Twin Birth

Twin Birth of Isaiah and Elijah

My pregnancy test was negative. I asked my mom what could be wrong with me as I had to pee all the time! She looked me straight in the eye and said, “It is because you are pregnant with twins.” I assured her I was not and asked for other suggestions to determine the cause of my new discomfort. She was not convinced but agreed to Google with me to see what else it might be.

Four days later, I took another pregnancy test because mom kept asking me if I was sure I was not pregnant. This time, the test was positive. I contacted my midwife immediately to assure myself a spot! I was ready for a homebirth and so excited to have this option. We had not anticipated getting pregnant this soon as our son was three and our daughter 11 months.

Twin Birth

Pregnancy was completely normal other than feeling nauseous daily, which was worse than with our other children. It seemed to get worse every pregnancy however (this being my fourth), so I decided it was totally normal. My midwives were pretty convinced I was only carrying one baby. However, with mom’s conviction and the plan for a homebirth, I decided to get a 20 week ultrasound. We are an hour away from the hospital and I wanted to ensure the baby was healthy. I felt better knowing things were normal inside me. Within the first two minutes of the ultrasound I hear “wow” out of the technician’s mouth. I looked at her and asked, “Did you just say, ‘wow’?” Then immediately added, “There are two, aren’t there?” She confirmed it and a forty minute ultrasound turned into an hour and a half (much to my husband’s dismay as he was trying to keep our two other babies happy). Now I finally understand why I could never fool my mom as a teenager!

During the ultrasound, I found out there was one placenta and two amniotic sacs. I was told that there was a small chance the babies could be a boy and a girl, so I decided this is what we are having although I did not want to know for sure. We also learned that the doctor would want ultrasounds every two weeks to catch any issues with the babies. I was not happy to hear this frequency, as I am not convinced ultrasound is 100% safe – especially with frequent use.
So excited for twins, yet devastated for the loss of our planned home birth, we left the ultrasound clinic. My husband and I discussed the possibility of having an unassisted birth away from the hospital. I called my midwife that night in tears over the impending doom I felt in being transferred out of her care. We spoke and she assured me she would transfer me to a wonderful OB/GYN and that no matter what, she would attend my birth, even though she could not provide my care. I was blessed beyond belief as midwives do not attend or get paid for twin births. I was and am so incredibly grateful that she would do this for me. I felt a little better as I knew she would support me in achieving the best outcome, despite not looking forward to the hospital surroundings.

The OB that my midwife recommended accepted me as a patient and I had my first appointment two weeks later. Upon arriving at the hospital, I could not find parking which made me five minutes late for the appointment. I got upstairs to the offices and the clinic had my birth date wrong, so I was sent downstairs to show proof of ID to change it. Everyone was exceptionally nice; however, I was starting to feel the sadness of not having it as cushy as it was with my midwives.
I got back upstairs and waited and waited. When it was finally our turn to go into the exam room, my daughter had a complete diaper blow out and I had no extra clothing for her. The nurse advised me she would come back later, so I could change her in private. My daughter had become sick and was becoming very fussy. I cleaned up her pants as best I could and put them back on her and looked at the time… I had only paid an hour for parking and here it was—time was up! I went out to the nurses’ desk and asked how I might deal with that. She told me they would take care of everything. I then went back into the exam room and bawled. I didn’t want to be here; I had a sick baby, was feeling overwhelmed with the changes to my birth plan and very anxious about meeting my new care provider. I am emotional at the best of times, but combining this situation with pregnancy hormones, I was a wreck! I eventually wiped the mascara running down my face and tried to get it together.

I started to breastfeed my daughter to comfort her and my doctor came in to meet me. The first thing she said was, “So you are having identical twins.” I was devastated, as I knew identical meant same sex and we did not wish to find out what we were having. I told her I did not want to know what we were having and I was not happy the surprise went from being one of three combinations to one of two. I also told her I was caught off guard with this news, as this was not what the ultrasound technician told me. My doctor said that she was obligated to discuss the details with me, as identical twins carry more risk of complications than fraternal twins. We discussed the risks involved with identicals, although she was very careful not to use any fear tactics or blow any risks out of proportion. From the way she was talking, I could tell she would be an awesome doctor and I started to feel a bit of relief.

