The story of my twin VBAC begins with the cesarean birth of my first son. A cesarean, that I believe could have been avoided had I been better educated. I assumed I would see an OB, go into labor, head to the hospital, and have the natural birth I wanted. Instead, I found myself subjected to multiple interventions that resulted not only in a scar along my bikini line, but left me emotionally scarred as well. I handled things much differently during my second pregnancy, and my second son was born via VBAC with the assistance of a wonderful midwife group. It was a completely healing and amazing experience.
My third pregnancy came as a complete surprise. We were not planning on a third child, much less a third and a fourth. I was on birth control, still heavily nursing my toddler, and had JUST gotten rid of all my baby gear. I never dreamed I was pregnant. I did not have morning sickness, and I blamed my extreme fatigue on my son and our nighttime nursing sessions. I thought I had an ovarian cyst; something my OB had suggested a month prior when I called regarding the bizarre behavior of my newly returned period. Since I was having some odd symptoms, my husband told me to take an at home pregnancy test. On Mother’s Day weekend, I finally took one, and was shocked when the pregnancy line appeared. Still I was not convinced. I looked on the internet and found that the symptoms of ovarian cysts are similar to pregnancy symptoms, and can sometimes cause a false positive. In my mind, this is exactly what had happened.
I immediately went in for an ultrasound, and found out that not only was I 12 weeks pregnant, but I was carrying mo/di (identical) twins. After getting over the initial shock, my first question was whether I could VBAC the twins. After all, I had already had a successful VBAC, so I knew my body could handle it. I was immediately shot down and told I would have a cesarean. I resolved right then to find another OB, or preferably a midwife, and to have my babies vaginally.
The search for a care provider was extremely frustrating and stressful. No birth centers in my area would take the combination of a VBAC and twins, and I was unable to locate a midwife who would deliver twins. Home birth is in a bad place in our state, so that option seemed out as well. Some doctors I spoke with would allow the twin VBAC, but required an epidural. However, I planned to avoid pain medication altogether, and wanted a birth as intervention-free and natural as possible. I spent hours crying over my situation and had countless nightmares. I understood that twin births could be tricky, and was not opposed to a repeat cesarean – as long as it was medically necessary. But, it seemed to me that my choices were so limited, that odds were I would end up with a cesarean, and simply because I was carrying multiples.
To counter the negativity, I put a tons of time and energy into researching the birth process, twin births, and VBACs. I read scientific abstracts, ACOG guidelines and recommendations, and birthing blogs, as well as contacting my local ICAN chapter. I emailed my former out of state midwife and doula, and a couple of L&D nurses that I knew, to ask their opinions on my birth. I asked questions in birthing forums. I watched documentaries and read books, and located a wonderful doula and her trainee, a mama who had birthed twins naturally herself. The information I found was reassuring and helped me to stay my course. I would continue to push for my right to have a natural birth.
Finally, based on the recommendation of my fantastic MFM, I located an OB who was fully supportive of a natural twin VBAC. There were some conditions though – Baby A would have to be head down, and I would be continuously monitored throughout my labor. Therefore, unless the hospital’s telemetry unit was available, my movements would be restricted to the area around my bed. This was a HUGE mental obstacle for me, as I had spent both my other long labors walking around and in the shower. I would also be delivering in the OR (a distasteful, yet common, practice with twins) – just in case something went wrong last minute. This was also horrifying to me, and I could not imagine delivering under these conditions.
By definition, twin pregnancies that share a placenta can be complicated, and this was certainly the case for me. At week 19, the babies were found to have a weight discordance of greater than 25%, and we were diagnosed as having Selective Intrauterine Growth Restriction (SIUGR). In addition, there were some issues with the blood flow in baby B’s umbilical cord, and she had low levels of amniotic fluid. These were all indications that we might be developing Twin to Twin Transfusion Syndrome (TTTS); a fast acting disease, that left untreated has a 90% mortality rate. We were given a few grim options, but decided to see weekly how things progressed. If the situation declined and we developed TTTS, we would have laser surgery. Our goal was to make it to 25 weeks, so that I could deliver if necessary. Getting to 32 weeks was considered a “pipe dream”.
