Part 1: choosing my birth support
Giving birth to my first son Kyriacos entirely under my own steam, by candlelight at the Birth Centre as night turned into dawn, was the greatest day of my life. I was the first to hold him, nobody took him away from us. He slowly opened his eyes in my arms, nursed and then Mike cut his cord after a long delay. It was the biggest achievement I could have hoped for. I buzzed for days, high on oxytocin and happiness, long labour forgotten.
Likewise, the first part of Alexander’s birth was wonderful, relaxed and in control at home with the same birth candle burning and the sounds of waves crashing. I had a super short first stage and wonderful relax in the pool through transition, before transferring to hospital for ventouse assistance to move the stubborn OP baby down. A traumatised Alexander at birth, but no episiotomy or stitches for me, and recovery was very fast. In the sling he went and Kyriacos and I went about our summer of fun with little disruption.
I had one wish for the twins’ birth, as I knew, sadly, that it would be my last. Four children is quite enough, and I’d had to work on Mike to push him to three. I had to make the most of every moment of this last birth. To replicate Kyriacos’s birth was the ultimate goal, but I knew that this might be more tricky with twins. I wanted to be a protagonist, not a patient.
Mike and I have always had opposing views on birth: he thinks birth is what doctors and hospitals are for, I think sick people are what doctors and hospitals are for. Although I still longed for a home birth, I had accepted the compromise that our next child would be born in a midwife led unit at a hospital.
It soon became apparent that there were several hurdles to overcome to achieve a natural twin birth that would be supported by most hospitals and midwives:
1) twin one (the presenting twin) had to be head down;
2) there would be some pressure to induce early (a long time before I considered my natural gestation length of 41 weeks as for the previous pregnancies); and
3) there may be pressure to accept a host of other unnecessary routine interventions.
I desperately wanted to minimise interventions and do this birth under my own steam. I investigated birthing support: doulas and independent midwives and it soon became clear that the independent midwife route was the only way I could hope for the birth I wanted. I searched for independent midwives with twins and breech birth expertise, and found Annie Francis. Annie and her colleagues at Neighbourhood Midwives could offer a reduced price package to top up NHS care, which was perfect.
With Annie on board, one of the first worries about which I confided in her was the limited facilities at my nearest hospital. I had heard of others where twin mums had given birth in the pool, and wanted Annie to put her feelers out to see what alternatives we had. She quickly arranged a meeting with a consultant midwife in a different hospital, which offered more choice to someone in my position.
The birthing room at the birth centre in which Annie and I had our first meeting with the consultant midwife was huge, had an en suite bathroom with own bath and shower, mats, a birthing ball, bars on the wall and a large comfy looking sofa. “I would love to give birth in this room” I whispered to Annie in excitement.
As my due date approached, we managed to move into our new kitchen, get past Christmas and New Year’s Day (not such good birthdays), organise the twins’ room and repaint the bathroom. Then before I knew it, I was 39 weeks and all the wishing that they would not yet arrive turned on its head and into worry that they now might have to be induced. I’d only had a few bouts of mild contractions and the home induction techniques that we’d tried over the last few days had shown no signs of moving things along quickly enough.
On Monday 5th January at 39+2, my blood pressure was slightly raised (and my ankles had been swollen and puffy for a couple of weeks) and I agreed with my consultant that I would come in the next day for a low dose 24hr administration of propess, with the option to go home for a sleep and reassess my options if it didn’t work. She gave me my first ever sweep and a pretty low bishop’s score, indicating that my body was not particularly ready for this birth to happen and that spontaneous labour was probably some way off. She gave me a 60% chance of success with propess the following day. I waddled quickly to catch the tube home, a desperate last attempt to ‘walk them down’. Since the next day was the twelfth day of Christmas we took down the decorations at home and made ready.
Part 2: the twins’ birth day
I walked and tubed to the hospital, bought a ton of magazines and snacks and was set up by the consultant midwife with the propess and telemetry monitors at 11am in a small side room. All the birthing rooms on both the hospital birth centre and the labour ward were full. Was it something to do with the full moon the previous evening?
The good news was that my cervix was now favourable and would comfortably admit two fingers. The midwife could feel twin one’s head but it still needed bringing down a lot more. Twin two, who had been breech since 29 weeks, now seemed to be transverse, but that didn’t matter she said, as he should turn after twin one’s birth.
Over lunch, I realised that I was more comfortable standing up leaning on the table and swaying than sitting down on the bench. Maybe something is going to happen after all, I thought. By the time we’d walked back upstairs, I felt intense pressure requiring me to concentrate on my breathing. Labour was clearly ramping up, requiring deep breathing and going off into my zone, although I couldn’t really tell the beginning or end of each contraction and could talk through them.
