my twin birth story: Noel and Linus (adding pics to post #4)

[AmyC]

My twins were 4 weeks old today (Sunday.) I wrote a lot of the birth details down the day after their birth, but I've had a hard time getting back to it to finish the story. (I didn't write Linus's birth story until tonight.) Between caring for the twins themselves, and with being sick (I finished the course of antibiotics for the Lyme disease treatment just a few days ago and overall I'm feeling sooooo much better), I've just not had the time to spend on it.

But I didn't want to let it get away without posting, so here it is. I am going to post it in installments because it's incredibly (embarrassingly) long. Feel free to skip the background if you don't want to wade through it. I am too tired to try to edit it down now, and the natives are restless and getting ready to nurse, anyway. So here's the story:



BACKGROUND

During the latter part of my pregnancy, I was going in to my OB's office for regular NSTs and BPPs to monitor the well-being of the twins and things like fluid levels. When I hit 38 weeks, my OB started talking about induction. The NST results that day were beautiful; my doctor turned the machine off very soon as the babies were very reactive on the strip. But basically, she congratulated me on getting to term, and then started talking about why they "needed" to come out, now.

She suggested an induction the following week. (My appointment was on a Thursday, I was 37w 6d at that point, and the date she suggested for the induction I would have been 38w 5d.) I had misgivings about the suggestion, partly because I really didn't want to be induced in general, and partly because it felt like I was just getting to term only to be hurried onto this induction path with no real window for going into labor spontaneously. Where was my window? Was I only "allowed" an opportunity for spontaneous labor if it happened pre-term?! I'd worked the whole pregnancy to end up with full-term, healthy infants, and I wanted a natural birth so much for them and for me. It felt horrible to be pressured toward something that I felt would increase the odds of interventions and the kind of birth I did NOT want.

The OB took some time laying out her induction protocol and explaining how it would work and how she preferred to proceed. She also said that even if I were in the small percentage of women who began contracting on their own after the Cervidil ripened their cervix, that I would "need" continuous monitoring throughout labor (even without pitocin augmentation) and that telemetry didn't work well with twins, so..... (So I'd be hooked up to a machine.) This was news to me, because my first appointment with her I'd asked if there was any reason that I wouldn't be able to use the tub & shower for labor support, and she'd assured me that they would be available and that they used telemetry, so I could move around freely during labor, labor upright, etc.

Since I was in a gown because I had just had the Group B strep swab at that appointment, (which in itself blew my mind, that they were testing me at 38 weeks, since all along she'd assumed I'd go early....I guess it just was an oversight and they realized it late), she suggested checking me for progress. I consented (or rather, I decided not to refuse--since she didn't really "ask" me, but I was conscious of my right to say "No thanks"), only to hear that I was firm and closed. I hadn't really been contracting or anything, so it wasn't exactly a surprise, but it was discouraging in light of my hopes to be ready to go on my own and avoid all the induction pressure. In the end, she told us to talk over the induction issue and call the office the next day with our decision.

It was a very emotional time for me (and I was not very weepy at all this pregnancy) for a variety of reasons. I wasn't feeling very trusting of my OB but I wasn't certain what my other options were. I thought about transferring my care to the tertiary center where we'd been consulting with perinatologists all along, but how would that work? I'd end up with whichever OB was on call when I went into labor, or else I'd choose the peri I'd liked best and....schedule an induction?

We decided to refuse the induction, and I called the office late in the afternoon the following day to decline, making an appointment for an NST (Monday) and BPP (Wednesday), instead. I explained to the nurse that I just had completed 38 weeks, and given that I could go into labor on my own that week, it felt precipitous and very pressure-filled to schedule an induction at that point. I felt tremendous relief after conveying the decision to the office, and that spoke volumes to me. It was hard to be the person who bucked advice, was not compliant or cooperative. It was hard to feel misunderstood and to assume that my OB saw me as "difficult" or reckless, but my feelings of relief after that call made it clear that after long and complicated deliberations, I really was against rushing the twins.

The thing that began creating anxiety in me was that I was beginning to realize that I didn't have a nice, sane compromise to show how reasonable I was. (I didn't really have some date that I was "okay" with saying "we'll induce if they haven't come by this point," therefore ameliorating my refusal.) All through the pregnancy, I'd been sort of operating on this "eventually an elective birth will be a reality if they don't come spontaneously" agreement with the doctors, but thinking it wouldn't come to that. Now that I had completed 38 weeks and was counting along toward 39 weeks, I was thinking more about that agreement that "eventually they'll have to come out." For me, this reluctant agreement was based on their chorionicity: I had told myself all along that if there were two placentas, there would be a lot more leeway than there was with a shared placenta. With a single placenta, there was going to be a "time's up" at some point.

But as I thought things through, I realized that if my main reason for nervousness was the unpredictability and scariness of developing acute Twin-To-Twin Transfusion Syndrome late-term or during labor, I wasn't exactly sure that I had a reason to think there was a deadline. Because the OB's reasons for recommending induction had nothing to do with the risk of acute TTTS.

If, like my OB, I was worried about placental function and postmaturity, about my babies ceasing to thrive in the uterine environment, and about twins being "term" earlier and therefore postmature earlier, then I had reason to think about elective delivery. But if I don't believe those assumptions, at least not with clear indications of such in my case, then exactly when was my "willing induction" date?

This was scary for me, because as well as wanting to be true to myself (and a good advocate for my babies and what I believed was right), I wanted to be the reasonable, compromising person....showing my doctor that even if the answer for now was No, I wasn't unreasonable and I knew that our monochorionic status meant we would have some sort of induction deadline. But I was starting to feel that even at 40 weeks (which my OB indicated was her absolute cutoff, although longer than she'd recommend), I wouldn't want to pull the plug on the pregnancy.

