I recently met several mothers expecting twins and I decided to post my birth story along with my Birthday Flikr photostream. The Internet is full of stories of how wrong things can get, I thought I would share my very boring story of a healthy full-term, hospital, natural, twin delivery. It’s not a beautiful home water birth or a terrifying train wreck. It happened in the operating room of a tertiary care centre in Ottawa, ON. All photo creds go to my oldest daughter Clara, minus one or two pictures taken by Dr. Doug Black, attending OB-Gyn extraordinaire.
First, some stats. My twins were di-zygotic, conceived from two fertilized eggs. Growing in-utero, they had two of everything: two amniotic bags, two placentas. We learned that we were expecting twins at 15 weeks of gestation. The girl was on the left, the boy as on the right and presenting first. They stayed like that until the end.
Going into the twin pregnancy, I was confident that I would deliver the twins naturally (without pain medication) and vaginally (as opposed to surgically). I did leave a bit of head-space for the eventuality of a C-section, joking with my midwife: “I had the hospital birth, the homebirth, the induced birth, the precipitous birth, the breech birth but the C-section is missing from my birth portfolio!” The first thing I announced to my new OB once I was transferred from midwifery care to a specialist was: “I don’t want to be induced.” He answered something like “We will induce you at 38 weeks anyway” and I decided to push this looming clash off my mind until 38 weeks.
Everybody was telling me that induction was unlikely. That, with my history, it would be awesome if I made it past 28 weeks. I went on modified bed rest at 24 weeks and the fear of being induced at 38 basically evaporated.
When I walked into my 37-week appointment, the obstetrical nurse said: “I’m sending the paperwork for your induction, expect a call from the hospital on Monday.” I was so sick of being pregnant; I didn’t have that fight left in me. In the medical practice where I was followed, physicians took turns being on labour & delivery call. As a result, patients could deliver with any one of 7 physicians. As we were leaving, my OB caught-up with me and said: “I’m on call Sunday. If it’s a quiet day I’ll call you in.” The thought of delivering — even on Pitocin — with this highly competent, greatly admired and well-liked physician completely changed my outlook on the induction. After that, I was praying that Sunday would be a quiet day so he could call me in. That Friday, I went for one last appointment with my ostheopath and she worked some magic, hoping that it would coax my babies out gently. It did not jump start labour but I’m sure that it helped getting things “favorable” because labour, once started, was quick and easy.
On the following Sunday — a gorgeous Indian summer day — we went about our daily business until we got a call at lunch time from the hospital: the power and the water were out, everyone on the floor was on generators and they would keep me posted. At that point, I was getting a bit nervous. Later that afternoon, around 3 pm, they called and asked me to come in. We packed our bags and left. As we were standing in the mud room waiting for our oldest son to return from visiting a neighbour, the earth shook: it was a mild earthquake. Little did we know how earth-shattering the twins’ arrival would be in our lives!
I remember walking up and down the stairs from the parking lot to the hospital’s main entrance and my husband asking if I would like a wheelchair. I said: “I have 30 minutes left to go in labour spontaneously, I’m going to make the most of them!” We checked-in and waited for our nurse. Nurse Sue — one of two amazing Sues who saw me through my labour and delivery — came to meet us and I was immediately heartened by her smile and positive disposition. As she was asking the standard questions about my pregnancy she was giddy with excitement: “You have all the boxes checked at the right place!” She seemed genuinely happy to have a healthy mom in front of her. She asked to see pictures of the children, asked for all their names. She didn’t have any children of her own she told us, but had been in Labour and Delivery for 25 years. I was so happy to have her! She installed the fetal monitor before a younger nurse came to replace her saying “The charge nurse says that you must go have supper now. I’ll look after your patient.”
Nurse Nicole was there just long enough to insert my I.V. line. The omnipresent IV line was one of the worst memories of my previous induced labour. I could feel it for every second of that difficult birth. And because of my history of post-partum hemorrhage, they wanted to keep it in for 24h after birth just in case I needed emergency treatment. I was going batty: couldn’t shower, changing clothes after delivery was a hassle; I was having a hard time holding and nursing my newborn daughter properly. In that context, I will forever remember Nurse Nicole, who was only there long enough to insert my IV line, as “The Nurse who gave me the IV I never felt.” It went in, I forgot about it and that was it. I forgot her last name but I wish I could send her a thank you card. “Dear Nurse Nicole, you have a special talent for inserting IV lines. Thank you from the bottom of my heart for being part of the wonderful memories I have of the twins’ birth as the nurse who gave me the IV I never felt.”
