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Stories of Birth, Pregnancy, and Newborns

Birth ButterflyChange of Plans: Twins' Birth

By A. Fitzgerald

My first birth was a glorious, natural birth.  My second birth was a harrowing and mismanaged labor, followed by an emotionally devastating cesarean section.  When I got pregnant the third time, I planned to have a homebirth. 

I desperately wanted to recreate the intimate, rewarding experience I had with my first.  It took a whole lot of discussion and a great deal of research to convince my husband that it was safe to birth at home, but he finally agreed to meet with a homebirth midwife.  After more research and phone calls, we met with a homebirth midwife whom we liked and trusted. 

During my first prenatal visit, which took place at my home around 12 weeks gestation, the midwife listened to the baby’s heart rate with a fetoscope (a non-ultrasound, fetal stethoscope).  Her forehead pressed just inches from my belly, the midwife moved the fetoscope around, listening, looking at her watch to time the beats.  “I heard it here,” she said, pointing to the right side of my abdomen.  “And, I heard it here,” she said, pointing to the center of my abdomen.  “Twins?” I asked.  “Probably not,” she said. “You’d be bigger if it was twins.  It was probably just the baby bouncing around in there.”  What a relief, I thought. 

At 17 weeks, I went to the Birth Center to see the midwife whom I viewed as my back-up in case my homebirth plans were derailed.  The same midwife who guided me so expertly through my first labor and delivery measured my uterus and said it was a little large for 17 weeks.  She put the doptone to my belly and heard a heartrate of 130 on the right side.  Exploring around my abdomen with the doptone, she heard a heartrate of 160 on my left side.  “Could be twins,” she said, “or a fibroid.”  To be certain, she scheduled me for an ultrasound the following week.

It’s an understatement to say that it was difficult to wait a week, in limbo, not knowing whether I was growing one baby or two.  My mind was spinning with anxiety and thoughts about everything:  Where will everyone sleep in our 3-bedroom home?; What kind of car will we need?; How will I manage to breastfeed twins?; Have I been eating enough protein?; and on and on. 

At 18 weeks, it was time for the ultrasound.  Within seconds of placing the ultrasound wand on my abdomen, the doctor proclaimed, “Well, there’s definitely two in there.  That was easy.”  Easy?  That’s easy for her to say!  Sure enough, there were two round melons, the babies’ heads nestled together in my belly. 

As I saw their little hands moving around, it brought tears to my eyes.  Watching those little ones dart around in there, all my husband could whisper was, “wow.”  From the ultrasound, the doctor could tell that both babies, referred to as Baby A and Baby B, were boys; I was going to have a house full of boys! 

For my birth plan, the twin pregnancy meant that homebirth was no longer an option.  I was disappointed, to be sure, especially because I knew my only option was a hospital birth, not at all the venue where I wanted to have my babies.  (The Birth Center where I had previously given birth did not allow VBACs in their facility.)  At least I was still able to use the midwives, this time with more involvement from the back-up doctors, who wanted to monitor the twins’ progress. 

From that point on, my pregnancy and the babies’ growth was right on target.  My total weight gain was appropriate for twins (nearing the 50-pound mark!), and the babies were growing and developing normally.  One baby decided to nestle his head under my ribcage which, as he grew, resulted in considerable pressure and pain.  It was difficult to find a comfortable position, and my belly was enormous. 

By 37 weeks, I was measuring as if I was 44 weeks pregnant.  I was ready to have those babies!  Everyone else was eager, too.  Looking eye-level with my protruding navel, my three-year-old son lifted my shirt and said, “When are these babies coming?!”  I told him I wasn’t sure, and that he should tell the babies to come out.  For days after that, he would randomly yell at my belly, “Time to come out!  Your big brother is ready to meet you!”

By 39 weeks, the midwives and back-up doctors were pushing me to have a non-stress test to make sure that the babies were still doing alright.  So, up to the hospital I went, where they hooked me up to the ultrasound and stretched the two bands to their limits over my girth.  Both babies looked good, but my caregivers were anxious for me to give birth. 

The midwife said she wanted to strip my membranes if I hadn’t delivered by my next prenatal appointment.  I knew that a scheduled cesarean section, something I wanted to avoid at all costs, was hanging over my head.  I really started to feel pressure to have those babies.

I wanted to try what I could, naturally and safely, to help my labor to begin.  I scheduled a massage with a very knowledgeable massage therapist and doula, and asked her to hit all the labor stimulating points she could.  The massage felt great, but no regular contractions resulted.  So, I used an acupuncturist to more aggressively stimulate the labor points.  I had some contractions following the acupuncture sessions, but they petered out in a few hours. 

My due date arrived, and there were still no signs of labor.  After consulting with an herbalist, I tried black and blue cohosh herbal tinctures in an effort to kick-start my labor.  Nothing.  I was starting to get discouraged.