This was when knowing that my cervix was firm, high, closed started to tweak me. Having reached 38 weeks with no signs of physical readiness for labor blew my mind. I found myself suddenly afraid that I was carrying a couple of 40+ weekers, and realized that this would put me at odds with my doctor and make things really difficult.

So, we stopped by the natural foods store and I bought some Evening Primrose Oil capsules. I started taking them, and inserted them vaginally at night. I continued accepting "prostaglandin deposits" from my husband, although that was a logistical challenge a good part of the time. (We had successes, but somehow it was hard to duplicate those successful positions or angles when trying later. Ah, the vicissitudes of life....)

I booked a massage and gave the massage therapist full permission to stimulate "contraction inducing" pressure points such as the ankles and the webbing between the thumb and first finger...."spleen 6", etc. I also decided to look into acupuncture, and began to call around looking for an acupuncturist recommendation.

After my first-ever acupuncture appointment, I went for a walk at noon on a wooded path on the campus where my husband works. While I was walking, I began to have "menstrual cramp-type" contractions, which I knew was a good sign. They seemed fairly regular and I tried to welcome them, assuming they were doing the work of effacing my cervix. These contractions continued for the day, regardless of what I did (activity or rest) which seemed like another good sign. I was excited, cautiously optimistic, and thinking that perhaps we wouldn't even need to keep the appointment for our next NST because we'd have our babies by then!

We called to book a room at a hotel in town. We were feeling really optimistic and proactive. The hotel was close to the hospital, and we'd visited earlier in the week to check out the options they had: we got a room with an oversized tub with jets. Ever since that appointment with the OB, I'd been thinking that it made sense to labor in comfort in a rented room rather than going to the hospital, since it seemed I wasn't going to get to make use of the features that had made me choose that hospital in the first place. (The birthing rooms, the tubs, the shower, intermittent fetal monitoring, or the telemetry option for continuous monitoring.)

We took along my birth ball, my Snoogle pillow, a CD player, my Hypnobabies CDs, our bag and my daughter’s suitcase. My contractions continued on past midnight, and I also passed a good amount of mucous (the first of anything remotely resembling a discharge during the whole pregnancy!)
I noticed the menstrual-type cramps when I woke in the night to pee, but things had slowed down considerably by morning. I had gotten 12+ hours of contraction activity after the acupuncture, and I remembered reading a birth story online in which a woman reported good responses every time she had acupuncture late-term. She specifically mentioned 12 hours of good contractions each time. I was antsy about getting more sessions scheduled to try to capitalize on the momentum I'd had, but the acupuncturist had told me it could take several days. He didn't seem gung-ho to book multiple sessions: he'd said that he’d be willing to see me on Monday (the next week) if nothing had happened over the weekend. So it didn’t look like I was going to get in any repeat sessions before then to try to capitalize on the momentum I’d had.

We booked the hotel room for one more night thinking things could pick up again, but I didn’t seem to contract at all the rest of the day despite my walking campaign. Back at the hotel, I spent time listening to Hypnobabies, telling the babies that it really WAS okay for them to come now, and working on sore muscles in the tub that night, but it felt like the room had been “wasted” and the whole thing was a profound let-down. Especially since I knew I’d be going in to the OB’s office for the monitoring after all, and I realized how much I'd been counting on not having to go in because I was in labor, or had already birthed my babies.

We went home on Friday morning after the office visit and a vague exchange with the OB about inducing. I was 39 weeks that day. That night (the night of the full moon) we went out to dinner with our four-year-old daughter, and I met a mom who had had an “under-the-table” homebirth in our town four months earlier. She said she knew her midwife was willing to attend twin births, and I felt dejected, like I hadn't fully investigated my options (although this woman said she didn't find out about this midwife or the homebirth option until her 7th month.) I talked about the pressure I was under to induce, and she actually placed a call to her midwife, who talked to her for a minute and basically said I was too far along for her to take me on, which totally made sense. (Especially since I went into labor the next night!)

We looked at the full moon as we left the restaurant, and I felt a mixture of inspiration (it was luminous and beautiful) and dejection. "Nothing" had happened; the full moon hadn't brought us our babies.

The next day, Saturday, I pretty much took it easy. I came to terms with the fact that I couldn't force labor on by walking (and I had hurt my hip, anyway.) I also accepted that the two nights in the hotel weren't "wasted" or a mistake. I wasn't sure how I'd deal with my OB, and we hadn't scheduled any appointments for monitoring (because technically we were supposed to be deciding about an induction the following week and only would schedule something further if we refused the induction), but the pressure felt somewhat lifted since it was the weekend and we wouldn't be able to negotiate any of that stuff with the office until Monday, anyway. I didn't have any more cramps or contractions...the occasional Braxton-Hicks but only with thirst or exertion, and nothing that would continue in spite of resting & hydration. Still, I felt a greater sense of acceptance or peace.

[AmyC]

LABOR

In the early evening, I spent some time online, sitting on my birth ball at the computer. My husband called me a couple of times for dinner. I stood to respond (it was 7 p.m.) and the cramps began when I rose to my feet. I was so happy to welcome them again. I went to the bathroom and noticed "bloody show" -- not the mucous plug the way I'd experienced it during my last (and first) birth, but actual red blood. Walking down the stairs, I told Joe what was happening.

