Embracing the Unexpected ~ A Freebirth-turned-Cesarean of twins

NDH

5 on earth, 9 in heaven, 1 in utero
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From the moment I conceived I had a strong feeling I was having twins, which got stronger as time progressed. I had planned on not having any ultrasounds this pregnancy, but felt that I needed to know what type of twins I was having to be able to direct the type of prenatal care I would want. Unsurprisingly when I had an ultrasound at 12 weeks, which my husband and three children were present at, we saw two babies and luckily they were DCDA. Knowing this I was quite happy to continue with self directed prenatal care, focusing on nutrition and tuning in to my intuition if there was anything else that we needed.

I had one encounter at the hospital at 30 weeks pregnant after an episode of vasovagal syncope, likely due to being slightly anemic. I booked in to the hospital as back up while I was there, so if I did have to transfer they would know me. The midwives I let were excited that I was planning a homebirth, and before I left the Dr (registrar, Dr G) had a chat with me about things to be mindful of. It didn't come across in a fearmongering way at all, and I went home feeling encouraged by a positive medical experience. I had been very apprehensive after many unpleasant experiences in the past.

Not once during my pregnancy did I doubt my ability to birth my babies. As a compromise with my husband I had agreed to give birth at my parents house instead of our own home out of town which is half an hour further from hospital.

At 33 weeks I had a quick ultrasound to determine placenta locations to ensure that I did not have placenta previa, which I did not.
At 34 weeks I had my birth kit prepared and in my van so I would be ready when and wherever babies chose to come. And then I waited. And waited. And waited.

I had felt that they would arrive between 38 and 39 weeks, and have generally been pretty accurate at guessing when my babies would be born. I did start having prodromal labour in the evenings and once even contacted my photographer to have her on standby if things progressed. Which they didn't.

I started going to my parents house every morning and spending the day there so that if labour went quickly, which we believed it would, especially after having prodromal labour, I would not have to drive.

At 39 weeks our van broke down and we ended up having to camp at my parents house indefinitely while waiting for a part. Prior to then, but certainly after being stuck there, I was feeling like labour wasnt starting due to feeling watched, and then having friends and family who had known our birthing plans all along suddenly start questioning my decision. Some I chose to engage with and educate, and others I simply ignored to save my mental energy and protect my bubble.

The day of my due date, a Sunday, I went for a 2km beach walk with my my 3 kids, my dad and his dog after church.

That evening after putting the kids to bed DH and I had sex, or as he joked at the time, he "induced" me, and then made the 40 minute drive home. I went to have a bubble bath where I started having contractions. They continued after getting out of the tub and I started timing them - a minute long and 5-7 minutes apart. They weren't very strong yet and I spent a long time wondering if/when I should call hubby back home. I know from past births that once active labour kicks in it goes fast (the last birth was only 45 minutes) so while i felt it was still in the very early stages I obviously didn't want to wait til active labour or DH would likely miss it.

I decided to try to sleep, and if I couldn't then I would call DH. After being unable to lay down through the next two contractions I texted DH to come back, but bring work clothes, and I turned on my fairy lights, put on my birthing necklace and robe and got to bouncing on my yoga ball.

I was having back labour which I was so glad to have DH on the way to be able to apply counter pressure. He arrived around 12:30ish.
We decided to watch TV in the back room while I laboured, and go back to my birth cave when things got too intense for me to concentrate on the show. He massaged my back during contractions. I wasn't timing, but realised they were starting to space out more. So at 2am I told DH that we should go to bed as it was still in early labour that could take a while. I was hoping to rest for a little while and wake up in active labour before morning.

