I Gave Birth to Twins at a Birthing Center

It was early September. My husband and I were driving to our anatomy scan at our local birth center, excitedly discussing if we thought our second child would be a boy or a girl, nervously hoping for a report of good health from the ultrasound tech.

The pregnancy had been eventful so far. As with my first singleton, I had severe hyperemesis gravidarum, only this time around it was much worse. At 5 weeks, I was put on heavy medication in an attempt to stop my constant vomiting and dehydration. By 11 weeks, I had lost 25lbs with no signs of letting up. My care team decided that a PICC (Peripherally Inserted Central Catheter) line was the best solution so that I would be able to receive daily hydration and vitamins intravenously.

Despite the complications with my hyperemesis, my pregnancy was still considered low-risk which meant that I was able to deliver under the supervision of midwives. The midwifery model of care was exactly in line with my own birth philosophy – low intervention with an emphasis on not only physical care, but emotional care as well. At each appointment, I spent over an hour with my midwife, getting to know one another, asking questions, laughing, and even crying together. I trusted her implicitly with myself and my growing family. She was exactly what I had been looking for in a care provider – someone who really knew me and listened to me. I had done extensive research during my singleton pregnancy and was surprised to find research showed that a birth center or at home was actually the safest place to deliver for a normal pregnancy. After a wonderful experience at the birth center with my son’s delivery, I was excited to be able to deliver with her again.

Fast-forward to 21 weeks. We arrived at the birth center around 5 pm for the ultrasound. l laid on the bed in the cozy, dimly lit room, ready to see my baby for the first time. The tech began the ultrasound and a couple minutes in she gave a strange look.

“Is this your first ultrasound?” she asked. A little apprehensively, I replied that I had one at 5 weeks to confirm pregnancy and get medication for my hyperemesis, but it was very early on. My mind began racing with all the possibilities of what could be wrong with our little one. She said, “Well… I don’t know how to tell you this…” My heart skipped a beat. I squeezed my husband’s hand. “Well…. Do you know what I’m going to say?”

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Then suddenly, it all made sense. She was trying to tell me there were two. Two babies! What on Earth?! I gasped and looked at my husband, who was staring into space with his mouth wide open. I demanded to see the screen for myself and the tech proceeded to show me two perfect little girls. I began to cry. My husband and I had decided it would be my last pregnancy due to my health issues, so two babies for one pregnancy felt like the most wonderful blessing.

My next question immediately went to my midwife, “Can I still deliver here?” I knew that having twins automatically put me at high-risk in California and therefore I was ineligible to deliver with her. She reassured me that we would work it out. I could still deliver out of hospital if I hired an OBGYN to supervise who specialized in out-of-hospital twin birth – enter Dr. Stu, the only obstetrician in my area who delivered twin and breech babies out of hospital. We met with him and hired him the next week. He and my midwife agreed to concurrent care and the pregnancy proceeded without complications.

While we were overjoyed to have found a way to deliver out of hospital with our trusted care team, others had misgivings. I had many comments ranging from discouraging to downright hurtful. Many people told me that it was foolish to even try because I would go into labor early. Their reasoning, “Aren’t all twins early?” Others accused me of harming my children because I wasn’t putting them in what they saw as the safest situation – delivery in a hospital. People told me horror stories of twins and/or their mother dying (even though the stories were of twins who were delivered at the hospital).



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These comments made the last 4 months difficult. I was completely confident in my choice – that it was best for me and best for my babies. My first vaginal delivery was fast and uncomplicated, my twins were healthy and growing well, my doctor fully capable of delivering twins and babies presenting breech. I was an ideal candidate for an out of hospital twin birth. While most people were well-meaning, they were unresearched. They came from a place of fear, not facts. They then tried to put that fear on me as well.

I was aware of the various risks that could develop, but I was also fully confident in my care team’s ability to assess any issues that arose as we went along, and I had faith in God’s plan for whatever came my way. Despite the negativity, I stayed strong. I knew my body had the ability to carry my twins to full-term and deliver them vaginally, unmedicated, just like my son.