As I sat at the table and tried to eat my dinner, the cramps continued with regularity and vigor. At one point, I asked Joe to time them, and I began to realize that there really wasn't a break between them. They continued in a seamless wave of surge-peak-receding followed by another surge and peak, which started before I could distinguish an end to the first set. There was no time between when I wasn't contracting. They were lasting about 2 minutes with no break in between. I thought that was kind of strange for beginning labor, but then I really am not quite the labor jock who remembers all the details about what is significant about how long & how frequent contractions are....

I was using my Hypnobabies training to relax around the surges and that made things manageable, but it all felt a bit revved up. Then again, that's what I was hoping for by welcoming the contractions as muscular and relaxing around them: that the lack of interference would let them accomplish their aim most efficiently.

In addition to things seeming "revved up," I had a weird concept of time: an hour and a half felt like 15 minutes, even though I could see from the clock how much time had passed. I was aware (by the clock) of the passage of time, but it all felt much slower.

Remembering how long my labor with my first child had been, I wasn't sure what we were in for. (With her, I'd been firm, high, and closed at 40w 5d, then I took EPO and began contracting at 11 p.m. that night, passing the mucous plug right at the start with regular contractions through the night. I labored at home all day the next day, and all night that night, then went into the hospital in the morning. I finally was fully effaced and a few cms dilated. I labored all day at the hospital's alternative birthing center, and our daughter was born after 11:00 that next night, at 41 weeks exactly.)

I believed this was the real thing (more bloody show that was disconcerting enough that I had to look it up online to see if it seemed within the range or "normal" or if it was more "concerning," but it seemed okay) but I wasn't sure if I was starting from a very firm & closed status or if the cramp-like contractions on Wednesday had accomplished a lot in terms of progress.

I was thinking about booking the hotel room again and dropping off our daughter with friends on the way (again, I believed this was the real thing, though uncertain about how far into the process we were, overall) and I wondered if my primary care physician (our family doctor) would be willing to meet us at her office and check my cervix, giving me an idea of whether we were progressed enough to go to the hospital then, or whether it was going to be more of a long haul type situation.

We were about 2 1/2 hours into labor. I had gone upstairs to lie down at this point, knowing that my pillows would help facilitate more complete relaxation around the contractions. This slowed things down a tad, but not in a big way. And honestly, I wasn't sure if things really had gotten easier, or if my relaxation was more effective (making things easier) in the supine position.

I was listening to one of my Hypnobabies CDs while Joe called my doctor at home. He spoke to her husband, who said she'd had a long day and was exhausted; she had gone to bed at 7 p.m. and was sleeping. He remarked (confusedly) that she wasn't handling my prenatal care, anyway, was she? Joe explained no, that I'd just wanted to avoid going to the hospital too early and had thought maybe she could check me out and give us an idea of where I was at in terms of progress.

Joe relayed all this to me, and we began discussing logistics such as packing the car and calling the friends to arrange for our daughter's care. Before too long the phone rang. It was my doctor! Joe talked to her for a bit and then gave the phone to me. I figured she was doing the old trick of seeing if the laboring mom could talk through contractions, and I wondered if the effect of my Hypnobabies training would disguise things at all, or give a "false read." I was pretty calm, a little distracted/fragmented, and I told her how things were going and narrated the contractions as they came and went. I also talked about how I was considering going to a hotel to labor, since I wasn't keen on being at the hospital if I couldn't use the most effective of their supports for natural labor, but how I'd like to have an idea of where I was at in terms of cervical progress. (She lives in the same town as the friends who were keeping our daughter for us, and her office is very near her home. I thought maybe she could meet us at her office and we could swing by there after dropping off O. I didn't actually ask her this, but I was hoping.)

She basically said, just call the on-call OB for my doctor's practice, and that it sounded like I was in active labor and should go to the hospital. She said especially with twins, it wouldn't be that great to surprise them, especially if they were short-staffed that night and needed warning to call in extra nursing staff. I expressed my disinclination to labor long there stuck to monitors, but she seemed to think we could use telemetry if constant monitoring were necessary (I mentioned that Dr. P had changed her tune on that and told me it "wouldn't work well with twins" just in the last two weeks.)

I already knew that the on-call OB was one my doctor specifically had recommended against using back when we'd just learned I was carrying twins and I was trying to figure out my medical care. She had thought we wouldn't vibe well at all and she'd been frank with me about why. She was pretty quiet when I told her he was the on-call physician. (I mean, what could she say at that point? "Oh, I'm sorry to hear that"?) She did ask me if my OB had said she'd come in for me, being twins, whether she was on-call or not, and I said that actually, she'd said she wouldn't be available that weekend. (I know this was another reason my OB was recommending induction: so she definitely could be there for me in a small town with just 3 OBs, two of whom would be less "understanding" of my preferences and concerns. Inducing me meant she could guarantee she'd be the doctor attending the birth.)

So anyway, I said Dr. P wasn't available and I think my primary care doctor had a judgment about that, but she didn't air it. Just asking, and assuming, that Dr. P would come in for me, kind of showed her expectation or opinion.

I have to think that it might have been different with different circumstances, but Dr. P was wrapping up her practice in town and moving to New Hampshire, and probably was using her remaining free weekends and days off to move her family. Her last day on the job was July 31 and I was "supposed" to have gone early, being pregnant with twins, which was the whole reason she'd agreed to take me on in the first place despite the proximity to the closing of her practice. I'd been conscious of this all along, and it added to the pressure I felt to be accommodating on the issue of induction.