The weekly ultrasounds were an emotional roller coaster ride. Every week I would be terrified that they would find only be one heartbeat, or that our situation had declined, and we would be boarding the plane to Florida where my MFM wanted us to have the laser surgery done. However, it was also reassuring getting to see the girls moving every week. Afterwards, would be the immense relief that we were still hanging in there. We got extremely lucky. I followed the recommendations of the TTTS Foundation, went on horizontal bed rest and drank protein shakes, and the babies’ weights and fluid levels evened out. A couple months later, for a few short weeks, we were even deemed a “normal twin pregnancy”.
Then at 34 weeks, Baby B had a major decline in growth. My MFM recommended delivering immediately. Although twin B was not in distress yet, he was highly concerned given our past history. He assured us that now would be our best chance at a natural delivery before B went into distress. After a few days of debating and calling him after hours to discuss the situation, we consented to the induction. I knew my chances of ending in a cesarean were higher with an induction, and I was upset that the girls were not picking their own birthday, but I also felt we were making the right decision for our littlest girl.
That evening, I got a call from the OB office, and was told to come in the next day for my cesarean. I was flabbergasted. This was not the plan, and I informed her that we were supposed to be induced. I was told that the doctor on call was not comfortable with a twin VBAC. Besides, she added, I was barely 35 weeks and there was no way I was dilated, and therefore an induction was unlikely to be successful. I was devastated and felt very betrayed. While this was not the main OB I had seen, I had met her before and she had cheered (actually clapped and squealed) when I told her my plans for a vaginal delivery. I could not believe how negative she had suddenly become. I told her that I was not going to have a cesarean unless it was medically necessary. She said she would leave a note to try and get me scheduled with staff who felt comfortable with my situation. I got off the phone and sobbed for over an hour.
Once I calmed down, I placed another call to my MFM and found him taken aback as well. He told me his report stated that we were aiming for a vaginal delivery, and he recommended that I call the next day and speak with a different doctor. He reassured me that an induction could be successful. An email to my former midwife also helped to calm my anxiety. I called the next morning and ended up scheduled with the doctor I had seen the most. He was very comfortable with twins, VBACs, and would even do a breech delivery, if necessary. I was ecstatic. I had one final appointment before the induction, and found I was already 3 cm dilated and 60% effaced. Both girls had been vertex for weeks, so we were good to go for the VBAC. I requested a membrane sweep, and once home, tried everything I could to throw myself into labor naturally. Unfortunately, I was not successful.
A couple days later we went to the hospital for our induction. It was strange arriving at the hospital and not being in full blown active labor, like I had been with both my boys. After about an hour wait, we were taken to a room in a wheel chair, which I found both funny and ridiculous since I had zero signs of being in labor. The EFM bands were strapped to my stomach to monitor both babies and an IV was placed. Since my GBS status was unknown and the babies were premature, they recommended antibiotics, which I accepted. It took over an hour for the nurses to get both babies on the monitor and to get a decent baseline reading of their heart rates. The nurses would spend most of their time during my labor trying to keep both babies on the monitor. At this point, I was waspish and very discouraged – this was a far cry from the natural birth I wanted, and I was scared that I would not be able to handle the pitocin contractions.
My doctor came in to check on me and said, “You know my policy on epidurals, right?” I tensed up and got ready for a fight. Had he been leading me on? I thought he was on board with my plans for a drug free birth. He finished, “if you want one, you have to ask me for it”. Whew! I would not be starting off my labor butting heads with my provider. This was the only mention of pain medication from any of the staff during my entire labor. He then told the nurse to start the pitocin at a low level. It was baby time!! I felt better now that things were getting started. If I was going to succeed in the VBAC, I needed to make the best of my situation and stop wallowing in self pity.
