THE JOY OF A NATURAL TWIN BIRTH

By Heather Eyestone

Previously published in Birth Issues Summer 2012

We originally began the journey of our third baby and pregnancy with midwives. Our daughters had both been birthed under their guidance. But at our 19 week ultrasound we learned our third baby was in fact twin identical boys!

Right away, I began to research knowing that my birth plan of a natural delivery with midwives would not happen, and my care would be transferred to an obstetrician, since I was now considered a high risk pregnancy. Most of what I read prepared me for the worst: NICU, premature babies, as well as many other complications a mother could face carrying her twin babies to full term. Despite the odds, I made it my goal to do whatever I could to ensure healthy full term babies.

One thing that I read up a lot on was birthing twins vaginally. My husband and I were committed to delivering our boys vaginally in an operating room, which is standard procedure for multiples. Some of the complications we discussed with our doctor were what if one of our babies was breech and did not turn head down or was head down and turned around during the birth of the other baby? We discussed different scenarios that could prevent our second baby from being born vaginally. Because we could not guarantee things would go perfectly, we talked about me getting an epidural which would allow me to still be awake should a complication arise and I needed to have a cesarean section. It was very important to me to be awake and see both my boys being born.

Along with our birth plan, we also talked about the change in my pregnancy timeline. Instead of considering 40 weeks full term, my obstetrician considered that a twin pregnancy became full term at 38 weeks. I agreed that I as long as my boys were a good healthy weight, I would be induced at 38 weeks, unless something else came up and they needed to come sooner, such as Twin-to-Twin Transfusion Syndrome, where one twin is feeding more off the placenta then the other baby causing the second baby to not get enough nutrients and not gain weight. The way our doctor explained how our boys were living inside my womb was that they lived in the same house (one large sac around them), but had their own rooms (each had his own amniotic sac) sharing the placenta, which is common for identical twins and can cause some development issues. We, of course, wanted our babies to be healthy and thriving.

October 5th, 2010. I was 38 weeks pregnant with twins. I was set for an induction (1). Instead, I did not end up getting a phone call like I had thought, but went into labour naturally. This is our story of how it all happened so quickly!

7:00 a.m.: I was woken up by one of our girls getting up. I found myself rather hungry, so I figured I would get up and get something to eat anyway. The sleep during the night had been rather restless as I was anticipating having an induction and all the possible interventions and management it entailed. Of course, the effort involved with labour was on my mind!

7:30 a.m.: I had been sitting in my rocker for a little doze when the phone rang. It was my husband, David, calling from work. He was in the last hour of his night shift and wanted to see how things were going, and if I had heard anything yet as to when the induction would start. The ring made me jump. I told him, “No phone-call yet. You can come home for a shower and we can leave for the hospital when we get the call.”

8:00 a.m., there about: I had been feeling a little off all morning, but I did not pay much attention to it since my body had not been feeling normal for the last few weeks. I had a few contractions already and just experienced a couple strong ones. It felt like it was when my daughter Diana’s labour started: I just needed to go to the washroom. I was not worried or thinking too much that it was labour because I was so focused on the impending induction phone call. However, my mom was worried and wanted to call someone for support. My mom had arrived a month earlier from Ontario because I went into false labour and she wanted to be here to help and make sure I could rest and bring our babies to full term. I suggested that she call Sarah, our friend, who was going to take me to the hospital should David be working. After being in the washroom I realize there was more to this, and I called David back to come as soon as possible.

8:10 – 8:30 a.m.: Okay, so this felt like the longest time in my life, just waiting to go. The contractions were strong and frequent, but not regular, anywhere from 5 to 10 minutes apart. My mom was very worried, I had never seen her so worked up and concerned before. So just before 8:30, I had her call Sarah’s house to be sure she was on her way and it turned out she was just pulling up! My mom helped me get ready for the car and insisted that if anything happened on the way, we call 911. I agreed with her and we were off.