So....we called the OB's answering service, then went about with our last minute preparations: me laboring, Joe gathering the bags. The answering call came back, with instructions to go on in to the hospital and report to Women & Childrens. We loaded the van and I took a minute to confirm my hypnosis & to raise my "lightswitch" to the center position, so I could walk and talk without leaving hypnosis, and I walked out to the van and curled up on the back seat around my Snoogle body pillow. I had the CD player and headphones, and I listened to another Hypnobabies CD as we rode into town.

All in all, a fair bit of time had passed since we'd called and said we were going to be heading in. We got to the hospital sometime after 11 p.m., and someone met me with a wheelchair and took us upstairs, got me to a small room with two twin beds (not one of the nice birthing rooms), checked my progress (I either was 2-3 cms or 3-4 cms...I can't remember for sure and neither can Joe), and hooked me up to a monitor. I think the test strip was pretty good.

They left me on the monitors until the doctor got there, and someone brought in an ultrasound machine to be ready for him. I gathered that I was in one of the relatively crappy overflow rooms, not one of the spacious birthing suites with the free-standing tubs. The space wasn't that inspiring for wanting to move around and labor freely or "creatively," anyway, so I tried not to resent being wired to the bed by the monitor. Joe had my Hypnobabies discs playing, but the CD player was on the other side of the room and though I could hear it, it wasn't front and center for me.

Dr. M, the on-call OB, was high-energy and very bulldozer-ish. He basically came in the room, introduced himself, announced that I had monochorionic twins with a breech-presenting second twin, and said we had no real choice but to have a vaginal birth with Twin A and then a c-section with Twin B (since he still was breech.) Or else, of course, to have both delivered via c-section. I challenged him with the info that Dr. P was planning to try an external version on baby B after twin A was born, and that none of the perinatologists in Albany had questioned the goal of a vaginal attempt for both twins.

He said no way should a version be attempted, that babies don't turn vertex even with more room in the womb and there's not time to wait for that possibility, anyway. (He kind of blustered through his reasoning against external versions, and I don't remember all of his "babies don't" rationales.) He said a version is risky for a breech baby. He said the only legitimate possibility would be a breech extraction (when the doctor reaches in, grabs a foot, and pulls out the baby. Not to be confused with a breech birth, when the mother pushes out a breech baby.) He came back with stats and studies, including one currently still underway in Canada that we'd heard of from one of the perinatologists, after which nobody was going to question c-section for a second twin who is breech. (Again, he was blustering/overbearing and his train of thought was not very easy to follow at this point, at least not while I was in labor, but he obviously was trying to pressure/influence/convince us.) He blatantly and clearly said we were jeopardizing our babies and not choosing in their best interest if we refused the c-section.

He then said we had the right to ask for another physician or to refuse his recommended treatment. We asked for time to talk. Everyone left the room.

The "good" thing was that in order for him to do the ultrasound to confirm fetal positioning (and baby B still was breech), they'd turned off the fetal monitor. And nobody hooked it back up. While they had left us alone, I pulled off everything that remained and pulled the velcro straps out from under me in hopes that that would be that for being tied to the machine.

I'd been contracting that whole time, and found it really hard to keep my "pressure-sensation" only contractions (thanks to the Hypnobabies training) while he was in the room. They were more like pain sensation contractions, and I was resisting and practically writhing on the bed through a few of them, due to the tension of his "vibe." I did not feel phased or frightened by his words, though, just stymied by how I was going to birth there with that obstacle in my way.

I told Joe that we should ask him or one of the nurses to page Dr. P and see if she was available, and if not, to ask for a transfer to Albany Medical, where the perinatologists with whom we'd worked were based. Joe went out to talk to Dr. M (I'd said I couldn't labor effectively if I had to be involved in the negotiations.) Joe told me didn't get many words in, but the guy asked why we were so against c-section, anyway, since it was our "safest option" at this gestational age....practically no-risk. Joe gave him a few reasons. I think he mentioned something about breastfeeding success; I'm not sure what else he said. I know he was under a lot of pressure. The doctor said there was nobody else available to deliver. Joe never got to bring up the question of transferring, because the guy was so take-charge in the conversation. He asked Joe, "So are you going to do this? Can I prep my team for surgery?"

Joe said he'd talk to me, and he came in and relayed all this to me. I know he was shaken and he said maybe the c-section was the right thing. I still was feeling calm and certain without self-doubt on this issue, albeit upset about what was happening and distressed about Dr. M attending the birth. But I had the Hypnobabies training to help with my centering. I was listening to the Twin Birthing Affirmations that were so familiar to me, and continuing to contract. I was thinking hard about what to do.

Someone new came into the room and introduced herself as a lactation consultant, and that Dr. M had asked her to speak to us since we seemed confused about whether babies could nurse after a c-section. She was nice, and we talked to her, but I had (yet again) to work hard to maintain my focus on relaxation. (I was glad then for my choice to do Hypnobabies rather than Hynobirthing, since Hypnobabies has built-in training for staying in hynosis while talking to other people and walking around.)

The doctor came in the room a bit later and I asked about transfer to Albany, and the doctor basically said it was against the law for him to transfer us because I was in active labor (2-3 cm dilated was his assumption based on the pelvic exam just before he talked to us, but I knew/suspected I was progressing fast.) I clarified that getting to Albany would be a matter of us checking ourselves out of the hospital and going to Albany on our own steam, and he said that was right.

I asked him about giving the baby a chance to rotate, and he dismissed that idea. He said something about "babies not doing that" which made about as much sense to me (since I've talked to mothers whose babies did exactly that) as "your twins are growing big and twins don't do that" which I heard multiple times from one of the members of the perinatologist team. I asked about breech extraction, and he said if we refused a c-section, that's what he would do. He didn't think it was best for the baby, though. He mentioned that if the baby was in distress or not tolerating labor, or if cord prolapse or placental abruption was an issue, c-section was going to happen. I said that had been my assumption all along; I just was not convinced that it was necessary to plan it ahead of time.

