the natural VBAC twin birth

I have had two pregnancies and births.  The first was with a single baby, Junebug , and it ended with a c-section birth.  The second was with fraternal twins, Buddy Boy and Miss Bee, and it ended with a natural VBAC (vaginal birth after cesarean).  What follows is my second birth story.

My water broke at 4pm on a snowy Valentine's Day in 2011 as I was sitting at the kitchen table.  The contractions started fast and furious.  I stood up, my pants drenched, and thought, "Oh wow, it's actually going to happen!  I'm going into labor!"  I was so excited and filled with disbelief; I didn't know what to do.  I ran upstairs (okay, perhaps it was more of a swift-ish waddle than a run) yelling for my mom, who was staying with us by then to help. 

"Mom!  Mom!  My water just broke!"  She couldn't believe it either.  She stood there for a second.  We cried, and hugged, and then she said, "well, let's get these wet pants off of you.  And then call your husband."

Perhaps my disbelief at the beginning of my own labor seems silly.  After all, I was 36 weeks pregnant with twins.  My water breaking at this point should not have been that surprising to me.  Especially because I was 1-2 cm dilated and actively trying to get my labor started using natural methods.  In fact, that same morning, my midwife stripped my membranes for the first time.  Around noon, I followed up with an acupuncture appointment aimed at stimulating my labor.  After the needles were placed, as I was sitting uncomfortably pregnant in the acupuncture chair, I literally felt Buddy Boy, "Baby A" (which means he was the lowest, or first, of the two babies), drop down into my pelvis.  As I toddled out of the acupuncture clinic, I knew his head was very low.

But since I experienced no labor and a c-section with my first pregnancy, and since this, my second pregnancy, was with twins, I never wholeheartedly believed I would actually have labor and contractions, much less experience an un-medicated vaginal birth.  My pregnancy with Buddy Boy and Bee had been a process of planning for what I wanted -- a natural VBAC birth -- while holding some mental and emotional space for what was statistically likely: another c-section.  I didn't want to go through the grief and disappointment of another failed birth plan, so the truth is that during my pregnancy, I never fully embraced the idea that a natural VBAC would happen for me.

The decision to "stay the course" with our natural birth plan after we found out we were having twins was not automatic.  After several days of sitting with the twin pregnancy news, and reading about twin births on the internet -- a google search for "twin births" resulted in a litany of interventions, traumatic birth stories and NICU-stay drama -- I decided I should leave Mary Mumford Haley's midwifery practice and find an OBGYN at the cutting-edge (and more intervention-prone) Women and Infants hospital.

My next appointment with Mary was already scheduled, so I figured I'd keep it and tell her in person that I would be leaving her practice.  I said something like this: "Well, now that we're having twins, I'll probably just have a scheduled c-section so I might as well be at Women and Infants for that.  Probably the babies will be born too early and have problems and need the NICU, so I might as well deliver there.  I guess I won't need a doula, either.  Thanks for trying to support my natural birth plan, but I guess it wasn't meant to be." 

Mary was so kind.  She didn't tell me all of these assumptions I was making were getting waaay ahead of myself.  Instead she said, "Jenn, if what you want is to schedule a c-section and switch your care to a Women and Infants care provider, that is a totally understandable decision.  But you should know that there's no reason at this point to think you can't have a vaginal birth with your twins, if that's what you still want.  And also, if you do need to have a c-section, John Morton is the doctor who would do it at Memorial.  He practices a method called a gentle cesarean.  Perhaps you should go and talk with him."  So I did.

During my first visit with Dr. Morton he spent a good 45 minutes talking me back from the ledge.  Twins can be born full-term and healthy.  Twins develop differently in the womb than singletons and they are often more developed at an earlier date.  They won't necessarily need a NICU.  If both babies are head-down when labor starts, there's no reason a vaginal birth shouldn't happen.  If baby A is head down when labor starts, and baby B is breech, then we can talk about what you want to do.  If the birth ultimately requires a c-section, it is still going to be a birth, not just a medical procedure.  Unless there are other complications, you will hold your babies right away on your chest and breastfeed them and enjoy those early moments of bonding with them, whether you have a c-section or not.  And in the event of complications before 34 weeks gestation, you will be transferred to Women and Infants for high-risk care.  But we will cross that bridge together if and when we come to it.

