The Twin Plan

The first text I received was in the early evening.

“The contractions are finally coming consistently!”

Weeks of prodromal labor, pressure to induce, chiropractic appointments, spinning babies activities, acupuncture, and numerous attempts at natural induction were finally at an end. Three hours later, I texted her husband to see how it was going.

“I think it’s time, but she doesn’t want to go yet.”

“Let her know that I am going to head out and will meet you at the hospital.” Reassuring them that I would be there before them was important. Being present and alongside of her during the whole labor process in the hospital had been a high priority, and as I was pulling into the parking garage, they let me know that they were on their way. She had dreaded going to the hospital from the very beginning, but even more so now that she knew her Dr. was not the OB on call.

She knew she would have to fight for her plan.

Her first two boys were born with no complications, and their unmedicated, vaginal births five and three years ago left her with the experience and education she needed to know that she had to find a provider willing to support her desire to give birth to her twins with the same uninterrupted, unmedicated, physiological approach. The search proved more difficult than she imagined, and even after she found an OB with a great reputation, she knew she would still need additional help.

She knew she would need a doula.

Our first visit was virtual, but I could tell right away, that this mama was a force to be reckoned with. She had done her research and she had joined every twin group forum she could find. She was eating well, keeping active and had a clear picture of what she wanted. She knew what was possible. After meeting with me several times, she confided that she wasn’t so sure her Dr. was going to support her in the way she needed, and she really didn’t trust her the way she would like to trust her. I had experience with this OB and I reassured her that every experience I had was positive and that she typically bent over backwards to give her clients the experience they wanted within a hospital setting. I have to admit though, that inside, I was also having doubts. This OB was really pressing her to induce, even though the twins were doing well. She said her concerns were due to the increased risk of stillbirth.

“An induction can be scheduled. That does not mean I will go.”

At the last appointment, several days before labor began at 39 weeks exactly, her OB had finally asked her what her “point of no return” was. “I don’t believe I have one,” was the reply, “I feel certain I will go into labor on my own before I am beyond 40 weeks.” The Dr. made it clear she wouldn’t be on duty over the weekend. I told my client that I thought this knowledge, more than anything, was what was fueling her desire to have her deliver early. The very reason she was so amazing, was because she would do things other OB’s would not do, and if she was not on duty, she knew there would be roadblocks.

“I wish there weren’t any people here.”

We had been walking the halls of the hospital for a half hour when I suggested a bathroom break. My heart was breaking for this mama who just wanted to find a quiet, dark place to labor in peace. After another thirty minutes of walking, stopping to sway and breathe, I saw her labor shift into a more trance-like state. When I walked her back toward the bathroom, she said that she would really like to labor on the toilet but it felt dirty, so we may as well check in, at least she would have a clean place to sit. We stopped again outside the door to check in.

None of us really wanted to cross the threshold but we knew we had to.

Initially, things went well. After a cervix check, it was confirmed that dilation was at a 7, possibly even an 8! We had confirmation that it had, indeed, been time to get settled in a room. Then birth plan was presented and the nurse raised her eyebrows and said, “I don’t think the on call OB is going to agree to this…”

“Don’t you want what is safest for your baby?”

The on call doctor was brusque and dismissive and would not support having twins in a normal labor and delivery room. My client calmly reviewed the plan that her OB had agreed to, and again calmly restated that she would like to have a peaceful, unmedicated birth in a labor room, not an operating room. The doctor eventually stormed out, leaving bewildered nurses who also continued to gaslight my client with questions like, “Don’t you know the risks if we have to perform a cesarean to get baby B out?” “Don’t you want baby B to have a safe delivery?” They struggled to find a vein to put in the saline lock, and blood ran down my client’s hand as she winced at each attempt.

“I just want to go home.”

Contractions had slowed down considerably over the last twenty minutes, which was no surprise, and my client and her husband were visibly upset. He held her and rocked her back and forth as he whispered that he would like that too. I quietly reminded them that whatever they decided, as they were being pressured into the OR delivery option, that they could request another provider. When the charge nurse called their OB and put her on speaker, it was made clear that even if they decided to deliver in the OR, the on call OB would not be acceptable. As quickly as they had entered, everyone quietly left the curtained off cubicle in triage, leaving us to try and regain clarity and composure.

“Your OB is coming in to deliver you. We are transferring you to a labor and delivery room.”

I was so glad I was wearing a mask, because I couldn’t stop smiling! We still had a long way to go, but at least now we could move forward with a provider who supported the birth plan! As soon as we entered the room, I dimmed the lights, got the music going, and checked the bathroom. It was clean but the piping ran up the back in such a way that we had to wedge pillows in so we could utilize the toilet for laboring.

The first half hour was a torrent of questions from the nurse who would be with us until the babies were born. Thankfully, most of them could be answered by the twin’s father who stood like a guard between the nurse and his laboring wife, currently tethered to the bed by the wires connected to the baby monitors.

“How long do you need me to be hooked up to these?”