At one point, he said, "You are high risk. You are a high risk pregnancy. Humans are not supposed to carry twins; humans are supposed to have one baby at a time." I got the impression that he honestly felt I was being stubborn out of ignorance or something.

I didn't say anything to him (I still was contracting and working hard to stay relaxed, muscularly, around my uterus and its work. "My job is to relaaaax," I would whisper to myself anytime my mental activity got in the way of relaxing around the process.) In a way, I knew what he was saying: humans aren't meant to have litters. But I had a sense of assurance that basically dismissed his comments, or at least displaced them. These were spontaneous twins, and the rate of identical twins worldwide across cultures and races has remained constant, and he was telling a woman whose cervix had remained firm and closed at 38 weeks that she was "not supposed" to carry twins when I knew I was carrying my babies to term in such a healthy way. The other thing was that I was going to have one baby at a time, as every mother of twins does: I was going to have two births.

He also brought up my file, which he'd been reading, and said that Dr. P had written that she'd advised me that I had a 60% chance of having a c-section for the second twin. He brought it up in a "your own doctor told you you had a very strong chance of having a c-section. Why is this a problem?" sort of way. I told him I wasn't sure she'd mentioned percentages to me, but that she'd reiterated the possibility (probability?) multiple times; it still wasn't the same thing as consenting to a c-section for the second baby in advance.

He told us to let him know our decision.

I had a bunch more contractions, relaxing ("My job is to relax") around them and hoping that this was allowing the uterine muscles to work double-time. This was so different than my labor with Ocie....I felt very little resistance to the journey, to what was happening in my body. This was very much like how I felt late in the day with Ocie, when the effects Ambien I'd foolishly taken the night before (so I could "rest through the contractions" and be fresh to labor the next morning) had finally left my system and I wasn't so scattered and frazzled anymore. Of course, at that point, the new midwife on call had decided my labor was stalling despite my explanation that I'd found my focus and finally was able to relax around the contractions the way I'd wanted to all along (her response was "labor doesn't get easier" and telling me that I was becoming too tired and losing my window for a vaginal birth.)

My response to the contractions this time wasn't perfect because I didn't have great pillow support on the bed to relax as well as I wanted (physically.) I'd packed my Snoogle pillow for that purpose, but I puked on it in the car, so that was a no-go. I needed two pillows for my leg, and not really "between my knees" the way the nurse had put it, but stacked a little in front so the top leg could rest on them while the bottom leg was just behind, and a lip of pillow for under my belly so I was comfortable and relaxed on my side. But I was making do with what we had.

I was starting to feel overwhelmed, though, and thinking things like, "Shoot, if I am going to end up with a c-section for baby B, why not just give in and have them both by c-section? Then this will be over." The thought of going through all the labor contractions, then the pushing, knowing that I had abdominal surgery in front of me (I had the irrational conviction that even if we agreed on an attempted breech extraction, the doctor would pronounce it impossible no matter what when the time came and I'd be having a c-section), just felt like too much. I felt afraid and betrayed and pessimistic. The thought of a c-section was upsetting and scary but a little seductive.

But part of me said, "I'd better ask for a vaginal exam, because I bet I'm in transition if I'm thinking this way." (Bless myself for learning from Ocie's birth....I'll always regret that I didn't ask to be checked one last time before transferring up to the LDR floor from the alternative birthing center, since it was almost an hour of waiting since making the decision to go up, and I'd continued contracting the whole time. When I got up there to be hooked up to pitocin, I was in transition, and I bet I'd have been able to stay down in the birthing center and have more of the birth we'd wanted if I just realized the signs, and asked to be checked, at the time. But, that regret served me well last night.)

I did tell Joe my thoughts (about having both babies by c-section), but acknowledged that it was mostly because I felt dejected at ending up with it either way, and the thought of going through all of labor with that ahead of me was challenging. I also said that I knew that laboring was good for my babies regardless of how they ended up being born, so I shouldn't just decide to do an end-run around the process even if the end result was going to be c-section. I also mentioned that I thought maybe I was in transition, though I couldn't remember when that typically come (the last 2 cms dilation or what?)

I asked the nurse to check me next time I saw her, and she did so and ran out of the room, saying, "I think you're complete; I have to get the doctor."

He returned with her, gloved up, and did an exam, saying "We have to get you to the O.R., you're ready to have this baby, the head is right there."

We never had given him our decision, and I was mindful of that but decided not to bring it up. Classic Amy.

[AmyC]

STAGE TWO: The Births


I kept my eyes most of the way closed so the switch from dim birthing room lights to hallway & then OR lighting wouldn't shock me too much. Joe left the CD player back in the room so I didn't have anymore Hypnobabies to listen to even though I'd been counting on the "pushing your baby out gently" CD for guidance during the pushing phase. (I didn't send Joe back when I thought of it because he'd already scrubbed up and I wasn't sure if leaving the room would be problematic or not.)

There were so many people in the OR. The anesthesiologist who'd prepped Joe for his bladder surgery and had done his spinal was there, and he remembered me. He sat near the head of the table through most of my labor with the second twin and basically kept his eyes averted, and I realized later it probably was to preserve my modesty because during much of the pushing I ended up upright on my knees facing that end of the table, and I wasn't wearing anything. At a certain point before the first twin's birth, Dr. M sent the surgical team out to give them a break, but told them to stay close so they'd be on hand for the second twin.