The nurse slowly increased the pitocin dose, but it seemed to have little effect on my body. I repeatedly asked for the remote telemetry unit, and was told they would bring it once certain the babies and I could tolerate the pitocin. As the dose increased, I began to have some contractions. The funny thing was that the only time they were regular and even remotely strong was when I was laying half reclined in bed. This was totally counter intuitive to everything I had read and experienced in my other labors, and even my doulas found it amusing. Every 20 minutes, I would get up to move, and the contractions would stop. All my fears about being in bed were unfounded, since this seemed to be where things were working best. I did not even bother to request the remote telemetry unit again.
I worried that I was not responding to the pitocin, and watched the monitor with my contraction patterns constantly. I knew that there was only so much pitocin that I could be given, and I was concerned as to what would happen when I reached that point. I had no idea if I was continuing to dilate since the nurse never asked to check my cervix and I never requested a check. To get my mind off of things, my doula had us play a fun word game. I also played cards with my mom and watched stand up comedians and other funny videos on youtube. To keep my strength up, I drank bowls of chicken broth.
After 8 hours, I had long since reached the maximum dose of pitocin. My contractions still were not very strong or productive, although they were a couple minutes apart. I had sprung a leak in my water a few hours earlier, and when the doctor finally came in to check, I was 5 cm and 80% effaced. At this time, he recommended breaking my water to kick start the labor. He said that he would allow me to try the pitocin for up to three days, but really did not recommend this because it would likely become stressful on the babies, and so far their heart rates had been perfect.
There was one other huge issue; my doctor would be leaving early the next morning. I asked him what would happen when he left, and he said that whoever was on would make the decisions as they saw fit. I asked who was on after him. It was the lady who had called me a few days prior and told me to come in for my cesarean. Panic set in. Both my labors with my boys had been over twenty hours each, and I was highly concerned as to what would happen if the twins labor followed suite. My doulas calmed me down and told me not to project that far ahead, but just to focus on the now. There was nothing I could do to change things and getting all worked up about it would not help the situation or my labor.
I discussed the AROM with my husband and doulas without the doctor being present. We weighed the positives and negatives, and discussed potential risks. One of my big concerns was being placed on a time line like I had been with my first son. However, my OB said that since I had already had antibiotics, an infection was unlikely, and he would not be placing me on the clock. There would be no 24 hour deadline. After some careful questions, I consented to the AROM with a cheery,“let’s get this party started”! My water was broken in a huge gush, and real labor began immediately.
I spent most of my labor leaning over a chair with the doulas massaging my hips and lower back. My husband was there to hold me and smooth my hair. I squatted into the contractions and “OMed” through them, remembering to loosen my jaw, while mentally telling my body to open. My contractions were now coming every minute and half, so the nurse lowered the pitocin, making them three minutes apart. Despite the fact that I finally felt like I was really in labor, I still focused on the monitors, and was concerned that my contractions were not as strong as they should be. Finally, my doula covered the monitors and had a heart-to-heart chat with me. She reminded me that while there were parallels between this birth and my first, it was not the same birth, and I needed to release my fears. I let go.
Time blurred and became meaningless. I entered my other worldly, primal place. From my disjointed state, I have a few foggy, out of sequence memories and impressions: getting hot and shedding my clothes. The lyrics, “this is it boys, this is war” from the song “Some Nights” by Fun, resounding over and over in my head. My unconscious choice of lyrics attesting to the fact that I felt like I had been battling my whole pregnancy for my VBAC. Mentally lecturing myself to stop singing, since I was not overly fond of that song, and then the whole process repeating again. Hours seeming to pass in minutes. Looking up at the clock and noting it was past midnight. Once again, hating the feeling of my water continuing to gush with each contraction and complaining that I was “peeing” on the floor. Requesting a cervix check and being 7 cm dilated. Transition. Seeing pink on the floor mat below me as my bloody show made its appearance. Struggling to climb in and out of bed with my ridiculously big belly. Leaning over the birthing ball, but much preferring the chair. The nurses unsuccessfully trying to keep the babies on the monitor. Stating over and over that I had to poop as the pressure increased when Baby A moved down the birth canal. Starting to naturally bear down. Panting through the contractions since I was only 9 cm. Noting the flurry of activity as both incubators were set up. Feeling encouraged when I realized that this meant the babies must be coming soon. Observing the increased brightness as they turned on additional lights above my bed and then converted it for delivery. Finally, the surprise and joy upon realizing that in an a extra vote of confidence, my OB was allowing for delivery in the room. I would not be giving birth in the OR after all!!