I Gave Birth to Twins at a Birthing Center

At 38.5 weeks, my water broke. It was 3:30 am. I didn’t have any contractions yet but I knew from my first birth that it was probably going to be quick. I called my midwife and told her I was coming in to labor at the birth center and got ready to go (as fast as humanly possible when you are gigantic with twins.) Half an hour later, the contractions started coming 5 minutes apart. We left for the birth center around 4:30 am. As many moms will tell you, the drive is one of the most difficult parts. I was laboring hard at that point, with contractions right on top of each other, unable to speak or do anything but try and breathe through the pain. My husband gently encouraged me as he sped down the freeway.

When we arrived at the birth center, I could barely walk. I began making low guttural sounds as I tried to amble up the steps. My midwife came over and gently placed her hand on my back – I screamed at her to stop – I just wanted to be left alone. We all gathered in the birthing room. Two midwives, two midwives assistants, the doctor, my husband, and me. It was quite the party in there. Everyone was excited for the rare chance to assist with an out of hospital twin birth.

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The environment in the room was one of quiet anticipation. Dimmed lights, hushed tones, the rush of water filling the tub. I leaned over the tub as intense contractions pulsed through my lower back. At around 5 am, I asked my doctor if I could begin pushing. He checked me, telling me that I was fully dilated and able to push. I got into the tub and after a few pushes, my daughter was born at 5:08 am. I was shaking so hard that I could barely hold her. Having been in labor for just over an hour, my body was in complete shock, struggling to catch up with all that had so quickly transpired.

I tried to enjoy the beautiful baby girl in my arms, but my only thought was that I had to do this one more time. Throughout this period of “downtime,” my doctor had been listening to baby B’s heart rate. I could hear a sense of urgency when he announced that baby B’s heart rate sounded low and that we needed to get her out. He had warned me in our appointments that this sometimes happened with twins because of the pressure drop after baby A comes out, so I was completely confident in his expertise in that moment.

After my husband cut the cord for baby A, all concentration went to getting her sister out. My contractions hadn’t come back as strongly, so my doctor began pressing on my stomach while I pushed so we could get her out faster. The pain was overwhelming, the intensity of the moment pulling me over the finish line when all I wanted was to give up. As her head came out, he asked if I wanted to catch her, and with the final push, I reached down to grab my baby and bring her up to my chest. A mere 16 minutes later, less than two hours since my contractions began, my second daughter had been born. No tearing, no complications, babies completely healthy. I was a happy, thankful twin mama.

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Birth can be scary, twin birth doubly so. More potential risks, more possibilities of things that could go wrong, but as my midwife constantly reminded me – twins are a variation of normal. God meant for my body to conceive these babies, to carry them – which was why I wanted to try and deliver them vaginally, unmedicated.

Not all pregnancies are the same, not all births are the same. There are many variations of normal. At the end of the day, it comes down to you and your birth values – the ability to CHOOSE. Research for yourself. Dig for information. Ask questions. Find a care provider who aligns with your philosophy and goals. Maybe that is at the hospital with a scheduled C-section, or maybe it is at a birthing center with a competent care team. But we should have choices. We should be able to start the conversation


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Hannah Mockary

Hannah Mockary lives in Southern California with her husband, 2.5 year old son, and 1 year old twin girls. Her experience delivering both her singleton and twins out-of-hospital was so all around amazing that she has become passionate about sharing this option with other moms! Besides chasing after three toddlers, Hannah stays active in the community by serving at her local church and part-time work with blogging/online marketing.   

A natural birth with twins? Yes You can!

