Twice as Nice

So, the last time I saw the people from "I don't like this part", it was Saturday, September 22. When I did her prenatal, once again there was a lumpy weird belly. I wasn't sure what part was what. It felt like a (shoulder? hip?) in the mom's left hip and who knows what all in the fundus and I could feel a head deep back in the pelvis. When I listened for hearttones that day, I listened to the lower one, then the upper and it was much faster. Okay. That's the first time they sounded different. I went back to the lower one, and it sounded the same as the upper. I went, "Well, maybe I miscounted" Yeah. Right.

Moms blood pressure was a bit elevated and we talked about how sometimes that will happen right before labor. I called FaeryLady to tell her my findings from the prenatal, but she was at another birth and couldn't take my call.

That Saturday, I stayed up late, watching through the fake news on Saturday Night Live. At midnight I turned out the light and went to sleep. At 2:09 AM Sunday, my phone rang. It was the mom. "My water just broke." I asked if it was clear, yes it was. Was the baby moving? Yes. I told her that if there was no change, to call me by daybreak and I would come and listen to the baby.

When I hung up, I got bad bowel cramps, ran to the bathroom and promptly had diarrhea. Whoa. LOL. I went back to bed and prayed for about half an hour. Just a stream of consciousness sort of prayer for all to be well, for God to be in control and guide me and my hands and my heart and my words.

Posie woke up to nurse at about 3 AM. At 3:30 my phone rang. The mom was having contractions 3-5 minutes apart and lasting about a minute. I called FaeryLady, who wanted me to go over and see if the mom was really working with them yet or not.

The entire way over there I prayed and prayed. "God, give me a sign if we're supposed to do this birth at home. Make it a clear sign, that I don't have to guess, but please don't kick me in the head! Let this be something I can handle, and if I can't handle it, please, please, just take my hands and do it yourself!"

I arrived at the couple's home at 4:30 AM. The mom was definitely working with the ctx, so I called FaeryLady and told her to come on. Each time I listened, I would listen low, and then listen high. Just in case.

We started filling the birth pool about 5:20. Ran out of hot water pretty quickly and starting dumping in pots of hot water. It was about 1/3 full (a LaBassine). The mom was having trouble getting comfortable, and her contractions began to change, and were no longer painful. I asked her if she wanted me to check her and she said yes. I checked her while she was standing by the bed. She was 10 cm and the baby was at a +1 station. She got in the pool and labored the baby down. Soon she leaned on the side of the pool and started exhale pushing. Very gentle. I could see her bottom bulging. The dad went in the other room for a minute to calm their crying toddler.

The mom leaned back after one push, near crowning, and I heard a decel down low. I listened up high, and heard a little ticking along heartbeat. I said, "Well, THAT baby is happy." The mom gave me a blank look.

She leaned back over the side of the pool and started to push again. Suddenly the urge overtook her and she started pushing hard. I was telling her to slow down and she was saying she couldn't, but she did. I hollered for the dad, and he came back in just after the head came out. The head did some funny rotations before settling on a direct OA face. The mom's bottom was up out of the water, so I knew I needed to keep the baby's face up in case it started to breathe before the body came. She pushed again and a small, early looking baby slid out into my hands. Oh. My. Gosh. I was figuring her for a 10 lb baby. There was most definitely another one in there. The dad helped me lift mom's leg and pass the baby through to her. They have four sons already. Mom grabbed her baby and looked between her legs and shouted, "It's a GIRL!?!?!?!?" The baby looked about 6.5 pounds to me (and I was pretty darn close, too, but I'll get to that.) APGARS were 10 and 10. She was perfect. It was 5:51 AM.

