Wednesday, February 27, 2013

A Satisfying Twin Hospital Birth with a Very Supportive OB

I have a guest birth story from Parenting Multiples community member Sera Fradgley. Sera shared her beautiful journey through pregnancy and the hospital birth of her twins Isaiah & Elijah. She writes: "I wanted to share my birth story with the community in case anyone is wondering if they can have a birth they want with an OB - I have now found out it IS possible although I had to fight really hard for it due to hospital 'policy'. I declined every single protocol and left (2 hours after birthing the placenta) without vit k, eye goop, IVs or epidurals."

Disclaimer: Every mama with the help of her care provider must decide what is the best birth for her. For Sera it was the help of a Midwife & an OB through her pregnancy and a hospital water birth.




I had just taken a pregnancy test and it showed negative. I asked my mom what could be wrong with me as I had to pee all the time! She looked me straight in the eye and said, “it is because you are pregnant with twins.” I assured her I was not and asked for other suggestions to determine the cause of my new discomfort. She was not convinced but agreed to Google with me to see what else it might be.

Four days later I decided to have another pregnancy test because mom kept asking me if I was sure I was not pregnant that week. This time, the test was positive and I contacted my midwife immediately to assure myself a spot! I was ready for a home birth and so excited to have this option. We had not anticipated getting pregnant this quick as our son was 3 and our daughter 11 months.

Pregnancy was completely normal other than feeling nauseous daily as I had not experienced that with our other children as bad. It has seemed to get worse every pregnancy however (this being my fourth) so I decided it was totally normal. My midwives were pretty convinced I was only carrying one however with mom's conviction and the plan of a home birth, I decided to get a 20 week ultrasound to ensure baby was healthy as we are an hour away from the hospital and I felt better knowing things were normal inside me. Within the first two minutes of the ultrasound I hear 'wow' out of the technicians mouth. I looked at her and asked, “did you just say wow?” Then immediately added, “there are two, aren't there?” She confirmed it and a 40 minute ultrasound turned into an hour and a half (much to my husbands demise who was trying to keep our two other babies happy). Now I finally understand why I could never fool my mom as a teenager!

During the ultrasound I found out there was one placenta and two sacs. I am told that there is a small chance the babies could be a boy and a girl so I decide this is what we are having although I did not want to know for sure. I am also advised the doctor will want ultrasounds every two weeks to catch any issues with the babies. I am not happy to hear this frequency as I am not convinced ultrasound is 100% safe – especially with that many.

So excited for twins yet devastated for the loss of our planned home birth, we leave the ultrasound clinic. My husband and I discussed the possibility of having an unassisted birth away from the hospital.

I called my midwife that night in tears over the impending doom I felt in being transferred out of her care. We spoke and she assured me she would transfer me to a wonderful OB/GYN and that no matter what, she would still attend my birth, even though she could not provide any actual care. I was blessed beyond belief as I know midwives do not attend nor get paid for twin births and I am so incredibly grateful that she would do this for me. I feel a little better as I know she will be able to provide me with the best outcome possible despite the hospital surroundings I do not look forward to.

The OB my midwife wanted for me accepted me as as a patient and I had my first appointment two weeks later. Upon arriving to the hospital, I could not find parking which made me 5 minutes late for the appointment. I got upstairs to the offices and the clinic had my birth date wrong so I was sent downstairs to show proof of ID to change it. Everyone was exceptionally nice however I was starting to feel the sadness of not having it as cushy as with my midwives. I got back upstairs and waited and waited. When it was finally our turn to go into the exam room, my daughter had a complete diaper blow out and I had no extra clothing for her. The nurse advised me she would come back later so I could change her in private. My daughter had become sick and was becoming very fussy. I cleaned up her pants as best I could and put them back on her and looked at the time... I had only paid an hour for parking and here it was, time was up! I went out to the nurses desk and asked how I might deal with that to which they told me they would take care of everything. I then went back into the exam room and bawled. I didn't want to be here; I had a sick baby, was feeling overwhelmed with the changes to my birth plan and very anxious about meeting my new care provider. I am emotional at the best of times but combining the above and the hormones during pregnancy and I was a wreck! I eventually wipe the mascara running down my face and try to get it together.

