Thursday, May 26, 2011

Confessions of a Mama who Birthed Twins at Home

©Rachel Fettig Klessig 2011. Rachel shares her perspective of birthing twins at home and managing bleeding at home with a trained assistant.

“My birth story for my twins really begins long before the actual birth. My husband and I already had 5 children all birthed in a hospital setting. Some of these births were not pleasant and I longed to have a homebirth. Because of restrictive laws and the fact that I had SLE (Systemic Lupus Erythematosis) it was proving to be very difficult.

In May 2009, I discovered that I was pregnant again and the laws in our state had changed in August of 2008 so I was very excited to plan a homebirth. We live close to the border of two different states and we had contacted a local midwife across the border and scheduled our first appt and ultrasound at 12weeks.

Within days of discovering I was pregnant, I began to feel very ill. This was quite unusual for me, as I never really had morning sickness before. I began suspecting that I hyperovulated and was having twins and begged to have my appointment moved closer. So at 9 weeks 1day I went to my midwife's house for my first prenatal and U/S. Right away we saw 2 sacs and 2 babies on the screen. A third area was examined for quite some time before the U/S tech decided we were only dealing with 2 babies. (It is quite possible the pregnancy began as triplets.)

You can see the two little babies here:
http://s78.photobucket.com/albums/j89/mrklessig/?action=view&current=twinpic.jpg

I sat on the couch where the U/S was preformed and just cried. I knew that my midwife had probably heard tons of times before from woman claiming they thought they were having twins. I gave my husband a little “I told you so!” and cried for quite some time. I am not sure what brought about the tears, both fear and excitement I suppose. I was just overwhelmed with emotion and the tears just poured out of me.

This midwife had delivered twins once by accident, as it was illegal in her state for her to attend a twin homebirth so she was not very experienced. We, nor she, felt comfortable with her as our primary midwife so I began to feel as if our hopes were dashed for our homebirth and doubted I even really wanted one because we were having twins.

The babies had separate sacs and placentas so that was a good thing to know when considering a homebirth. After several weeks of discussing having another hospital birth or going ahead with a midwife, my husband encouraged me to keep looking into a homebirth. Neither one of us wanted an OB to be scheduling our C-section the moment we walked in for our first prenatal so the search was on for an experienced midwife.

Over the next few weeks I googled and searched and called other local midwives and birth centers within 2 hours and nobody even wanted to talk to me knowing that I was expecting twins. I was beginning to get very discouraged when I was finally referred to a midwife about 3 ½ hours away from our house.

We met with her when I was about 12 or 13 weeks and both my husband and I knew she would be a great fit with us. We liked her very much; she had been practicing for decades, was very knowledgeable, and had attended twin births before. She worked as a team with one of her daughters and it was good to know that we would have a “team” already in place. I was already measuring 18 weeks at this point.

At 21 weeks we discovered we were having 2 little girls. They were both head down. I was ecstatic! I wanted so badly to have this homebirth and them being head down was critical with me feeling comfortable with it. I was nervous about breech birth, although my midwife would still have attended.

I continued to measure 5 to 6 weeks ahead during the pregnancy. It was pretty uneventful but by 28 weeks it was getting very hard for me to walk around without losing my breath. Because of my size, I had to get a carpenter's back brace to use as a maternity belt, which worked awesome.

I started having some contractions beginning at about 31 weeks and even though I wasn't really on bed rest, I didn't really do much. I had to lay down much of the time anyway because sitting upright in a chair put too much pressure on my cervix and that is when I usually had contractions. I needed to make it to 36 weeks for my midwife to deliver (not because of laws but because that is what we decided was best.) I would be 36 weeks on December the 18th. That day was ingrained in my mind.

I had my last U/S at 34 wks. I woke up that morning and my belly felt funny. I didn't know yet why but I felt lumps in all the wrong places. I had suspected that they may have changed positions and it was confirmed a few hours later. Both babies and turned frank breech. I became disheartened. They had been head down for so long. By the end of the U/S they were both transverse – so they apparently had lots of room to roam. My hopes for a homebirth became less exciting and I spent that evening very tearful.

We own an inversion table so we decided to give it a try. I hung at about 45 degrees for about 5 minutes before going to bed. The next day I felt that everything was back to normal but there was doubt in my mind whether they did change back or not.

Labor:


Thursday morning, December 16th, our new pack and play came. So I felt a little more like nesting. We unboxed it and put it together and then the kids and I started cleaning and rearranging things in my bedroom so we had a place to put it. I putzed around all day. Around 3:30 or 4:00 I sat down to knit a pair of mittens for Matt's Grandma for Christmas and started having contractions...not unusual for me.

