A Fight for a Twin VBA2C Birth in the Hospital!

I had my first son at age 18 and he was delivered by an old school OB who told me I wasn’t trying hard enough to push him out. He didn’t exactly offer a forceps or vacuum extraction because he told me these interventions were not designed to do 100% of the work. After a total of twelve hours in labor and pushing with an extremely strong epidural for two hours I was told “It’s time” and he discussed how he had tickets to a golf opening later that day while he operated on me. I was told I had a narrow pelvis and the baby never would have come out. My second birth was another scheduled cesarean due to me “not being a good candidate for VBAC” without reviewing my surgical report, just based on what I was verbally told was the reason I had a cesarean. With my third baby I put my foot down, found birth without fear, my local ICAN chapter, and found a lovely midwifery practice that actually reviewed my report and discovered the first doctor had noted “failure to progress” as the reason for my cesarean. I had a lovely and successful hospital VBAC at 40 weeks and 5 days.

My husband and I had three lovely boys but we decided to give it one more shot to get a baby girl, and if it ended up being another boy we would know what God was trying to tell us. Seventeen months after the birth of our third, and just one week after I stopped nursing him, we were pregnant. I knew the day I took the test it was twins. We told all our friends and family it was twins. At the 8 week ultrasound I asked my husband if he was nervous to see how many babies there were and he said no. The moment the wand hit my belly, there they were and all I said was, “I knew it”. Unfortunately the midwives that had helped me achieve VBA2C with our third were leaving the practice to start their own birth center, one that could not deliver twins. So I left the practice at sixteen weeks and moved to another midwives’ office that came highly recommended by my previous midwives. The new office was fantastic, very supportive and my pregnancy progressed beautifully. At each appointment I was given encouragement that I was perfectly capable of birthing these babies vaginally, and My OB Dr G. went over scenarios with me to explain all the risks associated with twin pregnancies but all of my options as well. I felt very well informed. I hired a doula, and set up a birth photographer and waited for the babies to be ready.

I had an appointment November 28th and had an ultrasound and confirmed baby A (a girl!) was head down while baby B (little brother!) was transverse. I was 35 weeks and 2 days pregnant. As previously discussed with Dr. G and all my midwives this was an acceptable situation to proceed with a vaginal delivery. Dr. G would even have been comfortable with Baby A being in a breech position but he warned me the other doctors on call in the practice would be uncomfortable. That night around 7 pm I started getting the all too familiar cramps and I started timing them. They were bearable and consistently 10 minutes apart. I texted my doula and she told me to try and sleep but to call her if they became unbearable or if my water broke. All of the sudden I started second guessing myself because it seemed like the contractions had skipped from 10 minutes apart to 4 minutes apart. I began to wonder if these were contractions at all or if I was just having stomach cramps. We called our doula and told her we were headed to the hospital to determine if I was even in labor or not and we would text her with an update. This was at 10:00 pm. My dad came to pick up the baby (the big boys were already at my parents’ house) and we were off.

The thirty minute car ride was unbearable and I just wanted to lay down in the seat because everything else hurt so badly! We got checked into the hospital and into triage and I let the admitting nurse check me for dilation expecting to be told I was 1-3cm and I could go home or walk around. Nope. 8cm dilated already. My husband was frantic and just texted the doula “8cm” she told me later she read the text and shot out of bed like a cartoon character.

In triage I was greeted by one of the OBs from my midwife’s office from a different office location (they all share the on call schedule) Dr. K and she told me she needed to have an ultrasound completed to confirm the position of the babies but that if baby B was still transverse it was going to depend on the way his spine was facing, up towards my face or down towards his exit, if it was whichever direction she didn’t favor, she would recommend a C-section. Dr. G had never mentioned spinal positioning of Baby B so I had a feeling already a fight was coming. The ultrasound confirmed baby A was head down and very low and baby B was transverse, and I never got a clear answer on which way his spine was facing only that she recommended a cesarean and she left to give my husband and I time to think about it. My doula arrived shortly after and we told her the situation and the doula asked if we wanted to pray about it. I said I didn’t need to because my husband and I both knew what we wanted to do.

We called Dr. K back in and explained we would like to try a vaginal delivery and that Dr. G and midwives had told us during our pregnancy this was an option as long as baby A was head down. I also had mentioned I did not want an epidural and should I need a cesarean for baby B I was willing to risk having to go under general anesthesia. Dr. K dropped open her mouth and asked if I understood her medical opinion was that I have a cesarean. I said yes but Dr. G had assured me this situation did not warrant an automatic cesarean. She told me Dr. G was not the one on call, and that he should have explained I have to listen to all the providers. I assured her I was listening, but asked if that means I do not get to make my own informed decision? She called me crazy, said she did not understand me and told me not a lot of doctors would even allow a woman who had two previous cesareans even attempt to deliver vaginally. I said I understood this and that is why I sought out this practice and my doctor specifically. She then told me I was risking baby B’s life and if I would need a cesarean it could take her as long as 10 minutes to get him out depending on the amount of scar tissue I had and that if his cord were to prolapse baby would be without oxygen and he would likely die, or be permanently brain damaged or have cerebral palsy. I knew cord prolapse and shoulder first presentation were only some of the possible outcomes and not guaranteed so I again said I understood and I still wanted to move forward with a vaginal birth. She asked me to repeat what it was that I understood because she wanted to hear me tell her I was ok with the risk of baby B dying. I looked her square in the eyes mid contraction and said, “I’m ok with the risk of baby B dying”, knowing full well it was a small risk and she was just trying to be a bully. She threw the consent form at me that I needed to sign showing she wasn’t liable if baby B died and I looked around and said loudly, “does anyone have a pen?” Dr. K also informed me that after baby A was born she was likely going to have to internally manipulate baby B and I was not allowed to retract from her or move up the table to get away from her. I said I understood and she again asked me to explain what I understood and I said “I’m not getting the epidural, you’re going to put your arm in me and it’s going to hurt like a bitch”.