I started to breast feed my daughter to comfort her and my doctor came in to meet me. The first thing she said is “So you are having identical twins.” I was devastated as I knew identical meant same sex and we did not wish to find out what we were having. I told her I did not want to know what we were having and I was not happy the surprise went from being one of three combinations to one of two. I also told her I was caught off guard with this news as this was not what the ultrasound technician told me. My doctor said that she is obligated to discuss the details with me as identical twins carry a risk of more complications than do fraternal twins. We discuss the risks involved with identicals although she is very careful not to use any fear tactics or blow any risks out of proportion. From the way she is talking I can tell she will be an awesome doctor and I start to feel a bit of relief. I asked her if she would allow my midwife to catch one of the babies and she said that would be no problem. She told me about the bi-weekly ultrasounds and I discussed my concern with doing that many. I was 22 weeks at this point and she was willing to discuss a different schedule but wanted me to go to the high risk ultrasound clinic first to get more details on my pregnancy. I asked her if she would be at my birth and she advised me of the rotation the OB's do at the hospital. This sunk my heart (and I am positive it showed on my face). While I was just meeting her for the first time, I felt she would be the best person to oversee my birth and I really didn't want a stranger in my delivery room. She booked me for an ultrasound 2 weeks later and we would discuss additional ultrasounds as well as if I could labour in the tub (my main request) at our next appointment.

After my first appointment, my doctor took time to call my midwife and advised her she could be as active in my birth as she would like and that she would do her best to be there. I think she saw how much I needed her support and care versus getting whoever was in the day I went into labour. I was so pleasantly surprised when my midwife called me with this news as it is unheard of for a midwife to have anything to do with twins once they have transferred care. It is also uncommon for a doctor to be on call for a birth at that hospital. I had the most generous and compassionate midwife and the most amazing OB who really cared about my wishes for this pregnancy and birth; both agreeing to be selflessly on call so that I could have a chance at the best birth possible. I also could not believe my doctor would be willing to give up her place catching the babies as a gift to me knowing how much I trusted my midwife and had such a strong relationship with her. I was feeling much better about the change of plans away from the home birth I had really wanted.

The results of the ultrasound at 24 weeks showed both babies growing exceptionally well with none of the potential twin issues. I was happy to know all was well and was looking forward to meeting with my doctor in two weeks. At my 26 week appointment we discussed when to do the next ultrasound and instead of the 2 week timeline she recommended I go back at 31 weeks for another which I was very happy about! We also talked about her partnership with my midwife and that she would allow me to labour in the tub assuming the room was free when I arrived at the hospital. I was starting to feel more and more astounded by her willingness to be flexible on my care and her genuine concern in providing me an optimal birth experience. We booked an appointment for the ultrasound in the morning and then I would go see her in the afternoon on my 31st week.

I made plans for a full day in Calgary at 31 weeks – ultrasound in the morning, a hospital tour and lunch with my midwife in the afternoon and then my midwife accompanied me to the appointment with my doctor where we went over my birth plan. My doctor had to take my birth plan to the head OB and Nurses at the hospital for approval as many things in it were out of the standard of care for twin hospital births. We booked an appointment for 2 weeks later to discuss the results of the hospitals decision.

At my 33 week appointment, I was advised that the meeting had not yet taken place so confirmation of my birth plan requests was still not available. My doctor wanted to do a 3 minute ultrasound just to confirm the fluid levels around both babies so I agreed since I could tell she was a bit concerned.

Around 34 weeks my midwife called me advising me the hospital did not like my birth plan at all and things were not looking good for a water labour or freedom from continuous monitoring and IV as I had requested. We spoke for over 1½ hours and I could not believe this was happening. Again I contemplated staying home to have the babies unassisted. I had luckily obtained my doctors email address at an earlier appointment and was so thankful. I sent her an email telling her I could not wait until our next appointment and I needed to resolve this as I was very upset about what I had heard.

She called me the next morning and we spoke in detail about why I requested certain things and that the water labour was extremely important to me. She discussed her concern with declining the monitoring and after hearing each others side, we agreed to compromise. She would make sure I could have the room with a tub if available and I would agree to continuous heart rate monitoring of the babies. After the discussion I felt this was a very fair compromise and was much relieved about the birth plans again.