I was unable to sit on the couch for any length of time without having them. They were becoming very regular though so I decided I should get up and go lay down and see if they stopped. Well, they slowed down but didn't stop so I let Matt know and I was off to take a bath and see if that changed anything. I didn't want my midwife to have to drive 3.5 hours to get here and I wasn't really in labor. After my bath around 6:30, the contractions stopped so I rested in bed.

I woke up at 4am on Friday morning, still no contractions, but I was wide-awake so got up to bake bread. Around 5:00 I sat down to finish the mitten I had started the day before and my contractions started up again. At 5:30 I rested but they continued at 6 minutes apart and fairly strong. At 6 I decided to take a bath again to see if that changed things. I went to the bathroom and had some pink spotting so I told Matt to call our midwife - It was the real deal!! I was exactly 36 weeks – I had been praying to make it to 36 weeks so that we could continue with our plans for a home birth. I had made it to our cutoff date!! I felt so enormous that day. I measured a fundal height of 45” and was 56 1/2” around.



I was asked to labor in bed for awhile until the midwives got closer so that things didn't progress too quickly. I made some phone calls to arrange for our children, cancel our visit with friends, and a couple calls to some prayer warriors.

My good friend Heather was the first to arrive at about 8:30. I had asked her to come for some moral support. She had 5 of her children at home and this was my first home birth and I knew she would make me feel calm. Our midwife friend had woken up that morning throwing up so I asked her not to come after all. It was a hard decision to make for me because I wanted her to be here but I also had some reservations because I knew she had some fear in her heart regarding this birth and I had been so calm about the whole pregnancy and birth except when I was around her. I think that everything worked out for the best with her not being able to come because of her being sick. It allowed me to labor and birth these babies without fear.

Matt spent the morning getting things ready. A fire was started in the cook stove so we would be toasty warm. He got the older children up to go do their farm chores. My mom came over to take the children to her house and I snuggled in bed with Clara (4yo) and Sarah (2yo) for a little bit and by about 7:30 or 8:00 the children were off to Grandma's. My midwife called me about every 45 minutes to get a status updates and there were really no great changes from the time my labor started. Contractions were the same and still 6 or 7 minutes apart.



When Heather arrived, she helped Matt set up the pool and they began filling it. My midwives were close so I got out of bed and sat in the living room while Heather clipped coupons and we talked and joked around. My midwife and her daughter got here around 10:00.

Babies’ heartbeats were checked and were both around the 140's even through a contraction so we were doing great. I spent some time in and out of the pool over the next couple of hours and we all just talked and joked around. It was so nice and relaxing and it really didn't feel like I was there laboring and they were all watching me like a pot ready to boil. It almost felt like a social call except the fact that I was stripped down to a sports bra and floating around in a pool in my kitchen/dining room.

Matt had started a batch of soup on the cookstove around 12:30 or so and had finished the bread that I started baking that morning. It was all smelling so good but I really didn't have the desire to eat more that a slice of fresh bread with butter and I had been drinking some juice.

My contractions never got fewer than 6 or 7 minutes apart but they were getting stronger. The last 6 were pretty painful and I needed to squeeze Matt's hands and couldn't talk through them. I had the last painful contraction at about 1:52 or 1:53 and immediately after my water broke...It was time to have babies!!

Birth:


My water never breaks before my baby is crowning so I knew when my water broke with the last contraction, I was going to be pushing a baby out with the next one. After I said that my water broke, everyone jumped up to scrub up. The next 5 minutes were like a whirlwind.

Judith, my midwife was standing at the opposite side of tub and I asked her if it was ok to push with the next contraction. She gave me the ok and said to push slowly. Well, I tried to push slowly but my body took over and out she came at 1:55. The first thing I saw was her little butt float up to the surface. I said something about her being breech after all and Judith assured me that she came out headfirst. 

The baby did a little somersault on the way up to the surface. I was holding her and they were rubbing her down. She was breathing but pretty purple and we continued to rub her down with towels to stimulate her. They clamped her cord later and Matt got to cut it.

Judith said that there was too much blood in the pool and she would like me to get out. We had discussed the possibility of hemorrhage or more blood loss because of the surface area of the placentas. I was about get out when another contraction hit me – only about a minute or two had gone by since the first baby had been born. I asked that somebody take the baby because the next one was coming. Judith felt and there was another baby, right on the heels of her sister. Judith's daughter was sent to put some pads on the bed so I could get out and into bed as soon as the next baby made her entrance.

Needless to say, I couldn't then get out of the tub. My body bore down and I pushed with everything I had. It was much harder that the first time. I could tell that my face must have been beet red from straining so hard. Judith reached down to feel again and what I didn't know it until after the fact, the first baby's placenta had detached and came down along side the second baby's head.