I asked her if she would allow my midwife to catch one of the babies and she said that would be no problem. She told me about the bi-weekly ultrasounds and I discussed my concern with doing that many. I was 22 weeks at this point and she was willing to discuss a different schedule, but wanted me to go to the high risk ultrasound clinic first to get more details on my pregnancy. I asked her if she would be at my birth and she advised me of the OB’s hospital rotations. My heart sank (and I am positive it showed on my face). While I was just meeting her for the first time, I felt she would be the best person to oversee my birth and I really didn’t want a stranger in the room.

She booked me for an ultrasound two weeks later. We would discuss additional ultrasounds and labouring in the tub (my main request) at our next appointment. After my first appointment, my doctor took time to call my midwife and advised her she could be as active in my birth as she would like and that she would do her best to be there. I think she saw how much I needed her support and care, versus getting whoever was on call when I went into labour. I was so pleasantly surprised when my midwife called me with this news, as it is unheard of nowadays for a midwife to have anything to do with twins once they have transferred care. It is also uncommon for a doctor to be on call for a birth at that hospital. I had a generous and compassionate midwife and an amazing OB who really cared about my wishes for this pregnancy and birth; both agreeing to be selflessly on call so that I could have a chance at the best birth possible. Knowing my doctor was willing to give up her place catching the babies felt like a gift to me, knowing how much I trusted my midwife and the importance of my relationship with her. I was feeling much better about the change of plans.
The results of the ultrasound at 24 weeks showed both babies growing exceptionally well, with none of the potential identical twin issues. I was happy to know all was well and I was looking forward to meeting with my doctor in two weeks. At my 26 week appointment we discussed when to do the next ultrasound. Instead of the two week timeline, she recommended I go back at 31 weeks which I was very happy about! We also talked about her partnership with my midwife and that she would support me labouring in the tub assuming the room was free when I arrived at the hospital. I was more and more astounded by her willingness to be flexible on my care and her genuine concern in providing me and my babies an optimal birth experience. We booked an appointment for the ultrasound in the morning. I would go see her in the afternoon. I made plans for a full day in Calgary at 31 weeks—ultrasound in the morning, a hospital tour and lunch with my midwife in the afternoon. Then my midwife accompanied me to the appointment with my doctor where we went over my birth plan. My doctor had to take my birth plan to the head OB and nurses at the hospital for approval as many things in it were outside the standard protocol for twin births. We booked an appointment for two weeks later to discuss the results of the hospital’s decision.

At my 33 week appointment, I was advised that the meeting had not yet taken place so confirmation of my birth plan requests was still not available. My doctor wanted to do a three minute ultrasound to confirm the fluid levels around both babies, so I agreed since I could tell she was a bit concerned. Around 34 weeks my midwife called me advising me the hospital officials did not like my birth plan at all and things were not looking good for a water labour or freedom from continuous monitoring and IV as I had requested. We spoke for almost two hours and I could not believe this was happening. Again I contemplated staying home to have the babies unassisted. Fortunately, I had obtained my doctor’s email address at an earlier appointment and I was thankful I had it. I sent her an email telling her I could not wait until our next appointment. I needed to resolve this, as I was very upset about what I had heard. She called me the next morning and we spoke in detail about why I requested certain things and that the water labour was extremely important to me. She discussed her concern with declining the monitoring and after hearing each other’s perspective, we agreed to compromise. She would make sure I could have the room with a tub if available and I would agree to continuous heart rate monitoring of the babies. After the discussion, I felt this was a fair compromise and was much relieved about the birth plans again.

I booked a late afternoon appointment on February 29 (35 weeks), as I was planning to go into labour this day and figured if I was going to be in town anyway. Well, I knew it was wishful thinking which is why when my doctor suggested a 36 week ultrasound, I asked her to bump it to 37 weeks. I had a feeling we would be having discussions about getting babies out and I wanted as few extra ultrasounds as possible.