I was so disappointed to wake up at 7am.
I started bouncing on the birth ball trying to get things going again, and did have a couple contractions. DH ended up going to work, after telling my family I was in early labour. Even though nothing was going on I spent the morning holed up in the bedroom reading my affirmations and doing figure 8s on my birth ball and lunges. I figured there was some malpresentation going on so started doing spinning babies exercises to work on a better position. I took the dog for a walk and went Curbwalking around the neighbourhood and had some phone calls to make while doing so. The whole time I was having contractions about 15 -20 minutes apart but they were getting weaker.
I did the Miles cricut and massaged Clary sage into my induction pressure points and did more ball bouncing. By lunch time despite all my efforts not one had contractions not picked up they had practically stopped. I still kept up with spinning babies though and when DH got off work I had him do Rebozo.
I went to bed defeated, and decided that I would go to the hospital in the morning if labour didn't pick up again in order to find out what kind of malpresentation I was dealing with so I could do focused exercises, and possibly get a stretch and sweep.

Tuesday morning I woke up discouraged that once again nothing was happening overnight. My dad took me to the hospital after breakfast. The midwife who took me into a labour room wasn't totally sure what she was feeling and asked if it was OK to have the bedside ultrasound brought in, to which I agreed. We discussed my birth plan again. They knew I was having a homebirth and the mw told me the Dr would want to have a chat about that. Being now 40+2 with twins I knew I would be facing a much different conversation than 10 weeks before, the last time I had been at the hospital.

Dr G came in with the ultrasound machine, and even with ultrasound wasn't quite sure what position baby A was in (it was a very poor quality machine) so she asked to do an internal so she could get a better idea from feel. I was 4cm and she could feel a spine.

They concluded that baby A was sacral oblique. Basically a cross between breech and transverse, with their lower back blocking my cervix. And baby B was head down trying to push past A and not having room to do so.
Of course the recommendation was an immediate cesarean, which I didn't agree with.

Obviously there was no way for them to be born vaginally as they were, but there was no emergency and babies can move position even in labour so in my opinion there was no need to have a cesarean. I asked if I could discuss it with my husband first though, and they told me to take as much time as I needed.

I phoned him and knew I would worry him if he could hear my quivering voice so I quickly prefaced the call by saying the babies and I were all fine, but I had upsetting news and I needed him to come talk to the Dr because I wouldn't remember it all. He left work immediately. When he arrived a midwife came in to describe what was going on and give their recommendation, as Dr G was in a birth, and then we went to walk around the hospital and talk.

I solidified my decision to go home and try to get them into more favourable positions, try to get in to the Webster certified chiropractor, and hope for the best while beginning to mentally prepare myself for the possibility of a cesarean.

We went back to tell them our decision, and Dr L the consultant came to speak to us too as Dr G was at a birth. While obviously she didn't agree with our decision and did go over all the risks we would be taking by leaving (mostly either overinflated or completely ridiculous) it never came across in a threatening or fearmongering manner, just that they were doing due diligence. They acknowledged without me having to remind them that all decisions were entirely mine. They wanted us to sign an AMA form before leaving, which we refused knowing it was not something we were obliged to do (though hard for me not to. I was worried it might negatively impact how they wouldnt treat me in future dealings and label me as a difficult/uncompliant patient. They very genuinely assured me that not signing would not impact future treatment in the least.)
So we left with assurances that I would return if I went into labour, and would be in touch the following day and on a day by day basis with what we planned to do.

DH and I went for lunch and then he dropped me off at my parents house where he them did another type of Rebozo more specific for breech/transverse babies, and I could feel some shifting happening. Including baby B moving up much higher, and I felt a bit hopeful. He went back to work.

I tried calling the chiropractor a few times and finally got through, but she couldn't see me til Thursday morning. I booked it anyway.

Dr G called back asking if I'd be willing to go have an ultrasound to get a better picture of how babies and placentas were doing. I agreed, and my dad drove me back to the hospital to pick up a referral and the Dr called the ultrasound place to get me in for an emergency appointment. They didnt have anything available but would call back if they could fit me in. I hadn't been home for long when they called back to say they could see me right away, so back in the car to the ultrasound place. Baby A now had a leg bent behind them with their foot in my cervix but nothing else had changed.

