Xavier & Cairo’s Natural Twin Birth – The right team & the right skills

When we fell pregnant with our first child we planned to have a home birth. A beautiful, romantic, divine home birth. We engaged Sheryl, our amazing midwife, and began to prepare to welcome our child into our home in November 2013.

I was going to be in Bali teaching yoga for two months in my second trimester, and we’d decided to decline the 12 week scan. It all seemed a bit complicated to arrange before I flew out and the pregnancy seemed to be progressing normally. I was happy, healthy and not experiencing any unusual signs or symptoms.

Off I went to Bali, and day by day my belly got bigger.

At 15 weeks my husband came to visit me. I was so excited to show him my little tummy. I was really beginning to show. I remember saying to him that I thought I looked big for 15 weeks and that my mum hadn’t shown until she was nearly 5 months along. As the days passed I began to wonder if there was something wrong? Perhaps I had gestational diabetes and the baby was getting really big. I spent hours on the internet scanning for images of other women at 15 weeks pregnant to see if there was anyone with a belly as big as mine. I contacted my midwife and between us we decided that it was just really hard to tell if I was bigger than ‘normal’. Perhaps it was just the way I was carrying.

At 18.5 weeks (still in Bali) I sent Sheryl a message saying that I felt HUGE and that I wondered if there could be two of them in there. It was a bit of a joke, as the students on the teacher training program I was working on kept saying “Are you sure it’s not twins?”. I dismissed the possibility of twins because there were no twins in my family and just thought that I must have been carrying my whole pregnancy out in front. Little did I know that’s not quite how it works with identical twins. They don’t run in families the way that fraternal twins do. Identical twins are a miracle.

Two days after I arrived back in Australia, at 20 weeks, we had our morphology scan to find out the sex of the baby.  We were so excited we could barely contain ourselves. The sonographer began to scan and I looked at the screen. It was the first time I’d seen an ultrasound of our baby and I was thrilled. An arm, a leg, another arm, another leg, a head, there were tiny body parts everywhere. While I was excitedly calling out the names of each body part, my husband was staring at the screen and then at the sonographer and then back to the screen. He has an 11 year old son, and from memory, he was pretty sure that a baby didn’t look that messy on an ultrasound. At the same time as Tim started to become concerned, the sonographer put down the ultrasound equipment and put her hand on my arm. My heart dropped into my shoes. The first through that popped into my head was that she was going to tell me there was no brain function. That the amazing little human, who I’d become so attached to, who I’d been feeling move around, was not viable. That there was something horribly wrong. As she held my arm she said “You know there’s two of them in there?” Tim and I looked at each other and screamed in delight! Then we swore and screamed and yelled, and then I felt like I needed to be sick. Twins, we were having twins. Spontaneous, identical boys. A 1 in 3,000 chance. This was so cool! I’d wanted a baby for such a long time and now I was having two! At the same time!

I called Sheryl as soon as I could speak. She guessed straight away what I was going to say. We were all jumping out of our skins with excitement! But carrying twins made my pregnancy high risk. Our little boys shared a placenta, but had two separate sacs (mono/di twins). It’s not the most risky configuration for twins, but it does carry it’s own potential difficulties. We spoke with Sheryl and decided that in order to preserve the sanctity of home birth and not chance becoming a bad news story, that we would move our birth to a hospital. We were blessed to be guided to The Royal Women’s Hospital in Randwick where we were cared for my the most amazing team.

Knowing that I was making the right decision for the birth of my babies didn’t lessen the grief I felt about letting go of the home birth that I so dearly wanted. I had visualised the most beautiful setting in our living room. Candles, low light, a birthing pool, and my baby in my bed with my husband. I cried. I cried a thousand tears for the loss of my home birth, for the fact that we would be giving birth in a hospital room with a machine that goes bing. I grieved the loss of intimacy as our birthing team of 3 turned into a circus of 10. But with Tim and Sheryl by my side, I decided that I would turn this around. That despite the fact that I was going to be in a hospital room I would create a home birthing ambiance. That I would, with the assistance of Tim, Sheryl and our OB Andrew, advocate for the most natural, intimate birth I could.

23 weeks arrived and I had another ultrasound. My cervix had begun to shorten. 5cms to 2.5cms in 3 weeks. I began to panic and I was referred to the Maternal Foetal Medicine department at the hospital for further monitoring. We wer

e now going to be scanned every two weeks. I cried again. I hadn’t wanted to be scanned so much. In fact I had only wanted to have one, maybe two scans during my whole pregnancy. But we made the decision that we needed to scan regularly to make sure the boys were ok. The risks of Twin to Twin Transfer Syndrome (TTTS) and my shortened cervix were too high for me to decide to decline further scanning.

At this point I decided that I needed to get really pro-active. We’d just attended the amazing She Births course and I knew that if I didn’t start to really ask questions and get organised, that there would be more surprises, so I wrote our birth plan. One plan for a natural birth, one plan for the C-Section delivery of twin two and one plan for the C-Section deliver of both babies. Sheryl helped me work through all of the points that needed to be reviewed and we had meetings with the teams at the hospital. There were about 4 drafts of the birth plans before we all agreed on how we would proceed. We went through every detail, in detail. I asked why and what at every point along the way. I was determined to understand everything on the hospital’s standard procedure sheet. I had some powerful and really constructive conversations with both the team in Maternal Foetal Medicine and my OB.

