“Well, I can see why you’ve been so sick” were the obstetrician’s first words after looking at the ultrasound screen. “That’s right…twins!!” But the shock of finding out that my (unplanned) pregnancy was twins was soon to be overshadowed by months of hyperemesis. I stopped being able to work. I was too ill to get up out of bed and couldn’t even walk to the bathroom without holding onto the walls. My days involved laying in bed, every slight movement of my head causing me to vomit into the white laundry tub beside me. Hospital visits to get my fluids topped up by an IV drip became a regular thing. I must have gone four months without washing my hair, as I couldn’t stand up in the shower and the smell of my shampoo caused projectile vomiting. I lost a lot of weight and became anemic… and I was miserable. But, much to my surprise, my babies kept growing. At around 22 weeks, slowly my appetite started picking up and I was actually able to keep small amounts of food and water down.
As my due date drew closer, I started to focus on my twins' birth plan. I'd birthed my first son naturally and drug-free and wanted the same for my twins' birth. Being a second time mum, I had confidence in my body to birth both babies naturally and I was determined to do just that. So, with this plan in mind, I was shocked and disappointed when the obstetrician told me a drug free birth with twins would not be possible under his care. An epidural was a 'must'. "I've seen too many twin births go pear shaped to take that risk!" he told me. "But it's just for pain relief, I don't understand the risks" I asserted. I was told that, as a blanket ‘rule’, all twin births needed to be supported by an epidural in the event that twin B (the second, non-presenting twin) needed some manual manipulation, once twin A had been birthed. Apparently having this done without pain relief was VERY uncomfortable. It just wasn’t in this obstetrician’s scope of practice to support an unmedicated twin birth. Fair enough. But his words of warning didn't dampen my determination for a natural birth. I'd just find an obstetrician who WAS willing to support a woman centered, natural twin birth. Working within the health regulatory sector myself gave me access to health practitioners across a wide range of disciplines. I did some asking around and was given the names of couple of obstetricians to try, eventually finding one willing to support my birth plan!
With my new obstetrician and team of midwives on board, and my hyperemesis at bay (for now), I thought the rest of my pregnancy would be smooth sailing. I couldn't have been more wrong! At 32 weeks I came down with influenza, which, along with complications arising from my hyperemesis, saw me hospitalised in the ICU for a week. The day after my discharge I was straight back in again, due to an excruciating fractured rib (thanks to my persistent hyperemesis and vomiting returning with a vengeance) and the concern that my illness may bring on pre-term labour.
While in hospital, I was hit with yet another huge blow - my twins were now both breech. I was told that, while some obstetricians may be willing to support a vaginal twin birth with a breech twin B, virtually NONE would agree to support a vaginal birth with BOTH twins presenting breech. WHY, though? I couldn’t seem to get a clear answer. Head entrapment was the main concern, though the risks associated with this could easily be mitigated by a breech experienced care provider. All I knew was that ever since the Term Breech Trial (a trial that was since deemed to be flawed in many ways), vaginal breech births were uncommon due to clinical deskilling. Vaginal breech birth was sadly a dying art. I knew what that meant - a c-section was looking like the inevitable. I probably googled 'how to turn a breech baby' a hundred different times, I did acupuncture, chiro, headstands in the pool and all of the spinning babies techniques. I even tried rubbing ice on my belly with music playing at my crotch!! Sadly, nothing worked and I burst into tears in front of my midwives and doctor when, at 37 weeks, I was told that my babies were both still breech. "Well, that's no good" my obstetrician (the amazing Dr B) said casually "But it IS possible to have a vaginal birth with two breech twins, if that's what you want". ‘Pushing the envelope’ was how he described it, but if he was willing to support me, I was confident that I could do it. He went over the statistics on breech birth outcomes and gave me links to research on the topic (having a university A/Prof in Obstetrics as your OB has its perks). I felt more assured than ever in my decision to stick to my natural birth plan. Breech, after all, is simply a variation of normal, and my obstetrician was definitely a 'unicorn' in the world of obstetrics – a true breech expert. He had to be one of the VERY few care providers in the country with the clinical skills, experience and confidence to deliver two breech twins naturally! My partner (Tean), coming from a risk averse legal background, was initially opposed to the idea of an unmedicated twin birth, and particularly opposed to an unmedicated vaginal double breech twin birth. Luckily, he was willing to keep an open mind, and after listening to both Dr B and I, had a change of mind. His contribution involved a statement along the lines of “I’m not into this hippie stuff like she is, but you seem to know what you’re doing”. Yep, and I was ready to DO THIS!