The drive to the Royal Alexandra Hospital in Edmonton – thankfully the traffic was smooth and we didn’t get caught up in construction, traffic or red lights. Sarah and I talked a little between contractions, now about 5 minutes apart and lasting for about a minute or more. I told her, “I am not going to leave the hospital without a baby. I am having these boys today no matter what!” I was not worried at all, I had given birth twice already and I could recognize that this labour was starting just like the girls’, and I was ready to be doing this all day.

9:00 a.m.: We arrived at the hospital. Sarah dropped me at the entrance while she found parking. As I was moving into the lobby, contractions kept coming and I was bent over working through them. Two nurses got off the elevator and saw me hobbling around. They told me to breathe and asked if I wanted help. I nodded and they grabbed me a chair and wheeled me right up to the Assessment and Induction room. On the way, I told them I was 38 weeks with twins and was set for an induction today.

9:05 a.m.: The labour and assessment unit nurses took one look at me, heard twins, and said to take me right to the Labour and Delivery unit. I was given a room right away. Not long after David walked in. What a relief to see him! He told me the nurses needed him to provide some information at the front desk. I could sense he was feeling no rush. I could not blame him. After all, it took a while with our previous children.

But I was starting to feel something change in my body. As I attempted to get the hospital gown on while trying to have a bowel movement, I realized that my body did not want to have a bowel movement… it wanted to have a baby! I kept thinking, “It’s all happening too fast. I shouldn’t feel like I need to push yet.” When David came back, I told him to go get a nurse immediately because I felt like pushing.

He was not in a rush again (so he told me afterwards), and waited for the nurses to come assess me. They came and by then I was on a roller coaster. My body had taken over and labour was rushing through. I was telling them, “It’s all happening too fast. It’s all happening too fast. It’s all happening too fast.” I kept repeating this. In the back of my mind I was thinking, “I can’t be in transition already, or can I?” However, the resident doctor and two nurses who were by my side appeared pretty calm. Perhaps everyone figured it was going to progress at a normal rate and we would have plenty of time for all the preparations for our twins’ arrival. I was the only one that seemed really concerned that something was about to happen.

9:10 a.m.: They helped me get up on the bed to listen to baby and to check my cervical dilation. The resident announced, “She is fully and bulging (2).” I hear and said, “Fully as in…?” Our doctor answered, “As in dilated.” I was in shock again, still repeating, “It is all happening too fast.”. I recall them bringing a portable ultrasound machine in when they were trying to get me up on the bed so they could check after they measured my contractions the presentation of the babies, but once they saw how dilated I was, it was pushed out of the way. From 24 weeks of pregnancy, and every 2 weeks after that, I had been having ultrasounds and they had always shown that my babies were both head down. By now, Sarah had joined us again in the room, and so had the whole labour and delivery hospital unit. David said that it looked like the walls had practically opened up and swarms of nurses and doctors were racing in our little room. What had been only a few minutes before a calm environment became a busy rushing room to assure a safe arrival of our twins.

This is when I asked about having an epidural; not that I felt I needed it but because of the plan we had made with our obstetrician. Although I was told I could have one, it was going too fast. By now I was shouting, “I need to push. I need to push. I need to push!”, and, “It’s happening too fast. It’s happening too fast.”

Suddenly, I felt a lot of pressure and my bulging bag of water burst. I could feel one of my babies on his way down. I mentioned the epidural again but I was told sharply not to think about it and to, “Focus, relax and keep breathing.” This is when the obstetrician arrived and proceeded to ask me if I was comfortable having some interns and students in the room. since a natural twin birth was not something they get to study and witness every day. I agreed but felt like it didn’t matter at this point: a parade could pass through and I would not notice or care.

David was holding my hand at the head of the bed and Sarah was beside/behind him. I was lying on my back as it was too hard to sit up, being so large, and things happening so fast. My body just went with the natural flow. I could see all sorts of doctors and nurses around and I finally started to listen. My baby was starting to crown. I realized that no matter what we had planned, it was happening and I was going to have my baby any moment. I decided to focus and go with it.

