[Issue 2:9]
I am looking for stories and information about giving birth to twins. My
midwife is out of state, and doesn't feel she can guarantee she will be
here in time for the birth of my babies. With this in mind, I have been
contending with the hospital and setting out my guidelines and preferences.
The one that seems to be the largest issue is the use of an epidural. For
obvious reasons, I am not eager to go that route, but at the same time,
would prefer it to a c-section.
At this time, one baby is head down, and the other (the one to emerge last) is
breech. While the doctor will leave me without the epidural for a vertex
birth, she is eager to use an epidural for the breech birth. I'm
frustrated, but I also realize her experience is not equal to that of my
midwife. I am clear that the birth of my babies is not about what is
easiest for my OB, yet I need information that will help inform her about
the ways she can help me in my deliveries without the use of any form of
sedation.
[Issue 2:12]
Do NOT let your OB talk you into an epidural, unless that's what YOU want!
My twins, born June '99, were in the same position as yours, and my OB
wanted me to have an epi for the second one too. I refused and we
compromised with a saline lock, which was put in place at the beginning of
second stage (and I regret agreeing to that, since it was unnecessary,
painful, and disruptive to what had been a very peaceful labour to that
point). His concern was that the baby would turn transverse and he would
need to do an internal version--reach in, grab the feet and pull--and that
it would be too painful for me. I decided to use gas (Entonox) if I needed
pain relief, and he was OK with that.
Eleanor was born entirely naturally, and I caught her myself with my
midwife's help. I held her on my chest, cord intact, while the OB checked
the position of the second baby. He broke her sac, found she was turning,
and decided to pull her out feet first (I think she would have turned
vertex given the chance, but he felt better safe than sorry, I guess). It
was incredibly painful having his hand in my uterus, and I was offered gas,
but couldn't concentrate on holding the mask and my baby, so didn't use it.
However, the procedure was extremely quick. Isabel was born a mere 2 1/2
minutes after her sister.
I am SO very glad I didn't have an epidural or any other drugs. Yes it was
painful, but the pain was so brief compared with the joy of being
unmedicated and able to return home later that day (about 8 hours after the
birth). Apparently they were still talking about us weeks later at the
hospital: the huge twins (8lb 10oz and 8lb 9oz) who were born without drugs
and went home the same day. (I explained to the nurses who were shaking
their heads that there was no way I could nurse two babies in a narrow
hospital bed!)
My only regrets are the saline lock, and the fact I had to give up my
homebirth when we discovered a second baby at 36 weeks. If I'd had time, I
would have found a private midwife who could deliver twins at home (the BC
College does not permit it).
My advice would be:
1. Write an explicit birth plan and sign it. That makes medical staff feel
more comfortable about honouring your wishes without fear of being sued.
State your preferences reasonably, and have contingency plans (i.e., if a
c-section is necessary, state how you would like that to proceed as well).
Don't forget to include how you would like the babies to be treated (e.g.:
type of suctioning, if any, when to cut cord, breastfeeding twin A to
reestablish contractions for twin B, etc.).
2. If comfortable, give birth in the hands and knees position for Baby A.
This makes it less likely Baby B will turn transverse (I wish I'd known
this, or I would have tried). Alternatively, have your midwife or a nurse
gently "hold" Baby B "upright" externally while you push the first baby
out, and until the buttocks are safely engaged in your pelvis.
3. Find out from your OB how long she is comfortable waiting for the second
baby. Some second babies are born hours after their twins, but not all
doctors are willing to wait that long, for fear the cervix will close and
may not dilate again for a breech, or one or both placentae will detach and
cause haemorraging or foetal distress. Establish ahead of time both of your
comfort zones in regard to watchful waiting.
Most of all, trust your body. Twins are rare but not abnormal, and if
giving birth to them was really so dangerous, natural selection would have
eliminated multiple gestations in our species long ago.
-Jennifer Landels, Vancouver BC
Reprinted from Midwifery Today E-News (Vol 2 Issue 12 March 24, 2000)
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