With that decision made, there was still concern about the way each baby would present during the birth. There was also concern about the increased risk in still birth for twins born after 38 weeks. I was well aware of the potential for a 'cascade of interventions' if I was to be induced, however, my obstetrician was quite firm in his advice that I be induced at 38 weeks and no later, should I not go into spontaneous labour beforehand. My instincts told me I ‘needed’ to go into labour naturally, but I had so much faith in my unicorn obstetrician, I was willing to put those feelings aside.
I went over my 'Active Birth Skills' notes and tried to mentally prepare for the now imminent arrival of my two babies. Squeezing stress balls had gotten me through my entire 36 hour first labour without the use of any drugs, so stress balls were my plan of action this time around too. I'd also enlisted the help of a doula, Brita, who was an amazing twin mum herself. Between Brita, the midwives and the unicorn obstetrician, I knew I was in the best hands possible, whatever the final outcome may be. At 37+3, during my now daily check, Dr B noticed that baby A had put his foot down. Literally. Footing breech meant a vaginal birth was a no-go and my obstetrician could actually feel the baby's foot above my cervix! I was also 2 cm dilated and there was concern I might be going into labour. I stayed in hospital overnight for monitoring, the concern of an emergency c-section hovering above me. Luckily by morning, baby A seemed to have shifted his foot, so with great relief I was sent home.
My only other obstacle was now the induction I'd likely need. At 37+6 a stretch and sweep was performed to try and get the labour ball rolling. If that didn't work, my membranes would be artificially ruptured the following day, and if THAT didn't work, a medical induction it was. Waking up in the prenatal suit at 38 weeks, all of a sudden it hit me - I'd be meeting my babies for the first time that very day! I had butterflies. I was also nervous at the thought of how the induction process would pan out but trusted in my obstetrician’s advice that this was the best choice, particularly as he had been so understanding of my concerns and desire for a natural birth from the get-go.
I was taken down to the delivery suit and at 9am. “How are you feeling? Any type of pain?” asked Dr B. “Well, aside from my rib fracture and feeling like my back is about to give up the ghost… I’m feeling some stomach cramps, sort of like period pain”. “Period-like pain is a good sign!” he said. Phew! At least something now seemed to be going in my favour. Twin A’s membranes were broken. Dr B prodded them with a medical ‘hook’ and out it gushed, splattering amniotic fluid all over my midwife’s pants! I was mortified. “At least it didn’t land in my mouth like it sometimes does!”
I was surprised by how quickly the surges started, very softly at first. I bounced on the fit ball, a stress ball in each hand, while one of my midwives sprinkled clary sage oil around me. The atmosphere was calm, almost tranquil and I felt good - relieved too, that no medical induction would be necessary. The surges became stronger and it was at that point that I called my doula. “I’ll just jump in the shower and then head on over!” she said. She lived about 50 minutes from the hospital, so I just hoped there was no traffic and that my surges didn’t get too intense in the meantime. Labour was progressing much more quickly than it had for my first birth. I had been warned that it would – but I was still surprised by how quickly the stronger contractions had started happening. My doula arrived about two hours into the contractions starting – another big relief for me! She knew precisely the spot to massage when the surges really started to kick in. I was lying on my side on a padded floor mat by this stage - the fit ball was no longer cutting it for me. Over the next few hours contractions became more and more frequent and more and more painful. Okay, excruciatingly painful is the only way to describe it. The hospital Head of Neonatal Medicine kept popping into the room to check on my progress, as did Dr B and his registrar. “How much looonger?!” I whined to the HNM at one point. “Not much longer now” she said unconvincingly. “I can’t dooo thiiis!” I moaned. “You ARE doing this!” said Ali, one of my midwives. She was right. “Healthy pain, healthy pain” – this was my mantra and I kept repeating it over and over in my head, through each and every contraction. I squeezed my stress balls. I squeezed them so hard that by this stage my hands were stained by the yellow dye that was rubbing off them.