She told me to keep pushing. The placenta had to be pulled out of the way to make room for the second baby to come out. I was continuing to push all this time and the next baby came out all in one gush, just like her sister, only she came out with her placenta and all – it was 2:00. Judith was rubbing her down and trying to see if she was breathing, which she was. The cord was immediately clamped, I was handed the baby, and I was helped out of the tub and into bed.

The Continued Chaos:

The contrast between the two babies was distinct. The first one was so purple her breathing was very rapid. She was retracting and needed some oxygen. Some was being blown directly in her little face but Judith thought it would be best to call a colleague of hers that had a bit more experience with situations like this to give her some oxygen therapy. I consented, the call was made and she was on her way. The second baby was very pale but alert. She was a bit cool and Matt was sent to throw some dry towels in the dryer to warm her.



I was filled with adrenaline. People were rushing around, babies were being rubbed down with more towels, Matt was getting me my RRL tea infusion and some other herbals that we had prepared earlier. The minutes immediately following their birth is like a blur because it all happened so much quicker than I had expected, but still I felt no fear about what was happening. I was lying next to them and taking turns letting them latch on and nurse. I was bleeding much more than they would have liked and we were trying to facilitate some more contractions to make my uterus clamp down to slow the bleeding.

It wasn't working fast enough and my bleeding wasn't slowing, so I got a shot of Pitocin, and then over the next hour or so, I got 2 more shots of it. The Pitocin just wasn't working. My uterus was still spongy feeling and wasn't clamping down. It is possible that I had some retained placenta that was causing some problems initially. I got up to go to the bathroom on a few occasions and lost a lot of clotty stuff and there could possibly have been some placenta there also, we just don't know for sure.

Matt and I were spending some alone time with our new bundles. I was taking turns trying to nurse them both. Judith and her daughter came in to show us the placentas and told us that we should really be praising God that our first twin is even here. The condition of the placenta was such that it probably would not have sustained her much longer.

The placentas were like day and night. The only way I can think to describe the first one was that it looked like it had been put through a meat tenderizer. It was pale and spongy and when you held it up in the palm of your hand and looked at the side that attached to the uterus, it just fell apart at the cracks and looked like a minute steak. The other placenta was dark red, firm, and solid.


My bleeding still was not slowing down fast enough so Judith gave me another medicine to help my uterus contract better. Some more time passed without significant results and another dose was administered. I trusted Judith fully with what was going on so I wasn’t fearful. I really wanted to avoid a transfer and didn't mind Judith doing everything in her power and expertise to get things under control. I knew she would let me know when and if we needed to do something more or seek additional help.

Matt continued to get fresh warm towels periodically from the dryer and it was finally time to do assessments and weights. I was dying to know how big they were. I had been praying all along for 6-pound babies. I was going to be ecstatic if I had 6 pounders, especially at 4 weeks early. My other daughters were 6lb 9oz at 39wks and 5lbs 15oz at 36wk4d.

Baby A was weighed – exactly 6 pounds – I was thrilled. She was also 20 inches long. Baby B's turn – 5lb and 15oz and 19 inches...WOW! 



Shortly after this Robin arrived to give our first baby some oxygen therapy. It was about 5:30. My mom had arrived with my older children so that they could do their evening chores and she came in to quickly peek at our new bundles. My oldest son Danial, who is 12, came in to strain the milk and got to peek at his new sisters. Robin helped with the babies and then also helped with trying to assess my bleeding to get that under control.

 My uterus was beginning to feel firmer, and was getting lower into my abdomen....Praise God!! We were moving in the right direction. The first baby immediately started to perk up and became better colored after a little oxygen therapy and we were on the right track. It seemed like it took almost no time from finally seeing some response from my uterus and my bleeding had slowed way down and my uterus was getting lower and lower in my abdomen.



We had a few quick visitors later that evening and by 7:30 Robin had left and by 9:00 Judith and her daughter had gone also and would be back the next day to check on us. We were left with specific instructions and a list of things to monitor over the course of the next 48 hours. We didn't get any sleep that first night and I don't think that I could have slept even if given the chance as I was so pumped up from the events of the day.

It was an amazing experience. My first home birth was with twins and it was awesome. It was by far my best labor and birth experience!”


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1 comment:

  1. Wow! That was a wonderful birth story. It touches me especially tonight as I am sitting here waiting to hear news from my Brother and S-i-L who were induced yesterday at 38+2 with their twins. Twin 1 is head down, twin 2 is breech but the team are keen for her to birth naturally. We are in the UK so I think less interventionist. I can't wait to hear and that story makes me even more impatient for news!!!

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