THE REAL THING
** I'm going to make a note here. I'm not going to going to use the real initial of the OB who wound up attending me. Given the unusual situation she was put in, I don't think it would be fair for me to potentially color someone's perceptions of her. **
On the ride in, we heard from the hospital that Dr. L was signed out for the day. He would not be back until that evening, so I was going to be attended by Dr. X, whom I had never met. I cannot fully explain how upsetting this was for me. My contractions literally stopped cold for almost 20 minutes on the drive in. I had worked so very, very hard to get to a point where I could accept Dr. W catching my babies. When I found out there was a good chance he would miss the birth, I had to consciously try to shift gears to accept Dr. L catching them, and I honestly didn't feel like I was okay with it by that point. Now, at the very last minute, I was getting someone I had never laid eyes on. I didn't even know if Dr. X was a man or woman! I began praying that this was another "trial run" and that I would be heading home later that day, or that the babies decided to wait it out until Dr. L or Dr. W got back.
We got to the hospital at around 11:30. Joe dropped Dede and I off at the door, and went to park the van, as it was a weekend and there was no valet. Dede and I waited next to the elevators for Joe to come back in and waited, and waited. After about 10 minutes we tried to call him on his phone, but the signal was horrible. Eventually, we got hold of him through the front desk to find out that he was already up in L&D. He somehow got turned around and wound up there. We went up and discovered our photographer (Tracy) was there as well. We got checked in, and went to Room 8.
We met our lovely nurse, Nicole, and before I even got changed we monitored the babies for a few minutes. Twin A had been vertex and presenting first throughout the entire pregnancy. B had been breech the whole time. When trying to get me wired up, A's heartbeat was right where it always was, but B was in a totally different spot. This led to some questions as to what position B was in. They decided to do an ultrasound to see where B was. I got into my labor clothes (no way was a going to wear a hospital gown). A resident that I like immediately (Dr. Hahn) came in with another resident, and it took about 15 minutes, but they eventually determined that B had turned, and was now oblique, not quite head down, but not quite transverse (sideways) with their head tucked into A's belly. I figured all the movement the night before was B moving, and it was very good news, as it increased the likelihood that B would flip head down, and I would not need a breech extraction.
I agreed to a vaginal exam, and I was 5cm and Baby A was at -2 station. This made me happy, as I was already halfway dilated. Joe ran across the street to get food for everyone, and I labored on the birth ball for about a ½ hour, during which Nicole to put in the saline lock. The contractions were a lot like I remembered, and I was working through them pretty well, but as they got stronger, I decided I wanted to get into the shower. We took the birth ball in there, and I sat on that with the water spraying on my lower back. I was in there for an hour or so with Joe feeding me broccoli cheese soup in between contractions, like the fabulous husband and labor partner he is. I went to knee/chest on the bed for a while after that, and the contractions were very hard to work through at this point. I was sure I was going to be in labor for hours and hours more, because my shortest birth had been 27 hours. (For reference, I'd been in labor about 11 hours at that point.) There were tears shed and I asked to be checked, so I could know if I'd made any progress. I couldn't imagine doing this for much longer. (Note for those not aware, these are classic signposts of transition).
Dr. X came in and was not what I would call warm and fuzzy. She checked me, and said I was at 6cm, and baby had dropped to +1. In the back of my brain, I knew from previous births that I typically go from 6cm to holding baby in less than 2 hours. In the front of my brain I thought, "All that for a lousy centimeter???" But Deb reminded me that baby had also moved way down, which made me feel a little better. After she checked me, Dr. X stood off the side of the bed with her arms crossed and you could tell she was not happy. You could literally just feel the tension, and I would almost say negativity, rolling off of her. I wasn't really aware of the conversation that was happening between her and my birth team, but I recall her saying something very similar to, "I realize certain things have been agreed to, but I wasn't a part of that, and I still have to practice in my comfort zone."
No joke. I. Saw. Red.
What went through my head was, "Oh, HELL no. There is no way this chick is going to come in here and (bleep) up months of planning because she's (bleep)ing pissed about getting shafted with me." I honestly don't think I said anything, as I was still working quite hard through the contractions. I left that up to my birth team, because that's what they were there for, and again, I have no idea what was said. She left the room and as soon as she cleared the door I said out loud, "I don't like her." I think there might actually have been a vacuum created in the room as everyone in it sort of sucked in their breath with a mental "Oh, crap." I went back to laboring while, unbeknownst to me a conversation took place between my supporters and my nurse. The outcome of which was asking Nicole to request to Dr. X that nothing be done without my consent.
Around 3:30 I went back to the birth ball, then switched to leaning over the back of the bed, and eventually standing on the bed. The position I was most comfortable in at that point was standing, but I was tired, and by standing on the bed, I could hold myself up with my arms on the side rails, not my legs. I'm not sure how often that has happened, because I think when Nicole saw me she said, "Oh! Well, that'll work."
(Funny moment: Throughout our time there, my support team had taken turns giving me counterpressure on my back, or doing a hip squeeze. I love my husband dearly, but realized when I was standing on the bed, that he is lousy at counterpressure. He wiggled and shifted his hands around instead of pushing constant and stable. While working through contractions on the bed, I remember saying, "I want counterpressure on my back, but not from Joe!" He, being the wonderful husband and labor support he is, was not offended.)
