Keeping Twin Birth Normal

by Jennifer Landels

 

I didn’t find out I was having twins until thirty-six weeks into my pregnancy. How on earth could I not know until then?

 

Well, it was my second pregnancy, so the extra tiredness and nausea I put down to the work of keeping up with a three-year-old. I measured bang-on normal size for dates right up through 30cm fundal height at 30 weeks. The fact I’d always measured slightly small with my first baby didn’t clue me in either: after all, second babies often measure larger. And what about the ultrasound? Well, I didn’t bother with that. I’m not a big fan of screening tests in general, and since I was healthy and everything about my pregnancy was normal, I saw no reason to subject myself to unnecessary tests.

 

That simple omission was probably the biggest factor in keeping my pregnancy and birth normal. If I’d found out about the twins at the usual 18 week ultrasound my pregnancy would have been much different. My care would have been transferred to an obstetrician, and I would have had the rest of the pregnancy to worry about the birth and postpartum. And I certainly wouldn’t have taken the holiday in London and Rome that I did at five months pregnant. As it was, I was completely relaxed and unconcerned for most of the pregnancy, and my blood pressure reflected that.

 

At 32 weeks the midwives and I became a bit concerned when my fundal height shot up to 36cm: four centimetres larger than expected. A bit of palpation turned up a head at the fundus and we figured the singular “baby‟ had turned breech, popping herself out of the pelvis where she’d previously been nestled head down. In fact, it was simply the two babies rotating around each other so Isabel, my breech baby, was in front, preventing us from being able to feel Eleanor, who was still snugged down in the pelvis. But it took some time to figure that out, so I spent the next two weeks between visits doing breech tilts and every other trick in the book to turn “the baby‟ head down.

 

During the next month the mystery continued: Eleanor and Isabel swapped places again, giving the appearance of a head-down baby, but the fundal height continued to grow. Worries about polyhydramnios (excess amniotic fluid) and an anencephalic (small-headed) baby were dismissed by fluid thrill tests and internal exams, and the search for more than one heartbeat only turned up an identical heart rate that sounded more like an echo than a second baby. Finally, at 36 weeks we decided on an ultrasound to solve the puzzle.

 

The tears I shed on the ultrasound table, and over the next weeks, were not just caused by anxiety over the impact twins would have on my life. I was in mourning for the home birth I would never have. Now I had to see an obstetrician, give birth in a hospital, and fight to avoid the interventions so common in twin births. My blood pressure shot up ten points on both scales and stayed that way for the rest of the pregnancy. I considered refusing to go to the hospital. I know my midwives would have attended my labour at home if I’d refused to move, but I didn’t want to put them in a position of contravening their scope of practice. I thought about hiring a private birth attendant, who would have done a home birth; but at 36 weeks, I was already considered term, and could go into labour at any moment. I had a great relationship with my current midwives, and didn’t feel I had time to develop a rapport with a new one. I decided to pick my battles, and see what I could do to make a hospital twin birth as natural as possible.

 

Fortunately, because the twins were discovered so late in my pregnancy, my wonderful midwives, Lee Saxell and Linda Knox, were able to continue as primary caregivers with the obstetrician brought in on a consulting basis. They found me a doctor who would work with me and honour my birth plan. Both Linda and Lee attended my birth at St Paul’s. They took fabulous care, both physical and emotional, of us afterward, and I was fortunate beyond deserving to have had them at my side throughout the whole time.

 

With an understanding and flexible obstetrician I was able to labour and give birth drug-free. After five short hours of labour I caught Eleanor myself with Linda’s help, and held her on my chest while Dr Bagdan pulled Isabel out feet first. I left hospital later that day with two beautiful, healthy baby girls weighing 8lb 10oz and 8lb 9oz, born at 40 weeks plus 2 days gestation.

 

Is there anything I would change? Of course.

 

I would have refused the saline lock put in my hand at second stage. It was unnecessary and was the first true pain I felt during labour. I would have given birth on my hands and knees. This would likely have prevented Isabel from turning sideways after Eleanor was born and allowed me to birth her as a frank breech, rather than having the doctor perform an internal version. The internal version, in which the obstetrician reaches inside the uterus to pull the baby out feet first, was the most excruciating two minutes of my life. But at least it was only two minutes. I would have insisted that Isabel’s cord not be clamped immediately, and that she be given oxygen with a bag and mask rather than at the incubator, which wasn’t working anyway.

 

These are minor complaints in the grand scheme of things, especially when I consider what might have happened if I had not had the support of my midwives; if I had been transferred to obstetrical care early in pregnancy; if this had been my first pregnancy; if I had not been so stubborn. I would have had monthly ultrasounds to check foetal growth (ironically, studies have shown more than five ultrasounds during pregnancy is related to decreased foetal growth). My blood pressure would have no doubt been high for the entire duration of the pregnancy instead of just the last four weeks. I would have been encouraged to gain more weight than I did; as it was, I only put on one pound more than I did with my singleton, despite the fact she weighed just under 8lbs and the twins weighed over 17lbs combined. I would have been pressured to have labour induced at 36 weeks. I would have been pressured to have an epidural during labour ‘just in case’, which likely would have prevented me being able to push Eleanor out on my own. I would have had to spend at least a night in hospital recovering, interfering with my ability to establish breastfeeding in the narrow confines of a hospital bed.

 

One woman’s story is only anecdotal evidence. My experience is not the same as the vast majority of twin mothers’ experiences, and it would be absurd to expect it to be.

However, what I hope others can gain from my experience is the sense that twin pregnancy and birth is not an abnormal condition but, like breech birth, a variation of normal. I can’t suggest you follow the same path I did, as most of it involved serendipity and unusual circumstances, but there are a few general tips at my disposal:

 

Talk, talk, talk. Talk to your caregivers about everything they expect will happen during pregnancy and birth and everything they will recommend. Find out why they expect these things, and why they make these recommendations.

Don’t forget your BRA: there are Benefits, Risks, and Alternatives to everything.

Jennifer Landels is a writer, editor, doula, childbirth educator, and is the author of the fantasy novel Allaigna’s Song: Overture from Pulp Literature Press. When she is not doing any of the above she can be found swordfighting with her partner or horseback riding along the Richmond dykes with her three daughters.

Research. Do your own research. If I’d had more time I would have learned about giving birth on hands and knees to prevent the second baby turning transverse.

Make a birth plan. Usually I suggest a one page birth plan, but having multiples warrants one page per baby. Include contingencies. “If X should happen, then I prefer Y”. Discuss your birth plan with your caregiver to find out if there are nonnegotiable points between the two of you. If you and your caregiver can’t find common ground you may want to consider changing caregivers, so write your birth plan early. You can always amend it later if your situation changes.

Be stubborn. If something is truly important to you, explain why. Trust your gut feelings. Be flexible. This is not a contradiction to the above. Again, your instinct will tell you when to hang on and when to go with the flow.

 

Above all, trust your body and your babies. Your babies know when to be born and your body knows how to birth them. All the medical technology and expertise is just back up for a normal yet miraculous process.

 

 

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