By Duncan Gray
It was Tuesday of week 36 and we were rushing get to the hospital for yet another scan, and we had run out of coffee. We had been diagnosed with mono-chorionic twins at the 20 week scan; two bags, one placenta, high risk and rates of intervention. Following the calamitous news we were ushered into the medical world of birthing and obstetrics, of which we had been blissfully unaware. Our first child had been a home birth, in the pool with friends, cat and midwives in attendance. We had a very positive experience with the home birth team; they have a general philosophy of ownership of your pregnancy, their midwives are pragmatic, knowledgeable and experienced, and there didn’t seem any reason to venture out in the Canterbury mid-winter when we could stay at home by the fire. However, home birth is not an option with mono-chorionic twins. We kept our indomitable home birth midwife who suggested we moved into the hospital for the day and make it home. Our first meeting with the obstetrician was not too successful. After two hours waiting, our midwife had to be elsewhere and we went into the appointment alone; intrepid home birthers in the lions den. The obstetrician was nice enough, although I think she was having a bad day, but we were quite overwhelmed by the long list of things that could go wrong. There is twin to twin transfusion syndrome (TTTS) during pregnancy and/or labour, placentas that don’t last the distance, uteruses that run out of elasticity and all sorts of horrors during delivery. At no stage was the possibility of a successful natural birth mentioned, perhaps, we thought, they simply didn’t. Could it be true that for thousands of years a mono-chorionic twin pregnancy was a death sentence to hapless females? We went home……we rang our midwife. “This is a natural process” she told us, “lots of women have done this before, you can have a natural birth, but this kind of pregnancy can have complications and you/your babies will need to be monitored”. Thus began a series of meetings and monitorings of twin 1 and 2 that had us in various waiting rooms on a weekly basis.
The discovery that we were having twins was a shock. There had been some difficult adjustments to accommodate our first born; what had we done now! But the news sank in and the palpitations receded. First priority was to keep Bridget healthy and well. Avoid stress we were told, Bridget sold her business and beloved ute. But every trip to the hospital raised thorny issues or revealed new problems, and several nights sleep would be lost each time. We were aware of an increased likelihood of medical intervention, either by induction or caesarean and the chain reaction of further intervention that often results. If intervention is necessary, then so be it. But it was not our preference and we were uncomfortable with the prospect of compromising our children’s health and our own experience for the sake of rapid transit through the hospital or medical convenience. Selfish, idealistic, stubborn? Hell hath no fury like a parent defending the choices they make for their children. Possibly because there is so much controversy on what is ‘best’, and everybody from the (wo)man in the street to the Professor of Obstetrics has an angle. It’s a minefield for parents and it all begins with that first conversation with your chosen maternity care giver. There are two main camps; the medical model and the au naturel, and all the shades of grey in-between.
Bridget tried her best to make friends with the hospital and persuade them that high risk pregnancies can make it to 37- 38 weeks and end in a natural birth. Nods and smiles. But, it was still a shock at week 36 when Bridget called me to say that she had been admitted to hospital because the doctors weren’t happy with the latest scan.
The blood flow in the umbilical cords, measured by Dopplers, was high in twin 1 and the babies relative weights had started to change. Twin 1 was 2.3 kg and twin 2 was 2.7kg. Bridget was not happy, she felt the scan was rushed and radiographer was different for every scan. Twin 1’s head was so far down in the pelvis that when Bridget walked she felt that she was going to give birth. Maybe this was making it hard to get an accurate measurement. The hospital wanted to get things moving and applied the pressure. What nobody mentioned, and probably a good thing, was that the margin of error of the size estimation was greater than the difference we were told was of diagnostic significance. Bridget felt OK and the babies were growing, but there seemed to be no way to prolong the pregnancy and she felt defeated. She wanted to go into labour at home with her family. Bridget felt she was on track for making it to 36 weeks and both babes heads were down.
The hospital kept telling us that in some countries identical twins are born by c-section at 34 week regardless. Bummed out, Bridget sat in the small hospital bed and tried to sleep. I went to the university to finish some paper work before our family doubled. Our first born went to Nana and Papas. The family spilt to each corner of Christchurch. All we could do was wait until the next day to see the obstetrician again.
Bridget cheered up after having been roomed with another women in the same predicament. But did not have a great night’s sleep. Hospital beds while heavily pregnant with twins are not ideal but at least they tilted up to stop the heart burn.
The following day bought more tests. After being in hospital for a ‘rest’ the scan might have changed. But hospital was not a place of rest for Bridget. The scan had not changed, but had not got worst, so we sat and waited for the Big Cheese to come and tell us her opinion. That day was busy on the birthing floor, so we managed to escape to the gardens and leave the wheel chair behind. Bridget spent the time walking after Lucia around the Heritage rose garden to bring on labour. The Obstetrician, based on the evidence, wanted to induce the next day. In hindsight this was quite a concession as there was considerable opinion that “C” section was best. So we took what we could and made plans for the morrow. We would need towels and a jug, as the hospital don’t have those?! The hot towels are the best pain relief if you want to avoid drugs. Our midwife arranged to meet us at 8:30am on the dot and we all retired to our different beds.
Bridget was stuck with a steroid jab at 2 am and next morning we went over to the birthing suite. It was quite peaceful in the suite. The hospital staff mostly left us to it and so the waters where broken and we waited. Nothing much, so in went the Oxytocin drip and we carried on chatting and gazing out the window as the staff changed shift. A few contractions came and we all watched the monitor. The Oxytocin was turned up and the contractions became regular. The need for continuous monitoring of both babies was difficult as two detectors were attached but Twin 2 kept moving. Eventually, a monitor was fastened to the top of Twin 1’s head all of which made it hard for Bridget to move around. Bridget started full labour and went from standing, to the hospital bed on her back. However, after several more intense contractions there was no movement and so we had a team effort to turn Bridget over without losing the heartbeats. Hospital staff appeared and the hot towels were flying. As soon as Bridget shifted twin 1 dropped down and pretty soon landed on the bed. The babe was quickly passed to Bridget to keep the scissor wielding obstetrician away from the cord. But then the cord was done and Twin 1 taken to be wrapped. To track down Twin 2 Bridget rolled over again and had an ultrasound.
Twin 2 was heading the right way, but to our dismay the obstetrician hefted out stirrups and seemed intent on taking over. The stirrups were to help with the pushing as Bridget was pretty tired and couldn’t be bothered giving birth to another baby, but two pushes later Twin 2 emerged before the stirrups could be fitted. Twin 2 came down with her water sack intact, which promptly burst to reveal a surprised and slightly blue baby, which was passed to Mum. The onlookers urged Bridget to talk to Twin 2, to get her breathing. The first little cry followed and Dad passed Twin 1 to Mum whilst Twin 2 went to get wrapped. Both babies were smaller than scans had suggested and were close to being sent down to the neo-natal ward, but as both were feeding straight off they stayed with Mum. Mum and Dad have been passing them back and forth ever since, and now at 10 months old they both are still feeding simultaneously at the breast(s).
All in all, the hospital were very good and looked after us well. I don’t know what would have happened if we hadn’t had our homebirth midwife to stick up for us. I believe without the repute, professionalism and care of our midwife our twins would not have been born naturally. Our Obstetrician commented afterwards that it had been one of the nicest twin births she had been at. But of course, home birth midwives don’t change shifts, and we were a team from scan to skedaddle as we took Lauren and Honor home two days later.