At around 4:00 I went to the bathroom, and instead of getting back on the bed, I decided to stand and lean on the end of it. Our photographer got me some pillows to rest on, and it was really hard to deal with the contractions at this point. I was starting to feel a little pushy, but I think I was still in denial that I could really be that close to being done, so I was fighting it a bit. I think Deb asked me if I was feeling pushy and I said I wasn't sure.
(Another funny moment: Dede was talking and trying to be supportive, but all I heard was yammering and I told her, "Oh my god, just shut up!"
At this point I was pretty much totally in my own world, so I'm going to tell from my perspective, and toss in bits I found out afterwards. I started to feel pushy, and asked for counterpressure again. Dede was pushing on my back, and I started to feel very, *very* pushy. I thought to myself, "They're going to want me to get on the bed so they can check me." No sooner had that thought cleared my brain than the first baby's sac broke all over the floor and he was RIGHT THERE. (Deb had heard my noises change and had laid towels down on the floor between my feet. She was sitting on the floor reaching between Dede's legs to guide out the head. At some point Dede swung a leg over and Deb scooted closer so she could catch safely if need be.) I was in sort of a half squat, and said something like, "I'm pushing!" or "The baby is coming!" and someone said, "Deb is back there." So I just went with it. His head came out, then a couple seconds later I pushed out his body. Dang that felt better!
There were only seven minutes between the babies, so this next series of events happened very fast.
I turned around, stepped over the cord, and was surprised to see Dr. H holding him, looking almost surprised. I giggled out, "It's a boy!" and scooped him up. I sat back on the bed and realized the room was full of people in blue scrubs. I had no idea when they all came in, and there was a bit of frantic energy and chatter since me birthing Baby A standing up, with the team just barely getting in there had not been anyone's plan. I don't think the ultrasound machine was even plugged in. I got the baby up on my belly, and realized with the monitor tube top on I couldn't get him skin to skin so I said, "Cut this thing off." Someone did and with Nicole managing his cord we got him situated on my belly, sort of off to my right side. One of the nurses squirted a huge glob of ultrasound goo on me so they could check where B was, but the machine hadn't booted up yet. I said to Joe, It's a boy, we had another boy!"and he gave me a kiss. Nicole asked me to rub the baby's back to try to get him to cry more, but we didn't think too much of it then. Dr. X was standing at the foot of the bed and waited a minute or so before telling me the ultrasound machine was taking a really long time to boot up, and asking if it was alright if she did an exam. Unfortunately for me, right when she asked that another contraction hit, which made the exam incredibly painful. She said she felt head, which I felt relief over, then said the sac was very bulgy, which I thought, "I don't give a crap about the sac, get your hand out!" I actually said, "get out get out get out get out!" Right as she finished her exam, they popped the ultrasound transducer on and confirmed Baby B was head down and the position looked "beautiful." The neonatologist poked his head in (he'd been called but since the NICU was on another floor, and the baby came so fast he didn't make it down), but since A was out, and B looked good, he left.
I said I needed to get up more, so they dropped the back of the bed, I scooted up, and then Nicole put the bed back up so I was basically semi-lithotomy. Dr. X asked to cut the cord, and Joe did that. I told him to take the baby as I felt another contraction coming on. Dr. H wanted to put a blue drape thing under me, which was not fun while having a contraction, but I was just going with it. It turned out to be a good thing that she did that, because right at the end of that contraction, Baby B's sac broke, and it was contained to the drape thing. There was some meconium in the fluid, and Dr. X asked Deb what the plan for meconium was. Deb said that as long as baby was vigorous, the plan was for baby to go on up on mom, to which Dr. X responded, "Ok." While waiting for the next contraction, Dr. X said something about being really close to being done, to which I responded, "Oh, thank God." I just kept my eyes closed and tried to relax.
Joe was holding the first baby and stepped over to me to tell me I was doing great. I looked at him and said, "Get that baby skin-to-skin." With the help of a nurse and Deb, he did.
I felt the next contraction coming on, and remembered how much I hated pushing on my back with my last birth. It is the most uncomfortable position ever for having a baby. I remember feeling the contraction in my upper belly, and almost feeling like I wasn't pushing right. Multiple people cheered me on, Dede reminding me I'd already done this four times, and Dr. X telling me I was doing awesome. When the contraction finally peaked and I felt it lower, I remembered how to push and apparently something looked different because Dr. X said, "There ya go momma!" The head came out, and a few seconds later, our second baby was fully earthside! She put him right up on my belly, and I got to announce we had another boy! There was applause from someone and cheers from a few people. They waited a few minutes for the cord to stop pulsing, and since Joe was busy holding one baby, I let Dede cut the cord.