I reached for the doppler and put it on her fundus and there were cord sounds. Ah, yup. I said,"I hear cord." The mom said, "is that good?" I said, it means there is someone else in there with a cord attached. She looked at me again. I think not quite comprehending what I was saying. There was not a drop of bleeding. I called FaeryLady and told her we had one small, early looking baby girl........ and another heartbeat. She freaked a bit and then asked me to palpate. I said the baby was just born 4 minutes ago and I needed to get mom out of the tub. The cord was very short -- the mom couldn't lift the baby any higher than her belly button. I got her up on the bed and tried to palpate. I couldn't tell the baby's position, but baby A was still on mom's abdomen too. I listened to baby B and heard a decel, so I clamped and cut baby A's cord and handed her momentarily to dad. I checked internally and felt what I thought might be a butt cheek, but I wasn't sure. FaeryLady was on speakerphone on the bed, being still an hour away. Baby B had stabilized and we NEVER heard another bad hearttone until the push before birth.

At this point, I called Preacherman and told him to pray and what was happening. He was so calm and reassuring and loving. He said, "You are so good at what you do. You can do this. It's not a problem." What a wonderful man. I then called SuperDoula because she had twins last year at home. Someday she will be my apprentice. I asked her if her husband was home. She said yes. I asked when he had to leave for work, and she said 10 PM. I told her, "Get your butt in the car, I need your help. We've got twins here and FaeryLady isn't here yet." Her husband had been on days the past week --from 6 AM to 2 PM. If he had been gone, she would not have been able to come and help me. So many people's schedules had to coordinate for this to all work out the way it did. God is so amazing. So amazing. I am in awe.

Since the mom wasn't contracting much at this point, I just continued listening to baby B, helping her nurse baby A (who nursed like a champ) and watching for any bleeding. When FaeryLady arrived, I told her the presenting part was lower and she asked, "What is the presenting part". I said, "I don't know." She asked the mom if it was okay for her to check and she did. She said, "It's not skin, it's bag, bulging with water in it still, and I feel toes." The baby was double footling. I just put my head in my hands and closed my eyes. I was sure FaeryLady was going to say "That's it. To the hospital for a section." But she didn't jump to anything.

We stopped a minute and I asked the dad to pray. To pray that the baby would get in a good position. To pray that the labor would pick up again.

We evaluated where we were. The baby sounded good. The mom was for sure 10 cm dialated. The bag was intact. What reason did we have for rushing off somewhere? None. So, we kept mom laying down in case her water did break, we didn't want the cord rushing down.

FaeryLady went out to the car and just happened to (providence!) have a copy of the Midwifery Today Tricks of the Trade booklet that has the outline on attending twin birth inside it. We reviewed step by step. It recommended turning baby B into an optimal birth position as soon as possible and then breaking the water. It said that it would be very hard to reposition baby B once contractions resumed. She looked at me and said, "We need to turn this baby." We listened carefully with the fetoscope. FaeryLady jiggled the baby's butt, trying to find where the head was. I suddenly could feel and grasp it up by the mom's left ribs. I was able to get a finger between the ribs and the head and just held it there while FL jiggled the butt some more. I gently, gently massaged the baby downwards, always stopping if there was any resistance. Hearttones were great throughout. When the head got to the level of mom's umbilicus, all of a sudden, "plunk!" it went down into the pelvis. I held the baby in place with both hands and had FL reach in and check. She looked at me and said, "I feel a head. I can feel a suture line. I don't know what way it's facing, and I DON'T CARE!" We all praised God.

Since the bag was intact, the book recommended breaking the bag at this point. By now, Baby A was 4.5 hours old. Mom was not having any contractions. We tried to get things going again with herbs, homeopathy, walking, nursing Baby A, breast pump. All to no avail. We decided to try and get her to push the baby down without contractions to see if it would stimulate things to start again. She was able to get the baby down to zero station, but no further. She expressed several times a fear of pushing the second baby out and that she didn't want to feel the ring of fire again and that she was afraid of the pain. We did all we could to reassure her that it would not be the same as the first time and that it would be much easier this time. I don't think she believed us.

