My Twin HBAC / VBAC


Okay, so I wrote out my birth story 2 days afterwards to share on some of my birth boards. I cleaned it up a bit and took out some of the more gory details so I could share it here. I figured that some of my online pals may be curious about it, and hope that some of the folks finding my blog by searching about twin pregnancy will read this, be encouraged and inspired, and know that natural birth IS a safe option for women having multiples.

So, here it is– the birth stories of HM and BN. Enjoy!

The background (skip it if you just want the birth details):

nursingnewleviI guess it really begins with the birth of their older brother, my third child, born in 2001. I had planned a homebirth, as I had really hoped to avoid unnecessary hospital interventions. As things would turn out, I ended up transporting to the hospital and having an emergency cesarean due to transverse lie. When I transferred to the hospital, they were clearly in no rush to get me on pain relief, and I labored flat on my back until I was 9 cm dilated. During the surgery, the doctors all laughed loudly and joked with each other, not paying any attention to my crying. When I had a medication reaction and didn’t think I was breathing, nobody could hear me whispering for help between their music and loud talking. I spent most of the surgery afraid that I was dying, and was amazed at the hospital’s dehumanizing treatment of me and my baby. Before his birth, we had wanted a large family one day. Afterwards, I was so devastated by the loss of the birth I had planned, and so overwhelmed by fear that I would never again experience natural childbirth due to a prior cesarean, that my husband and I decided we didn’t want any more children.

Just last year, things shifted in our thinking a bit. I had researched vaginal birth after cesarean (VBAC) enough to know that it is a safe option in situations where induction, augmentation, and other interventions could be avoided, and we decided to try to conceive our fourth child. After I was pregnant, I began my search for a provider, and found that several local hospitals no longer allowed planned VBACs, and that none of the local doctors would be fully supportive of a VBAC. I looked into homebirth with a direct entry midwife, only to learn that the midwife licensing board made it illegal for direct entry midwives to deliver VBACs in my state as of 2004, even though they had successfully been attending VBAC homebirths for many years before then. Only a CNM could deliver a VBAC at home, and no CNMs in my state could find a backup OB to support them in a VBAC homebirth.

Through referrals from our many friends who had given birth at home near us and online acquaintances, we found a very naturally-minded midwife in a nearby state who used to work our area before she moved away. While she was not willing to drive all the way to SC (a several hour drive from her) while I was in labor, she was willing to take me on as a client provided we were willing to drive for appointments and for the birth. We agreed, and began our search for somewhere to stay for two weeks before and two weeks after our due date, so that we would already have a temporary home to have our homebirth VBAC (HBAC).

A month after securing our midwife’s services (but just before our first appointment with her) and feeling confident with our course of action, we went in for a non-medical ultrasound to find out gender, and were SHOCKED to learn that we would be having both a little girl AND a little boy. The sonographer took several extra pictures for us (including several showing that we had two placentas, which later proved valuable information), and later that day we panicked, calling our midwife and letting her know we would be finding an OB and switching providers. We were just too scared to go through with a twin HBAC.

We did a little more research, though, and found that twin VBAC moms are no more likely to suffer uterine rupture than singletons, learned that twins with two placentas have minimal complications (if any) compared to singletons, and began to wonder if it was really necessary to resign ourselves to a mandatory cesarean at the hands of a surgeon. I called my midwife back and asked her what her experience had been with twins. It turned out she has delivered tons of twins when working in hospitals, and almost 20 sets of twins (including many twin VBACs) since switching to a primarily home-based practice over a decade ago. All twin births were successful, none required transport. We switched back to the original plan, and began preparations for a twin HBAC.

Labor Begins:

For WEEKS I had been having strong and uncomfortable contractions– so many so that I was terrified of preterm labor. Somehow I made it to 36 weeks (the earliest my midwife would attend a twin homebirth) and we relocated. My husband stayed with me and the kids Fridays through Mondays, and went home every Monday to work a full week. In spite of regularly growing contractions, I made it past 38 weeks, and when I was 38 weeks and 1 day (with a fundal height measuring 50 cm), my husband went back home to work his week. That night, I tossed and turned, having contractions in my sleep. Tuesday morning, May 8, around 3:30 am, I was awakened with painful contractions coming every 2 minutes. This had happened before, so I tried all my usual tricks to make the “false labor” go away. I had a glass of diluted wine, drank lots of water and rested on my side, and around 4:15 am I gave up and got into the bathtub to see if that calmed them. At 4:45 am, still unsure if I was in real labor or not, I called my husband and asked him to come be with me just in case it was time. At 5:00 am, I called my midwife and let her know what was going on. She told me to call my other labor assistants and get everyone on their way.

Around 5:30 am, as I was making the bed and getting my birth pool ready (I had really wanted a water birth), my water broke and things intensified. Around 7:00 am, the midwife arrived and said it was fine for me to get into the birth pool to take the edge off the contractions, and the water was SO soothing! By 7:15, the midwife’s assistant arrived, and by 7:30 my husband was there. Things get a little blurry after that point, since I was in a good bit of pain. At first, I did really well, breathing through the contractions, relaxing, staying calm. My doula and friend from back home would pray with and for me during the tougher ones, helping me to stay focused and peaceful. By around 9:30 am, I was thrashing about so badly during the worse contractions that it took four people holding my arms to keep me from drowning myself! At that point (in transition, obviously), I was exhausted already, and moved to the bed so I could lay down.

