TheHolisticParent.ORG Hope's Twin Homebirth

Hope's Birth Story- A Homebirth of Twins

HOPE…..
The story of a twin homebirth as told by the attending midwife

Hope and Solomon were expecting their 3rd child. Previously, they had used
one of our local CNM’s. A friend of theirs had used us for her birth last May, and
so they decided to birth this final baby at home. Hope is a very go with the flow
kind of girl and when she came for her 23wk appt, she said she felt huge with a
lot of activity. I was not there for that appointment, but Kathy said she agreed with
Hope. Then upon measurements and palpation, she strongly felt there was at
least 2 if not 3 babies in there. Hope was measuring 28 weeks at that time. So,
she agreed to get an ultrasound to verify the situation, and the following Monday,
she found out she was having twin girls! They were ounces apart and looked
great. Baby A was head down, and baby B was breech. Hope and Solomon took
it in stride and decided to explore their options. They met with the only local doc
here that has been known to do collaborative care for homebirthers. He told her
he did not recommend doing twin births at home, and if she were to deliver at the
hospital, it would be in the O.R. That was the end of that. Hope and Solomon
decided they were going to have faith. They trusted the process, and they trusted
us.

Hope’s last birth was about 2 hours long, so we knew the probability of these
babies coming fast was good. She lived about 10 min from me and a good hour
from Kathy. We decided to ask Nina from CHOICE, who said she would
recommend Audra as she was pretty busy around Hope’s due date. So we
asked Audra and she agreed!! This was going to be Audra’s and my first set of
twin births we had attended! We had our birth team pulled together, which was a
good feeling. Kathy, Audra, and I did Hope’s home visit at 35 weeks. The babies
were in the same position. Baby A was on right side head down, and baby B’s
feet were by baby A’s head. At 37 wks on a Sunday, Hope called and said the
contractions felt different so I went over and checked her and found her to be
6cm. It was a much different cervix than I had felt before…it felt “baggy”. Kathy
came and tested her for amniotic fluid because she felt leaky, and it came back
negative. So we went to grab something to eat and checked in with her later.
Nothing had really changed so we all went home for the night.

On Tuesday, we ended up with quite a learning experience. I had checked in
with Hope before driving all the way to Newark for prenatal appointments, and
she said I was good to go. I was there for about 45 min, and she called to see if
I had left yet. Her contractions were short still but painful, and she said she
would feel better if I was a little closer. So I headed to her house to listen to the
babies. Kathy’s gut told her to head out too, so she was right behind me. The
babies sounded good, so Kathy checked Hope and found her to be 8-9cm with
baby A at +1 station. We called Audra, and she headed over. Hope had a family
member come pick up her kids. We got everything set up, and decided to go
grab some lunch, which would give Hope her space and let her get into a better
labor pattern. Hope and Solomon went walking and a few hours later, I checked
her again and thought she was 9cm. That’s when Hope thought her water may
have broken. Fluid would gush out of her after each contraction. Sometimes,
Hope would run to the bathroom, and other times she just stood over a bucket.
She had 2 hours of more intense contractions, had a fat anterior lip left upon
vaginal exam, and then her contractions spaced out, got less intense, and her
cervix reverted back to 6cm. Baby A went higher back into Hope’s pelvis. We
wondered if maybe her uterus was tired? We all went home and decided to
check in the morning; maybe use some herbs, maybe go in to the hospital.

There were a few things that didn’t have me convinced Hope’s amniotic fluid was
leaking after all. For starters, she was 38wks, therefore I would have thought
there would be vernix in the water. Second of all, there were times she would
make it to the toilet and not just leak everywhere. I came home, and while feeling
slightly defeated, wondered if this twin birth we had all worked so hard for might
not happen at home. Then what would Hope’s birth turn out like in the hospital?
I decided to try to find everything I could on why Hope wasn’t delivering. The thing
that stood out the most to me what this from www.gentlebirth.org.

Very Stretchy Cervix

There's a type of cervix that stretches amazingly under your fingers, even with a
weak or irregular labor pattern. Sometimes the labor stalls out altogether. Have
any of you come across cervixes of this type before? How did you measure them
and what did you tell your client? How did they end up? (always baggy to the
end, finally stretched, etc..?)

On occasion, they are kind of neat. Sometimes these women are so stretchy they
can open to nine or ten centimeters with a slight stretch of your fingers.
Sometimes, they even rest there at 8 cm or so and can walk around for days or
weeks.