March 11, I finally went into labour! I was so excited that I was going ‘early,’ as I was now 37 weeks. By the time my husband and I got to the hospital, my contractions were two minutes apart. It was around 8:00 pm and both my doctor and midwife came. The only problem was the tub room I wanted was not available. I made peace with that since I had both my midwife and doctor here for the birth and that was most important. I had a great nurse and I ended up walking with my midwife to try and increase my contractions. We did flights and flights of stairs and my midwife did acupressure on me. While the contractions were constant, they never progressed. Five hours later, we all decided nothing was happening and that we should leave. We were advised to book a hotel since the contractions were so close and going home would not be wise. An hour after booking the hotel my contractions totally stopped. Neither my husband nor I could sleep and so after being at the hotel four hours, we started on our way home around 6:30 am . . . what a huge letdown heading home without babies on the outside!

At my 37 week ultrasound, I was advised that both babies were doing exceptionally well and scoring 8/8 on their biophysical profile. 1 From there I went over to see my doctor prepared for “the talk” about getting them out. At this point the risk of stillbirth increases but only by 0.06% so I was ready to decline any intervention. The sonogram doctor had faxed my OB the ultrasound report and with the results we decided to have “the talk” next week. My doctor told me I would get the big blue ribbon at the farm show for biggest identical twins she ever attended. I’m not sure if she was calling me a cow. We had quite a jovial relationship. I remember being excited hearing we were having twins as I thought I just might have six pound babies but I should have known.

A day before my next appointment, I received a call from my midwife advising me that this pregnancy was going on too long and no one was comfortable with this for much longer. She suggested I agree to a membrane sweep and that the doctor had made mention of induction two days later if that did not work. I was also told that a number of things had changed since the beginning of my pregnancy and that I may not have the support I wanted should I not get the babies out in the next very short while. At this point I was completely devastated. Everything was looking so very great and positive and now I was feeling huge pressure to make decisions to get babies out sooner than they may be ready. I had this pressure at the end of all of my pregnancies and it is so stressful for me. My body is strong and can carry babies longer than average I suppose. Everywhere I go people are telling me I am huge, but I feel great and don’t even really ‘feel’ pregnant. I continue to do my normal daily activities (measuring the equivalent of 54 weeks pregnant).

The next day was my appointment. I did not sleep well that night and was very anxious about what my doctor would say. I was very upset and so I brought my husband along for support. My doctor sat down with me and very compassionately told me that my 38 week identical twin pregnancy was like a 43+ week singleton pregnancy and as the risks increase, her comfort with letting the pregnancy carry on was dwindling. She also clearly told me it was entirely my choice and as long as babies are doing fine, she was happy to work with my wishes. I apologized for being the client to put so much pressure on her as I knew there were people around her who were not supportive of my birth plans. I couldn’t help but feel horrible about the extra stress I was creating for her. I am positive my doctor fought for my desires and I am pretty sure she was given a really hard time for not strong-arming me to protocol. For that and a few other reasons, I agreed to a membrane sweep to try and encourage the babies to come out. We booked an ultrasound for about 48 hours later to check on the babies, if I was still pregnant then.

At the ultrasound it was determined that Baby B was now larger than Baby A and had also turned breech. Both babies were looking great and my doctor came to meet me after my appointment to discuss next steps. She made it clear she would like to induce but that the ball was in my court. I decided another sweep would be a reasonable compromise and booked an appointment for three days later. I did not want the babies to come that weekend since she was away. I was praying to be able to have these babies on a schedule that would work for her. I knew I needed her at the birth to get the support from the hospital. I had become very attached to her compassionate way of working with me and I appreciated her not scaring me into submitting to her wishes. At this point I couldn’t even imagine working with another OB. With my doctor away, I nested. I was panicked that the babies would come, while she was gone. Thankfully the nesting was short-lived and it never turned into anything, so I went in for a second sweep after that weekend. This time she was nowhere near as gentle . . . I could tell she wanted these babies out. I was now 39 weeks and I have a feeling the pressure was on behind the scenes that she would ‘let’ me go this far with identical twins, which are almost always born or taken before 37 weeks. I couldn’t believe I was pregnant either as these babies moved from being possible Aquarians to likely Pieces and now Aries. No one thought this pregnancy would go on this long!