I booked a late afternoon appointment on Feb 29 (35 weeks) as I was planning to go into labour this day and figured if I was going to be in town anyways... Well, I knew it was wishful thinking which is why when my doctor suggested a 36 week ultrasound at this appointment I asked her to bump it to 37 weeks because I had a feeling we would be having discussions about getting babies out and so I wanted very few extra ultrasounds.

March 11 I finally went into labour! I was so excited that I was going 'early' as I was now 37 weeks. By the time my husband and I got to the hospital, my contractions were 2 minutes apart. It was around 8pm and both my doctor and midwife came. The only problem was the tub room I had wanted was not available. I made peace with that since I had both my midwife and doctor here for the birth and that was most important. I had a great nurse and ended up walking with my midwife to try and get my contractions stronger. We did flights and flights of stairs and my midwife did acupressure on me. While the contractions were constant, they never progressed. 5 hours later, we all decided nothing was happening and that we should leave. We were advised to book a hotel since the contractions were so close and going home would not be wise. An hour after booking the hotel my contractions totally stopped. Neither my husband nor I could sleep and so after being at the hotel 4 hours, we started on our way home around 6:30 in the morning... what a huge let down heading home without babies on the outside!

At my 37 week ultrasound, I was advised both babies were doing exceptionally well and scoring 8/8. From there I went over to see my doctor prepared for “the talk” about getting them out. At this point the risk of stillbirth goes up but only by .06% so I was ready to decline any intervention. The sonogram doctor had faxed my OB the ultrasound report and with the results we decided to have “the talk” next week. My doctor told me I get the big blue ribbon at the farm show for biggest identical twins she has ever had. I'm not sure if she was calling me a cow? We had quite a jovial relationship. I remember being excited hearing we were having twins as I thought I just might have 6lb babies but I should have known...

A day before my next appointment I received a call from my midwife advising me that this pregnancy was going on too long and no one was comfortable with this much longer. She suggested I agree to a membrane sweep and that the doctor had made mention of induction 2 days after should that not work. I am also told that a number of things had changed since the beginning of my birth and that I may not have the support I wanted there should I not get the babies out in the next very short while. At this point I am completely devastated as everything was looking so very great and positive and now I am feeling huge pressure to make decisions to get babies out sooner than they may be ready. I have had this pressure at the end of all of my pregnancies and it is so stressful for me. My body is strong an can carry babies longer than average I suppose. Everywhere I go people are telling me I am huge, I however feel great and don't even really 'feel' pregnant. I continue to do my normal daily activities (measuring the equivalent of 54 weeks pregnant).

The next day was my appointment. I did not sleep well that night and was very anxious about what my doctor would say. I was very upset and so I brought my husband along for support. My doctor sat down with me and very compassionately told me my 38 week identical twin pregnancy was like a 43+ week singleton pregnancy and as the risks increase, her comfort with letting the pregnancy carry on is dwindling. She also clearly tells me it is entirely my choice and as long as babies are doing fine, she is happy to work with my wishes. I apologized for being the client to put so much pressure on her as I know there are people around her who are are not supportive of my birth wishes and I can't help but feel horrible about the extra stress I am creating for her. I am positive my doctor has fought for my desires and am pretty sure she has been given a really hard time for not strong arming me to protocol so for that and a few other reasons, I agree to having my membranes swept to try and encourage babies out. We booked an ultrasound for about 48 hours later to check on babies if I am still pregnant then...

At the ultrasound it was determined that baby B was now larger than A and had turned breech. Both babies were looking great and my doctor came to meet me after my appointment to discuss next steps. She made it clear she would like to induce but that the ball was in my court. I decided another sweep would be a reasonable compromise for us both and booked an appointment for 3 days later as I did not want the babies to come that weekend since she was away. I was praying to be able to have these babies on a schedule that would work for her. I knew I needed her at the birth to get the support from the hospital and I had become very attached to her way of working so compassionately with me and not scaring me into submitting to her wishes. At this point I couldn't even imagine working with another OB.

