My son Oliver was born in 2006 at home following a wonderful labour and birth attended by my independent midwife, Debs. It was a fantastic experience and I was on a high for weeks afterwards. When Oliver was about 18m old we started trying for another baby, but after struggling with secondary infertility my husband and I had two cycles of IVF in 2010. The second cycle led to a non-identical twin pregnancy.
At first I was overwhelmed by the idea of caring for two babies, but was blasé about the birth, as I felt it was just a variation on normal, and assumed I would plan a home birth. Once I started Googling though I had a big wobble. Everything I read said I would have a more medicalised experience of pregnancy and birth, and “natural” birth when it came to twins seemed to mean vaginal birth but with lots of intervention (cannulas, epidurals, CFM) that contradicted everything I had learnt about facilitating the hormonal cascade necessary for a smooth birth. To make matters worse, I’d had a swab when I’d gone into hospital at 13 weeks pregnant with suspected kidney stones, and this had come back positive for GBS – another reason why I might end up in hospital for the birth. Having found my first labour intensely painful, though manageable because I was able to move instinctively and felt safe with my known midwife and husband, in familiar surroundings, I was terrified at how much pain I might feel stranded on my back, in bright lights, with strangers coming in and out of the room, and fearful. Not only was I fearful for myself, but more importantly I was fearful for my babies. I didn’t want my babies to struggle with breastfeeding because I’d had an epidural. I didn’t want them to be anaemic because their cords had been cut too quickly. I didn’t want them to be damaged in the course of a forceps delivery, and all because the normal process of birth had been disturbed. If these interventions were necessary for their safety, then of course that would be different, but I feared they would happen simply because of a cascade of unnecessary interventions. I was in quite a state. But then two things happened. I confessed my fears to the local consultant midwife in normality, who was amazingly reassuring and positive, and my midwife from my first pregnancy came back from an extended trip abroad and I could talk things through with her properly.
I went through every significant additional risk of di-di twin pregnancy and birth with my midwife. About the two biggest risks, pre-eclampsia, and premature birth, I could do nothing but give myself the best chance of avoiding them by eating well, resting enough and keeping my stress levels low in pregnancy, and dealing with them as best I could if they happened. My premature birth plan (pre-35 weeks) was not much different from my term birth plan, except that I would go into hospital.
For twin birth at or near term, I really struggled to find much credible evidence about additional risks. Breech birth was one consideration, but the Hannah Breech Birth trial is extremely flawed and did not evaluate the option I would have chosen, that of physiological breech birth with an attendant skilled in this mode of delivery. Postpartum haemorrhage is also more common with twins, but I felt that a physiological birth with an oxytocin-promoting environment (warm, dark, trusted birth companions, privacy and avoiding stimulation of the neo-cortex with language) would give the best chance of minimising blood loss. I decided to use nipple stimulation if needed to slow the bleeding, and of course my midwives would have oxytocic drugs to administer if needed. As a well nourished, healthy woman, the worst that was at all likely to happen was a trip to hospital for a blood transfusion. The final category of concern was regarding condition of the second twin and possible cord prolapse. In my midwife’s experience, if the mum stays upright after the birth of the first twin gravity brings a heavy part of the second baby (head or bottom) down into the pelvis and onto the cervix, re-starting contractions. Baby number two’s sac is usually intact at this point, and the pelvic outlet being plugged from then on by the head or bottom means that the cord is unlikely to prolapse. It was difficult to get any specifics about the general “condition of the second twin” issue, but I felt that a physiological, oxytocin-driven birth was the most likely type to result in both babies being fit and well, and that in the event of a concern over baby 2’s condition I could always transfer to hospital, as in any labour.
By the time I’d had these long discussions with my midwife, and read for hours around the subject – including evidence-based books, original research papers, RCOG green top guides and the views of leading birth experts, my head and heart were in agreement that I would be most likely to have a safe, gentle birth if I planned to be at home with my very skilled and experienced independent midwives. Once I felt at ease with my plans for the birth, I relaxed and mostly enjoyed the rest of my pregnancy.
I loved going to Aquanatal and yoga classes and was very amused at the fact that at every class from about 35 weeks onwards women at the pool said “ooh, you’ll not be here next week – look the size of that bump!”. They’d given up saying it by the time I attended my last class at 39 weeks.
On my due date, I went into labour. That morning I’d felt… well, just different. Even more frequent peeing than usual, and lots and lots of pressure in my pelvis. Then contractions started, but not much more strong or frequent than my normal Braxton-Hicks at first. The tightenings were very chaotic and irregular, but over several hours became more strong and regular and I began to find it difficult to interact with my 5yo. At about 11 am he said “Mummy, what do I do when you’re in labour” er, good question. We decided he and I would both be happier if he went out with friends so he was collected and the contractions continued to build in frequency, length and intensity. Soon I was on my hands and knees on the bed, sounding (singing long low notes) and vigorously swinging my hips in a figure of 8 with every contraction. I was still pretty lucid in between contractions. Although Oliver was going out, I decided that although the friend I’d lined up to come and be responsible for him during my labour wasn’t needed for him, I really wanted her there for ME! Caroline soon arrived and was wonderfully encouraging and reassuring, not to mention an excellent masseuse. I’d felt a bit lonely beforehand as my husband was busily setting up the pool in the living room, lighting candles and so on. When I was getting desperate to be in the pool, it was finally filled sufficiently for me to get in
As I got into the pool I had a little weep because it felt so completely amazing, It made a huge difference to the pain of the contractions and suddenly it was all much more manageable. As the contractions intensified I was gradually entering labourland. My ability to use language was drastically reduced as my primitive brain took over. For example, to indicate to my midwife, who’d arrived by this time, that a contraction was finishing and that she could listen to the babies’ heartbeats, I just sat back and said “baby” – I wasn’t capable of forming full sentences.
