CAM Birth Story #46: Erica's HBAC with Twins

In honor of Cesarean Awareness Month 2010, we will be filling the blogosphere with stories from real women (and their families) who know first-hand the consequences of a 32% cesarean rate. Each day we will post at least one birth story submitted by these women. Prepare to be moved (hint: grab a box of Kleenex)!

From Erica…

Cast of characters:

T – ‘alpha’ midwife and primary care provider throughout the pregnancy
C – ‘beta’ midwife, a.k.a the “stunt double” midwife
N – third midwife brought in to cover for the stunt double
P – midwife’s assistant
Cyd – child care provider, cook, bouncer, and general MacGyver
Katie – photographer

It was around 5am Wednesday morning, July 16th. I was 37 weeks pregnant. I’d stumbled into the bathroom for the 276,445th time. It was especially annoying this day because I was doing yet another 24-hour urine catch to test for signs of pre-eclampsia.

After I was done, my bladder still felt full and odd. I didn’t really feel in control of it, but with the weight of two babies sitting on my bladder, things had felt weird in that region for a very long time. I tried to get up two more times and had to sit back down when more fluid came out. At that point, I decided I’d better try to catch some of it to add to the 24-hour jug.

The fluid I caught was lightly tinged pink. I stared in disbelief, trying to get a grip on the fact that it seemed my water had just broken. I tried to remember everything I knew about rupture of membranes, color of fluid, and what was OK and what was not. I was slightly panicky when I realized that my birth kit had just arrived in the mail the day before and that I had *nothing* else prepared for this birth. I didn’t even have any diapers in the house!

I woke Derek and told him we needed to call T, our midwife. I went back into the bathroom, still leaking fluid, and tried to calm down. Derek talked to T briefly and then handed the phone to me. The first order of business was to make sure that Baby A, the girl, had not dropped a foot through my cervix when my water broke. We’d known for weeks that she was breech, and she kept putting one foot under her bum, making her a single footling breech occasionally. At T’s request, I felt around and confirmed that there was neither foot nor umblilical cord dangling anywhere. She said, “OK then. We’re on. I’ll be there shortly.”

I was stunned. I protested that she didn’t need to come right away; after all, I hadn’t even had a single contraction yet, and my last labor had been a very typical 12 hours. She said, “It’s twins. Things are going to happen soon.” She was right. It took maybe 20 minutes for things to get started, and in that short span of time, I was more than ready to call the midwife back.

By the time Derek had called all the members of the birth team – midwife, second midwife (whom we jokingly called the “stunt double” midwife), midwife’s assistant, Cyd (whose role included child care provider, cook, and bouncer), and photographer Katie – I was beginning to be a little worried that we’d waited too long to call. This labor wasn’t wasting any time.

Everyone started arriving at about 7am. The second midwife wasn’t going to make it in time, so we called in a third local midwife, N, to assist. I was already working through contractions, making a whole lot more noise than I did in my previous labor. T talked to me for a little while, asking the usual questions about how things were going. Then she looked me in the eye, smiled, and told me we were going to have babies by noon. I internally rolled my eyes and thought, “yeah right”, remembering my labor with Grace.

However, the joke was on me. This labor was already vastly different from my labor with Grace. I was stunned at the speed with which things seemed to be progressing, and I was a little scared of the intensity. I was caught by surprise by nearly every contraction, each one being noticeably stronger than the last. Grace’s textbook 12-hour labor had moved forward steadily and slowly, with time to get used to the pain and intensity level of a group of contractions before moving to the next level. This labor gripped me from the start and careened forward wildly, giving me no breather and no time to adjust.

For the first couple of hours after everyone arrived, there was a lot of hustle and bustle as we all tried to gather up the birth kit materials and household items we needed. The midwife’s assistant was in the basement setting up the birth pool and heating water on the stove after our hot water heater was drained. Cyd and the kids were doing pretty normal things, like getting breakfast, watching DVDs, and playing in their room.

I was very happy to hear someone finally tell me that the birth pool was ready. The whole show moved to the basement “birth suite” at that point, and I climbed in the pool. Oh my goodness, that first five or ten minutes in the warm water felt heavenly. It was such an enormous relief. The midwife’s assistant added more hot water, and I just relaxed limply into the bottom of the pool. Derek kneeled beside me outside the tub, and the midwife continued gathering up all her stuff.

Here’s the scene in the “birth suite”. T, the midwife, is in the white t-shirt; it looks like she’s leaning into the pool to listen to Baby A’s heart rate on the Doppler. P, the assistant, is the one in the green t-shirt, holding a wristwatch and timing contractions.

Then the next contraction hit, and it was a whopper. I was thinking, “Hey, wait a minute! Isn’t water birth supposed to calm things down, not intensify them??!” I moaned and growled and yelled, blowing off all the energy and intensity by vocalizing. I hated being so loud, but it was the only way I could cope. Derek stayed close to me, talking and saying all the right things to keep me focused. During contractions, I clung to him and howled. Everyone else stayed back and let Derek and I work together.

Occasionally, T would ask me to let her listen to the babies’ heart tones. This required me to stretch out on my back in the pool, which was awful if I got stranded that way during a contraction. Still, I knew she had to do it, so I tried to do as she asked. The babies’ heart rates sounded fine, and things progressed quickly.

