Friday, January 24, 2014

birth times two

When I was pregnant with Harriet, I did lots of research on unmedicated child birth. I read books and took classes. We had a doula. Our doctor was trained in water birth, and we delivered at the hospital in our area with the lowest c-section rate. I was physically, mentally, and emotionally prepared to give birth with very little intervention, and I feel really lucky to say that Harriet's birth was pretty perfect. Not only did it go off without a hitch, but it proved to be a life-changing, thoroughly healing, top-of-the-mountain experience for me.

This time around, I am becoming more and more aware that my experience will be completely different. My husband now works at a different hospital, and if we deliver there, our birth is essentially free. If we were to deliver at the hospital where Harriet was born, we would pay thousands. So the choice is obvious. This new hospital has a brand-new, beautiful mother/baby center...a far cry from the maternity ward of the hospital where Harriet was born where we had to run our tub for twenty minutes to get warm water.

This new hospital does things much differently. Most physicians are a part of a large group, so you really have no idea who is going to deliver your baby, whereas the doctor we worked with during my pregnancy with Harriet did all of my appointments and was called out of his bed at 2:00 in the morning when we needed him.

During my first appointment with my new OB group, the doctor assured me that "this isn't going to be a granola birth." She went on to explain that no hospital in our city does waterbirths for twins. She explained that I will deliver in an operating room, even if the birth is unmedicated. She also explained that there will be lots of people and lots of monitoring. If I hit 38 weeks, I will be induced. Although I really hate the idea of induction (I'd rather let the babies choose their own birthday and I know that induction makes labor much more intense), I'm actually okay with this since the stillbirth rate in twins goes up after 38 weeks. Plus, at that point, they grow better outside the womb than in it.

As far as what type of birth I'll be having, the babies and the doctors will decide. I have a little bit of power in this, but not much. If Baby A (the one who will be born first) is bigger and head down, I get to try for a vaginal birth. Otherwise, it's an automatic c-section. As of right now (26 weeks), the babies are both transverse, but Baby A is bigger.

When Baby A is born, Baby B will likely flip around due to all of the free space that suddenly opens up. Apparently, if Baby B flips breach, some doctors will literally reach their arm in while exerting pressure on the outside of my abdomen to flip the baby to a head-down position. I've heard this is the most painful part of the birth. Other doctors prefer to deliver the second baby breach and will even flip Baby B from the head-down position (using the same method I just mentioned) in order to be able to grab its ankles and deliver it feet-first. Other doctors don't flip babies at all, so if Baby B ends up breach, I get a c-section.  All of this depends on which doctor happens to be on call and what the babies do.

I do get to choose whether or not to have an epidural, and this is the part that makes me the most nervous. Assuming I'm lucky enough to have Baby A in the head down position and bigger than Baby B, I will try for a vaginal birth. I would really, REALLY prefer to do it without an epidural. Here's why:

  • I've done it without an epidural before and I know I can do it again. The fact that it's twins doesn't scare me one bit, as far as the pain goes. I trust my body 100% and I know I can handle it. I've never birthed with an epidural so there's a lot of unknown there. 
  • I hate the idea of that needle in my spine. When I was pregnant with Harriet, that fear was probably the main thing that led me to pursue unmedicated birth in the first place. 
  • I don't want somebody telling me when to push. When I was giving birth to Harriet, I had all kinds of helpers and they were all wonderful. But it was my job to bring her into the world and I liked the fact that it was me, my body and Harriet making it happen. It was such an intimate thing, and the thought of some stranger yelling "okay, now push!" already makes me irritable. I want to feel it myself. 
  • I won't go into the complications that can sometimes arise from epidurals, but from what I've researched and what I've seen friends go through, I just don't want one. I want the easiest recovery possible since I'll be caring for two newborns and a two-year-old, so I want as little intervention as possible. 
BUT if I end up having to have a c-section and I don't have an epidural in place from the beginning, they will put me completely to sleep for the remainder of the birth. This is due to the fact that they often need to get the second baby out RIGHT NOW and don't have time to put in an epidural and allow it to take full effect before making the cut.