With timing being what it is as my doctor was away, I of course nested... I was panicked that the babies were coming as she was gone. Thankfully the nesting was short lived and it never turned into anything so I went in for a second sweep after that weekend. This time she was no where near as gentle... I could tell she wanted these babies out. I was now 39 weeks and I have a feeling the pressure was on behind the scenes that she would 'let' me go this far with identical twins which are almost always out or taken before 37 weeks. I couldn't believe I was pregnant either as these babies moved from being possible Aquarians to likely Pieces and now Aries. No one thought this pregnancy would go on this long! My doctor asked that I would have an ultrasound again at my 39.5 week appointment to which I agreed to an in-office one to quickly check fluid levels. Baby B was back head down and she was happy to offer induction at any time. I declined as per usual and she respectfully accepted after booking another ultrasound for 6 days later as we were at a point where we were having to monitor the babies very closely due to them being considered far post dates at a 46 week equivalent.

Since my aunt was here from out of town, we decided to get steaks and have a nice dinner. (last time she was visiting and our daughter was “over due” we had just sat down for steak and ended up rushing to the birth centre so we figured we should try that again). I had put the steaks on the BBQ and was bending over to get our dogs their supper and pop, my water broke. My water had never broken before steady contractions in past so I was unsure how this would play out. It was about 5:30 and I called my midwife to let her know. She said to come in once contractions were steady and so I waited, wondering how long it would be. Brian suggested we go in right then but nothing was happening so I said we should wait. Oh how I wish I would have listened to him... My midwife called my doctor and told her my water broke so my doctor used her influence to hold the room I wanted with the labour tub. I was so thankful to her and could not be more blessed by her going so far above and beyond for my birth. My midwife then headed to a meeting she had for around 6:30 and I watched everyone eat steak (yet again) as I was not in the mood. By 6pm I was getting strong contractions and they were very close so we were in the car and on the way to the hospital by 6:10. It was an hour drive and by ½ way there I knew it would be the longest hour of my life (although it was a little less as the speedometer was above 160 the entire drive). Hard contractions were now 2 minutes apart and my midwife was on the phone to me the whole drive into the hospital telling me I could do this and to NOT push! Within 15 minutes of the hospital I had the overwhelming need to push. It was all I could do to keep this baby in. Each contraction pushed baby further down and I was having a VERY hard time not giving into my body. I fought and fought and we finally arrived at the hospital where my doctor, midwife and a nurse were waiting for us outside with a wheelchair. My husband was permitted to park at the emerge door while they wheeled me up to the room – I was SO ready to get into that tub... but my doctor and midwife had other plans; they wanted to get the heart rates of the babies and the tub wasn't filled yet. AHHH, PANIC! I needed in that tub an hour ago! Here I am stuck being monitored with baby not cooperating so I finally said half jokingly, half assertively that they could check the baby's heart rate AFTER it was out. The tub now had a few inches of water in it and I happily jumped in... the tub was so much better than I pictured it as I was told it was so small and with my size I may not even fit. That was not the case at all; I was SO thankful to be in there! Once in the tub my thoughtful midwife provided me a cool cloth for my forehead and I was able to relax for the first time in almost two hours. Approximately 20 minutes later, Baby A was caught by my midwife and placed on my chest. I was very excited to look down and see a boy! He looked nothing like either of our other children and I was surprised to see that as they had looked so much alike. His cord pulsed for a really long time while he laid on me in the warm water. We knew to now expect another boy.

After about ½ an hour I felt I may have more contractions coming on so we had an ultrasound to see baby B's position. He had turned breech from just a few hours ago. Since I knew a breech water birth wasn't an option and I wanted to be in the tub I asked my doctor if we could turn baby vertex. I wasn't sure if she would let me back in the tub since hospital policy did not allow water births. I had been very careful to not share baby was coming so I could have at least one water birth. My doctor told me I would have to get out of the tub but before I did, I decided to ask last minute if we could leave the babies and cords uncut until the placenta was out. I had signed a 3 page waiver regarding delayed cord clamping and all my other non traditional requests at a previous appointment however I never made mention of the cord clamping being this delayed. She accepted my new request and so I utilized everyone's help to get out of the tub and onto the bed with baby A still attached to me. We decided to use external pressure to get baby B head down so my doctor moved him gently with her hands. His heart rate started to fluctuate and I was advised to have my water broken to get things moving quicker and ensure he stayed head down. I was ready to meet him, so I agreed and my doctor broke my water. Everyone was shocked how much fluid there was – I guess that is why he was able to move so freely!