I finally learned (after many experiences with false and stalled labors, while
many times of rushing to the home because I thought the baby would be born
within minutes, etc.) that these women are different, and we should measure
their cervix in a different way. Their cervical dilation is irrelevant to their labor.
They can be at 8 cm with contractions and then completely different without a
contraction. Their cervix may even go backwards and tighten up again. They may
get to where they seem to be fully dilated and then the contractions stop. Or they
can be laboring and go from 4 to 9 in one contraction. I think the type of
contractions they have are really important --- because it's the type of
contractions they have which gets and keeps labor going -- not the dilation of the
cervix.

Eventually all of these women have normal labors -- usually about two hours. It
seems as if they just went into "real" labor without all the preliminary stuff. And
the babies really didn't fall out like we thought they might. Mom still had a couple
hours of labor. A couple of them had many bouts of start-and-stop-labor. I
remember one woman who we spent several overnights at her house on several
occasions until she finally went (and stayed in) real labor. She had a two hour
labor, but she'd been "9 cm" for a few weeks. I thought we'd have seen a baby
within a few minutes!

To me, the key seemed to be the type and quality of contractions. In all of these
experiences so far, they were completely unpredictable until they started having
strong contractions well over 60 seconds long. Anything shorter than that could
peter out and stop at any moment.

I also found that I think it's best to discount the cervical dilation with a loose and
baggy cervix, unless it is also well thinned (thinning seemed to be the key with
some of these women). [The loose and baggy cervix may be the "shirt sleeve"
cervix associated with an ill-fitting or malpositioned head.]

I've also known people to just AROM with these women when folks get tired of
feeling like they are "always on the verge of labor but the baby will never come" (I
say of course the baby will come, and true labor will begin). It's too much stress
for some midwives and for some moms. They are frantic about being so far
dilated and not in labor -- or of being in start-and-stop labor -- and they can't
handle it emotionally, some will go for induction (home or hospital). If AROM, a
mom will probably go into labor, but she might not. Then, she is disposed to
malpresentations. Some of the women I've worked with (or known of) handled
things very well. Others got stressed out, and we all ended up wishing there'd
never been a cervical exam in the first place!

I have had women with start and stop contractions who walk around 5 cm or
more dilated for weeks. The key is the word 'labor'. If labor stops, I walk away. I
have also found that women who have stretchy, thick cervices and are 4 cm may
have taken something to initiate labor. If that is the case, again I go home. They
will deliver in a few days, usually.

Yes, both midwives and docs AROM with the 'hope' that it will "get things going".
BIG mistake. Membranes should never be ruptured until the woman is close to
birth with strong contractions where there is no doubt that she will continue. I
have talked with midwives who have ruptured membranes at 8 cm to get
stronger contractions, but instead all labor stopped.

I sent that info via email to Audra and in the morning I called Kathy. I asked Kathy
if I could check Hope’s fluid and listen to the babies’ heartbeats. I got there
about 8am. Hope looked good. The babies were good, and the amnio swab was
negative. I called Kathy to tell her what I had found and she asked hope and
Solomon if they would be willing to get an ultrasound, which they were willing to
do…just do double check. A few hours later, they called to say that fluid levels
were both 16!!!!!!! Both babies were also now head down! So we figured out that
all of the work Hope had done the other day had been turning baby B to a vertex
position!!!! Baby B was pushing baby A down into the pelvis stretching Hope’s
cervix! We all felt great. The babies were great, and so we waited!

At 2:05am on the morning of the 15th of March, Solomon called me with bad
reception on the phone, telling me that Hope’s water had broken and that she
said the babies were coming. Still half asleep, I first called Audra, as she was
next closest, then Kathy, and then our other helper. I got to her house about 2:
20am, and found her to be on her hands and knees saying the babies were
coming, and she couldn’t move or else. I asked her to give me a few minutes to
get some things set up, listened to the babies, and checked to see where baby A
was…...complete and +1. I called Audra and asked her to hurry. She was 5 min
out. Just as Audra was walking in the door, baby A was coming out at 2:37am.
She was perfect. Audra clamped the cord, and we got Hope onto the birth stool.
Audra broke baby B’s water at 2:45 and out popped baby B who was also born at
2:45. Hope’s bleeding was next to nothing! Within 10 min or so, the placenta
was born, everything was blissful. Poor Kathy missed it all!

It was an amazing roller coaster ride and wonderful birth of two precious baby
girls.

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