I told Mike that he wouldn’t be going into the office today, so he dashed home instead to put on some comfortable clothes and shoes in which to meet his new sons.
I hung out alone gazing out of the window through my labour daze. The pressure was building into what I thought in a panicked moment was an urge to push and I longed to get into a private room, yet still none were available.
I saw the midwife down the corridor who finally showed me into that same birth room in which we’d had our first meeting, which was free but hadn’t been cleaned. Going to the toilet relieved me of a good deal of the pressure. A further check at 2.30pm, once the room was cleaned, confirmed that I wasn’t yet fully dilated and about to push out twin one, but still only 3-4cm. The pressure soon returned and contractions felt pretty continuous again. I texted Annie who said she’d head in.
The next few hours were spent very pleasantly in the birthing room gazing at the sunset listening to waves crashing music whilst having fairly mild contractions that I occasionally had to stop chatting with my midwife, Annie, and Mike to breathe through. They were not getting much stronger and I felt a bit of a fraud to have called Annie in and stopped Mike from going to work. However, I didn’t want to eat anything and only wanted to drink Lucozade and water, so there was clearly some progress. I mostly knelt up on the sofa resting my head on the window ledge on top of two comfy feather pillows from home. I was also able to rest curling up on my side on the sofa.
A check around 7.30pm showed very little progress since the afternoon check, and the midwife announced that twin one’s ear was presenting. She said she could break my waters if I wanted to speed things along, and encourage alignment and positioning, including the appropriate part of his head to present first. There would be a risk of infection and a recommendation of further interventions if it didn’t work, but given that I had progressed very quickly in my last birth after my waters had broken, the same would probably happen this time. I was tiring, and faced with the unpleasant prospect of a fruitless night in hospital (which the propess had made necessary), during which contractions were strong enough to keep me from sleep but not strong enough to get into active labour, and this all might be for nothing when the propess wore off the next morning.
I agreed, and so got on the dreaded hospital bed for the first time for the midwife to do it. She made a slow leak and a huge amount of fluid came out. As I got off the bed and leant against a baby cot, a powerful surge welled up causing me to grip the cot and breathe deeply. It had a beginning and an end, and when it finally subsided I turned to my team and said: “now THAT was a contraction”.
I spent the next couple of hours alternating between standing leaning over the cot, sitting on the toilet, and kneeling up on the bed (which was a bit like using a sofa after all) resting my head on my pillows on its upright back. Mike, rather hopefully, offered a different track for me to listen to other than the waves crashing music, which I politely refused. I was perfectly in my zone and able to adopt any position that I wished, but I do remember thinking at this stage ‘why is having this natural labour so important again?’ The contractions were intense. The TENS was out ready, and the pool was being filled for me. I chose not to use the TENS since I hoped we could move to the pool very shortly. Both twins were listened to frequently using hand held dopplers.
It was a relief to hear that the pool was finally ready, so I put on my dressing gown and walked the short distance to the pool room and had several blinding contractions on the adjoining toilet before getting in. The last one felt more pushy than those before.
I seem to remember that before I got into the pool somebody had voiced the worry (I think it might have been Mike repeating what he’d just learnt earlier) that the pool might slow my labour down. Not a chance. The warm water felt delicious and was an incredibly welcome respite, but after a couple more contractions they almost magically changed into pushing ones.
After a few more contractions I was encouraged to feel twin one’s position. I could touch his head but he was a long way up, much further away than Alexander had been upon full dilation at home (after he then failed to come down). I was checked in the pool, and it was suggested that I try different positions in the pool and then worked very hard out of the pool using assisted deep squats holding onto the wall bars to bring baby down.
Due to the fact that several strong contractions and hard work in different positions had not assisted in beginning to budge him, my midwives suggested we return to our birthing room (which I did leaning over the back of a large wheelchair still having strong pushing contractions whilst somebody pushed me back to the room), so that we could continue trying different positions to try to bring him down. The midwife tried turning his head to a better position during a couple of contractions and assess where the space was to determine which position I could adopt to help bring him through my pelvis.
I was so pleased that the babies had waited until the consultant midwife had returned from holiday before I went into labour. She and Annie worked together wonderfully. I suspect a less experienced hospital midwife would have wanted to hand me over to theatre after my own further attempts to bring him down in this position failed, rather than actively helping me birth my own baby before that could happen.
Finally after much hard work and no doubt an extremely red face on my part, something shifted enabling twin one to move almost all the way down within the space of one contraction. Another contraction or two, and a lot of detailed instructions on panting and pushing, twin one emerged in ‘superman pose’ with his hand up by his head like his two older brothers before him, crying as he came out, and was put on my tummy with his cord still attached.