Three days past my due date, my midwife stripped my membranes. She said if it was going to work, labor would start within 24 hours.  My caregivers’ talk of cesarean section had progressed from a whisper to a shout, and they want to see me back in two more days for another non-stress test.  I inquired about induction, or rupture of membranes, to start my labor, but I was told that I was not a candidate due to the previous cesarean. 

I really didn’t want to schedule a cesarean.  I believed that it was better for labor to initiate, for the babies to be prepared for birth by the action of the contractions, even if labor ended up in a c-section.  At the same time, I did not want to compromise the babies’ health by waiting too long before they were born.  I knew enough to know that placental insufficiency and uterine rupture were concerns because of being “post-date,” especially given that it was a twin pregnancy with a previous cesarean.  I was struggling mightily to deal with these competing concerns.

Twenty-four hours after my membranes were stripped, I still had no labor contractions.  Those babies just did not want to come!  I phoned my former homebirth midwife for advice, and she recommended that I drink castor oil to stimulate uterine contractions. 

After two root beer, castor oil floats, and nipple stimulation with a breast pump, contractions started.  They were 5-6 minutes apart, moving to 2-3 minutes apart.  I felt so encouraged, thrilled, that I might be in labor.  I walked.  I squatted on a birth ball.  I did pelvic tilts on all fours.  I was ready to go!   After about 7 hours of contractions, I called the Birth Center.  The midwife told me to make my way to the hospital to be checked. 

Another 2 hours later, around 10 pm, I arrived at the hospital.  A vaginal exam revealed that I was 3 cm dilated and 80% effaced.  Ugh … 10 hours of contractions, and I was still only 3 cm!  The midwife recommended that I walk around for an hour, to see if I could get labor moving along. 

An hour later, there was no change to my labor or dilation, so the midwife recommended I take a sleeping aid.  Her hope was that it would relax my uterus, which she felt was aggravated from the castor oil, and then allow real labor contractions to take over. 

The sleeping aid knocked me out.  I slept better than I had in 9 months.  Morning arrived, 5 days past my due date, and I was having no real contractions.  The caregiving team (consisting of two midwives and two doctors) arrived to talk with me, once again, about their concern for the babies’ health if I continue to stay pregnant.  They asked me to go ahead and agree to a cesarean.  I told them I would agree to one, but I wanted two hours to do what I could to try to get labor going.  They agreed.

I hoisted myself out of the bed, and my husband and I began walking the halls.  We stopped at the nursery window and looked at the babies in their bassinets.  We passed rooms with laboring moms and rooms with moms and newborn babies, and we walked some more.  I had very few contractions, and the ones I did have were mild. 

Just before noon, I returned to my room, feeling utterly defeated.  My midwife came to check my cervix and I told her not to bother; I knew there was no change.  My team of caregivers started preparing for my surgery.  Everyone knew how disappointed I was, how hard I had worked to have a healthy pregnancy and VBAC. 

I was wheeled into the operating room and anesthesia was placed.  My husband joined me at my side.  The room seemed filled to the brim with people: one anesthesiologist, one nurse anesthetist, one midwife, one doctor, and four nurses.  Within mere minutes, Baby A was born.  He was big, and dark haired, and he had a loud voice.  They showed him to me briefly, then took him to the warmer.  It took a lot longer to fish out Baby B, who was still breech, but trying to turn head down.  He was finally lifted out, also big, with a loud voice and reddish hair.  The voices of both babies filled the room.  I told my husband to leave my side to be with the babies across the room while the doctor began the process of restoring what was undone by the surgery. 

twins birthShortly, my husband brought Baby A and then Baby B to my side.  I longed to hold them, but had to be content to look at them and tell them how much I loved them. The babies were both robust and healthy and - here’s the kicker - weighed 7 pounds 9 ounces and 7 pounds 13 ounces! 

As soon as I left recovery, I had the babies with me in my hospital room, and I began the process of learning to breastfeed two babies at once.  Not an easy task, but I discovered that propping both my arms and the babies with pillows was key. 

When they weren’t in my arms, the babies slept together in one bassinet, snuggled together as they had been for the long 40 weeks and 5 days.  Thirty-six hours after the birth, we left the hospital and headed home, about to start on an adventure for which we had no roadmap and an inadequate amount of sleep.  What we did have was loads of love for these two little guys and lots of help from grandmothers and friends.

Looking back on it, my pregnancy and birth experience with the twins helped to prepare me for life with twins, plus two older children.  The experience required me to release my somewhat rigid expectations and to make decisions based on what was best in the situation, not what was perfect in an ideal world. 

And, unlike my previous c-section, where I felt my birth plans were trashed through labor mismanagement, this time I felt it was the right choice.  I had done what I could do, everything I knew to do, to start labor, and it hadn’t worked.  There were forces at work more powerful than me.  I am grateful for the lessons I learned from this pregnancy, labor and delivery and, most of all, for my two healthy baby boys.

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