By the time baby was down to zero station, I felt much better about breaking the water, so I did. Still, unable to make much progress. We tried sitting, standing, squatting, kneeling, hands and knees, laying down, birth stool.... none of it worked.

Mom was getting tired. Baby sounded great. The head was down and well applied. There was no bleeding. But it had been 9.5 hours since Baby A. I turned out the lights, tucked mom into bed and told her to sleep for a while. It just didn't feel right to have her push the baby all the way out while not having any contractions. I was really worried about bleeding afterwards, especially with no contractions.

FL and I went on the porch to talk. I called another midwife with twin experience who assured me that the mom's body would do it eventually. She said that I had done everything right so far.

The mom slept for 1.5 hours on and off, resting on her left side. We kept listening about every half hour for heart tones. When she woke up a bit, I had a heart to heart with her. Where I live, we call it a "Come to Jesus meeting." I explained to her that her body could do this. That I thought she was made to do this. That it wouldn't hurt as much as the first time, that yes, it would hurt, but not as bad. That she had to push this baby out. I told her that if she would not push the baby out, we had to go to the hospital for them to cut it out, because they could only come out those two ways. I said that when her contractions began again, that she would have to "Man up" and give birth. She said OK. She would.

When she was done resting, her labor began again. Now she was finally having urges to push again. She got the baby to about a +1 station, being very instinctive about trying different positions. She ended up semi-sitting on the bed with her feet pressing on my knees as I sat cross-legged in front of her. Finally, we could see a smidgen of head. Then we put the doppler on her belly and..... the hearttones were AWFUL! Like, 40 bpm! I looked at FL and my eyebrows hit my hairline. She said later she wasn't even sure it was the baby or not until she saw my look. I looked at the mom and said, "You need to push your baby out NOW!" FL got up by her, grabbed her foot and pushed her leg all the way up, and within less then 2 minutes, we had a direct OP head out. And it was pink. And the baby was pursing lips. I waited for rotation, she pushed again and out came baby girl #2. I put her up on mom's belly and she started to cry right away. She was much bigger than her sister. Her APGARS were 9 and 10. One point taken off for weak muscle tone at one minute.

I reached up and felt her fundus and it was hard as a rock. I hugged the mom and started crying with joy, relief, amazement, and just, wow. Time of birth of the second baby: 6:17 PM. 12 hours and 26 minutes after her twin sister.

I was so pleased that her uterus stayed firm. She had NOT ONE DROP of blood until the placentas came, which was 36 minutes after the birth. There were two. The chorions were fused. Baby B latched on to the breast 24 minutes after birth.

Baby A's placenta (on the right) looked really nice and healthy. Like she could have easily had another couple weeks in there. Baby B's placenta had infarcts and calcifications, some weird jelly stuff between the membranes and the fetal side, and a velamentous insertion with a short cord. If we had insisted she push that baby all the way out, that cord would have broken, and the baby would likely have died.





The mom's total blood loss was less than 500 ml. She had a small tear along an old episiotomy scar that didn't need stitches. Both babies are nursing well.

Baby A was 6 lb 5 oz. Baby B was 8 lb. 3 oz. Sooooo many things went into this birth being as wonderful as it was. So many people's schedules were free that day for everyone to be able to work together. I couldn't have done it without FL, my dear, supportive, wonderful husband, SuperDoula, and this wonderful family who was utterly dedicated to birthing their babies naturally. And the entire time, God had my back, man. He was right there with me, showing me what to do and whispering in my ear each step. I think God gives midwives an extra measure of intuition and we should always listen to it. For all you Christians in the blogosphere, please join me in praising and thanking God for this beautiful birth and an extremely growing and learning experience for me.

I am told by a midwife friend of mine that for each Apprentice, there is a defining moment when they know they have become a full-fledged midwife. That moment came for me last Sunday, when I put that doppler to a mother's belly after her baby was born, heard another heartbeat, and did not run screaming from the house. I stayed. I was calm. I did what needed to be done. I am a midwife.