I had rapid-fire contractions and couldn't find a break to move from the bed (I'd rolled in on) to the table, but they kept telling me that I needed to, so I eventually did. I said I didn't want to be on my back (the OB said he only needed me there for the breech extraction--which we'd never finalized, but I guess he assumed we were set on that) and I tried being on my hands and knees for awhile. I felt lots of pressure but was waiting for the urge to push. Finally, I tried some tentative pushes...nothing obvious to anybody else.

I waited for the birthing waves and pushed gently and gradually started to "feel it." It took awhile. I ended up moving upright on my knees, with my arms hooked around Joe's neck/shoulders and those of the nurse beside me. I didn't ask her; I just did it. I pushed pretty hard, at least when I could feel it, and also tried "breathing out the baby." I ignored instructions from anyone else (mostly the nurse, who offered low-key coaching from time to time), though I did consider if it "felt right" to me and sometimes I did what she suggested for the next "pressure wave." (Guess she was being considerate of the fact that she knew we were using hypnosis...she kept saying "pressure wave" instead of contractions!) Back in the other room, she had complimented us several times on how beautifully we were laboring together, and yet she'd still be shocked at how speedily I'd made progress (she was the one who'd checked me.)

The hypnosis worked well for me, as far as pain management. I definitely felt I was experiencing the “comfortable vaginal twin birth” I’d been preparing for. But it wasn’t easy, exactly. It felt a little like things were out of synch, or a little bit willy-nilly, in terms of the productivity of my pushing. I’d been counting on having the “pushing phase” disc to listen to, but I didn’t have that. Maybe it would have helped to economize things a bit. I have no sense of how long I was pushing; it seemed like a “long time.” Joe estimates it was about twenty minutes; I don’t know if he is right.

I felt the ring of fire but it was distant, a sensation that didn't feel exactly painful, just a ring that I "recognized" (in a “hey, that’s the ring of fire” way) and I pushed through it after a moment. I didn’t think about pushing gently or incrementally; I just bore down. Noel's head was out, and then his body burst out in a tumble. I'm not certain if anyone actually caught him, poor little guy. They clamped and cut his cord immediately, and whisked him over to the warmers to check him out. The doctor had been sitting quietly nearby during the whole birth, not doing anything apart from offering perineal support (with olive oil) one time, and keeping up with the intermittent monitoring. I was grateful to him for his low-key role at that time.

After Noel's birth, he sprang into action, calling back the surgical team, saying I had to turn around and get on my back, with my legs elevated. I took my time, partly because maneuvering on the skinny O.R. table was SO awkward, and partly because I was exhausted & uncomfortable (and freaked out by the metal clamp dangling down and swinging--the clamp at the end of Noel's umbilical cord), and partly because I wanted the time to meditate/communicate with Baby B and remind him "head down, facing back, chin to chest." AND give him time to begin to turn. I told him he had lots of room and to USE IT to improve his chances of a safe vaginal birth. (Breech extraction has its risks, and it never was my first choice for birth, albeit more desirable to me than a c-section.) I also did my finger drop Hypnobabies technique, trying to center myself against fear and uncertainty.

I finally got into position and the doctor reached in. I don't remember feeling anything. What he said then is a blur, but I think he did try for a foot and realized the baby had slid transverse and was on his way into a vertex lie. I'm not sure if he (doc) manually manipulated that process anymore, but I know he called out, "We have a cephalic presentation!" in a very excited voice. Joe confirms this, that he sounded manic and giddy. [I saw him briefly when we were leaving the hospital, and I asked him what happened. He said, "I turned him." (He was all smooth and glib and matter-of-fact at this point. It made me wonder if I'd imagined his tone in the OR.) I pressed for more details, asked if the baby had turned transverse or was turning and he said yes, the baby was transverse and he reached in, got a foot and the baby easily turned vertex.]

After a few pushes, I said this position was crazy and that I wanted to get upright again. The doctor, bless his heart (because the attendants seemed to look to him for "permission" at that point), said, "This is a vertex vaginal birth. She can use whatever position she wants." (This is sort of what he said when I first got to the O.R.--that the first birth could happen however the mother wanted. That it was the breech extraction that he needed me to be on my back.)

So, I got upright, moving gingerly again. The contractions didn't start up right away. When they did, I didn't really feel the urge to push (I think it was because the baby's head wasn't really engaged yet, or something regarding his positioning.) This was a little stressful to me because before the birth, Dr. M had been harping on "no more than 15 minutes between babies, because of the shared placenta. Too risky to go longer," and I felt I was going to run out of time based on his clock.

I don't remember the same kind of pressure that I'd felt before, the feeling of an impending poop. I pushed hard, but it felt random to me. I kept looking over to Noel under the warming lights, and he was so calm, staring up and looking around. I felt upset that he was alone those few feet away, and that I was missing his calm, alert period. I also felt fearful of being too tired to get Linus out, and that I'd end up having a c-section. I am not sure if the sensations/urges and my pushing efforts ever got synchronized. I know that I pushed hard.

The intermittent monitoring did not seem to come very frequently, but things seemed fine the couple of times they checked. Then they checked again and had trouble finding a heartbeat. Or they weren't certain that it was the baby's heartbeat and not mine. I remember that the anesthesiologist grabbed my wrist and waited quietly, counting, then told the doctor my pulse rate. I'm not sure if it differed from whatever they'd found with the Doppler, but things got very stressed at that point.

