The Centers for Disease Control and Prevention’s National Center for Health Statistics has found that in 2009 — the most recent year for which complete information is available — the cesarean section rate hit another record high at nearly 33 percent. The International Cesarean Awareness Network (ICAN) points out that this is the 13th consecutive year cesarean rates have increased. It says a surgical birth rate of nearly 33 percent roughly equates to 1,359,105 out of the 4,131,019 births in the United States. C-section rates for multiple births are even higher. They are also higher for breech babies (some docs won’t even try to deliver a breech naturally), women with preeclampsia, and women whose labors are induced. If you’re dealing with all of these issues, you’re almost guaranteed a date with a scalpel.
But not Elysia and her twins. Please read their amazing story:
(Warning: Graphic and includes a lot of labor and delivery lingo)
On Tuesday, May 17th I went in for a routine 36 week office visit. My blood pressure was a bit too high, and there was a bit too much protein in my urine, and I was more swollen than they liked to see, so they drew some blood to do additional testing and sent me home with a kit to collect urine for analysis. They did a vaginal exam while they were at it, and I was 2 cm dilated, 50 % effaced, with Baby A at a -1 station.
The next morning around 8:30 I woke to a phone call from the doctor’s office. My liver function was off—preeclampsia—and they wanted to induce as soon as I could get to the hospital. As a “high risk” twins birth, I already knew we would have to have continuous monitoring on both boys, a hep lock, and to deliver in the operating room with a doctor rather than a labor room with a midwife. I hated that now we would have to spend the whole time laboring at the hospital instead of getting started at home. But I was very ready to get those boys out of me, so there was a level of relief involved, as well.
Chris came back from work, we finished packing our hospital bag, and headed to (the hospital). We arrived around 11am, I think, and our doula was already in our room waiting for us. The nurse midwife on duty, spoke with (our doctor) on the phone, and since my cervix had started dialating already and I was going to be hooked up to a blood pressure machine for the preeclampsia and monitored continuously anyway, they recommended trying a small dose of Pitocin to try and kick-start labor. They started me at 1 (I don’t know the units—but 16 is considered to be the “equivalent” of your body in labor, and the midwife I’d seen at the office the day before said that 32 was how much doctors often dispensed at a previous job) and gradually worked me up to 9. At that point (the doctor) came in and recommended we dial back the Pitocin, and break Baby A’s water. She didn’t want to increase the Pitocin any more and put any more pressure on my over-extended uterus (I had measured 50 cm at the office the day before) and thought that AROM would do the trick. After we allowed her to break Baby A’s water, I started to finally feel some cramping, and they decreased the Pitocin to 2, then 1.
I was totally miserable before labor really even began. The itching I had felt for 7 months had gotten worse in the last few weeks, and was aggravated by anything touching me, and I had three bands tied around my belly monitoring the babies and me, an IV, and a blood pressure cuff. The labor nurse tried to find a wireless monitor so I could shower, but the hospital didn’t have a hook-up that enabled them to monitor twins wirelessly—only one baby—so I was tethered. And Baby A was so far down, they had a hard time keeping the monitor on him, so my range of motion was hindered. And although we had previously talked about eating and drinking at will, my new higher-risk situation put me on a clear liquids only diet. (My doula) went and brought back good jello and ginger ale for me.
In late afternoon, I finally started to have some strong contractions. Around 7pm, our doctor was relieved by (another doctor). With our first doctor, we had long ago talked about how she might deliver vertex/breech twins. If Baby A presented head down, after delivery she could reach up briefly into my uterus and pull Baby B out by the feet. The relieving doctor was more concerned about the fact that Baby B was breech, and recommended I consider an epidural because reaching up for Baby B could be unpleasant, and she didn’t know me or know how I would handle that sort of internal manipulation. Also, she was recommending we do an internal monitor on Baby A since he was so far down and we kept losing him on the external monitor.
I kinda got freaked out about her epidural recommendation. Things already felt so different from what we had hoped—and I wasn’t coping very well. I asked the nurse to find our midwife, and she came in and we talked. She said the doctor was just very thorough and wanted me to know the range of possibilities, but that I should stick to my birth plan if that was what I wanted. Our midwife’s background is as a home-birth nurse midwife, but she had additional experience in a more medical/obstetric practice model, as well. Also, our doula has twins who were delivered at 25 weeks gestation—so small she couldn’t even touch them for weeks after they were born. Sure, a lot of our options and birth plan were no more, but I didn’t need to feel pressured to make this decision.
I felt (emotionally) much better after talking with her, and continued laboring, miserably itchy, with limited range of motion due to the monitoring, and my blood pressure cuff, and the IV… The nurse, our midwife, and our doula took turns holding Baby A’s monitor in place so I could be on the birth ball instead of in bed.