When I found out I was pregnant with twins, I was doubly excited, and knew I still desired a home birth.  However, I realized many practitioners see all multiple pregnancies as high risk, and I would have to advocate for my wishes, while seeking out an experienced care provider.  As a home birth midwife, I have assisted with natural twin pregnancies in the United States, and abroad as a traveling volunteer.  While we are fortunate here to have medical interventions available, such as epidurals and cesarean sections, they are not needed for every birth, including every multiples birth.  So how can you best achieve your chance for a natural birth? Education, maintaining a healthy pregnancy, and trusting in yourself.  Here are my top tips to natural birth success with multiples:

 

Nutrition - starting in the first trimester, it is important to eat a health diet, including whole foods, lots of water, and a quality food - based prenatal vitamin.  One of the most important nutrients for moms is protein, which provides amino acids, known as the building blocks to cells.  With adequate nutrition, not only will you be growing healthy babies, they may also have a better chance of making it to full term, which also increases your success of a natural birth, while decreasing their risk of NICU time.  Good protein choices are lean meat, eggs, low mercury fish, beans and legumes.  Additionally, it is important to “eat the rainbow,” meaning many colors on your plate - think red peppers or strawberries, green broccoli, kale or spinach, oranges or carrots, yellow lemons or bananas, as each colored whole food provides different key nutrients and vitamins.  Drinking plenty of fluids will ensure babies have enough amniotic fluid, contractions don’t start prematurely, and can  help keep your fatigue at bay.  To combat nausea, try not to get too hungry, and keep bland snacks like cereal or dried fruit nearby.

Exercise - Once given the go ahead from your provider, prenatal exercise is another essential part of maintaining a healthy pregnancy, and will prepare yourself for birth.  Prenatal yoga, walking and swimming are all great options.  A walk outside also gives the added benefit of vitamin D!  When in doubt, consult before trying something new, and avoid heavy lifting, torquing maneuvers or high impact exercises, unless it is okayed.  During pregnancy, the babies need to get in optimal birth positions, and avoiding strenuous abdominal exercises, as well as doing weight bearing activity, can help make that possible.  As your pregnancy progresses, a maternity cradle, or wide, elastic band will offer support when standing or walking for long periods of time.  If you are placed on bed rest, ask if there is still any exercise you can do, such as leg lifts or arm exercises, because even a little movement may be beneficial.  You can also practice gentle breathing techniques, such as longer exhalations than inhalations or blowing, which may be helpful to use during labor.

Childbirth Education - Take a class with a local educator, watch natural birth videos, read childbirth preparation books and talk to experienced parents so that you have the knowledge to make an informed decision about your birth preferences, including place of birth.  A natural birth can happen at home or in hospital!  Research your birth preferences but be flexible.  Decide which aspects are most important to you, and also what part of your plan you could modify, in case things change.  In birth, preparation is helpful so you know what to expect, but the unexpected can occur, and its important to know why an intervention is being offered or recommended.

Self Confidence - now that you’ve ate healthy, exercised gently, and feel informed about labor and birth, hopefully you can enjoy your pregnancy!  I know easier said than done, but remember people have been giving birth forever.  Once you’re pregnant everyone has some piece of advice to offer, so take in the positive, and let the negative stories go.  Find affirmations or images that make you feel empowered and strong.  These can be your mantras during labor and birth.  Another essential is trusted a labor companion, which could be a friend, relative or partner, and statistics show that someone with a birthing person throughout their birth is the best thing you can do to reduce number of medical interventions.  Remember, this is a special time and you can do it!

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One of the best parts of an unmedicated birth is the feeling you have once your little ones are in your arms.  In fact it is the highest level of oxytocin, the love hormone, that a person will ever experience in their life!  However, no matter how birth happens, it is transformative and beautiful, and with multiples, only enhanced with each baby.


Here is our first family photo: happy, healthy and at tucked in at home!

 

Jacquelyn Ingram is a licensed midwife and international board certified vacation consultant.  In addition to serving home birth clients and teaching classes for expectant and new parents, she also runs a non profit corporation, Global Aurora Foundation, which aids individuals and non government organizations around the world, that serve women and children.  modelmidwife@gmail.com

2017 Birthing Instincts Year in Review

 

