Twin Birth Story - Caitlin's Perspective

Prodromal Labor

I had a doctors appointment the day before Thanksgiving. I asked to be checked and have my membranes swept if there was any cervical dilation. The midwife said the cervix was 2cm dilated and membranes were fairly separated already so the sweep wouldn’t have much effect, but she did it anyway. I had an induction scheduled for the following week, and I knew that if labor didn’t start on its own the end was near. Later that afternoon contractions started. They were not too intense or regular so I didn’t bother timing them, but they weren’t going away so I asked my parents if they could come up to stay overnight in case we needed to go to the hospital. We went for a walk with the boys when Dane got out of work. Contractions picked up on the walk, but I could talk through them easily and they didn’t require much concentration.

Anton

Dane was very distracted because he knew Anton was going to be put to sleep that evening. He was having a few drinks, and I was getting nervous that labor might truly start and he wouldn’t be prepared to take me to the hospital. Contractions faded as the evening wore on, and Dane spent some time processing the loss of his beloved animal companion. The next morning was Thanksgiving! This is Dane and my favorite holiday, and I was hoping labor would hold off. We had a nice day with family. My parents joined in the festivities with Dane’s side of the family. They had been visiting from Jersey in case I went into labor and nothing had happened. I continued to have mild contractions and my mucus plug came out in the evening. Nothing was getting more serious or intense, but I kept warning Dane that it could happen anytime.

Black Friday Shopping

At 2:30 a.m. on Black Friday my water broke. It wasn’t a huge gush, but I knew it was my water because I had more liquid leaking involuntarily with each contraction. I called the midwife on call to let her know. Because my last labor was very quick after my water broke with Sanderson she agreed to have us make our way to the hospital. Dane heard me on the phone and he jumped out of bed. He asked what was going on and said he had a feeling this was going to happen tonight. We had a few bites to eat before we left, I knew I wouldn’t be able to eat much in labor, and we stopped for some kombucha on the way. We sat in the parking lot for a few minutes to relax preparing for the unknown that would be the next 12-24 hours. 
We were directed to OB Triage where the doctor verified my water had broken and checked for cervical dilation. I was admitted at 4cm dilation and sent up to labor and delivery.

Advocate and Educate Yourself

I met with the midwife on call. There are several midwives in the RBWC practice and this particular midwife was not one I had seen often. She wanted to discuss the plan written in my chart. The plan included the following recommendation from the OB Doctor: An epidural is suggested while in labor. This is to encourage "laboring down" without actively pushing.

My neurologist was concerned that active pushing could lead to another stroke. While he was not necessarily saying a stroke would be caused by the Valsalva pushing, the unknown nature of the stroke meant that my neurologist and a neurosurgeon I consulted with would not support a vaginal delivery. During the last few weeks of my pregnancy the OB doctor was able to advocate on my behalf. He was confident that my previous deliveries made me a perfect candidate for a vaginal delivery (of twins) and I was so grateful for the chance to avoid a cesarean section. While I was aware that the epidural was the plan my OB was most comfortable with, I asked to proceed without the epidural until labor had progressed to the point where delivery was imminent. This caused some conflict between the midwife and myself. After some discussion she agreed that we could wait for the time being. This ended up being a tremendously important decision.

Labor Did Not Intensify

After hours of waiting, walking, and monitoring the babies nothing seemed to progress. Finally I initiated the conversation with my midwife about pitocin augmentation. This synthetic for of oxytocin is a drug designed to initiate labor. It’s possible that my labor would have started on its own if I had waited longer.  It’s also possible that my overly distended uterus was simply not contracting efficiently. But in either case, hospitals have protocols for a long labor after membrane rupture and I knew my clock had started. Infection risk increases after 12-24 hours and c-sections become the safest solution. I was interested in getting labor going and I was willing to introduce interventions to make this happen. The midwife agreed this was a good idea. She consulted with my OB doc who said we needed to wait a few hours. He was not available and he wanted to be there for the birth. When he gave the okay they started a Pitocin drip through my IV. While on Pitocin the hospital required constant fetal monitoring. The only way to keep both babies on the monitor was to lie on my back in a particularly uncomfortable position. No movement to cope with contractions, and no change of position was allowed without a nurses assistance. It took 2-3 more hours of increasing the Pitocin dosage for a labor pattern to be established. When contractions finally started to get painful and close together I began to recognize that labor was finally headed in the right direction. 