My doctor asked that I would have an ultrasound again at my 39.5 week appointment. I agreed to an in-office one to quickly check fluid levels. Baby B was back head down and she was happy to offer induction at any time. I declined as usual. She respectfully accepted after booking another ultrasound for six days later. We were at a point where we had to monitor the babies very closely due to them being considered so far post dates at a 46 week equivalent. Since my aunt was here from out of town, we decided to get steaks and have a nice dinner. (Last time she was visiting and our daughter was “overdue”, we sat down for steak and ended up rushing to the birth centre, so we figured we should try that again). I put the steaks on the BBQ and was bending over to get our dogs their supper and pop, my water broke. In my other births, my water had never broken before steady contractions, so I was unsure how this would play out. It was about 5:30 pm and I called my midwife to let her know. She said to come in once contractions were steady and so I waited, wondering how long it would be. Brian suggested we go in right then but nothing was happening, so I said we should wait. Oh how I wish I had listened to him!

My midwife called my doctor and told her my water broke so my doctor used her influence to hold the room I wanted with the labour tub. I was so thankful to her for going above and beyond for my birth. I could not be more blessed. My midwife then headed to a meeting and I watched everyone eat steak (yet again) as I was not in the mood. By 6:00pm I was getting strong contractions and they were very close, so we were in the car and on the way to the hospital by 6:10pm. It was an hour drive. By half way, I knew it would be the longest hour of my life (although it was a little less as the speedometer was above 160km/hr the entire drive). Hard contractions were now two minutes apart and my midwife was on the phone to me the whole drive into the hospital telling me I could do this and to NOT push!

Within 15 minutes of the hospital I had the overwhelming need to push. It was all I could do to keep this baby in. Each contraction pushed baby further down. I was having a VERY hard time not giving into my body. I fought and fought. We finally arrived at the hospital where my doctor, midwife and a nurse were waiting for us outside with a wheelchair. My husband was permitted to park at the emergency entrance while they wheeled me up to the room —I was SO ready to get into that tub… but my doctor and midwife had other plans; they wanted to get the heart rates of the babies and the tub wasn’t filled yet. AHHH, PANIC! I needed that tub an hour ago! Here I was stuck being monitored with baby not cooperating, so I finally said half-jokingly, half assertively that they could check the baby’s heart rate AFTER it was out.
The tub now had a few inches of water in it and I happily jumped in. It was so much better than I pictured it. I was told it was so small and that with my size I may not even fit. That was not the case at all; I was SO thankful to be in there! Once I was in the tub, my thoughtful midwife provided me a cool cloth for my forehead and I was able to relax for the first time in almost two hours. Approximately 20 minutes later, Baby A was caught by my midwife and placed on my chest. I was very excited to look down and see a boy! He looked nothing like our other children and I was surprised by this as they had looked so much alike. His cord pulsed for a really long time while he laid on me in the warm water. We knew now to expect another boy.

After about half an hour, I felt I may have more contractions coming on. So we had an ultrasound to see Baby B’s position. He had just turned breech within the last couple of hours. Since I knew a breech water birth wasn’t an option and I wanted to be in the tub, I asked my doctor if we could turn baby vertex. I wasn’t sure if she would let me back in the tub since hospital policy did not allow water births. I had been very careful to not share baby was coming, so I could have at least one water birth. My doctor told me I would have to get out of the tub but before I did, I decided to make a last minute request to leave the babies and cords uncut until the placenta was out. I had signed a three page waiver regarding delayed cord clamping and all my other non-routine requests at a previous appointment; however, I never made mention of the cord clamping being this delayed. She accepted my new request and so I used everyone’s help to get out of the tub and onto the bed with Baby A still attached to me. We decided to use external pressure to get Baby B head down so my doctor moved him gently with her hands. His heart rate started to fluctuate and I was advised to have my water broken to speed things up and to ensure he stayed head down. I was ready to meet him, so I agreed and my doctor broke my water. Everyone was shocked by how much fluid there was—I guess that is why he was able to move so freely!
Contractions started fairly soon after that and I was told his heart rate was iffy. After a few minutes my doctor said very seriously and firmly that she was very concerned about this and that I really needed to get him out. I had a couple more contractions and pushed very lightly until she finally said to me, “Sera, I would not pressure you at all unless I was really concerned. You know that.” I nodded my head in agreement. She said, “You have one more contraction to get him out or we are going to have to use the vacuum.” A whole bunch of people filed in the room including a man. I said to get them out of there, “What were they doing in here?” Apparently my doctor told me the NICU team was coming in from waiting outside—at her request they were asked to not come into the room at all unless needed —I appreciated that! I did not hear her telling me they would be coming in and I was surprised by their appearance when I pulled the cloth off my eyes. My midwife took notice of my demeanour immediately and asked them to close the curtain for my privacy. I am so thankful for her intuition.