Dr. M called for me to turn around and lie down. He said that he didn't have a heartbeat, or that he couldn’t confirm a reassuring fetal heart tone anymore, and that the baby needed to come out right then. I wasn’t sure if they had gotten no heartbeat on the Doppler, or if it was that they weren’t certain whether the heartbeat they heard was mine or the baby’s. I also wasn’t sure if the pulse rate that the anesthesiologist got from me confirmed that it wasn’t my heartbeat they’d heard on the Doppler, but that the baby’s rate was “unreassuringly low.” Or if, indeed, there had been no heartbeat found for the second twin. I didn’t try to ask what the scenario was; I just asked what he was going to do. He said he was going to assist in getting the baby out via vacuum extraction, and he barked at the nurses to help me get my legs up. Joe held up my left leg.

All of this pretty much was a blur after the fact, plus I waited too long to try to write it down. But I think I pushed, and he used the vacuum. I don't remember feeling anything at the time, and suddenly the baby was out of me, on the table. I could see him. He wasn’t really moving, and he wasn't pink. I wondered at the time if it was vernix on his skin, which is what it looked like, or if he just was lifeless and gray or bluish. I never thought things would end badly, but I wondered if he was okay. Joe was similarly concerned because the baby seemed stunned or dazed to him, but he saw him move and make a sound within seconds, and he immediately assured me that the baby was okay. Dr. M yelled out for some piece of medical equipment, barking about having asked for a second set, and the nurses sort of fumbled around. He said he’d do it himself. I think it may have had to do with clamping the cord.

They took Linus to the isolette next to Noel and by that point we could hear him crying and see him kicking. His ferocity was such a contrast to Noel's wide-eyed and round-mouthed (a little "O") calm. I told Joe to go over to the boys and I turned back to attend to stage 3 of labor. Dr. M mentioned to me that there might have been some transfusion between the twins, but that if that was the case, the second twin was the “recipient” rather than the “donor.” He suggested that this may have served the baby well at the end (by giving him “extra” blood which may have balanced out whatever distress he was in.) There really was no obvious sign of TTTS, though. Twin B had more red blood cells than his twin, but neither twin was polycythemic and Twin A was not anemic.

[AmyC]

STAGE THREE AND BEYOND


I don't remember much about the experience of pushing out the placenta, in terms of feeling contractions or not. I still was on my back. I was looking over at the boys, most of the time. Stage 3 seemed to take a long time. I knew going in that hemorrhage is a common complication of twin birth (from the large placental implantation site, among other things), and I knew from a blood test just 6 days earlier that my iron levels were low. I already was prepared to consent to a shot of pitocin.

I did end up hemorrhaging, and I remember Dr. M pressing firmly on my abdomen at the time. I accepted an intramuscular shot of pitocin. (My hemoglobin and hematocrit numbers dropped low enough over the next day without rebounding at all, so in the end I consented to a blood transfusion, receiving 2 units of blood.)

Dr. M said I didn't tear, but that I had an internal "skid mark." At first it sounded like it didn't need repairing, but he ended up saying it just would be a couple of stitches. It seemed to take a long time. I remember being aware that the placenta was in a basin to his side, (he’d spent some time inspecting it), and I really wanted to get a look at it. I wanted to see what it looked like, to see if there were obvious calcifications (I was sure of it, given all the Tums I ate during the hyperemisis of the first half of the pregnancy before I knew better), and really I just wanted to get a look at the placenta that had nourished my babies and filtered toxins through those nine months. The words were in my mind and I was turning them over and over (waiting for an opportunity to make my request?) but I never actually asked. I was drifting more and more and feeling incredibly tired, probably because of the blood loss.

I also was distracted by what was going on with my arm. The hep lock in my left arm had come out at some point during the births, and several people in sequence were trying to get an IV in my other arm. This was a big problem for the nurses....the veins kept collapsing or something. They called several different people to try. Finally the anesthesiologist was successful and got a line into my elbow (admittedly terrible placement) and I got fluids and pitocin.

By the time I got into a bed from the table and they wheeled me back to the room where we’d started out, I was fading fast. I kept thinking that I wasn’t going to be able to hold the boys, let alone keep my eyes open to look at them and focus on them, because I was so weak and tired. They had gone to the nursery and Joe had stayed with them, both to be with them and to make sure our wishes were honored as far as the newborn procedures go. He brought them back to the room so that I could hold them for the first time, and they spent what was left of that first night sleeping with us. I was, indeed, exhausted and weak, but I lay there looking at them. I did nurse them, too, though I don’t remember much about that.

The thing I remember is that from the start, postpartum, I felt joyful and empowered, and as soon as I’d rested and started to rebound from the blood loss, I felt completely able to focus on the babies. This was a sharp contrast to my experience after birthing my daughter, when I felt so much distress about the birth. My need to process it and to heal emotionally almost distracted me from bonding with her; it certainly conflicted with that focus on her. This time I wasn’t focusing particularly on how empowering the birth experience had been, but the satisfied feeling was a foundation for my focus on the twins and I was “moving on” into mothering my newborns without effort or conflict or distraction. That was so wonderful.


Noel Stephen was born on Sunday, the 20th of July at 2:20 a.m. He weighed 7 lbs and ½ ounce, and was 19 inches long.

Linus Patrick was born on Sunday, the 20th of July at 2:50 a.m. He weighed 7 lbs and 11 ounces, and was 20 inches long.

The twins were born at 39 weeks and 2 days gestation, the night after the full moon.




****ETA a few pics here

[AmyC]

REFLECTION


Joe has since told me that in the hallway, the doctor had told him "Your wife is very high risk with a twin pregnancy, and she's been lucky not to have had any complications thus far in a monochorionic twin pregnancy."