After about 5 minutes of skin to skin with Daddy, the staff took Baby A over to the warmer to be evaluated. While they were checking him over, Joe and I had a quick discussion about which baby was going to get which name. (We heard the staff chuckling at us, since most twin parents know what they're having and who is getting what name long before the birth.) We decided since A came out first, he'd get the name which came first in the alphabet, so he became Ethan. Baby B became Lucas. Ethan looked okay, and they brought him back to me so I could hold both babies at the same time. I think this is where I pushed out the placenta, and although I wanted to, I never wound up getting to see it in person. (My encapsulator did send me pictures, though.)
I think somewhere in there Joe presented me with a small bottle of orange juice he bought earlier when he went to get lunch. He knows how much I like it after birthing (seriously, it NEVER tastes better than right after giving birth).
In comparing their color, Ethan had a whole body bluish tinge to him, and I looked at Nicole and said, "He looks really blue." She said, "Yeah, he does, so I'm just going to take him over to the warmer and give him a little oxygen." He still didn't pink up, and when they checked his oxygen level, it was only in the 60's, so they called the neonatologist back in to take a look at him. (I don't really have a good grasp of how much time passed as I was dealing with the last parts of having just given birth). They worked on him in our room for maybe 10 minutes or so, and decided he needed to be moved to the NICU so they could run some tests and try some other things. No one seemed overly concerned at this point. Joe went up to the NICU with him.
This is the point at which Ethan's story kind of separates from mine. You can go to his carinbridge site to read about what happened to him: Ethan's Story
As for me, I was bleeding quite a bit. Nicole pushed on my belly several times over the next hour, but my uterus just wasn't clamping down right. I looked at my belly and could literally see a bulge where my uterus was at. Problem was, it was kind of over my right hip bone, which is not where it was supposed to be. Lucas was only mildly interested in nursing, and I was still passing big clots an hour after they were born. I think Dr. H came back in and asked if I would consent to Pitocin to try to get my uterus to clamp down. We discussed different methods of giving it, and I decided on the IV, as I could have it turned off when things resolved. I have to say, the contractions that vile substance caused were worse than labor.
In the course of the conversation, we chatted about how things went, and she said, "I've never caught a mom standing...everything was backwards!" They started the pit but I continued to pass clots, and so at around 7:00, Dr. H came back and told me she suspected I had some clots stuck in my cervix and she wanted to check me. She asked if I wanted any pain medication, and I said no, to which Deb popped up with,"This is going to be a whole hand." I looked at Dr. H and said, "Oh! Well that might change my opinion. What are my options?" She told me it would be something that would be in my system for maybe an hour, and that the babies could potentially get it, so I declined. It wasn't as bad as labor, but it wasn't real pleasant, and she pulled out 200cc of clots. After that my bleeding slowed down and everyone relaxed a little.
I think the rest of the next 12 hours blends with Ethan's story, so I'll end this with how I feel about the whole thing. Six months later, I'm honestly still trying to wrap my brain around the idea that I did it. I not only had a hospital birth, I had a hospital birth with twins, and I had a hospital birth with twins on my terms. For the past decade, I had been severely jaded with medical professionals, with good reason. I had been manipulated and abused by "the system," and didn't want anything to do with it. I never, in a million years, would have thought a group of complete strangers would do so much to make my birth not just tolerable, but to make it *good.* And I can honestly say, it was good. No, it wasn't a homebirth, but it was probably the best hospital birth I could have asked for. I have gained new perspective on what people are willing to do when asked.
It never would have happened without the incredible amount of work by Patty and the nursing staff to find the best setup possible, or the willingness of the various specialties of the hospital to stretch themselves and try something new. Yes, Dr. W missed it, which caused quite a bit of stress, but without him initially agreeing, it never would have happened. I know he never saw any of this coming when he first told us we were having twins, but he was amazingly supportive and worked very hard to make it all happen. Yes, Dr. X had a bit of an attitude, and added some stress I didn't really need during labor, but she asked before she did anything, and did what she was asked, namely to leave me alone for the most part and don't drop the babies. :o) In conversations following the birth, it was expressed by Joan that it was good for the hospital to see they didn't have to do everything the same way, every time, and she felt they had grown from it.
Despite not going exactly as we thought it would (didn't really foresee the standing up birth) I hope the hospital saw it as a positive. I hope the idea spreads that women are individuals with individual needs, and they don't have to do everything the same way, every time. I hope the time comes when out of OR births for twins are more openly accepted, and women get to have the kind of birth I did. Most of all, I hope women reading this realize they do have choices, and don't have to settle for "what's always been done" if it isn't going to be good for them.
**I'm adding this part at to clarify something. Some questions have arisen about how the perinatologist missed a defect so bad that it required immediate surgery. There several reasons. This defect (Supracardiac Total Anomalous Pulmonary Venous Return) is only a 1/10,00 defect, and accounts for only 1% of congenital (born with) heart defects. It only manifests after birth, and is usually seen in conjunction with other defects, so unless they see a more common defect, they don't look for this one. If that weren't enough, even a fetal cardiologist with the right equipment could still miss it, as it is very, very hard to spot in utero. Ethan also had blockages in addition to the defect, which made his case so critical. All that to say, we are incredibly happy with the care I received from our perinatologist, and are not the least bit upset he didn't see this during any of my ultrasounds.**