When you expect to have a fast labor, it’s hard mentally when six, eight, ten hours pass and nothing is happening. My labor progress, or lack of progress, was completely normal but I was thinking that it would be over by sunrise and I knew it hadn’t really started. I missed my boys and I wanted to be able to tell them they had two new siblings. The nurses had changed shifts and changed again and I was still lying there. Plus I was really hungry! The hospital plays a little tune of rock a bye baby when someone on the floor delivers, and we heard 10-15 babies born while we waited for our little ones to arrive. A few nurses said, “oh you are the one with twins?” as I moped around the halls wishing my babies would come. I reminded myself that labor can be more like a marathon than a sprint. Just because my previous labor went quickly did not mean something was wrong with me or the babies. Dane helped me to stay positive and keep moving forward.

The Epidural

I requested another cervical check after the Pitocin started kicking in, and I agreed to the epidural at 5 cm. When I received the epidural the anesthesiologist and my nurse seemed very pleased with themselves that I no longer needed to be in pain. The pain relief was nice, but this was not my goal. I wanted to deliver two babies, as safely possible. I wanted to deliver without the epidural, but I trusted my OB, and after a long labor I wanted to do anything that would facilitate a smooth delivery. And I was miserable with the epidural. I could still feel contractions on one side of my body. One leg was so numb that it felt like a tree trunk that I couldn’t move at all and the other leg felt completely normal. Contractions felt weird and still incredibly painful on one side, yet I was helpless and I couldn’t move. I asked the nurse to help me change to the opposite side-lying position to allow for gravity to move the medication to the side of my body that was not numb, this worked to some degree and contractions faded and I could no longer feel them. The anesthesiologist came back and told me she was going to give me some more medication. I practically shouted at her, I didn’t want more! I just wanted it to work on both sides. I was having a complete panic attack with the numbness and lack of control. How do people have any idea if they are pushing when they have an epidural?!

I know the epidural is a great option for pain relief in labor, but this was not the highlight of my labor. I was still concerned that labor would stall for some reason, and I would end up needing a c-section anyway. But I could see the contraction peaks on the monitor and I could feel my babies head was coming down. I knew progress was happening.

The Delivery

After what seemed like an eternity, a nurse can to check to see why my “baby a” was no longer being picked up on the monitor. It's because her head was coming down the birth canal. She proceeded to deliver this baby while I felt nothing, and place her up on my chest.

Dane woke up to the baby crying and me in total shock as the room became flooded with doctors and nurses preparing for ‘twin b’. I was supposed to deliver in the operating room, in case of an emergency, but everything happened so fast that my OB decided we could deliver the baby who was presenting breech in the same room. Loads of people just stared and laughed as they curiously watched a butt come first and a head be delivered last.

People talk about breech delivery being a lost skill. C-section becomes the only option for women who have a baby presenting breech because no doctor will agree to deliver a breech baby. I was fortunate to have a doctor who was willing to patiently allow for this baby to come down with the help of a nurse who pushed on my belly with the contractions. It took 8-10 contractions before the second baby arrived. It was bizarre watching a bunch of people stare at me from down below while I wondered what was happening. At this point the epidural had worn off slightly, so I could feel when contractions were coming, but I still couldn’t feel pain or whether or not I was pushing. The doctor reached his entire arm inside me to attempt to turn the baby manually and check on the presenting parts. Meanwhile, my OB was teaching a young female resident how to deliver the breech baby, and he talked her through and assisted with the delivery. It makes me happy that other woman will have the opportunity to deliver breech vaginally as my OB nears retirement.  In the end, I was so thrilled that everything went smoothly. Keenan needed a little help getting started so nurses stimulated him off to the side before allowing him to return to my chest for some skin to skin time. 

Everything went smoothly with the placenta delivery. After suffering a postpartum hemorrhage with my last delivery, the placenta is something I was anxious about. The doctor showed Dane and I the two fused placentas and the membrane that separated the two babies. They checked me for signs of tearing and allowed us some time to be alone before they came back for weight and other newborn evaluations. 

Recovery

We were moved into a recovery area of the hospital where we stayed for about 24 hours before heading home. The first evening we got a little sleep, as we learned what life is like with two newborns. My postpartum bleeding was minimal because of a Pitocin drip that was kept running for six hours after the delivery. This was to prevent another postpartum hemorrhage. It has been a week now and I feel better each day. Moving around the house was difficult at first, but now I am feeling mostly back to normal. I need to remind myself often to slow down because I know that I am still healing, and when I do too much I have to pay for it later in the day. I am constantly amazed at the elasticity of the female body. Yes, I still have saggy skin and a fairly sizable belly, but the change in my body in just one week is pretty remarkable. 

This blog was written by Garage Strength co-owner Caitlin Browne. You can find more from Caitlin on Instagram @traditionalfoodsmodernlife

For Dane's version of the birth story click here

 

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