I really want to avoid this scenario. I'm not sure how many minutes (hours?) old the babies would be by the time I woke up and got my bearings enough to hold them and nurse them. It makes me so sad to think about missing all of that time...which makes me think I should do the epidural...but then I remember that simply having an epidural makes a c-section more likely and I change my mind right back. 

I have no idea what to do. I know that I will get plenty of comments about how the most important thing is that both of our babies are delivered safely, no matter how it happens. I am 100% with you on that. That definitely is the most important thing and the day of their birth will be fully celebrated no matter how they get here. But I do want to be my own advocate in this. I want to do my research, wisely consider my options and make the choice that's best for them and for me. I also know that there's an anxious part of me that wants as much control over this process as I can get and fears that if something goes awry, everything will fall apart. For example, I'm so scared that a c-section or even just an epidural will completely derail breastfeeding. I'm worried about having one baby vaginally and the other via c-section and how that will affect bonding. I worry about all sorts of things like that.

So if you have experience with any of this stuff, I would love to hear your thoughts. Thanks (so much) in advance.

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Here's a quick update on the babies:

I'm so grateful to say that they are doing marvelously. Our growth ultrasound this week showed that they are 2 pounds (74th percentile) and 1 pound, 14 ounces (60th percentile). My cervix is right where the doctors want it to be. The fluid levels are great. We couldn't have asked for a better report.

But my OB appointment later in the week was a little sobering...and confusing. The doctor chided me for my "excessive weight gain." I have gained forty pounds thus far, and apparently I was supposed to gain 40 pounds TOTAL. No one told me this before Wednesday. In fact, I have been very purposeful about packing on the pounds. Most of the twin moms I know gained about 60-70 pounds during their pregnancies, so that's what I've been shooting for. And Dr. Barbara Luke, the author of When You're Expecting Twins, Triplets or Quads: Proven Guidelines for a Healthy Pregnancy, makes a very compelling, research-based case for gaining far more than 40 pounds during a twin pregnancy. I'm not exactly sure who to listen to or what to do about the weight issue at this point. I'm just trying to be mindful about the types of foods I'm eating and I'm watching my portions. But yeah, hearing the words "excessive weight gain" four times at your OB appointment is kind of a bummer.

29 comments:

  1. Well obviously I'm no help, but I'm super excited to hear from you! I was actually thinking about you yesterday and wondering how the babies were doing! And I totally agree... twin weight gain is confusing. I know several twin moms who were told to gain 60-70 and to do as much of it as possible super early, but then I know others who were told 30 pounds and were chastised for gaining too much too soon... so confusing! Don't let it get you down! You're all healthy, that's the important part!

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  2. Whew, those are some heavy decisions to make. I'm sure you will make the perfect one for you and your babies, through research, your doctor's guidance, and just your own gut feeling. I wish I had some more advice for you but this is uncharted territory for me. I'm glad to hear the babies are doing so well!!

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  3. Oh wow, such hard decisions about the birth...it sounds like you are doing your due diligence, though, and I hope you'll come to a peaceful decision. So glad that you are doing well and the babies are so healthy!

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  4. I'm no help either, but I'm glad to see an update from you. I think that the epidural vs no epidural debate may be decided for you based on what Baby A does. If he/she is not head down, then I'm assuming they'll do a c-section no matter what, right? The few women I've talked to who have had to be put to sleep after Baby A comes out have woken up minutes after Baby B was taken out (I'm talking like 5 minutes or less.) I have NO idea how common this is, but it might be a question to ask your doctor.

    I"m glad you and both babies are doing well!

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  5. You certainly have some big decisions ahead but I am sure you will take plenty of time to think it over, research and make the best decision for YOU. I don't have any actual advice because like you said, this is your decision and I am sure your gut will lead you in the right direction. All I want is for you to have a birth experience that works for you and leaves you at peace in the end.

    Gosh, that seems crazy about the weight gain comment!! From everything else you know (and I have heard from other twin mums too), I would not worry about gaining more weight. 40lbs seems like it would definitely be on the low end for twins. I think you should just do what your body tells you and you will be fine. Don't let those docs get you down!

    So glad to hear both little ones are doing well in there!! :)

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  6. Jeez, these decisions are hard! I honestly haven't even thought about it at all bit probably should. I'm glad both babies are doing so well!!

