If I had been pregnant with a singleton, I doubt I would have found my way to planning a home birth. Which is too bad; homebirthing a single baby would be a pretty easy decision. Choosing to homebirth twins requires a little more faith in nature, your body and your midwives.
I had been considering birthing with midwives at the birth center annex of the local hospital when, at 19 weeks pregnant, I found out I was carrying twins. Multiple births don't qualify for the birth centers in my area, so I stuck with my OB practice. As time went on, I realized my preferences for a natural birth would not be respected. When I brought up birth plans, the doctors countered by calling mine an "unproven pelvis" and worried about "fetal death." According to one labor nurse, the hospital has an 80% caesarian section rate for twin moms. After exhaustive research from which I pieced together my belief that, for me, a twin homebirth would be safe, I found a willing midwife and got supplies together. I even got to talk to a mother in my local Moms of Multiples club who had successfully homebirthed her twins a few months before. I was a bit mystified that she wanted to talk less about her birth experience and more about having young twins, but I took that as a very good sign.
Finally, at 38 1/2 weeks along I started feeling some prelabor. After a day of mild contractions and an agonizing drive home from work, my husband and I decided it was best that we start taking our maternity / paternity leave time and get ready to welcome our twins. That was Wednesday. On Thursday very mild contractions continued, and we tried to encourage things by taking long walks and nesting around the house. We walked four miles, followed by trying out my breast pump, which I had heard could jump start labor. No progress with the contractions, but we got a great night's sleep!
Almost everything I read said twins came early, and our OBs said that going past 38 weeks was dangerous. Instinctively I knew better, but there was a grain of doubt in my mind. So, because I was going on 39 weeks, and because our midwife was leaving for vacation that Saturday, I decided to try castor oil to get labor moving. These were not good reasons to evict my babies, which I mildly regret. I wouldn't recommend castor oil, but it did work!
At 5am Friday morning I took my first dose of castor oil in orange juice. At 6am I took my second dose, and as I was violently and involuntarily spitting it out, Baby A's water broke. Mucus plug and all came out in one convulsion; it was unmistakable. My husband and I were very excited. We rested and ate some. After lunch, I called my midwife, her assistant, my doula and my mother and asked them to come. Contractions were coming more regularly, but still not much to speak of.
Contractions were stronger by the time my mom came, around 1pm. A little more when my doula came an hour later. By the time the rest of the crew got there, the contractions were strong and I would occasionally throw up. First I threw up my lunch. Then I threw up the water I tried to drink. Then it was just dry heaves. Throughout the night people kept offering me food and drinks, but I couldn't stomach either. In my haze I remember one of the assistants offering me some sort of super-juice in one of our Waterford whiskey glasses. I think she had cracked a raw egg in it. It was surreal.
As things progressed, I was glad to be able to change scene and walk between rooms, totally focused on my contractions and my doula's coaching. Having Jen, our doula, there to help was invaluable. Because I could trust her so completely, there was nothing I worried about. I just focused on what I needed to do, and when.
While I was focused on progressing, the assistants had a fiasco over the birth tub. Our hot water ran out and the tub filled with cold water. With no hot water, our radiators stopped working temporarily and it got cold in the house. Water was boiled for the tub. And the gas was left on. It's kind of funny in hindsight, but was an annoying distraction for my husband and mother at the time.
My attention was on the fact that I wasn't dilating very well. For the hours of work, I was only 4 cm or so. Maybe it was because one or both babies were posterior. Maybe because they would have liked to stay in for another week or two. Maybe because their heads were locked. Probably because I was dehydrated. There's no way to know for sure.
Once the birth tub was ready, I wanted to get in it. At first, my midwife said no. She encouraged me to do lunges, walk up the stairs 2 at a time. I tried everything, tried to make the contractions come more regularly and stronger. But it hurt and I was tired, to the point of falling asleep mid-sentence. It was fatigue like I've never experienced.
The low point of the night was at about midnight. My midwife asked me what I was afraid of. My mom called it the midwife's "intervention." I didn't know why she was asking. I was thinking very literally at the time, all business, and it didn't make sense to me. I thought about it and was honest. The thing I was beginning to worry about was that I wasn't progressing and would end up having to transfer to a hospital. The contractions had just about stopped and I was trying to be rational. Thinking back, I realize the midwife thought my lack of progress was caused by psychosomatic causes, which were far from the case.
In a fortuitous development, not long after that point, my midwife left for her vacation. Her backup was on her way, although it was a long drive from Pennsylvania to the District of Columbia. In those hazy early morning hours my mom, doula, husband and the midwife's assistants napped by the fire.