I went home to do inversions and breech tilts and the miles cricut again, and I called my sister who has had two cesareans, one emergency and one elective, to hear her stories and get an idea of what to expect. Since my very first birth I have always had a contingency plan for a cesarean, and I've read and listened to cesarean stories over the years. But still I had never imagined myself having one, and now that's what I needed to do. Honestly though I came away from the talk dreading it even more. Especially due to the recovery.

At some point Dr G phoned to discuss the ultrasound, and said the babies had dropped from the 25th to the 6th percentile and that was an indication my placenta was failing and they really recommended I have a cesarean within 24 hours. I rolled my eyes at all the predictable scare tactics she used this time, and said I would let them know my decision in the morning but knew I wouldn't be going for an elective cesarean. I was confident the babies were fine and measuring much bigger than the scan indicated.

In the morning I ignored the first few phone calls, wanting to ignore everything going on and connect with the babies and encourage them to turn. But they were persistent in trying to get ahold of me so I eventually answered, declined to go in for a cesarean and articulately explained my reasons for doing so when asked.
She agreed with my statement that ultrasounds are notoriously inaccurate at estimating size at term, but stated that the only measure they have for determining health. I said that wasntvan strong enough indication that babies weren't healthy and I trusted my intuition better than technology. But did agree to go in for a NST that evening when DH got off work.

I spent the rest of the afternoon doing more inversions and breech tilts, and basically hung out in frog position for the day, praying for babies to turn and intermittently crying.

I met DH at his work at 4:30, we quickly did another Rebozo and made our way to hospital.
We ended up being there for a frustrating 4 hours because they kept being unsure they were picking up both babies separately and spent ages with the ultrasound trying to make sure they were getting two different heartbeats as they kept measuring so closely in sync. And while I kept implying that I had enough and wanted to leave, I never said the actual words "I'm done and want to leave until nearly 9, which I should have done after the first pointless hour.

My kids were asleep when we got there at 9, only the second time ever I wasn't there to put them to bed and the first time they didn't even get to say goodnight on the phone.

We had a bite to eat and DH went to bed. I had a good cry and spent more time in serious prayer. Not just that the babies would turn but that I would be able to accept it if they didn't.

As soon as I went to bed around 11 I had a strong contraction. And then another. I got up and laboured quietly alone for a little while, wondering how long I should Labour to give them the most chance of turning before going in. But since only a couple hours before baby A had been footling transverse, I hadn't yet had any chiro, and hadn't felt any shifting movements in the meantime. I had this sense of peace flood over me that this was it. The babies had chosen their birthday, but also a mode of birth that I had not expected. And while I was afraid of the actual surgery itself I had no doubts that it was what my babies needed.

I woke DH, and my dad was still up and went and woke my mom. With a sense of complete calmness I went about packing a suitcase - totally haphazard. I didn't have much at my parents house in the first place that would have been good to take to hospital, and I did have a wave of sadness when indent to grab baby clothes from the basket and realised I didn't have anything with me that didn't say "born at home". I told mom she would need to go shopping for a couple of outfits before coming to see us in the morning.

The 4 of us prayed together, I kissed my sleeping children, and I phoned the hospital to let them know we were coming in and off we went.

Half way there I realised I had forgotten to insert sterile gauze in my vagina for microbial seeding before we left the house. So I did it in the hospital parking lot. Lol.

We called to let them know we were there, as a midwife has to come down the front door after hours. Meanwhile I was still having strong contractions maybe every 3 minutes that were taking focused breathing. I was meditating on my affirmations during them "I am strong and unafraid" "the only way out is through" "God is my refuge and strength" "God has not given us a spirit of fear, but of power and of love and of a sound mind" were some of the main ones that came to my mind. But most of my affirmations I had hung up with the lactation of Homebirthing I found were easily transferable to preparing me for the cesarean.