Joe tried to counter with, "Well actually, no, she's worked hard in order to grow them well and to avoid complications. She had a lot of intention from the beginning and was informed about improving her odds against common complications."

Of course, the doctor's reply was, "You got lucky." Joe said Dr. M didn't really seem to hear him most of the time, and talked over him. I know his technique in the room with us seemed to be to talk faster and in a slightly more and more abstruse way, when we would challenge or object to anything. I had a hard time following what he was saying about studies, even though I knew some of the studies he was rapid-fire spitting out.

I had heard a little about his "style" before, and I wasn't happy when I learned he was on call. But though dealing with him before the birth was very, very difficult, I am glad to have had him there during the actual birth because he didn't really influence it negatively, and because the outcome was good. And if I had to choose between him or my own OB being there, I think I would choose him. Mostly because A) we got what we wanted in the end (he'd agreed to a breech extraction attempt, and when baby B turned vertex he was fine with me birthing however) and because B) in the last two weeks, my doctor had made it clear that she'd require constant fetal monitoring and she said telemetry wouldn't work so I couldn't walk & get in the water, etc. after all, but this doctor didn't seem wedded to that (cfm) at all. In fact, from the time he got there to meet us, we were off-monitor. (He took us off to check fetal positioning with ultrasound, and nobody hooked us back up.) And in the O.R. throughout all of stage two, they only did intermittent checks of the fetal heart rate. It was very freeing to have nobody looking to a machine to know when I was contracting (I was the only one who knew) and not to have the constant analysis and hyper-reaction of the constant monitoring.

I think I was BETTER able to have the birth I did withOUT my OB than with, though the initial interactions were incredibly off-putting and challenging. (I always was concerned about the external version prospect that my OB had offered, though I preferred it to automatic c-section, and I knew that Dr. P had said she would NOT deliver a breech twin so if he didn't turn, we were out of luck as far as a vaginal delivery. I also wasn't sure about how the external version would "go down," if there would be any time at all to see if the baby turned on his own, and I worried that the version attempt could cause twin B to go into distress. At least with the possibility of the breech extraction, he could be born vaginally even if he didn't turn. And Dr. M gave us that possibility.)

[firespiritmelody]

WOW. Amazing. I am so proud of you Amy for sticking to your heart and following your intuition. You did such an amazing job and it's wonderful. Congratulation!

[Novella]

Fantastic! No need to apologize about the length. . . I loved reading every minute of it. I think it's great when birth stories contain so much of the mental aspect of it all. That's key.

[~bookcase~]

Amazing account mama, thank you for sharing it, and congratulations on both the births and how you worked with the staff around you.
Amazing woman, you!

xx

[christyc]

Awesome birth-- you fought so hard! I'm at the same time furious (that you had to deal with all that negativity and nonsense) and full of joy (that you were able to overcome it all anyway).

Amazing!

Congratulations on your twins!

[spirit4ever]

Wow!

Amazing!

So empowering! :

[Linzie2]

Wow! I knew I would love reading your story...you're always so well spoken (er, well written I guess ) Really great story, and really great outcome, too! You really stuck to your guns and that is amazing! It's so easy to be intimidated!
Also, it's funny how things worked out....that you were glad that your doc wasn't actually the one to attend when to begin with the other guy was a total ass.
Anyway, awesome story and welcome Noel and Linus!

[sophiaflute]

I was glued from the beginning of the story and couldn't wait to find out what happened. I was so impressed. Through all that, you were able to stay so focused and determined and fight for what you believed in. You are very inspiring, and stuck with your motherly intuition. Thank you so much for telling your story.

[AmyC]

Thanks for your kind comments. I'm bumping to say I finally put some photos on Flickr and posted the link at the end of post #4.

It's also here.

[Picturesque]

Truly amazing! Thanks so much for sharing! You are an inspiration. Congratulations on your little boys.

[William's Mom]

All I can say is - WOW! You are an inspiration.

Congratulations and love! :

[JennaW]

Amy,

I spent a lot of my free time yesterday coming on here to keep reading your story.

Truly incredible and amazing. You worked so hard growing those boys and you deserved your double vaginal birth (not that anyone deserves a c-section but you know what I mean...)

Sorry the doc was an ass but I can totally see where you are coming from that it turned out well that he was there rather then your OB. I too ended up having my least prefered CNM attend my birth but she ended up really making my natural birth happen in the end..

Your boys are just gorgeous and you look great!

Also, give your husband a pat on the back, DH and I have sense had many conversations since the birth about how stressful it was for him- it sounds like Joe was put under a lot of pressure but still held strong for you as well as he could.

Blessings to you and your new additions.

Jenna

[KerriAZ]

WOW, Amy! Amazing story! You did a GREAT job for yourself and your boys! (Who are just WAY adorable, btw!!!) You GO girl!! I'm proud of you!

[mamaeliz]

Wow!!!!!! What a story! You are a strong, strong woman and your babies are so lucky to have you as their mama. I am really touched by the journey that twin mamas must go on to birth as they believe to be the best for their babies, and I can't believe how you and other twin mamas who have birthed in the hospital have to spend so much time negotiating while laboring. A truly amazing story given your circumstances. It sounds like health-wise you've had a tough go of it, having to get transfusions, and then dealing with Lyme disease. Wow! And I loved the pictures. You are one beautiful family and those babies are just luscious!!!! Hugs to you, mama, and thanks for posting.

[feminist~mama]

What a fabulous story! Thanks so much for sharing! Congratulations!