Well, that went fast. Another year of births, advocating and teaching for the Birthing Instincts team. I want to specifically thank my staff and students, Kati and Catalina along with all the midwives who refer and trust me with their clients. As always, a special thanks to midwives Beth Cannon and Blyss Young who have been with me through it all. It is always interesting to look back so let’s see what adventures, both personal and professional we had in 2017.  As always, I was available to answer questions, emails and calls from midwives and clients pretty much every day, 24/7 365. It didn’t take long to see that the 2017 practice was going to be caring for more and more breech families. As choices diminished with the retirement of Dr. Ronald Wu and the banning of breech and most twin deliveries at multiple hospitals women were left with fewer options. We are happy to note that friend and colleague, Emiliano Chavira, MD helped picked up the baton and gave women the option of a hospital breech birth at St. Francis Hospital in Lynwood, CA. The first week of January saw the waterbirth of our first 2017 twins born 45 minutes apart. The very next day we dropped off my daughter, Madeleine, at LAX on her way for her semester abroad in Barcelona. A month later I traveled to Barcelona to visit and we had a great time. Seeing the sites, sampling the food, the Salvador Dali Museum and catching a match between Barcelona and Real Madrid were all special. Not much better than Father-Daughter camaraderie.

Sadly, in late January, we lost my dad to his battle with father time. He lived a wonderful 96 years and will be missed (Reminder: You can hear some of his wisdom and humor when I had the good fortune to interview him on his 96th birthday at DrStusPodcast.com #100). Later in February I once again traveled with the charitable Cure Cervical Cancer team, this time to Vietnam. We spent just over a week teaching and screening for cervical cancer in the villages around Ha Long Bay. My stepson Max moved back to LA from Brooklyn so now all my kids are in the SoCal area and family gatherings were made that much easier. April saw the arrival of the Annual ACOG Meeting, this year in San Diego. While there was much to see and learn there was an obvious huge gap between the medical birth world and the midwifery one. I was inspired by the lack of acceptance of breech and limitations on VBAC and twins in the lectures to go on and acquire a breech trainer, Sophie and her mum. With the help of so many of you and a GoFundMe account I was able to raise nearly all of the $11,000.00. Thank you all so much. Happy to say the Sophie and her mum now reside in my apartment in downtown Los Angeles and are looking forward towards many journeys in 2018.

 

The month of May saw a well-attended ICAN event in Santa Barbara in support of VBAC. Dr. Emiliano Chavira, Dr. Terry Cole and Jen Kamel of VBAC Facts joined me and some eloquent VBAC mothers for an informative evening. We also had an emergency episode of Dr. Stu’s Podcast in support of our friend and colleague, Dr. Brad Bootstaylor in Atlanta. His local institution was trying to restrict legitimate birthing options. Funny, with more and more literature coming out supporting the importance of the microbiome and the concerning high cesarean rate you would like to think hospitals would be climbing on board instead of going backwards. Big sigh!

 

June saw me travel to NYC for a special night with an old friend and a dinner party in Manhattan. My friend worked for the United Nations and she and I were treated to a warm hug from Swami Amritaswarupananda Puri, the spiritual leader better known as Amma. A very special moment. Another special moment came when a local ENT physician and his wife had a beautiful home waterbirth against the best advice from all his partners and medical colleagues. What do they know, anyway? In July, I was privileged to be invited to the swearing in ceremony to American citizenship of one of my clients along with several thousand new Americans. Another very special and moving moment. Only a month later she gave birth in her bed at home. Welcome Piper!

Congratulations to my long-time associate, Jason Rothbart, and his beautiful bride, Leigh on their August wedding in Spokane. Nature continued to show its wonder with the total eclipse that, for 3 minutes, mesmerized the country. All year long many visitors came to spend time with me, saw clients, attended a few births and pick my brain. I enjoy these interactions and they keep me on my toes. With the onset of Autumn, Nebraska Birth Keeper Angie Hock spent a week with the highlight being a Los Angeles, Kings hockey game, of course! September saw my colleague Rixa Freeze of Stand and Deliver blog fame and me submit a paper for peer reviewed journal publication comparing 60 home breech births with 109 home singleton cephalic births. We hope it will be out very soon. In October, Sophie and her mum held their first seminar with Dr. Stu attended by local midwives in Ventura. We are very excited with the expanding teaching schedule for 2018 and we are hopeful to get CME accreditation so we can attract doctors, residents and medical students to these events. (Check the calendar page on the web site)