Finally, 7 hours after the AROM, I was 10 cm with a small cervical lip. I did a test push and the nurse tried to move the lip back, but it did not work. Slightly discouraged, I continued to labor a little while longer. During my next attempt to push, she was able to remove the lip. It was time to push. During my second pregnancy, this was the part had been a relief to me, but now I found it exhausting and difficult, partially because I was out of shape from the bed rest. Like my first VBAC, I tried pushing in a couple different position before ending up partially reclined on my back where I felt most comfortable. I held onto the back of my thighs, pulled my legs up, and curled into each contraction. The nurse immediately began to count and coach me, but I shushed her. I took lots of breaks during contractions, pushing every other contraction. This seemed to irritate her. Oh well. After about an hour, my husband told me he could see Baby A’s head. I pushed for a little longer, and with a great big yell of “SHIT THIS HURTS!”, I pushed Baby A out completely. Kaylee Alayne was born on 10/26/12 at 1:59 AM and weighed 6 lb 6 oz. Since she was premature, I only got to hold her a few seconds before they whisked her away to be checked by the NICU staff.
I felt relief that it was all over, but then I realized I still had another baby to push out!! Things seemed really chaotic after that. The doctor had a nurse run an ultrasound on Baby B to check her position. Then he broke her water, and I felt another huge gush. I was having a really hard time feeling the contractions, but continued to push anyway. He held her in place and helped guide her down. I only had to push a couple of times before Baby B came out sliding out, 9 minutes after her sister was born. I vaguely remember my mom asking something about her missing toes, but I discounted it immediately as nonsense, especially since we had so many ultrasounds and no defects were ever detected. Madelyn Jane was born 10/26/12 at 2:08 AM and weighed 4 lb 10 oz. With all the craziness, I never did find out how long either of them were, although it is in my discharge notes somewhere. I got a quick picture with her and her sister before she was taken to the NICU for breathing issues.
I began to hemorrhage afterwards. The doctor pumped hard on my stomach, which hurt far worse than anything during the labor and delivery. I begged him to stop, and he calmly said that he had to keep going because he was trying to avoid a blood transfusion. I was given more pitocin, cytotec, and shot to control the bleeding. Eventually it slowed down and my placenta was delivered. He stitched up my minor tear without any pain relief, and I was left to hold and nurse my oldest daughter. After everything had calmed down, my husband told me that Madelyn was indeed missing a couple toes. I think he was worried that I would be upset, but I responded that I could care less, and that we would deal with any walking issues if/when they arose. After everything we went through, I was just thrilled to have my girls earthside and safe!
I had done it! I had delivered two beautiful baby girls vaginally and without any pain medication! I was in love instantly and excited to be a twin mama. Madelyn would stay in the NICU for a couple days, but we would all go home from the hospital together. I would ultimately end up needing a blood transfusion, but other than that, my recovery was fast and relatively painless. I was on my feet immediately and chasing after my two other boys.
While this was not the intervention free, water birth that I had dreamed of, it was still a perfect birth because it was mine, and I had owned it. Unlike my first birth, I did not feel powerless. Instead, I felt completely empowered. I had questioned the doctors, explored options, and made educated decisions. I understood the benefits and risks of every intervention that I consented to and stood my ground. I believe this, along with my careful provider choices and my supportive husband, made all the difference in succeeding. Most important to me is the message I hope to impart to my girls with their own birth – that how you birth matters, that they can they can trust in their bodies to give birth, and that, no matter what, they should stand up for what they believe in, and not let anyone tell them that their dreams are not possible.
Update: The girls are now 4 months old. Kaylee is doing great and growing like a weed. We had some health scares with Madelyn, and she just underwent open heart surgery in mid-February to close two holes in her heart. She’s home and recovering great, and hopefully will catch up to her sister in size soon!