Contractions started fairly soon after that and I was told his heart rate was iffy. After a few minutes my doctor said very seriously and firmly that she was very concerned about this and that I really needed to get him out. I had a couple more contractions and pushed very lightly until she finally said to me: “Sera, I would not pressure you at all unless I was really concerned, you know that.” I shook my head in agreement. She said, “You have one more contraction to get him out or we are going to have to use the vacuum.” A whole bunch of people filed in the room including a man. I said to get them and him out of there, what were they doing in here? (apparently my doctor told me the NICU team was coming in from waiting outside - at her request they were asked to not come into the room at all unless needed – I appreciated that!) I somehow did not hear her telling me they would now be coming in and was surprised by their appearance when I pulled the cloth off my eyes. My midwife took notice of my demeanour immediately and asked them to close the curtain for my privacy. I am so thankful for such intuition from her. At this point I realized my doctor was very serious and so I covered my eyes again and I prayed out loud. I prayed for a strong contraction and I prayed for strength to push. I continued to pray while I was reassured from my midwife that I had the strength to do this. It was like everyone disappeared and I begged God for help. My next contraction came and I pushed with all my freshly replenished energy. We went from showing no head at all to having a whole baby caught by my midwife and again placed on my chest.

The male paediatric specialist now came over and introduced himself (boy was I embarrassed for freaking out on everyone!). He looked over the baby on my chest and was very happy with his condition so he and his team left the room. I looked down at this baby who looked nothing like his brother. He was much fuller in the face and seemed totally different. I was so thankful at this point that both of our boys were here at last and perfectly healthy!

Both boys were still attached to the placenta at this point and it was now time for the final birth. I wanted confirmation that they were identical so I asked my doctor to look over the placenta to see if the placenta fused as I was surprised identical twins could look so non identical! She looked it over and confirmed the blood vessels crossed over the membranes and thus they were indeed identical. We took a picture of the boys still attached to their placenta after my midwife made heart shapes in their umbilical cords and then my husband cut the cords. We are both so very thrilled with our new additions!

My nurse confirmed I was not hemorrhaging and checked my vitals. The blood pressure cuff was causing my veins to pop out of my skin – it was so painful and my midwife again advocated for me, advising that my nurse could leave as she would finish up with me. I had no tearing or bleeding issues and felt no need for any drugs so I declined the oxytocin that was expected I would have – I said I would breastfeed instead.

I then got up and thanked my doctor for allowing me the birth I wanted. It went about 60% of the way I had envisioned but it was 100% perfect. I have never felt so overwhelmed by the selflessness and kindness of a doctor before. I know how much she went out of her way for this birth and I am in such awe of her courage and compassion. She left very shortly after the births and I was sad to say goodbye.

We got some pictures with my midwife and nurses and I had wished I thought about pictures before my doctor had left.

It was now just my husband, our midwife, me and the boys. The boys were Isaiah: born at 1929 weighing 7lb, 9oz and 19 3/4” and Elijah born at 2025 weighing 7lb, 13oz and 21”.

I nursed the boys then my husband and midwife dressed them while I got dressed. I then wrapped both babies on my chest in a carrier and we all walked down the hallway to the exit.

It was like walking down the green mile! Upon passing the nurses station everyone was staring at us. I don't think anyone who just had twins a couple hours ago has ever walked out of there! We said thank you again to our nurses and walked out to the car to buckle babies into their seats for the drive home. My midwife gave me some arnica to help with the afterpains and made arrangements to visit us at home the next day. We were in the hospital less than 5 hours, it was fantastic!

My husband and I drove home with the boys talking about what a fantastic blessing we had been given with such an amazing birth, mostly due to the compassion of our amazing midwife who stuck with us through this pregnancy and delivery as a total gift since she had transferred my care almost 20 weeks earlier and our doctor who had so much care and concern for me that she went well out of her way to make this birth extra special. We are in awe of both of their selflessness and compassion as well as the two very healthy boys we have just added to or family. God and these amazing ladies have made this amazing day one which we will be blessed by forever!


Thank you Sera for sharing your positive hospital birth experience with us all!


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