Eventually, my doctor and the resident Mylène came to say Hi and order the induction. First, they were going to rupture my membranes, then wait and see. While I had been in labour on and off since 34 weeks and despite the 24 weeks effacement scare my cervix was long, closed, and the babies were nice and high. Like -3 station high. “Yay, I thought, here comes Pitocin…” I asked my doc: “Once my membranes are ruptured, how long do you give me to go in labour before you order the drip?” He answered “I don’t know… I’ll come back to check on you around 9:30 pm, then we’ll see.” It was not quite 5 pm. I thought “I could have the babies by then!” and a huge weight lifted off my shoulders.
After my membranes were ruptured, the charge nurse came to check on me and inform me that my epidural was on the way. I clarified, as I had previously with the case nurse at the clinic, that no epidural had been requested, ever, and that I had no intention of taking anything to birth my babies that would prevent me from driving my car. She looked puzzled and gave me the ol’ spiel about twin deliveries and how it was sometimes necessary to use forceps, or to grab Baby B from inside and what not and basically, how they would all feel better if I only got the damn thing already. I agreed to the epidural after 8 cm, once I was sure that labour was well established and unlikely to stall or slow down.
One thing I learned from studying bioethics “in the field” is don’t pick a fight with the charge nurse: they usually came by their position by being highly competent, decisive and strong-willed. They have the power to make your stay very enjoyable or very annoying but your doctor is still responsible for medical decisions affecting your care. So don’t pick a fight with the charge nurse.
My doctor came back to visit and said: “We’re here to make sure that you have the most comfortable labour” (or something like that), to which I replied: “I don’t want to be comfortable I want to un-medicated!” By then, they were starting to get my drift. He said: “With twins, we really prefer working with the epidural. If I need to use forceps or manipulations, you understand that I won’t have time to wait for the epidural, it will have to be done cold turkey. Also, if you need a c-section, my only option will be to put you under and you will miss the birth entirely.” I really respected that about my OB: he never made it about me (as in “You need the epidural. You have to take the epidural!”) It was always about them and their ability to practice (as in: “I would be more comfortable if you had it.)
At that point, I had started having mild and irregular contractions. They were not really painful (I was still catching-up on the daily news on my handheld) or very long. I didn’t think I was in labour, real labour, yet but my nurse had one look at me and said “Oh we’re meeting these babies tonight for sure, you have that look.” I thought “Ah?” I walked around a little but it turned to be uncomfortable in the cold and anonymous hospital hallways. And with my history of precipitous labour, all the nurses had been warned to keep a close eye on me. I felt like a circus animal. When I returned to my room, I noticed the crash-cart by the door. They were leaving nothing to chance. If I could do it again, I would insist on staying in the L&D room to deliver.
I still didn’t feel like I was in labour yet. I was uncomfortable for sure but like previous labours, contractions never felt like they peaked and decreased, it never felt like they were going anywhere. They were short, irregular. They would start and abruptly stop, leaving me to wonder if I really had a contraction or if I was just imagining things. Yet, when the nurse hooked me up to the fetal monitor, the graph showed strong and regular contractions. At 8 pm, they decided to check my dilation again. I winced and got ready for a major disappointment, but the nurse’s eyes got suddenly saucer-like. “You’re over 8 cm. It’s time to get to the O.R.” Then she remembered the epidural and said “I will get the anesthesiologist!”
My birth plan was made of a one-page chart summarizing my birth history. The chart had one row for each child and six columns titled “gravida” (or pregnancy number X), “Baby” (girl or boy with name), “date of birth”, “gestational age”, “birth weight” and “additional comments” (for details such as breech birth, precipitous birth, placenta abbruptio, post-partum hemorrhage and so on.) Believe it or not, the “additional comments” part was never recorded by my obstetrician and would not have been communicated to the hospital staff otherwise. I thought this was relevant information, especially in the context of a twin delivery. If a twin is in a breech position, wouldn’t you think it was relevant to know that I had already delivered an 8 lbs breech baby before? I thought it should be! I also mentioned that all my previous births were natural, un-medicated vaginal deliveries, and that bit of information turned-out to be crucial to garner the support of the anesthesiologist (and consequently the rest of the L&D team) for my wish of a natural twin delivery.