November is often remembered as the month of Thanksgiving and this year there was much to be thankful for. Our student, Catalina, discovered some very exciting personal news. More to come on that in 9 months! Dr. Stu gave a talk on breech techniques at the 2017 MANA conference. And while not everyone seemed in the thankful mood this year it was nice to see so many old friends and colleagues. Congratulations to Dr. Stu’s niece and nephew on the unmedicated delivery of his great niece proving once again that good things can happen in the hospital setting. Dr. Stu’s daughter, Madeleine, turned 21 and she celebrated by going skydiving with her friends and drinking legally with her dad. The year ended on a sweet note with a Christmas HBAC in Santa Barbara proving once again that good things can happen in the home setting, too! As always, Dr. Stu and his staff want to express their gratitude to all the mothers and fathers and birth professionals who have supported the Birthing Instincts mission. Your trust and assistance provide the sustenance that keeps us going all hours of the night. Happy new year to you all.

 

2017 Birthing Instincts Statistics

 Total Clients in care: 45

Transfer of care prior to labor (TOC): 6

 

1)     Twins, 37 weeks, SPROM, A is footling breech

2)     VBAC, Macrosomia, Type 1 Diabetes

3)     Twins, VBAC SPROM at 34 weeks

4)     Twins, SPROM at 35 weeks

5)     VBAC, IUGR

6)     Twins, TTTS at 23 weeks treated with Laser therapy

 

 

Laboring Clients: 39

                  Primips: 21 (Includes 1st time mothers and VBAC mothers)

                  Multips: 18

 

Vaginal: 32 (82.1%) (Home Vaginal Delivery Rate is 72%)

                  NSVD:                      15

                  Vacuum:                4

                  Twins:                      2

                  Breech:                   9

                  VBAC:                       2

 

Transports: 11 (Rate 28%)

                  Cesarean:               7 (Rate 17.9%)

                  Vaginal:                                    4

 

Transports in Labor:

1)     Breech, VBAC, Hypertension (VD)

2)     VBA4C, Pain

3)     Breech, Arrest @ 6cm

4)     Br/Vtx Twins, Arrest @ 7cm

5)     Breech, Arrest @ 7cm

6)     Breech, Floating @ 5cm, Footling

7)     42 Weeks, Desired pain relief (VD)

8)     Breech, VBAC, 4+ Meconium at 8cm

9)     Twins, VBAC, Sharp suprapubic pain at 10cm

10)  VBA2C, Hypertension (VD)

11)  Primip, Vertex, Desired pain relief (VD)

 

Summary: 45 clients entered into care with Dr. Stu as the primary caregiver in 2017. Many entered into care late in their pregnancy because of newly discovered breech presentation and midwife care going beyond 42 weeks. Six of these women developed antenatal problems requiring a transfer of care to a hospital based physician. Of the 39 remaining, 32 delivered vaginally (82%). There were 11 transports with 4 of these delivering vaginally in the hospital and the remaining 7 transports having a cesarean section (18%). All 4 vacuums were at the request of midwives to assist with their laboring clients. As our practice has evolved we are seeing more clients with conditions considered high risk in the medical model as choices diminish resulting in higher cesarean section and transport rates than in previous years. Many local midwives are accepting VBAC clients with more confidence and Dr. Stu saw more than 20 of these women in consultation for VBAC “clearance”. While not required by California law, consultation gives reassurance to those midwives and clients who prefer a second opinion. Structural 20-week scans and dating ultrasounds as well as biophysical profiles continue to be offered to midwife clients in a reassuring environment. In addition, Dr. Stu continues to provide the option of repairing significant lacerations in the home setting when requested. We assisted births from San Luis Obispo to San Diego and even had one family relocate from Aspen, Colorado to have their twin birth plan honored.

All of us at Birthing Instincts, Inc are honored to be of assistance and provide these services to the families and practitioners who desire them, wherever they may be.