It didn’t take long for me to start feeling a little panicky. This labor was SO extreme, and it felt almost nothing like my previous labor with Grace. In trying to verbally express that, I managed to blurt out a lot of, “This doesn’t feel right” and “This is just WRONG”. Derek and T worked with me, Derek trying to talk me through it and T trying to ascertain if something was amiss or if I was just being really expressive.

I was doing a lot of howling, and now things were turning a little more toward shrieking. There was intense pain, yes, but what was even more astounding was an incredible feeling of excess energy that I couldn’t get rid of! I was holding onto Derek as hard as I could, letting him support my weight during contractions and help me relax between them.

I was doing a lot of complaining about the intensity, and T told me that things were going to have to get even stronger before I could push out those babies. She was trying to get me to embrace the contractions and stop fighting them, but I just didn’t want to hear it at that point. I said, totally deadpan, “I don’t like you anymore”. Which, of course, caused everyone to laugh. T said, “You’re paying me an awful lot of money to do this if you don’t like me.” It even struck me as kind of funny then. Bear in mind that I’m about two hours away from having two babies at this point.

When the first pushing contractions hit, I freaked out all over again. I didn’t think this labor could get any harder or more intense, but oh my goodness, it DID. And it was SO different than what was familiar to me from my previous labor, I just couldn’t get a mental grip on it. The howling and shrieking turned to outright screaming. I just couldn’t help it – the energy was enormous and yes, the pain was too. After two or three of those contractions, I realized the kids could NOT stick around for this birth. I knew Gabriel had really wanted to see the babies being born, but I just couldn’t subject the kids to this. I felt bad about it – very briefly – and gasped, “Someone go upstairs and get the kids out of here.” Cyd gathered up the kids and a few of their things, and headed out the door with them.

Funny story: I didn’t know this at the time, but just as Cyd was getting ready to leave with the kids, my neighbors came over and knocked on the door. They asked if we could cut it out with the screaming. Cyd informed them that no, I couldn’t, because I was having a baby – well, *babies*. They left, and apparently felt pretty bad about it, because the rest of the time we lived in that townhouse, they would periodically see me outside and apologize for interrupting the birth.

Pushing felt bizarre with that breech baby coming down. From my previous birth, I remembered the sensation of a solid object applying even pressure as it came down. That wasn’t what I felt this time. Pressure was diffuse, and it felt lumpy, for lack of a better term. It all felt so….odd.

I howled and shrieked, and screamed and pushed. I was standing up to let gravity help the baby out, but the warm water of the birth pool felt good too, so I was crouching with just my bottom in the water during pushing. I remember shouting that I wanted it OUT!!!! I wasn’t feeling panicky anymore, but there was a sense of urgency so great that it was something akin to panic. T answered, “Then push!” She continued to try to monitor Baby A to make sure that the breech wasn’t causing a cord problem and that everyone was still doing OK, but the pool and the crouching were causing her to have to go through all kinds of gyrations to get her Doppler in there. The resultant photos show me, Derek, and T in bizarre contortions and combinations that caused us to dub those photos “the bizarre donkey sex photos”. They’re hysterically funny, but I won’t be sharing those in a public forum!

T had Derek get into the pool with me to support me from behind, so I could lay back in the water. This gave T a better angle to work with the baby, who was not only breech but had a nuchal cord. Our photographer got an excellent photo of the arrival of the breech waterbirth:

After a lot of pushing, shoving, screaming, and fiddling, Abby arrived at 11:51am. She was perfect, and I basked in that moment of post-birth euphoria. I knew I was halfway there – one more baby to push out, and it would all be over!

Derek and I got a few minutes to enjoy Abby before I felt more contractions. I’d been assuming that there would be a significant amount of time between the twins’ births, time for me to rest and regroup before pushing out the second twin. I was surprised by the contractions, and even more surprised when I felt a nice, even, round head coming down right away. It was a familiar feeling, and I knew exactly what to do. I told T that the second baby was coming, and almost before she could turn her attention from Abby, I pushed Niko out into the birth pool at 11:59am. There was much joking that I’d gotten Niko out so fast, he shot into the side of the birth pool. T scooped him up and put him on my chest along with his sister.

Niko was apparently annoyed at being ejected so quickly, because he was a bit slow to breathe. I held him the whole time T worked on him, and Derek and I talked to him. I don’t know how many minutes it was, but I was never worried. Derek and I could see his tiny fingers move every time we talked to him, so we knew he just needed some encouragement.

Both babies nursed right away, as I sat in the birth tub with Derek behind me. It seemed so surreal – two babies in my arms, and both beautiful and perfect. And T had been right – Niko did it with only one minute to spare, but both babies had arrived before noon!

After some drama involving getting the twins’ two fused placentas out of me, and getting me out of the birth tub, I got settled in the little bed in the basement to nurse and coo and cuddle. I’d passed out for a few seconds as the result of blood loss and a very indignant diaphragm, which found itself having difficulty functioning after being used to the weight and pressure of two small people. After all that was over, though, I started working on trying to figure out the tandem nursing thing!

Originally posted on Erica’s blog.