The births:

labor1

Soon, I told my midwife I thought I might be feeling the urge to push with contractions, and that it actually made me feel a little better to push a tiny bit. So, with the next contraction, I began pushing. As things would turn out, I pushed a LONG time for a little baby who had spent the last two weeks at a +1 station. It didn’t take long for him to crown, but then he couldn’t make it any farther thanks to an overenthusiastic episiotomy repair from a previous birth. I was crying, worried about how this was affecting the baby, but my midwife checked his heart tones after each contraction and reassured me that as long as his heart rate was good, we were okay. Finally, after 15 minutes of pushing with very little progress, my precious little son was born at 10:46 am. He was crying as soon as his head was out, and was nursing like a little barracuda 20 seconds after he was born! He pinked up right away, and they delayed clamping and cutting the cord until it had stopped pulsing. He weighed 7 pounds, 4 ounces, and was 20 inches long.

We left him at the breast, since the nursing might stimulate contractions to get baby B into position, and from the time he was born until the time his sister’s head was firmly engaged in the birth canal, my midwife’s assistant held her in place from the outside so she wouldn’t flip. After a few minutes, contractions started up again but they shortly became uncomfortable again and I asked someone to take my little angel boy so that he would be safer than I felt he was in my arms, with all the discomfort I was in. I switched to using a breast pump between contractions to keep things going, and soon enough I knew it was time to push her out. I was exhausted, and not very enthusiastic about it at first, and couldn’t bring myself to push that hard. Plus, I was expecting that after just birthing one baby, the second one would be easier, so I don’t think I was expecting the challenge she became. At some point the midwife suggested a squatting position to push for a few contractions. It was so hard to support myself, that once the baby’s head was engaged, I was begging to lay back on the bed again. So, I pushed for the next several contractions propped up in a half-sitting position. She wasn’t moving down very much, and I was getting discouraged, so I forced myself to get a little more energetic about the pushing (since that’s what my body was telling me to do anyway). After several contractions, there wasn’t a lot of progress, and I was in pain and needed to get back on my side again. My midwife, for the second time during the births, asked everyone to take a moment and pray with me. At that point, things started to move along, and after a VERY long pushing stage, my precious daughter was born, posterior and forehead-first, with her cord wrapped around her neck and shoulders, at 12:49 pm. Her posterior position had contributed to my extended pushing phase and slow descent with her. She was a little slower to pink up, and took a little longer to figure out how to nurse, but soon enough was alert at my breast like her brother had been! She weighed 7 pounds and was 21 inches long.

I birthed the placentas at 1:09 pm, and although there were clearly two separate placentas, they had fused together in the middle and came out in one giant piece that likely weighed between 5 and 6 pounds– almost like delivering a third baby, but without the giant head! I needed one stitch to fix a small tear from my difficult second birth. I was bleeding heavily, and over the little while after the birth had one intravenous shot of pitocin and two shots in the hip. I was also given my first dose of methergine (which I took for 2 days postpartum), and given a lot of blood-building and iron supplements to help replace what was being lost. I also had several clots remaining that my midwife manually removed, and after the clots were pulled out my bleeding began to subside. Apparently, excessive bleeding is a bit more common with twin pregnancies since my uterus had two raw areas from two placentas instead of just one.

Thoughts on the experience:

So, I have now had my first completely unmedicated, natural birth, my first home birth, my first VBAC, and my first twin birth. What an experience! I feel so good about how it all happened, and am so thankful that we chose the path we did because I KNOW that I otherwise would have been forced into an unwanted, and completely unnecessary, cesarean. Although I worried a bit before the birth about the toll that being so big was going to take on my uterine scar, during labor I never once questioned how my scar was holding up. I have no regrets about my birth experience, for the first time ever, and feel only positive about how it all went down– not exactly easy, but definitely uncomplicated.

My babies were at the breast within minutes of being born, and my precious husband was able to be more involved in this birth than any other– what a wonderful support he was! My other children were able to come in shortly after each birth to see their new little siblings, and the babies’ first night was spent bonding with their parents and siblings, rather than being poked, prodded, weighed, and messed with all night long. I’ve been able to rest when I need to, recover in a way that feels best, and avoid being poked, prodded, and beeped to death during an already exhausting and physically challenging time. I am SO THANKFUL for these beautiful little babies, their curious little eyes, and their sweet little cries. They are beautiful, precious, sweet, and fun to watch and be with.

I am thankful for my incredible midwife, her guidance throughout the pregnancy, her competence and patience during the birth, and her friendship postpartum. I am thankful for my birth team, my incredible midwife’s assistant, and for my friends who drove up from back home to be a part of that experience. I am thankful for my family, for my precious children for their excitement and awe of these babies. I’m thankful for my sweet husband for being there for every moment, holding my hand, stroking my hair, and kissing my forehead; for encouraging me, believing in me, and helping me out; and for being a complete and active partner in the birth process. And most importantly, I’m thankful to God.

Many times during this pregnancy, I prayed for this pregnancy to be safe, to protect us during this uncertain time, to guide us as we made choices about our birth plan, to keep me and my unborn children safe and healthy throughout the pregnancy and birth, and to help us to somehow fit all the pieces together for the birth to come together according to the Divine plan. I committed that if all went well, and my babies were born safely into the world, I would give back to others planning for their twin births. Ultimately, it wasn’t just me, or my midwife, or my birth team, or my husband who brought these children into the world. It was pure Spirit, whose wisdom guided every aspect of the experience. I truly believe that the universe provided the perfect people to surround me during birth, the perfect place for me to birth, and the perfect babies to hold in my arms, grateful for the opportunity to parent two more little ones and in awe of the divine aspects of motherhood. What a blessing!

If anyone reading this has heard any of the usual doubts cast upon the ability of twin or VBAC moms to birth safely, please know that there are options. Natural twin birth or natural VBAC (or a natural twin VBAC) may not be the right choice for everyone, but it can be the right choice for some women, and it can be done safely. I have proof!

sleepingbabies

 

(And there’s now a video to go along with the story )

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