Then, it felt like the contractions wouldn’t stop. No break in between. I didn’t feel like I could keep this up without a break—and got hopeful that maybe this was transition and it wouldn’t last long and we would be through soon—only to discover I was only 4 cm dialated, 80% effaced, and that this was probably back labor that continued between the contractions.
I requested an epidural, and an internal monitor for Baby A.
They were a huge relief—and everyone kept remarking what a great epidural I had! Kinda scary—everyone seemed so amazed because I could tell when the contractions happened, but they didn’t hurt, and I had enough feeling in my legs that I could lift myself up a fair amount and roll over with just a bit of assistance.
And then we slept. Around 7 am maybe, the doctor came in and found that I was around 8 cm dilated—really just a lip left around one side, that would probably go away if we rolled me on my side. A while later, our midwife checked again—good to push! I expected it would take hours, especially since I had had an epidural, but apparently that “great epidural” I had allowed me just enough sensation that I could push effectively. It was really nice to finally be able to do something—instead of just wait. After only a little bit, I was told to just hang out, that they were getting the operating room and the doctor. I wanted to keep going—not wanting to spend any more time in the operating room than necessary, as the bed would be more narrow, the lights brighter…
…but we made the transition to the operating room pretty quickly. They transferred me to the operating table, inclined it a bit so I wasn’t flat on my back, and our midwife set up an ultrasound on Baby B while I worked with the doctor to push out Baby A. It didn’t take but a few more pushes. At 36 weeks 6 days gestation, at 8:41 am Thursday May 19th, baby A was born. 7lbs 4 oz! His cord was too short to put him on my belly, and once Chris cut the cord, a nurse whisked him to the side and everyone went into high gear to get Baby B out.
The doctor reached up and broke my second bag of waters—which gushed out. Baby B then crawled up into the topmost corner of my now-roomy uterus and did the splits, trying to avoid being born! The fear was that he would move transverse, get tangled in his cord, or that my uterus might hemorrhage, so the doctor tried grabbing his feet to pull him down. After almost 20 minutes with her hand in my uterus, she managed to get him where I could push him the rest of the way. At 9:01 am, Baby B was born breech at 7lbs 5 oz. His cord had been a bit compressed on the way out, so the nurses went to work on him, and it took a bit for him to pink up and cry, but he did.
While they were tending to Baby B, the placentas came out together. Then the doctor sewed up a 2nd degree tear and our midwife started “massaging” aka, POUNDING on my uterus. They upped the Pitocin, but I still wasn’t contracting enough to avoid bleeding too much, so they gave me something stronger. The anesthesiologist had turned down the epidural and left, thinking the show was over, but the uterine manipulation really hurt, and the doctor yelled for someone to get it hooked back up, which they did rather quickly, but ugh…I hadn’t been prepared for that. My uterus finally started to respond to the drugs and our midwife’s pounding, and they rolled me back to the labor room. our midwife kept pounding, and the unpleasant side effects from the anti-hemorrhage medicine kicked in. After a hazy amount of time, they transferred me to a post-partum room and brought in the boys, which we then named Milo (baby A) and Everett (baby B)..
Both babies had blood sugar issues— one Everett’s landed him in NICU later that night on an IV and antibiotics, and Milo quickly lost 10.4 % of his birth weight, which freaked everyone out. By Saturday evening, Everett’s blood sugar was under control and they were weaning him off the antibiotics. On Sunday I was discharged, but allowed to stay in the room as the twin’s guest, and Everett was allowed to room-in with us while the NICU staff periodically checked in on him to make sure he was doing well. After passing their car seat tests (a preemie birth requirement—they strap them in the seat and monitor their heart/lung function for an hour) we were all sent home on Monday, with the stipulation that we see a pediatrician the next day to monitor Milo’s weight.
I am so grateful that I went ahead and had the epidural, because they would have had to put me under general anesthesia to get Everett out otherwise. And while in my hazy immediate post-partum state I didn’t get the good breastfeeding start I would have liked, at the time of this writing, both boys have regained their birth weights and are finally starting to get the hang of latching on, though they still have to wait their turn as we haven’t figured out how to tandem feed them just yet.
So…not the birth we “planned” for, but we are delighted they are here! I’ve got to say, though, that having only one baby sounds so…manageable. Two is a lot!!!
The take home messages of this beautiful birth story? Giving birth involves a team, and you are captain of that team, sometimes things don’t go as planned, so be flexible, AND you can do more than you think you can. I bet Elysia amazed herself on this day, and continues to amaze herself.
She amazes me.
Thank you so much, Elysia, Chris, Milo and Everett, for sharing your story.