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  7. Two part comment.
    1) your OB is WRONG about your weight gain. You are right on track for having twins. Do not allow them to guilt you. It was because I gained as much weight as I did (meaning I was eating appropriately for the pregnancy) that the Beats were as healthy as they were. If OB gives you more crap, bring in Dr. Luke's book.

    2) I faced a similar decision. One thing I want to clarify is that having an epidural does not increase your chance for a C-section. What it does do is increase your chance for a C-section where you are awake. Considering it is very likely you'll have to do a breach extraction (really? they'll flip Baby B???) if you do a vaginal birth, it's something to strongly consider. Yes, getting the spinal tap isn't fun (they had to tap me twice in order to insert that catheter), but after that it's painless. And most importantly it meant I got to see my babies ASAP verses having to be in recovery.

    All that said, it may be worthwhile getting a second opinion. It's one thing to go down a certain road, it's another to feel forced.

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  8. I don't have much advise other than to listen to your heart. I know you'll find peace with whatever decision is right for you.

    It's so good to hear from you and it thrills me to know things are going so well with the babies. xoxoxo

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  9. You are absolutely right that the most important thing is to bring the babies into the world safely and to keep you safe as well. You are also right that much of this is out of your hands- it really will depend on what happens with the babies on the day. We can research and try to plan and control, but it really comes down to what is happening on the day.
    I was wondering if it might be possible to insert the epidural ahead of time but only run medication if you need it? That would give you the chance to avoid general anesthesia.
    Very best wishes.

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  10. I am sorry that so many of these decisions will be taken out of your hands. I know that is hard. Hopefully as the day gets closer it will become clearer what has to happen (i.e. Baby A will go head down or not).

    As for the weight gain, your babies' weight is amazing. They are holding their own with singletons nicely! So frankly, I would keep doing what you're doing and ignore the doctors. If you start restricting now the babies might not grow as well. You are doing a fabulous job, mama! Plus you looked great in your belly pics- it looks like all the weight is going to the belly! And if 35 pounds is still 'normal' for a singleton, how can adding an extra baby add only another five pounds? There's baby, placenta, padding for breastfeeding, etc.
    xoxo

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  11. First off, you're so lucky to have had such an awesome birthing experience with Harriette! Honestly with my first pregnancy (Lily's) I was so into having a natural child birth and did tons of prep, only to deliver her early...yes it was natural but she also died shortly after. With Ian's pregnancy I gave up complete control of all of that putting my faith in my OB whom I loved and trusted completely. I learned the first time around that as much as I want to control labor most of it is out of my control. I ended up having an emergency c-section with him, although they were able to give me an epidural for it so I was awake for the surgery and could see him right after. With this pregnancy I'm again trusting my OB and in all likelihood will have another c-section. As you said the most important thing at the end of all of this are healthy babies, the rest is just extra.

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  12. I was so worried about birthing twins. My biggest of the fears was having a double whammy with both birthing experiences. I had a very easy birthing experience with baby a but baby b didn't go according to my plan. I won't give you all details in case you don't want to hear but I posted their birth stories on my blog in July if you do. I will say this...although it didn't go according to plan. They are here and perfectly healthy. That's all that matters now.

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    1. And I gained 55 until 15 pounds of fluid the last week. I read Dr Luke's book too. In fact you are supposed to pack on weight early with twins. You are doing great! :-)

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  13. Can you ask for a anesthesiology consult? Would this help answer questions about their general practices at that hospital? Also IF you do decide on an epidural can you get a "low dose" or no dose epidural more for the purpose of having it in place in case the delivery turned to a c-section?

    Another thought, if you do end up with a c-section, consider the post-birth stuff they do to baby (eye ointment, bath, etc) and make a decision to have some of these items wait until after you have had time with the babies. We waited on the bath because it can take awhile to get their temperature to rise after the bath and they don't release them back to you until the temperature rises.

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  14. I agree with you that just getting an epidural would increase your chance for a c-section if you're getting to attempt a vaginal birth. I'd try to avoid that, because it sounds like if the 1st baby is head down, you have a pretty good chance of delivering the 2nd baby vaginally as well since some docs will help that baby flip either head or feet down. My SIL delivered her baby footling breech (into the water! only a singleton pregnancy though) with absolutely no problem. I'll be praying you get a doctor who is open to letting you try to have a vaginal birth for both babies. My neighbor vaginally delivered her twins girls med-free at 40 weeks - both about 7#. I hope you get that too!!

