that caused the pain. My husband had to take time off work to care for our new baby as I was heavily medicated. The pain in the back of my head went away after 23 days. I remember having myself convinced I had a brain tumor. I believe my CM started when I was about 9 years old after a severe neck and head injury that went untreated. I'm praying for a dx soon...
Based on my experience I would opt for the CSection.
If I would have known I had chiari when I gave birth. My epidural went up. My face went numb on one side. They had to turn it off. Have a C section. No way I would push out a baby with chiari. No way I would have an epidural.
I know you're scared. It's hard when you have such a joyous event and have to take into account this terrible disease. It's up to you to decide what's best for you and your family and that takes time, planning and research. No one can tell you which path is best - it's something you need to decide on your own.
To clarify a couple of things I read upthread... Unless you're having general anesthetic (being put completely under, which is incredibly rare) a spinal injection is required for a cesarean birth. You can't avoid an epidural by having a cesarean. And an epidural is NOT the only form of pain relief there is for a vaginal labor. There are plenty of pharmacological and alternative pain management techniques to choose from. Some hospitals are experimenting with nitrous oxide ("gas & air") which has been available in Europe for ages. Again, it's up to you to research these either on your own or in the setting of a childbirth education class. A doula can be a tremendous help as well - she's on call to answer questions, allay fears, and support your family. Depending on where you live, you may even find a doula who has attended out of the ordinary births. And yes, we support mums who choose medicated or surgical births. :)
This all depends on your comfort level, and it's not an easy choice to make. If you weigh the risks and benefits, and in your heart decide that a vaginal birth is best, or a cesarean makes you more comfortable, or any combination in between, no one can fault you.
I wish you the best!
Katrina W.
Hi I am also pregnant right now , I only have 25 days left and I am going to try to have a natural birth. Everyone that I have talked to has said they were not able to have a natural birth. I’m hoping that is not the same for me.
How far along are you? If you’re still early try not to think about it. Just all the good things that are going to come out of haveling a baby. For me it was kinda like siking myself out of the pain and stress of chiari. Once you do that you’ll feel so much better and be so happy about your pregnancy. You might still have some bad headaches threw out and they might taper off or continue till the end. Tylonel is a lfe safer. Just try not to over do it.
When I talked to my doctor they told me o couldn’t get pregnant unless I had surgery. Well he was wrong.
I will update you after I have her. And let you know how everything went.
Hi Melissa, I have had chiari, like most I believe, since birth. I had no idea what it was exactly or the symptoms it caused until long after I’d had my child. (now 4yrs old) because if the extreme headaches from exertion, my dr and i decided that a c section was the best option for me. I couldn’t exercise at all let alone push out a kid! Everyone is different however so please go with your gut. Listen to your body and decide what is best for you. Good luck!
I would recommend not doing the epidural my doctor said that chiari malformation is a Neurological disorder. That the epidural has a bigger chance in harming us more. I had 1 baby natural no problems and other two c sectioned but they put me to sleep on those two. I suffered from my migraines before the kids so no it shouldn't make things worse but discuss the epidural thing with doctor but I remember my doctor specifically said in my case it was way to dangerous to get the epidural. Kids are a wonderful gift take it easy and do not over do your self if you feel pains that concern you, do not hesitate to go to doc on it I went into prelabor 5 times with my last one not realizing I was in labor til I went for my appointments. I do not want to scare you but we all are different and with Chiari our pains are not like most pregnant women so we may not realize whats going on. My pain tolerance is high when it came to pregnancy I didn't even feel pushing my first one out and he ripped me no meds. Yet I felt the pain from the c-section when I woke up from it that is. My advice go natural if problems occur they will do a emergency c-sec which saved my middle child. Just have someone you trust in your family to keep a eye on your vitals and the babies vitals as well. My doctor didn't know it but for some reason my brain wouldn't produce the dilation on middle child got stuck at 6 and baby went into distress thankfully my family walked in just in time and saw our heart beats yelled for doctor and they rushed me to surgery. Just word of advice have someone in room with you at all times for the natural birth. If they put you to sleep to do c-section you cannot have someone in the room. My best experience was the natural birth I was out of hospital within 2 days don't stress over what can happen just discuss everything with your doctor and do not hold any symptoms to yourself no matter how gross.
I had a baby 2 months ago and also have Chiari. The doctors were unaware of my Chiari with my 1st daughter and I had a normal delivery with an epidural, now I've had the same headache since I had her and they're almost positive either the pressure of bearing down for delivery or the epidural caused it. With this baby my neurosurgeon at Duke recommended I have a c-section with general anesthesia which therefore eliminated risk of building up pressure in my head from bearing down and any risk from an epidural. I think every doctor will tell you differently because Chiari is something that everyone seems to feel differently about. However, I did feel most comfortable having the c-section and general anesthesia because then it was just one less thing to worry about for me. The c-section was very painful when I first got up and moving at the hospital, but honestly I rather take that pain than have my Chiari symptoms get any worse. I will tell you that with general anesthesia the dad can't be in the room, but he can be right outside the door.
I delivered 2 kids both before I knew what I had, but I had no problems at all during delivery. I kept having severe symptoms and had surgery soon after diagnosis. If you have any questions for me, I can elaborate. Take care and good luck!
I think you should take your concerns first to your husband and then both of you discuss that with your OB. They are the best ones to suggest anything to you and alleviate your concerns.
Jennifer
Thank you everyone… it means a lot to read all you responses… I am leaning toward have natural delivery with help from forceps or vacuum to reduce pushing. . I am still scared. . I am trying not to freak out and just relax… I’m hoping for the best… I appreciate all of your words of encouragement and kindness it means a lot!