After Dr. K stormed off the nurse asked if I needed anything so I said “Yeah, can I have a new doctor?!” I was half joking but she said I absolutely could, and she went to get the doctor on call from my previous practice that delivered baby 3. Dr. S. very calmly explained the risks and where doctor K was coming from but she admitted it was also possible that baby would turn head down perfectly fine. She suggested however I get an epidural port placed in case I need an internal version or if I need a cesarean that way the baby wouldn’t have the anesthesia in his system. I agreed to have the port placed and Dr. S. let me know she was going to attend the birth alongside Dr. K which I found to be pleasing. Scrubs were administered, apparently we were going straight to the OR for delivery, no time for an L&D room!

I asked for some scrubs for my doula and birth photographer and was informed they were not permitted in the OR. My doula has attended three twin births at this hospital and was allowed in the OR for all of them so it’s not hospital policy so I asked them to confirm this with the charge nurse and it turns out it’s up to the anesthesiologist so they wheeled me in and the anesthesiologist said my doula could come in but she needed scrubs. Dr. K loudly interrupted and said my doula could absolutely not come in there were far too many people in the room. I argued that my OB and all the midwives had assured me my doula was perfectly welcome in the OR but I was again shut down with an impatient firm glare from Dr. K. It was clear she was trying her best to control my birth anyway she could. They shut the door on my lovely doula and photographer and started helping me onto the table.

The anesthesiologist placed the port and then asked about administering the medication and myself as well as Dr. S informed him I wanted no medication just the port placed. Dr. K loudly exclaimed of course I needed the medication administered why else would I be getting the port. I was pouting at this point and just furrowed my brows looked straight ahead and said fine. The anesthesiologist said quietly to me that no, he would not just administer the epidural if I didn’t want it, I was the one that got to make the decision. Bless this man. I told him Dr. K was being a very insistent bully so we agreed together that I received just a small dose of medication to make sure it was properly placed. I was checked for dilation and was told it was a good time to start pushing now, so when I had contractions I could start pushing. I pushed two or three times and I hear Dr. K ask for a hook for AROM and I shot my head up and said wait what are you doing?! She said “Oh, did you not want me to do that?” I said, “UH NO!” But a few more pushes later and Dr. S explained if I let them break my water she would likely come right out. So I conceded and pop went the water and out came the head. 3:13 am my beautiful baby Girl Brinley Harper was born. She didn’t cry right away but when she did it was loud and she was pink. 9/9 Apgar scores and she weighed a whopping 5lbs 7oz. Dad was not asked if he wanted to cut the cord (which he did).

As soon as baby A was delivered Dr. K was elbow deep in my business and grabbing baby B’s head while Dr. S pushed from the outside to get babies body to turn. I heard Dr. K call for the anesthesiologist because they needed to “section” me open but Dr. S asked for the ultrasound to determine position. After about fifteen minutes of scanning and waiting not at all patiently, baby B was finally in position head down and ready. No cesarean needed, but he was still very high up so I needed to push him down and I had to somehow do this without the assistance of gravity.

An hour and a half it took to push him down all the while Dr. K is trying to break my water. They call it “membranes of steel” I tell them all it was my high protein diet. A nurse to my left shifts on her feet and repositions herself and I remember turning to her and asking if she’s alright or if she needs a break so clearly I am full of jokes. I can see baby girl in the warmer to my right and she’s just quietly looking in my direction. I am tired of pushing and just want to hold my babies so I announce I am done pushing and want the cesarean. Everyone thinks I am not serious. Another contraction comes and I do not make a sound, no one realizes it is happening. I am so clever I think. Someone sees it and says “hey a contraction! Push!” “NO” I shout. At this point I am so parched I am dying for water. I asked them to wheel me out of the OR so I can have a drink then they can wheel me back so I don’t contaminate their precious sterile environment they are forcing me to deliver in. I’m brought a wash cloth and told I can wipe my mouth out, I am not pleased. Then someone tells me baby B is almost there, I call them liars. Dr. K finally is able to break his waters and I give a mighty push roaring with intensity and my sheer will to make my baby appear. Someone tells me not to make noises with my pushes, I shout “I WILL MAKE NOISES IF I WANT TO!” And out baby B comes. They place him on my belly and dad gets to cut the cord. Despite having an arm inside and two babies coming out, I am intact. Thank you tiny baby Jesus. Declan Oliver is born at 4:47 am weighing 5lbs 3oz. Dr. K walks over to my bedside takes a long look at me and says “good job” I take a long look at her and say “thanks for not cutting me open even though I asked you to.”

Both babies got to come home with us three days later. I hear now from my OB that I am an inspirational story for the practice, and that he is so proud of me for being able to stand my ground and make sure I was a part of the birthing process. And I’m proud of myself as well. I honestly hope maybe my success story will help give Dr. K more positive personal experiences to draw from when she’s delivering future babies and dishing out her personal statistics. And with that, my birthing career is complete and my family is whole!

Story submitted by Stephanie Shuman. 

Photographs by Hillarie Laver.