Around 4 or 5am, in comes the cavalry - the backup midwife - IV in hand! She plugged me in immediately, and I took 2 liters in before getting up for another go at things. Once I was feeling more alert she checked and I was fully dilated! Oh the relief to hear that. We went back up to my bedroom. I was having irregular contractions. Ones I really had to think about before deciding if they were real or not. The new midwife gave me a couple shots of pitocin, which didn't seem to do much.
At about 9am the new midwife told me to lie on the bed and push through my mild contractions. Her idea was that lying on my back would help with the posterior babies. It wasn't working for me and I asked to use the birth stool. The stool was how I always imagined birth would be easiest. The midwife had a theory that the chin of Baby B was blocking the shoulder of Baby A, something she had seen before in vertex-vertex twins. So she had an assistant hold Baby B up (from the outside).
After the midwife quickly massaged my perineum (I remember looking up at one point and seeing bloody fingerprints on one of our bottles of olive oil sitting on my bedside table) I pushed and pushed, to the midwife's careful instructions. In a few short minutes my first daughter was born. Belle. She was covered in vernex and had a neuchal cord, but had perfect apgar scores and a beautiful round head. Much bigger than I ever expected six pounds, eleven ounces to look! I gave her a sip at my breast and rested a moment before handing her to Will.
Now the frequent checking of heartbeats got even more regular to monitor baby B. Apparently more complications arise with the second twin. I rested and got ready to push again, back on the birthing stool. Midwife Judy ruptured my second bag of waters. By now the contractions were totally gone. When I was ready, in too few pushes to remember, Izzy was born. An hour later and almost a pound lighter than her sister, but every bit as perfect. Strangely no vernex.
After the two births I remember bleeding on the birthing stool. I didn't try to look. The fluid sounded like it was flowing so fast it couldn't possibly be blood. But it was. My midwife later estimated that I lost 1000 to 1500 cc. Having heard that my mother hemorrhaged after my birth, I had expected it. The research I had done suggested some blood loss was normal. So I wasn't too worried. I may have gotten a third shot of pitocin and in time the stream stopped.
Now I could get back to the bed from the stool. I was still attached to the IV and I remember struggling to get to the bed through all the tubes. My movements were stuttered and I couldn't quite control them. My midwife looked over and saw me, and barked that I was fainting and needed help. The assistants guided me through and the moment passed. But I thought it was interesting that faints came on with trembling, and not the cinematic swoon.
Once in bed, nursing Izzy was wonderful because I could relax some. Both babies were born! But I wasn't quite comfortable since the clamped umbilical cords lead back to the placenta, still inside me. I handed Izzy off to my mom and got to the work of delivering the placenta. It wasn't easy, mine was a monster placenta. With lots of coaching and some gentle pulling on the cords, the midwife and I got it out. The inspection began - to make sure the placenta was intact and to reconstruct how the babies had been housed for nine months. I'm still not sure if there had been two placentas that fused, or one from the beginning. But it was funny to see the midwife and assistants peering and poking to see where the cords came in and how the membranes divided.
With the business completed, the assistants helped clean up a little. My father and in-laws came to see the babies, and to bring me breakfast that I could finally keep down. The fact that my dad brought me a McDonalds breakfast shows how worried he was; it may be the first time in twenty years he went there. He's a New England stoic with a healthy streak of pessimism. Knowing the difficult time his little sister had with her twins (bedrest, caesarian section, NICU time), he had been very concerned about my twin pregnancy and especially about the homebirth. When my mom called to tell him all was well and that we needed him, I'm sure it was all he could do to get food in hand and steer the car to my house.
When the excitement ebbed, my very exhausted mother and doula went home to rest. They had been up through the night without a break and working as hard as I had! I knew I loved these women, but had no idea of how tough and caring they could be. It was an amazing experience and taught me much.
One thing I hadn't planned for in my homebirth was what to do afterwards. In a hospital, the family is cared for by nurses, but at home, when the birth's done, everyone leaves. That's where my in-laws came in. They were brilliant and stayed with us through the crucial first night when Will and I needed every minute of sleep we could get. I set the two babies in one pack 'n play by my bed for easy nursing. I was so pampered; I never saw one meconium diaper. The second morning, our midwife came back for a follow up, and lectured us all on basic care. She almost sounded like an airline hostess, reciting safety precautions. It was such a high time, and we were fortunate enough not to need any of the warnings. The babies and I recovered smoothly. Within six days, when I brought the babies to their first visit with the pediatrician, they were back at birth weight and then some. No jaundice for them, no tearing and not a moment of baby blues for me.
Being at home made an exciting but difficult experience as safe and comfortable as it could be. It was some hard work and I needed a lot of help from many people, but I wouldn't consider doing it any other way.