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  15. Ugh to the weight gain comments! Of course I know nothing from personal experience, but through living vicariously through others I think 40 pounds is fine so far and you look great and healthy and different OB/GYNs have different levels of weight concern. :) Also, I have a friend who delivered twins vaginally (FOUR HOURS APART), and without an epidural. She had a vaginal block, that she sings the praises of--it apparently quells the hoo-hoo pain without interfering with pushing at all. So there's that... Also, I nominated you for an award! Because you're awesome...

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  16. Girl you are going do great! Trusting the Lord will protect both you and the babies and give you a peace about the delivery! So glad to hear they are all doing well :)

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  17. Just to give you another side of the epidural/induction debate…I was induced at 40 1/7 (with a baby conceived through IVF) and my labor was amazing and super smooth. Total time was 5.5 hours from first dose of medication to Drew's first breath. His is my one and only labor experience so I can't say it if was "more intense" but it was bearable. I did end up choosing to have an epidural when I was 7cm dilated because I really wanted to be present at Drew's birth - everyone is totally different but my mother-in-law had mentioned that she felt like she wasn't present for her boys' births because she was trying to stay on top of the pain and I think that would have been true for me too. With the epidural, I still felt my contractions, they just felt like pressure rather than pain. And, I knew exactly when to push - there wasn't anyone telling me to do so. I pushed for 8 mins and my magical little guy was there.

    And, having performed lots of spinal taps, I can tell you that there is only a needle for the insertion of the procedure, it comes out after a few seconds and just a small catheter is left in place. I was scared of the procedure too (hypocritical, I know, since I do these procedures) but it was nothing compared to labor. And, I agonized about post spinal tap headaches (since I have underlying migraines) but I have any issues. I actually offered to buy my anesthesiologist anything he wanted because the epidural was so fantastic.

    I know this is only one story and that you can find stories where things don't go as easily but I just wanted to give you the other side. You might be induced and have an epidural and it might be marvelous. Just wanted you to have another mental picture to ponder.

    Thanks for sharing in your blog, I really love following your story!

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  18. I love reading your blog entries, Emily! And from what I've seen and heard, you are doing GREAT! There are so many decisions, and sometimes it's hard to know what is the right one(s) but you'll make the decision(s) that are best for your family. I have had both medicated and non-medicated deliveries and both have benefits. The medicated deliveries provided very little pain, and the non-medicated birth provided a quicker recovery and, in my case, was simply because I dilated to 10 VERY fast and there was no time for an epidural. I was also lucky enough to have a natural birth with the twins and was induced at 38 weeks. It was a very smooth delivery and, as you mentioned would be the case with you, I was in an OR with THREE teams of doctors. The boys were born 42 minutes apart...and my Baby B boy turned out to become Baby A during delivery. :) Let me know if you have any questions, but you seem so well prepared and I know you'll do great. Whatever the decisions turn out to be and however the birth process goes, it will become your family's cherished story. Wishing you the best for the duration of your pregnancy!

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  19. So much to consider here and I'm glad you've done so much research on it and are preparing yourself for all the outcomes. For both of my births (one induction that ended in a c/s and one med-free vaginal birth) my babies were taken away to the special care nursery for an extended period of time. I didn't really get to breastfeed either of them for hours and hours after they were born and I didn't get that immediate skin to skin either. I was really really bummed about that, but long term, breastfeeding and bonding went extremely well. No issues with supply or latching even though they both got formula in their first hours.

    I hope you get to vaginally birth both babies and delivery goes very smoothly. With twins, it seems so much is up in the air and even more so being in a big doc's group like you are. best of luck and so glad the babies and you are doing great!

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    1. So encouraging to know that there were no issues with breastfeeding long term. Thanks for sharing your story!!

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  20. I was lead to your blog by a friend of mine I used to dance with over a year ago. It's been a joy seeing/reading your story of struggles and triumphs while growing your family. I'm huge into research (aside from that I work in the scientific field - I love researching and knowing as much information about things as I can get my hands on!) - and I'm SO excited when I hear about others gathering knowledge for their situations to try and get a better handle on what is going on.