At this point, I should add that I could not be forced to agree to the epidural. The issue was not whether or not I would be “made” to accept it against my will. The question was rather how much fighting I was willing to put up. And my experience fighting for my vaginal breech had taught me one thing: I am not a fighter. I abhor confrontation and I didn’t want to welcome my babies in an atmosphere of confrontation.
The second part of my birth plan had 7 wishes in bullet point. Simple like (1) No epidural before 8 cm and only if medically needed (ask for reason); (2) Ice chips, a rocking chair, face cloths, empty bowl to throw-up; (3) if labour progresses well, even slowly, no epidural, no rupture of membranes. Etc.
Now back to the birth story. The staff was passing the birth plan around like it was the Ten Commandments. When the anesthesiologist came to see me as they were getting ready to transfer me to the O.R. he said: “You had 6 children without epidural, you know how to push. If I give you the epidural, you will lose that ability and I don’t want to take that away from you. Even if I give you the epidural at this point, I will not give you a full dose since you need to feel what is going on. You won’t be pain-free. I will be with you in the O.R., if your doctor needs to perform a crash C-section I can put you to sleep in less than 30 seconds but I need you to understand that you will be under complete anesthesia and you will miss your babies’ birth.” I replied: “I know and I’m ok with that but my doctor didn’t seem comfortable working without the epidural” The anesthesiologist said: “Let me talk to him.” And this is how I didn’t get the epidural. The anesthesiologist talked my OB out of it.
Up to this point, labour had been very mild and uneventful. I didn’t even think I was in real labour until they told me I was 8 cm dilated. But when we started making our way to the OR I started getting nervous and, as a result, in more pain. The OR bed is not meant to deliver, it’s meant to make a surgeon’s work easier. That fact didn’t sink-in until they transferred me to the OR table and I realized that it was barely as wide as I was. I had nowhere to rest my arms and I had to hang to my bed sheets to avoid having my arms dangling from each side of the bed. It’s also very difficult to adjust your seat on a bed that’s barely as wide as your bum. And forget about moving around: you are now in a sterile environment all prepped for surgery, with faceless, scrubbed, nurses sitting by rows of gleaming surgical tools. Anyway, even if you wanted off the bed, you’re too high off the floor to simply get down. You’re at surgeon-level, remember?
So continued my labour, now more intense and more painful for another hour or so until I heard the nurse call my doctor in over the phone. “Yes, she’s starting to push”… Was I really? Ok then… it was time to push! They lowered the bed as much as they could so I was almost lying flat on my back. That’s when I heard my obstetrician ask “What do you do with the feet?” The resident answered: “What about the feet?” and he replied: “There are no stirrups.” At that point, I was too focused on labour to understand that he was a teacher asking his student. I had a second of panic thinking “You’ve been a doctor for 30 years, shouldn’t you know what to do with the feet??” Then my doctor said: “Put a foot on your hip” and I felt him grab my foot and tuck it against his hip so I had something to push against. The resident did the same thing. I was the most comforting gesture in the OR. That physical contact with my medical care givers was priceless. It centered me, their energy ran right through me and I felt like I could push. I gave one or two big pushes and out came Lucas. They took him to the warming bed. There is a picture of my son being shown to me but I couldn’t see him, I was lying on my back.
After Lucas was delivered, my legs started to shake uncontrollably as they often do after childbirth. I took a deep breath and realized I had another baby to push. Things got more serious at that point. I said: “I can’t push anymore, my legs are shaking too much” and my OB answered firmly: “You’re not pushing with your legs. I have your legs, forget about them. Now push again!” I gave another major push and a half and out came Ève. I heard my husband tell my daughter: “She’s significantly smaller” and they took her to the warming bed. I was given a shot of Pitocin in the leg to prevent haemorrhage (a standard procedure for a great-grand multipara with a history of post-partum haemorrhage) and we waited for the placentas.
At that point, I was lying on my back on the OR table waiting for the placenta to come out. Both placentas were at the back of the uterus and fused together. They came out easily. I heard my oldest daughter ask if she could see the placentas and they said: “Sure!”, bagged the placentas and showed her the bag. I laughed because in a previous home birth, she had been given a placental anatomy lesson by my midwife. When she asked for the placenta, she meant “Hand this thing of beauty over to me so I can check it out.” But that’s not what they heard.
I was so high when they were getting ready to clean me up and look at the damage. I had a small tear requiring a small repair. I kept repeating “Did you see what I just did??” and all the OR nurses were laughing saying “Yes! We were there!” I overheard one ask the other “We never see all-natural twin deliveries.”