My need for privacy was intense, as is normal for women deep in labour. My one regret about Oliver’s birth had been that the room was too light because I had very thin curtains. This made me feel observed and exposed, so this time around I made sure the room could be made very dark, and even put up curtains to separate the living room from the corridor and kitchen.
At one point I had the strangest sense of being in a circus ring being observed by a crowd, so I asked for some people to go in the kitchen (by this point the second midwife had arrived so there were 4 people there). By now I was pacing the pool on my hands and knees, sounding loudly. Every few contractions I’d get a particularly intense one, and I couldn’t sing through it – I roared instead. I found that the sounding helped to keep my lips and jaw soft and relaxed, and this has been associated with a relaxed cervix. In reflecting on my first labour, I’d felt that fear of the pain and of a baby passing through me had contributed to quite a long pushing stage. This time I wanted to accept and submit to the strong physical sensations and concentrate on allowing my body to open up. Whilst deep in my second labour I kept moaning “open, open”. At one point I felt between my legs and, with great surprise said “oh! I am open!” As time went on, I started to say that I wanted it to stop, that it was too much. I also fiercely told the people in the kitchen to stop whispering. Clearly I was entering transition, and around this time my contractions spaced out markedly. I got a bit of a “rest and be thankful” stage. My lower back felt quite crampy at this point and I wanted some counter-pressure. I asked Paul to rub my back, but he told me afterwards my back looked completely different to normal and he was worried about damaging it. I think he must have seen the Rhombus of Michaelis appearing as the baby started to move down – in fact the ilea being pushed out was probably what gave me the crampy feeling in the first place.
Then I started to get a little grunty and then POP my waters went with a violence that really shocked me. My upper body shot forwards. I didn’t know what had happened. Had a baby’s head shot out? No, just the waters, but then the pushes started in earnest, with frightening intensity. It felt like my body was trying to vomit out my baby from below and I was retching at the top end too. My breathing became panicked and I said I was frightened. My midwife gently suggested I blow and almost immediately I felt more in control.
With only a few pushes my baby’s head was out, and with the next contraction the rest of her body. Debs calmly explained what to do which helped – bring her up to the surface slowly and gently. I just gazed at my beautiful baby in awe. In just 10 minutes or so my upright position brought baby no 2 down onto my cervix and re-started contractions. With baby no 1’s short cord, it became very uncomfortable to hold her even with Paul‘s assistance and as her cord had stopped pulsing Debs clamped and cut it, and I handed her to Paul for some skin to skin. By this time he had got in the pool.
Baby no 2 also came out with only about 5 minutes of full-on pushes and I was amazed and delighted to see as she rose through the water that she was still in the caul, the membrane covering her face. It’s supposed to be very lucky (not that I’m superstitious).
Now that there were no more babies to birth, we checked the sex of the babies and I was so happy to have girls. I just sat there with a big grin on my face saying “I have daughters”. Although twins are considered to be “term” at 37/38 weeks, my babies had copious vernix at 40 weeks – I could have potted and flogged the stuff as facecream! Their fused placentas were also in perfect condition. I had a physiological third stage but although the placentas separated quickly, annoyingly they didn’t come out for three-quarters of an hour or so. I could feel them only just inside me but they stayed put for a while, only coming out when I raised my knee to try standing up.
The babies weighed 7lb 2oz and 7lb, and we called them Rose and Philippa. It was wonderful to snuggle up with them in our big bed and just admire their perfection. Caroline brought me delicious soft fruits to eat and I enjoyed a lovely cup of tea. I spent most of the next few days bed with them, mostly naked to allow for lots of skin to skin and unrestricted feeding. This special, intense time really helped me to start bonding with each of the babies individually and to establish feeding with each.
My twin birth was such a wonderful experience. I felt supported, safe and empowered. Afterwards, when I struggled with breastfeeding (both babies were tongue tied), thoughts of their joyous birth buoyed me up. Their birth had left me feeling invincible, and that’s a hard feeling to shake even when things are tough. Physically and emotionally I was in a good place to begin dealing with the challenges of being a mother of three. Looking after twins is hard enough, without having to deal with major surgery or a traumatic vaginal birth.
Nothing is guaranteed in birth, but I felt that I gave my body the best chance I could to have a normal, physiological birth. If I’d had to have a c-section, or any of the less dramatic interventions, I think I would have felt disappointed, but accepting. After all, a small number of women do need the help of modern obstetrics to have babies safely, and thank goodness that support is there if it’s needed. I trusted my independent midwives to help me make informed choices, whatever happened, and to stay in control of as many aspects of my birth as possible.