9:23 a.m.: David Patrick Eyestone arrived with a cry into the world. He was briefly shown to me and whisked off to the baby bed in our room to be checked. David teared up for a moment and I had a moment of relief from contractions. I just gave birth! But, “You have another one coming,” the nurse reminded me. “At the next contraction, the doctor is going to break the second bag of waters3.” As it came, I told her the contraction was starting, they then broke the bag and suddenly my second baby was racing to the world. This time, I was better prepared and focused. I tried my best to listen to the obstetrician and pushed and stopped as he instructed. I felt my baby slowly come out, head, shoulders, and body.

9:28 a.m.: Mark Dylan Eyestone arrived into the world. He cried too, and David got the chance to cut his cord. He was then taken to his brother and checked up as well. After 1.5 hours of labour, I had two boys and no tearing. Amazing! David weighed 6 lb and 1 oz, measured 19 ¼ inches long, Mark weighed 6 lb and 10 oz also measuring at 19 ¼ inches long.

We were given permission to leave the very next morning, but after a long stressful night trying to get used to nursing twins and being awake all night holding them, we asked for a second night to help prepare ourselves a little more before we brought them home to our family.

It all feels very surreal for me. I held each of the boys and sat in a daze for most of the morning trying to figure out what had just all happened. I am so thankful my husband was strong while I could not be. Having my best friend, Sarah, by my side made it all possible for us to stay focused while seeing a friendly familiar and calm face.

I did not think that after an 8 hour labour for Diana and 12 hours for Amy that the boys would ever be that fast. I am thankful, though, that it is over and I did not labour that long at all. It was so much easier with twins! Today is the start of our new life together as a family: two girls, two boys, and happy parents.

Heather Eyestone is a stay-at-home mom in Spruce Grove Alberta, to 4 wonderful children: Diana, Amy and twins Mark and David. She enjoys scrapbooking and geocaching as her hobbies. She also enjoys blogging about being a twin mom.

 Editorial notes:

1. An induction is when your labour is artificially started and managed in hospital. Your caregiver will insert a gel on the cervix to make it stretchy and favourable to birth. You may stay at the hospital in a non-private room without your partner for several days before anything happens. You can advocate to go home until your cervix has shown some changes. Once your cervix is stretchy, an IV is placed with synthetic oxytocin to cause uterine contractions. The drip is monitored by a nurse and administered via a pump. This will mean that from start to several hours postpartum you will have the IV in. Women have reported that the contraction pattern in unbelievably strong. Some women cope well but most will end up asking for an epidural. Some babies find this contraction pattern too strong as well, and may have trouble coping over the long term, which can lead to a cesarean. If your caregiver recommends an induction although your baby is not in distress, remember that the SOGC recommends a ‘wait-and-see’ approach, or to consider it 10 days after the due date. Whatever the reason behind an induction, the pros and cons should be thoroughly explained and weighed. Some would argue that it is an over-management of labour, others believe it is worth it as it may give a chance of having a vaginal birth rather than a cesarean.

2. This is when the bag of waters, also called the sac or membranes, is like a water balloon about to explode. It is between the cervix and the baby’s head. Not all women experience this bulging. The water can very well stay behind the baby’s body. It can depend on how the baby’s head is presenting and how high the baby is in relation to the pelvis. This will affect how the head is pressed on the cervix. If it is not completely pressed, some water can accumulate in the front and create this water balloon effect. In some cases, the water balloon can slow down the labour, which is good for a fast birth, but for most women it will not be welcomed, especially for first-time moms who already tend to have longer births. The reason why the bag of waters can slow down labour is because it is not as hard as the head, so as it pressed on the cervix it does not apply the same pressure as a hard head would, thus slowing down dilation and progress. It can be identified when a woman has start-and-go contraction patterns. Of course, a vaginal exam will be the easiest way to diagnose it.

3. Some twins have one bag of water and others have two. They can also share the same placenta or have two.