With the pushing stage now imminent, the room was packed! Tean, Dr B, his registrar, the Head of Neonatal Medicine, three midwives, two pediatricians, my doula (Brita) and a student observer were all crammed into the birthing suite. There were also knocks at the door every now and then - other health providers wanting to come in and witness a double breech birth in action. I moved onto the birthing stool (a ‘seat’ designed to assist a mum-to-be in an upright position during birth) to help gravity do its work. I squeezed my stress balls through every coached ‘PUSH!’ and pushed with all my might. At some point I screamed at Dr B - “Just pull this thing out of me!!!” But he didn’t. He very calmly and methodically told me to push a little harder. For me, pushing out a breech baby felt different to pushing out a cephalic baby. There was no ‘urge’ to push. It took a lot more strength in each push to feel like I was getting somewhere. There was no feeling of relief once the head had emerged, so it seemed to take longer and required more ‘coaching’. Six painful, HUGE, exhausting pushes later, twin A, our little boy, finally emerged bottom first into the world! Ever so lightly, Dr B held his body (so he didn’t plop down and fall right off the birthing stool) while I pushed and just before the head came out, his chin was tilted downwards to prevent it from getting stuck.
Half the job was done! I was elated, but now had to refocus my efforts on getting twin B out safely. After a short while, our baby boy’s umbilical cord was cut, and he was handed over to Tean for skin to skin. I then moved up onto the hospital bed, just in case twin B needed some manipulation in order to get out. My stomach was prodded and the monitors were moved around. With HUGE relief to me, twin B was still bottom down and ready to make her entrance! I was almost there – I just had to push her out now and the hard part of the birth would be over. Dr B broke twin B’s membranes and the second gush of amniotic fluid rushed out. The surges continued and with another five pushes-with-all-my-might, our little girl emerged, also bottom-first into the world! This time, my obstetrician didn’t even touch her until the very last moment, just tilted her chin down enough once her body was present in order to prevent head entrapment. She was brought straight up onto my chest and she latched on for a feed almost immediately. Pure magic! Then… the emotion seemed to hit me and I burst into tears… I’d just given birth to two babies – two BREECH babies – without any drugs or medical interventions. I felt on top of the world! Once twin B’s cord had stopped pulsating it was cut, and my two beautiful, perfect, HEALTHY babies were brought back into my chest for a feed. I was in a bubble of bliss! Then, without warning, the bubble burst. My midwife, Ali, was in tears next to me and Brita was hugging her. “What’s wrong?!” I asked. What had I missed? Nothing, it turned out. She was overcome with emotion, relieved and elated with the amazing birth she’d just supported! I later found out that a birth like mine was extremely rare - most midwives will go through their entire career and never witness a double breech vaginal birth of twins. Our twins - a little blonde-haired 2.72 kg boy and little dark-haired 2.57 kg girl – were named Samson and Amaris, meaning ‘sun’ and ‘moon’. After a six and a half hour labour from start to finish, I couldn’t be happier.
Following the delivery of the placentas (a part which is all a bit of a blur really as I was still in my ‘bubble of bliss’) and some alone time with our new babies, my superstar obstetrician, Dr B returned to the room. “Turns out this ‘hippie’ might be onto something!” he said with a smile. I’d had, according to him, a ‘textbook’ vaginal breech birth (and double breech, at that!). Zero complications, zero tears or scratches and, most importantly, two incredibly alert, healthy babies!!
Recovery from the birth was amazingly fast - I honestly felt like I could have gone for a run half an hour afterwards! Both babies also took to breastfeeding really well, and (despite my hyperemesis and worries over not being able to breastfeed twins) my milk supply was overabundant! I went on to not only exclusively breastfeed the twins, but I also managed to donate over 120 litres of my breastmilk to other local families and NICU babies.
In retrospect, I now consider my twins’ birth to be a life defining moment. Not only did it make me the mum of two gorgeous, healthy, inquisitive, playful, cheeky, loving souls, but (and without wanting to sound too corny!) it completely changed my self-concept and outlook on life. I feel more confident – in my choices, my physical capabilities, and in my own instincts. I feel strong, resilient and brave. Why? Because I stepped outside of my comfort zone, I asked questions, I read all the research and then some, I chose not to blindly follow protocols, I overcame major health challenges, I advocated for myself and my babies under a unique set of circumstances, I persevered with my belief that I could have the birth that I wanted, despite the many objections and nay-sayers… and I DID IT!