 
(Photo courtesy of Blink of an Eye Photography.)

So I took a leap of faith that my birth story could be different, that my body could somehow pull this off -- that at age 35 I could have a natural vaginal birth with two babies after having had a c-section less than two years prior.  It seemed ridiculous, and impossible, but I was going to try.  I pushed myself towards that open and vulnerable place, the soft spot of my heart, where hoping, planning and preparing for what I deeply wanted met the sharp edge of uncertainty about whatever would in fact happen. 

Throughout the rest of my pregnancy I kept Mary Mumford Haley as my primary care provider.  My dear husband and I contracted Severine from Birth in Harmony to be our birth doula.  I met with other twin moms in Providence who were living proof that not every twin birth resulted in super-stressful, prolonged NICU stays -- and that when that did happen, there was great care and support available.  And I scheduled periodic appointments with Dr. Morton for his opinion and continuity of care as well.  Since both Mary and Dr. Morton deliver at Memorial Hospital, I was actually hoping they might both be there for my birth -- Mary to deliver the babies if everything went well, and Dr. Morton to do a gentle cesarean if it was needed.  I felt great about my birth team.  Now if I could just make it to 34 weeks!

I tried to rest, eat right, and take care of myself so that I could keep the babies on the inside as long as possible.  I worried my blood pressure would start to climb again, as it did in my first pregnancy, so I tried to eliminate stress wherever I could.  This was easier some days than others.  The weather was turning from fall to winter, the New England days were becoming short, cold and dark, and I was starting to be uncomfortable at night and less able to sleep well. 

Around my 29th week, I was diagnosed with gestational diabetes, a common occurrence in twin pregnancies.  I felt overwhelmed and disheartened by this news, which required strict attention to my diet, including preparing and eating 8 small intentionally balanced "meals" per day.  Feeling huge and exhausted while caring nearly full-time for my 1.5-year-old daughter, the pregnancy was a major physical challenge.  I felt exhausted all the time.  Oh, how I would have killed for a six-hour stretch of continuous sleep and a pint of mint and chip ice cream!

One big difference between twin pregnancies and singleton pregnancies, even if you're going the crunchy-birth-team route as we were, is the amount of prenatal monitoring and testing that happens with a multiple pregnancy.  I underwent a staggering number of ultrasounds.  My birth team wanted to be sure that both babies were growing and thriving, especially as the pregnancy entered the third trimester.

As the calendar passed the 34-week mark and the babies were looking good on the stress tests and ultrasounds, I started believing that we might actually avoid a prolonged and difficult hospital stay.  I started to relax about it all just a bit.  They were pretty big now, over four pounds each, and growing and thriving.

Buddy Boy under my left hand; Miss Bee under my right.  (Photo courtesy of Blink of an Eye Photography.)

But then during my 35th week ultrasound, Baby A's (Buddy Boy's) belly measurement was showing too-little growth from the previous measurement.  I was told over the phone by Dr. Carpenter, the OBGYN who directs the practice where I received my ultrasound testing, that this sometimes happens late in twin pregnancies: one baby stops thriving and it becomes better for the babies to be on the outside than the inside.

Mary also reviewed the data and discussed things with us.  Ultrasounds are not perfect; they give a good sense of what's happening, but the measurements aren't an exact science.  Buddy Boy's heartbeat was strong, he was moving and kicking all the time, his head and legs and other measurements were showing steady growth, he had plenty of amniotic fluid in his water sac, and it's possible that the belly reading was just off for some reason.  But it was also possible that what Dr. Carpenter anticipated was correct: that my sweet baby boy was beginning to thrive less on the inside of my body than was best for him. 