In the end I agreed to a lot of the standard procedures (including induction at 37 weeks), but I refused the epidural, which is administered with twins to help if an emergency delivery of twin two is required. My OB provided me with several other options and explained the risks of not having the epidural in great detail, but I was determined to feel everything.

At 37 weeks the day came to be induced. We tried several more natural options, including a foley catheter and artificial rupture of my membranes to get things started, but nothing was happening. At 11am we started the syntocinon. Nothing happened until 2pm. Then it was on. My contractions were in full swing. I told Tim to call Sheryl “and tell her to be here by 3pm!”. I was in established labour and it was intense. The contractions rolled one into the other with no breaks.

The syntocinon had been turned off once my contractions were established, but it had done it’s job. The contractions became stronger and stronger, with no breaks, and I began to loose my grip on things. I was in the warm pool but I was freezing cold. Sheryl and Tim were pouring more and more hot water in but I was still freezing. The midwives decided to take my temperature. It had spiked from 37 to 39.5 degrees. It turns out that the group B Strep that had shown up in a swab prior to the labour had taken hold. We think it may have been because my waters were broken early in the day. Either way, that had been my choice and looking back I still wouldn’t have done it any other way. I wanted to exhaust all of the natural options first.

By this point I was inconsolable and the contractions continued to roll on. I had thrown all of the monitoring equipment across the room and was refusing to put it back on. In my head I was begging someone to offer me an epidural. I remember that I kept saying it was too much, that there were no breaks. But no one did offer me the epidural and I would’t ask for one out loud.  If I was at home there would have been no epidural, but there wouldn’t have been any syntocinon either. What did get offered was the gas, and I took it. It gave me something to focus on that wasn’t the intense rolling contractions that seemed like they would never stop.

Apparently no one except me was that happy with the fact that I’d thrown the monitors away and was refusing to put them back on, so they called in the OB to do an internal to check how things were progressing. I was fully dilated. Not only had I been delirious with a super high fever, I’d been going through transition too. No wonder I had thrown the monitors!

Xavier was born head first at around 7.30pm. My amazing husband caught him as he came out and placed him on my stomach. I was elated. I’d just birthed the first of my two little boys and he was perfect.  It was perfect. I felt strong and I’d listened to my body, only pushing when I felt the urges. After a few minutes of Xavier being out, Tim cut the cord and Xavier was wrapped in a blanket for me to hold. I offered to breastfeed him, but he must have known that I was going to be very busy again soon. I remember Tim taking our little boy on his arms and going to sit in a chair nearby. This is my most vivid memory from the birth. I remember looking over and seeing my beautiful tiny little baby in the arms of my big strong husband and knowing that he was safe. As soon as I saw that my little boy was safe I knew I was ready to birth again.

The room was full of excited people, there’s quite a team when twins are involved, but I called them all to order. I had another baby to birth and I needed to concentrate.

With Andrew’s guidance I began to birth our second boy. He was posterior and breech, and I distinctly remember Andrew telling me that I needed to work with the baby to turn him. With each push I visualised little Cairo turning. And with each push he did. He turned a little more each time, and then he was with us.

Natural Twin Birth  – After 5 hours of intense labour, both little boys were in the world and on my chest. They began to feed almost instantly, and so did I, as Sheryl fed me chocolate. I was in heaven.

I was quite positive about my ability to successfully birth my boys prior to the course, but afterwards I knew I had everything I needed and would be able to birth my babies in the way that I wanted to. No matter what happened along the way.
I used a lot of sounding. Long low sounds through out. The massage and acupressure were great during the labour, but the most powerful tool by far was the birth preferences template. Because we were having twins we were able to plan for a vaginal birth, 1 x vaginal and one C-Section and a double Caesar. The planning process allowed me to process and surrender to the flow of the moment.
Tim felt more empowered after the course. He felt that he had practical tools to use during the labour to help me. Absolutely. We’re a team anyway, but She Births helped us to shape our expectations of each other and allowed us both to be engaged throughout.

We stayed in hospital for the next 3 days with wonderful care, until we decided that we were ready to bring our boys home. Bringing our children into our home for the first time was a wonderful moment. Exhausted and relieved we all crawled into bed and rested, just like I had wanted to.

Despite some complications along the way, this birthing experience was the single most empowering and extraordinary experience of my life. I’m glad that we chose to birth our twins in hospital in the end. We needed the support that they were able to provide. I’m also really proud to have advocated for myself. I asked the hard questions, had the difficult conversations and was well informed. This helped me to make the choices along the way that made my birthing experience so magical.

I would like to thank the team at The Royal. They helped us to create what I call my home birth in hospital and it could not have been more perfect. It would not have been possible without our wonderful midwives, Sheryl and Jo and our inspired OB Andrew. Special thanks to the team in Maternal Foetal Medicine who had to endure some pretty tough questioning and to Michelle our third midwife, who came in at the change of shift and captured some of the most amazing birth photos I’ve ever seen.