The nurse replied that they needed at least twenty minutes and it seemed like a fair trade off after the triage experience. As soon as the time had lapsed, we checked to make sure the TENS unit was still in place and then moved to the bathroom. I pulled the birth ball in and wedged it in tightly so dad could sit behind mom as she sat backwards on the toilet and faced the wall, her head buried into the pillows I had placed there. He rubbed her back as she expressed the need to poop.

“If you feel like you need to poop, we really should get off the toilet.” I recognized the paradox of my statement and reiterated, “We definitely don’t want to have the babies in here.”

“No, I really think I need to go.”

“Give a little push, and we will see what happens.”

She was right, and she did go, but I was still on high alert. Labor had definitely picked up. She was such a peaceful laborer it was hard to tell how far along she was. The bathroom was only barely big enough for the two of them so I took my place outside the door at a distance so I could see through the crack in the door but not be seen. I wanted them to be alone, and I wanted her to be able to focus with no distractions. At one point, right before I had her change positions, she asked me how to get things moving along.

“The reason I am not doing anything is because things are moving along beautifully. You are doing an amazing job.”

“I don’t feel like I am doing an amazing job.”

We had been going back and forth from the toilet now for a few hours. Spending the alternate time rocking and swaying in her husband’s arms. She said things felt so different from her other boys’ births and I could tell this unnerved her. I reassured her that different was ok. Things were going well. She was doing everything perfectly. On the last trip to the toilet, she said she was beginning to feel constant pressure and the need to push, and I quickly said, “then we need to get up!” To which she replied, “I don’t think I can…”

We moved swiftly, getting her off the toilet, calling the nurse, and guiding her to the bed. She recoiled and told the nurse she absolutely could not deliver on her back, it was too painful. Calling for the squat bar, she squatted and tried to lift herself up. The Dr. came in, and remarked that she would have to be able to lift her bottom higher in that position, and maybe a side lying position would be better. It was clear that the work of labor had taken its toll. I could tell she was reluctant because she had delivered before with the squat bar. Again, it was difficult to gauge what she was feeling because she was outwardly so serene. She shifted on her side, and her demeanor changed. She grabbed my hands and looked into my eyes.

“I am scared.”

I softly reassured her that she was almost there. The nurse moved the stirrup in such a way so that she could lay on her right side with her right leg supported. I don’t usually coach pushing in an unmediated birth, but I guided her because it was suddenly clear how powerful the waves had become and she seemed to be faltering.

“This just feels so different from the other times.”

The doctor said, “the baby is right there.”

Her husband, in his excitement, said “just push the head out!”

“Big breath, then hold it as you bear down. That’s it, that’s it. You are doing so well.”

I was holding her hand left hand with my left hand. She was gripping the bed rail with her right. Her body shook but her face never gave the indication that she was pushing. It was all where it should be. She roared the first twin out as I quickly slipped my right hand into my pocket to grab her phone to take pictures. The genders were a surprise, and we all waited for dad to make the announcement.

“It’s a boy!”

The surprise on her face was evident as the hospital gown was quickly unsnapped so she could pull him up to her chest. “I thought for sure that baby A was a girl!” He looked perfect and cried immediately. What had seemed like an hour was really only several minutes. The bed had not been broken down and the doctor sat on the end of it waiting for baby B as we all cooed over baby A and I snapped pictures. It was not a long wait. Within ten minutes, dad was shedding his shirt to quickly take baby A and give skin to skin. Baby B was born twelve minutes after baby A. All seemed well as dad announced,

“It’s another boy!”

Surprise again rippled through the room, and we all commented on how she was definitely a “boy mom!” and how much fun their big boys would have with them. Cuddling baby B as baby A snuggled into dad’s chest, the placenta came out with the continued contractions. The placenta, which was the size of two large salad plates side by side came out with one last push. Mom winced and asked if there was any tearing. Thankfully, she was tear free, but pieces of the amniotic sac had torn off and needed to be retrieved. She ordered a dose of pitocin to be administered into the saline lock that was in her hand, and I remarked that this was a standard procedure when a shadow crossed my client’s face. She winced as it took several minutes for the doctor to pull out the long, stretchy pieces of the amniotic sac. She made her quiet exit after cleaning up and expressing her congratulations.
The NICU team came to look over the babies. Baby A had latched and had some time to nurse but baby B had not. The NICU nurse wanted to take him to the nursery for observation. His breathing wasn’t what they wanted it to be. He wasn’t in any danger but they just wanted to observe for a few hours. Baby B was not going to be released from his mama’s arms until he had been able to nurse for a few minutes, this mama bear knew that once she released him, she may not have the chance to nurse him for several hours and she was not willing to risk it. It was definitely more difficult for him to latch than baby A but before he and dad left for the NICU, he had one feeding. And his mama had peace of mind knowing that his dad would be with him, and I would be with her.

The nurse came in to ready us for the move to the postpartum room. I put the water bottle into my client’s hands. “Drink up, hydration is going to be more important than ever.” She looked up and thanked me for being there, and for staying.

“Of course,”

I answered, fighting back tears as we got settled in the room. “I am happy to stay and cuddle baby A!” I encouraged her to close her eyes for a quick power nap if she could. This incredible woman had shown me determination, stamina, and grace in a way I had never witnessed before. It had been my privilege to be invited in to her birth.

“That is what doulas are for.”