Mary suggested she check to see if I was at all dilated.  She checked, and I was.  I was 35-and-a-half-weeks pregnant, but my cervix was ripe and I was 1cm dilated.  Both babies were measuring about 5 pounds.  And Buddy Boy's head was low.  Both babies were head down.  With all the factors considered, including my gestational diabetes and my history of high blood pressure late in my previous pregnancy, Mary recommended we try stripping my membranes after my 36th week began.  If my body was ready, the stripped membranes might help stimulate my labor.  If my body wasn't ready, then it wouldn't.     

And Mary was right.  After my water broke on Valentine's Day afternoon, the day she stripped my membranes, my mom and I changed my wet pants and Dear Husband (D.H.) was racing home to take me to the hospital.  My contractions were already making it hard for me to talk, so I knew I didn't want to linger around for more labor at home.  We called Severine, our doula, to ask her to come to Memorial Hospital to meet us.  Good news: she was already there, and Mary was, too!  They had just finished another birth.  She'd let Mary know we were on our way!

The contractions in the car ride over were very intense.  I couldn't walk by the time we got to the emergency room; the contractions were coming very close together, double-peaking.  Miss Bee was up high, her bottom protruding out from under my right ribs, her water sac still intact.  Buddy Boy's body was low along my left hip, his head pressing down on top of my cervix in my pelvis.  As D.H. and a nurse wheeled me up to the birth center, I remember feeling worried that I was transitioning.

When we got to the hallway where I would be checked in, a door was open to my left.  From my seat in the wheelchair I could see inside a small room where Mary and Dr. Morton were sitting around a table in their scrubs, scarfing down some pizza.  Severine was there, too.  When I saw the three of them sitting there I started crying uncontrollably.  Big, loud, shaking, snotty, ugly cry from the very pregnant lady in the wheelchair in the hospital hallway.  Mary came running over, still swallowing her pizza.  The contractions were still coming intensely, but the wave of emotions I felt when I saw the three of them in that room is what overwhelmed me.  I knew:  I am going to be okay.  However this birth experience happens now, my babies and I are going to be okay.  My birth team is all here, in this hospital, in this room eating pizza, waiting for us.  On Valentine's Day.

Mary examined me and I was not transitioning.  I was 3 cm dilated, but Buddy Boy's head was already + 2, which means he was very low.  So I labored.  And labored.  And labored.  I went so deeply inside of myself I didn't know that depth existed.  I felt my mind slide down into the expanse of a profound reserve I didn't know was there. 

Buddy Boy and I worked together for the next 10 hours.  I kept talking to him, telling him to hang in there, to keep pushing his head down, to keep working with me, to come out and greet the world, that we would take care of him when he got here.  I was hooked up to all sorts of machines -- fetal heart monitors for both babies, a blood pressure monitor for me, and a hep lock in my left hand in case I needed an emergency c-section.   

At one point Buddy Boy's heart rate slipped off the monitor.  So they stuck a little probe up onto his head to keep a good read on him.  Meanwhile, Miss Bee was just chillin' in her own private swimming pool, her water sac still entirely intact.

About 7 hours into labor, my blood pressure became very high.  I had been laboring on a large bouncy ball, standing up, and in the bathroom.  Mary said I needed to lie down until the birth was over.  This might seem like a simple command, unless you have two near-term babies in your belly, rolling around inside of you like two bowling balls on top of one another and all your other organs, and also you are in labor.

This is the point where the snoogle body pillow saved me.  I was able to prop myself halfway between my back and my side, laboring.   God bless that snoogle pillow!

My labor room was calm and dark.  The lights were low, D.H. had some music on the iPod for me, he was serving me small sips of water, Severine was rubbing my neck and shoulders.  Soon, when it was finally time to push, I would need to transfer to the operating room (OR).  This was because I was having a VBAC (vaginal birth after cesarean), and there was a rare but serious possibility that my uterus would rupture where my c-section scar left a weak point across my lower belly.  I knew this was part of the deal in attempting a vaginal birth: I would be pushing out two babies under the bright lights of the OR, with a bunch of emergency doctors standing by to save my life in the rare case that my uterus ruptured.  I tried not to think about this.