    That being said, I know that you're going to do what is absolutely best for you and your precious babies. Here is my opinion of what I would do if I were in your shoes.

    Having had an unmedicated water birth myself (at home!), I completely understand your fears and anxiety about an epidural, C-section, etc. With the prospect of having twins and not having a set doctor for labor and delivery (which is think is a HUGE disservice to both Mom and baby(ies) ), I would personally go with an epidural despite all the potential side effects. Here is why: With an epidural, if the case arises where one or both babies is not doing well, you can still get immediate (or close to it) skin-to-skin after a c-section. You also won't have to wait (as long) to start breastfeeding. With that in mind, I would wait as long as possible to be induced, then labor for as long as possible before getting the epidural. If all works out well, you would be able to birth both babies vaginally. If not, then you get to be with your little ones sooner rather than later because you won't have to wake up from anesthesia.

    I'm so so happy for you and your growing family! Even with all the comments I know you will still do more research to make sure that you make the right choice for you and your babies. You are such an awesome mama! Oh, and I wouldn't worry too much about the weight. Some docs have stricter views on weight than others. Obviously you don't want to gain too much, but from what it sounds like you're doing an awesome job eating healthy and growing strong healthy babies :)

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    1. Thank you so much for taking the time to comment. I have to say that I'm curious who our mutual acquaintance is! It's also so refreshing to hear someone who has done an unmedicated water birth say that she would have an epidural. Thanks for your honesty and for thinking all of this through with me! Also, great advice about waiting as long as possible for the epidural.

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  21. I don't know if you ever read Suz over at Suz's Treats but her birth stories of her twins might interest you. Here's Zac's link (he came first so it makes sense to start there) http://suzstreats.com/zachs-birth-story/ and she had the epidural (I think maybe it was required at her hospital?) but both babies vaginally. If it were me, I'd have a doula again even if it seems like a zillion people will be around for delivery. Our doulas (one at each girl's birth) have been invaluable in helping us cope with labor in the hospital and running interference for me/us when we didn't want intrusions from so many people or if we needed the nurse right away for whatever. Priceless to me to have that safety net person to help us out. Good luck deciding and planning what you can plan.

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    1. Thank you SO MUCH for sharing this link. It was very, very helpful. Great advice about the doula too. I really appreciate your comment! Our doula has had twins herself too, so I think she'll be a great resource for us.

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  22. I have no advice other than I love ya and I can't wait to meet these babies! You are such a wise woman and I know you will make the perfect decision for your family! I seriously know nothing about giving birth, but I better get learning because I feel so out of it!

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  23. I was so against having a C-section that I didn't do much research on them. I even tuned out during the C-section day of our childbirth class, because it wasn't for me. And then... I had a C-section. I have very mixed feelings on the whole experience, but I have a beautiful, healthy baby and that is, as they say, what matters. BUT! A few months after he was born, I came across this video on a "natural C-section": http://www.youtube.com/watch?v=m5RIcaK98Yg (if that doesn't work, let me know and I can send it another way) and I wished I'd known about it from the beginning! It's minor adjustments in how you're medicated and monitored and, to me, it would have made all the difference to be able to hold and nurse my baby immediately after he was born, instead of waiting over an hour to do more than kiss his head. Just something to look into, in case it would make that option less undesirable. :)

    I love hearing about the twins' progress, and I can't wait to hear about them when they arrive! Congrats again!

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  24. I was so torn on what I wanted to do as well. I always thought I didn't want an epidural and I watched my sister give birth three times without one, so I knew it was possible. Then as it got closer, I was afraid I wouldn't be able to handle it, but the nurses/doctors all told me I could change my mind and ge one if I needed to in the end. I NEVER wanted a c-section, but I absolutely didn't want to end up with baby A delivered vaginally and then have a c/s for baby B. Turns out, the decision was made for me and I needed a c/s. When the time comes, you will make the best decision for you. Just be prepared for the unexpected, especially with twins. I'm so glad that both babies are doing well and I hope they continue to do so!

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  25. I love your blog! ..and Congratulations!!!
    www.mommy-dreaming.blogspot.com

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