I was hooked up to the ctg upon arrival, and they needed to do am internal exam so DH removed the gauze and put it in a ziploc. I had been 4cm at the two previous checks, and was now 7cm at 12:30am, an hour and a half after my first contraction.

I was gowned and stockinged up and given the pre-op meds while waiting in triage for the surgical team to arrive, and then wheeled in the bed down the hospital to theatre. DH was with me up until the point that i went into theatre so he was there when I met Patrick the anesthetist and my nurse Tracy. The anesthetist was asking me a bunch of questions while I was contracting, which I answered by shaking my head yes or no.
And then we had to say goodbye while DH went to get gowned up and I went into theatre.

Getting the spinal wasn't as bad as I thought, and I immediately started going numb and had to have help laying down. The anesthetist used an ice cube to confirm that I had no feeling below my breasts and once the drape was up and I was shaved they brought DH in.
I had previously discussed with the Dr (Dr L was the one we had seen earlier that evening, and the Dr who did the surgery) that we wanted delayed cord clamping and the babies would be laid between my legs for a couple minutes before being taken to the warmers, and then brought to me for skin to skin within a few minutes. But it suddenly occurred to me that I had never asked to keep the placentas, which I said to DH. The Dr overheard and said that would be no problem.

Then I could feel painless tugging, and a sudden weightless feeling and I knew the babies were out. DH said Jeremy has a brother but he hadn't seen the other baby, and when we asked they told us she was a girl. I could see her from the warmer she wa taken to, but his warmer was out of sight behind the drape. She was huge and healthy and everyone was exclaiming over how big they both were.

He was brought to me for skin to skin right there while they sewed me up, and I said he was so tiny. I was sure he was my smallest baby. From across the room she just seemed so much bigger. She had had meconium in her waters so they wanted to observe her on the warmer for a few extra minutes. And then I began to have a reaction to the anaesthetic. I felt light headed and began dry retching. Patrick recovered my bp quickly, but I still felt kind of yuck and out of it for a while so my memory is kind of hazy afterwards. But I remember Patrick and hubby walking to recovery beside me and we were there for about an hour. I got skin to skin with my daughter, and apparently tandem breastfed but have no memory of that. (but I have a photo). I remember that I kept drifting in and out of sleep. I so badly had wanted to be fully present to be able to take in and remember every small detail of the birth, but hadn't considered the effect the drugs would have .

When I could start wiggling my toes and moving one of my legs Patrick bid is farewell and we were wheeled to the maternity ward while my husband stayed behind chatting computers with someone lol (they were having issues with the computer after an automatic reset at 3am and he helped them fix it LOL).

Babies were born at 1:31am (same time) both weighing 7.5lbs (same weight within 5 grams). We got to my room around 3:30 and there was a spare bed for DH to sleep on, and we both crashed hard til 7.

The babies were with us the whole time.
I stayed 4 days in hospital and my kids, who had no preparation for me having a hospital stay did absolutely amazing with the transition. I was especially amazed at how well my 2.5 year old adapted. My mom brought the kids in to visit twice a day and we face timed before bed each night.

It was far from the birth I was expecting, and I do have some sadness about what I missed out on, but it was still a positive experience that has left me feeling powerful and amazing. And I know it's because I retained my autonomy and was treated with respect throughout every decision making process. Something that I so dearly wish every woman could say bout her birth. Birth is unpredictable, messy, raw, and takes us to places we never thought we would have to go, but we all deserve to feel powerful and amazing no matter how we give birth.
I may have been cut open but I still birthed intuitively and autonomously and advocated for my babies as best I could with the knowledge I had at the time, and that's something to be proud of.
 
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Thank you for sharing! I was really paranoid about having twins (wrong diagnosis by doctor in my first trimester), and it is great to hear and understand your experience with it. I am totally for a natural birth but I can understand how surgery was the best option for your babies then :)

Congratulations!
 
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Congratulations on your twin birth and for fighting for what you believed was right for your babies rather than presuming medical intervention straight away was the answer.
 
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