As I moved from 9 to 10 cm dilation, through the transition, the nurses were anxious to get me into the OR.  But Mary held the line.  Not yet, she said.  Not yet.  She helped me stay in my relaxing coccoon of the low-lit labor room until the very last possible minute.  She didn't want me to get to the OR too soon and have my body freeze up and stop progressing.  She wanted my body to be 100% ready to push when we got there.   The nurses, on the other hand, didn't want me pushing on the gurney on the way to the OR, nor did they want my uterus rupturing in the hallway.  It was a tricky balance, but Mary read the situation and called it just right.

The pushing lasted 45 minutes.  It was loud, and messy, and really freaking hard.  At one point, the anesthesiologist tried to put a second hep lock on my other hand (I already had one), so he could quickly get me Pitocin if I needed it.  "She's not using Pitocin," Severine told him.  "She's doing this birth without any drugs."  Then Mary said, "She's giving birth, not having surgery!"  This was my small window into how my experience might have ended up had I been in another hospital, with a different kind of birth team.  The anesthesiologist was just doing his job; he probably wasn't used to being part of a natural vaginal birth experience.  He was highly trained and accustomed to meticulously administering drugs for surgery, not standing by in his scrubs to wait for a natural birth to run its course.  I so felt grateful to be with my birth team at this moment.

I must admit that after about 40 minutes of pushing, I started yelling for Mary and Dr. Morton to just cut me open and take Buddy Boy out.  They laughed at me.  No, seriously, they did!  Dr. Morton was like, "Um, yeah, you can thank us later for not listening to you right now."  And I knew I was being ridiculous.  But man, I'd had enough.  And just then... there he was!!!

 Mary caught all 5 pounds of him and placed him on my chest.  She put a little hat and a blanket on him to keep him warm.  He nursed right away, and I was so in love with this precious little person.  I felt so elated and relieved!  He was finally here!  We left his cord attached for several minutes while he nursed.  D.H. and I enjoyed these sweet first moments of our son's life.

But, of course, Miss Bee was still in my belly, her bag of waters still intact.  Dr. Morton had warned me about this sometimes-tricky moment during one of my prenatal visits.  I believe his words were, "After the first baby is born and the second one is still inside, that's when the magic happens."  He had experience in this department, including delivering my friend Laura's twins 8 hours apart because he was sage enough to chill out, let her get some sleep, and realize the second baby was okay to stay inside for a while.  I trusted him and Mary, but wondered what magic it would take to bring Miss Bee into the world at this point.

Bee wasn't under any stress; her heartbeat was strong and steady.  But my contractions ground to a screeching halt.  Nothing.  We waited, and focused on Buddy Boy.  After about 20 minutes, Dr. Morton suggested we break her bag of waters to see if that might get my contractions going again.  It didn't.  She was still inside, not ready to come out, and with no reason to be born today at all, other than the fact that her brother had just been born and my body -- with its still-high blood pressure -- needed for her to be born now, too. 

Dr. Morton said, "Jenn, what if you just push down, try to push her out, even though you don't have any contractions to work with?" 

"Okay," I said.  So I pushed, and down she went, and I pushed again, and out came Miss Bee, into Dr. Morton's hands.

With Buddy Boy on my left and Miss Bee now on my right, I could hardly believe I was holding my two sweet babies together in my arms.  It was really my first experience with what is now a familiar feeling as a twin mother:  that feeling of how incredible these two little people are, so singular and yet so attached here in my arms, and how overwhelming it is to tend to both of them at once! 

They were born 24 minutes apart.  Miss Bee took a bit of time to nurse.  She was more sleepy and smaller than her brother, weighing in at 4 pounds 11 ounces.  D.H. cut both of their cords and after what felt like a good long while.  I had plenty of time to just lie there, nurse and snuggle them while I was getting stitched up.