I was delighted that he was covered in vernix, my first child to have any, or indeed be born before his due date. He was beautifully slimy and I had that familiar feeling of wondering how somebody so close to me could look so unfamiliar, as all our new babies did when they were born. His cord was not very long so he remained on my tummy for a minute or so, before I cut his cord myself. I then brought him up to my chest and tried to feed him but he wasn’t interested yet. I kept him for a few minutes skin on skin under a towel, shading his eyes from the lights. We named him Gabriel.
I barely had time to cuddle and bond with Gabriel when I had to say: “somebody take this baby” and hand him over to concentrate on the contractions, which I was pleased did not let up or slow down. The contractions remained strong but were not pushy yet, and twin two’s heartbeat was good, so I knelt up as before leaning over the upright back of the bed. I saw that Mike had taken off his shirt at the request of a midwife and was giving Gabriel skin to skin. It was really sweet. I remember asking: “Please could somebody video Mike?” I think that I then went through a kind of second transition at that point, as I tried not to feel dismay at the thought of another pushing stage like the one I’d just had. I was tired but still determined and ready to knuckle down again and give it all I had left. I tried not to feel any self doubt.
After a few more of those strong contractions, twin two’s waters broke with such force that everyone jumped back in synch. There was a lot of water again, and I was filled with a great relief and positive thinking as this meant he would come down and surely the end was near.
The midwives asked me to turn around so they could check twin two’s position, which I allowed. I was overjoyed to hear that he was now head first. Amazing news, after all that time in breech and then transverse earlier in the day. “Hold on”, she said. “I think it’s a shoulder.” This was confirmed by ultrasound.
Before I knew it, an obstetrician had magically appeared and I agreed to her attempting to turn him to head first with the next contraction as I panted and tried my utmost not to push. However, when the position was checked again, he’d turned straight back to shoulder first, and now there was bleeding. Before my midwife had even opened her mouth, I knew what she was going to say. It was as though I’d just been arrested and was being read my rights. But this situation was exactly what emergency caesareans are for. “Let’s go”, I said.
Any disappointment that I may have felt at having to do this was saved for later. Everybody, including myself, knew that this was the right thing to do. They could not tell where the bleeding was coming from, and twin two did ingest some blood as it was. It was action stations and I submitted to the process, which was fast and slick. Within minutes, we were in the operating theatre and I was being asked if I’d had a general anaesthetic before. I had chosen not to have an epidural during my natural labour, and so had expected to be put under should emergency surgery be required. I understand that Nico was born around 11pm, that he required a little resuscitation but that his agpars went up quickly after that.
When they woke me up at around 1am, I noticed vaguely that there were two babies in the crib next to me and that Mike, Annie and some other staff were there. My consultant midwife was still around too. But, what I noticed most of all, were the belting contractions which had not abated in the slightest from the moment I had been put under. In fact, coming to them cold, they seemed much stronger. The babies were out, the placentas were out, I was informed. So what the hell were these? I think the technical term is after pains, although I suspected that my body probably didn’t realise that I’d completed giving birth since nothing further had come down the birth canal since Gabriel. Those lovely endorphins seemed to have vanished.
Immediately, I made to kneel up and lean over the back of the bed to cope with the powerful contractions. I was informed very quickly that I had to remain flat on my back post surgery and was shown my compression bandage and catheter. This was the new reality. To cope with having to take the pain lying down, I was offered a huge array of drugs and I took the lot.
The babies were both crying and I was desperate to feed them. Mike told me that a midwife had warned this would probably make the contractions stronger, so he didn’t want to give me a baby to feed yet so as not to cause me more pain, though I didn’t see that it would be possible for them to get stronger than they were already.
It took a few hours before contractions were at a level that I felt I could cope with, but I got my babies to feed before then. The pleasurable feelings that were generated by nursing them, in fact, seemed to help me cope with the pains. I was so out of it that I could barely focus on their little faces.
Arriving home some days later, I was an emotional mess. After cuddles with all my boys, I went straight for the shower, and the next day Annie’s colleague Tina arrived to prop me back up again. After a couple of weeks at home, I began to feel normal again and my haemoglobin levels rose back to pregnancy levels. I could finally assuage the cabin fever and go out without fear of keeling over in the street.
The twins were exactly 7lbs each at birth. They had regained their birth weights about a week after birth, and three weeks after birth, Gabriel weighed 8lbs 11oz and Nico weighed 8lbs 4oz. Now we are all doing well.
When I tell people of the birth, many of them say: oh poor you, double whammy (i.e. vaginal birth and caesarean). No, no, Gabriel’s was a wonderful birth, I tell them. There is virtually no recovery from a normal vaginal birth. It was very much a single whammy. Nico’s took nothing away from Gabriel’s, and Gabriel’s made up for Nico’s. I am still buzzing from the high of birthing Gabriel under my own steam. One out of two is better than none!