At this point I realized my doctor was very serious and so I covered my eyes again and I prayed out loud. I prayed for a strong contraction and I prayed for strength to push. I continued to pray while I was reassured by my midwife that I had the strength to do this. It was like everyone disappeared and I begged God for help. My next contraction came and I pushed with all my freshly replenished energy. We went from showing no head at all to having a whole baby caught by my midwife and again placed on my chest.

The male paediatric specialist now came over and introduced himself (boy, was I embarrassed for freaking out on everyone!). He looked over the baby on my chest and was very happy with his condition so he and his team left the room. I looked down at this baby who looked nothing like his brother. He was much fuller in the face and seemed totally different. I was so thankful at this point that both of our boys were here at last and perfectly healthy! Both boys were still attached to the placenta and it was now time for the final birth. I wanted confirmation that they were identical, so I asked my doctor to look over the placenta to see if the placenta fused. I was surprised identical twins could look so non-identical! She looked it over and confirmed the blood vessels crossed over the membranes and thus they were indeed identical. We took a picture of the boys still attached to their placenta after my midwife made heart shapes in their umbilical cords. Then my husband cut the cords. We are both so very thrilled with our new additions!

My nurse confirmed I was not hemorrhaging and checked my vitals. The blood pressure cuff was causing my veins to pop out of my skin – it was so painful. My midwife again advocated for me, advising that my nurse could leave, as my midwife would complete my care. I had no tearing or bleeding issues and felt no need for any drugs, so I declined the routine oxytocin. I said I would breastfeed instead. I then got up and thanked my doctor for supporting me in the birth I wanted. It was about sixty percent of what I had envisioned but it was one hundred percent perfect. I have never felt so overwhelmed by the selflessness and kindness of a doctor before. I know how much she went out of her way for this birth and I am in awe of her courage and compassion. She left very shortly after the births and I was sad to say goodbye.

Twins

We took pictures with my midwife and nurses. I had wished I thought about pictures before my doctor left. It was now just my husband, our midwife, me and the boys. Isaiah: born at 7:29 pm weighing 7 lbs., 9oz and 19 3/4” and Elijah born at 8:25 pm weighing 7lb, 13oz and 21”. I nursed the boys, then my husband and midwife dressed them while I got dressed. I then wrapped both babies on my chest in a carrier and we all walked down the hallway to the exit. It was like walking down the green mile! Everyone was staring at us as we passed the nurses’ station. I don’t think anyone who just had twins a couple of hours earlier has ever walked out of there! We said thank you again to our nurses and walked out to the car to buckle babies into their seats for the drive home. My midwife gave me some arnica to help with the afterpains and made arrangements to visit us at home the next day. We were in the hospital less than five hours. It was fantastic!

My husband and I drove home with the boys, talking about what a fantastic blessing we were given with such an amazing birth. The compassion of our amazing midwife who stuck with us through this pregnancy and birth as a total gift since she had transferred my care almost 20 weeks earlier and our doctor who had so much care and concern for me that she went well out of her way to make this birth extra special made such a difference to our experience. We are in awe of their selflessness and compassion, as well as the two very healthy boys we have added to our family. God and these remarkable women have made this amazing day one that will bless us forever! B
Sera Fradgley is married to her very supportive husband and best friend. She is a stay at home mom to their four young children. She loves hobby farming and enjoying their animals and land as a family.

1. A biophysical profile uses ultrasound to measure body movements, muscle tone, breathing movements, amniotic fluid, and heartbeat in order to assess whether the baby is getting enough oxygen through the placenta.

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