When it was time for them to be examined, it turned out their blood sugars were very low, and they needed to have a bit of formula, which was administered from a little cup (no bottle nipple to potentially confuse them).  I was cool with that.  Mary informed us that the babies were smaller and more premature than she'd thought they would be, and so she felt most comfortable relinquishing their care to the pediatricians at Memorial Hospital (usually Mary provides newborn care to the babies she delivers).  The babies were doing okay, there was no emergency or problem, but they needed a bit of extra attention and monitoring given their size and level of development.

They spent the first two nights in incubators, like this one, to keep track of their vitals and provide a warm, controlled temperature.  After two nights, the hospital staff had weaned them off the temperature control with no problems and they disconnected all the machines.  Both babies were thriving and doing fine on their own.  During this entire time, the nurses woke me up to breastfeed each of them every 1.5-2 hours.  It was exhausting, but I was grateful for this closeness and time with each of them.  I decided not to tandem nurse them, so that I could enjoy this bonding time with each of them individually (and also, tandem nursing stressed me out!).

(A funny aside: when I first saw that Time magazine photo of the woman nursing her older toddler, in her skinny jeans and her cute "slightly undone" hairstyle, I immediately thought of this picture of me, above.  This, my friends, is what a nursing mother often looks like!  And it ain't so sexy.)

On day two, Junebug came to meet her new brother and sister.  And on day three, which was Junebug's 2nd birthday, I was able to have them with me in my room.  Miss Bee was discharged on the third day, as was I.  But Buddy Boy was jaundiced (we'd experienced the jaundice drill before because Junebug was also jaundiced) so he spent an extra 24 hours in the hospital under the billy lights.  But I still got to nurse him every 2 hours.

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So here is what I've learned about birth, from my two very different birth experiences... 

There's about 10% of things you have any control over, if that, and about 90% of things that you don't.  But those 10% of things can be important.  In my case, I think it is likely that with different care providers, I never would have received the advice to strip my membranes at the start of my 36th week.  I think it's likely that I would have gone in for another ultrasound later that week, that Buddy Boy's belly measurement wouldn't have been convincingly improved, and that the doctors would have wanted to induce me with Pitocin at that point.  Maybe that route would have resulted in a vaginal birth, or maybe it would have ended in another c-section.  Mary's advice to get labor going naturally before that scenario could play out is one of the biggest reasons that this natural VBAC was able to happen for me.

Another moment in which I was very glad to have Mary as my care provider was when my blood pressure was spiking during my labor.  I think some providers would have suggested a c-section at that point.  But Mary just asked me to lie down to try to lower my blood pressure.  She trusted my body, saw that I was okay and progressing.  It was a judgment call, but it turned out to be the right one.  She erred on the side of trusting my body and trusting the labor process I was having, while very closely monitoring me, instead of prematurely defaulting to a c-section.

And perhaps the most important thing that Mary did to help my labor and birth happen naturally was her pushing the hospital staff to hold off transferring me from my cozy labor room to the OR before I was really ready to push.  The hospital staff was understandably anxious; it's not every day they dealt with a crazy lady like me who was trying to vaginally birth twins without any drugs and with a big c-section scar across my lower abdomen.  If anything was going to go disastrously wrong, like my uterus rupturing, they wanted it to happen in the OR where they were prepped for surgery and ready to handle it.  This, of course, is what I wanted, too!  So there was a delicate balance between a righteous fear of a potential serious emergency situation vs. the confidence that my body knew what it was doing, that these babies were coming naturally and vaginally, and that if we left it well-enough alone it would all be okay.  Mary made this call, again siding with trust and not with fear, and as a result I was 100% ready for pushing by the time I was wheeled into the shockingly bright lights of the OR.

There are a zillion small ways that this birth story could have taken a different turn, and I am so glad that it happened the way that it did.  I am so glad that the 10% of things that I had any control over -- my birth team, my wishes for the birth to be unmedicated and vaginal, my choice of hospital -- were what they were.  But I also feel grateful that the 90% of things I couldn't control ended up the way they did, due to no planning, effort, or preparation of my own.  

When I was pregnant with Junebug, during my first pregnancy, I didn't know this.  I thought that if I just made the right choices -- choosing a natural birth plan, choosing midwives over OBs -- that I could thwart a corrupted hospital culture of interventions and achieve the birth experience that I wanted.  Looking back, this seems hilarious to me.  But I also think that some of the "natural" child birth resources I relied upon during my first pregnancy relayed an over-confidence in how certain choices could produce certain outcomes.  I now know this is not the case.

My two different birth experiences have taught me there's no guarantee in birth, and there's no one "right" way to do it.  A birth story is made up of a million different intersections of real-time decisions and actual body circumstances.  There are judgment calls being made during every birth, at many different moments.  For me, having a birth team that I knew would make wise judgment calls that I could trust and feel good about was essential.  And an enormous privilege, for which I will be forever grateful.  But once I had vetted and chosen that trusted team, I had to let it go.

For anyone looking for a non-traumatic twin birth story on the internet, I hope you've enjoyed reading this one.  It was the most joyful, intense, painful and triumphant experience of my life.  It's true that a natural VBAC birth with twins is rare, and I am profoundly grateful to have experienced it.  It is not impossible.  But neither is it something that any of us can completely control.  Birth is so much larger than our plans.

And on the fifth day we brought Buddy Boy and Miss Bee home from the hospital... and the REAL work began!

Comments

[Megan Kennedy-Farrell]

On the brink of birth for the second time myself, I'm grateful to have read this (even if there is only 1 baby in my womb.) Thanks, especially for the reminder, "But once I had vetted and chosen that trusted team, I had to let it go." Thanks!

[Jennifer]

Megan, thanks for your comment. I am so excited for you, your family, and the birth (and life!) of baby #2! Will keep you guys in my thoughts.

[Abby]

Jenn, I love this story! I have lots of thoughts in response, but I really wanted to encourage you to send your story to the Birth Without Fear blog. She's a huge advocate for natural birth, but also very supportive of mothers who aren't able to have that for whatever reason. She has a ton of great birth stories and I'm sure she'd love to share yours, given how rare it is. The website is birthwithoutfearblog.com and her contact info is there.

[Jennifer]

Thanks, Abby! I'll check it out.

[Laura Folkwein]

I am so glad you are writing and sharing your life online, Jenn. Deep thanks.

[Jennifer]

Thanks, Laura! I appreciate the encouragement!

[Kerstin]

Hi Laura-
I am also in RI., I am having twins- going on 8 weeks. This is #4 and #5. I have had all vaginal deliveries- terrible experience at W&I last time- I delivered my second on my own at home by accident- didn't make it to the hospital in time! I am very interested in Mary and was wondering if you know how to reach her, I would love to go her route! Please get back to me!

[Jennifer]

Hi Kerstin,

I understand that Mary is focusing on her home birth practice right now and is no longer doing births at Memorial Hospital. If you are looking for a home birth, I recommend contacting the RI Birth Network (check them out on Facebook) or checking the forums at mothering.com for referrals of midwives who would consider home birthing your twins. If you are looking for a hospital birth at Memorial, I suggest contacting Dr. Morton or Dr. McGee. I'm sure Memorial Hospital can give you their contact information if you don't have it. Best of luck to you!

[DebbieKL]

Great birth story! Thanks for sharing. I had mono/di twins vaginally (in the OR) with no complications at 36w. Baby B did come out feet first, but it wasn't much harder on me. Many parts of your story brought back memories!

[Jenn]

Kerstin,

Mary does have privileges at Memorial now, so that is an option! You can look her up at RI Home Birth & Hope Family Health. Sorry I didn't see this earlier!

[Jennifer]

Good to know, Jenn. Thanks for the update on how to find Mary!

[Jennifer]

Friends: the wonderful Leah DeCesare (my post-partum doula!) just wrote a great post about having a successful VBAC. You can read it here: http://motherscircle.net/secrets-of-vbac/