Monday, October 5, 2015

Happy Breech-Cephalic Twin birth

 Midwife Jewel shares a happy birth story: "Kathryn came to me at 8+6 wks gestation. At the time her fundal height was more like 15-16 weeks. We talked about possibility of twins, dates being off, how she often measured large for dates early in her other pregnancies. She wanted to wait until 20 weeks for an U/S, but I think we both knew something was afoot and she had one at 14 weeks that confirmed twins. 


"It seemed like the most important thing was to find someone experienced with supporting a mom with twins and there just wasn't an option in Casper, WY. Plus, even though Kathryn had had 3 previous straight forward, no issues, VBACs (after a primary c/s for FTP ). [failure to progress, an obstetrical phrase generalizing a lack of progress leading to cesarean.] The local hospital has a VBAC ban and that was going to be an issue too. The most frustrating part I think was that the doctors kept stringing her along, perhaps thinking that she would just give and schedule a c/s. Little did they know of Kathryn's determination.

"I have a good friend in Boulder, a midwife," Jewel shares, "and I called to get some referrals and encouraged Kathryn to contact them. We continued to see one another monthly so that I could do Mayan Abdominal massage, review The Three Sisters, keep encouraging her to eat adequately for twins (enough protein etc) and just keep her spirits up. I think all of that played into the awesome outcome she had with her twins. She also did moxa with an acupuncturist several times and that may have helped turn baby A. Kathryn was doing Rebozo Sifting twice a day, and following it with a forward inversion. She was also doing belly massage and have done the sacral and pelvic release. She walked for 15-30 minutes each morning."

Kathryn, herself, adds:

After the childbirth options in Casper WY left me hanging, I decided to pursue other options out of state. My midwife was not able to deliver twins (per Wyoming state law), the OB I transferred to was a kind but was not comfortable (or very experienced) delivering twins naturally and counseled me to have a C-section. Further the local hospital has a VBAC [vaginal birth after a previous cesarean] ban and even if I persisted against my OB's wishes, I would still be met with a non-supportive hospital staff. 
My midwife and other friends helped seek out VBAC/twin friendly doctors in Denver Colorado (4hour drive). I interviewed the first doctor and felt very confident that he was the one (Dr Breeden) but in the week prior to meeting with him (33 weeks) we discovered that both babies were breech. ...I needed a VBAC friendly doctor who was not only  experienced with twins, but also willing to do a first twin breech delivery. 

I had been given Dr Hall's name, but felt inwardly nervous about a breech delivery. And of course, anyone I mentioned a breech not only thought I was crazy, but also thought I was taking my babies lives in my hands. While thinking and praying about consulting Dr Hall,  I continued with Spinning Babies recommendations for rotating breech babies. The website was extremely helpful. I started by keeping it simple (Rebozo Sifting, Forward Leaning Inversion, walking, rocking, staying upright etc). After a week went by but no shifting, I consulted a chiropractor and a acupuncturist. I also went ahead and made a future appointment to see Dr. [Michael] Hall. 
Just because of scheduling, I saw the acupuncturist first for Moxa treatment. I was able to see her twice before the babies came. One baby did rotate from full breech, to vertex/transverse, but would you believe it was Baby B!? So we were still looking at a breech delivery for a first baby and by now I was 35 weeks.
I went ahead and met with Dr. Hall, Denver's own breech specialist. We left the appointment with joy and peace! After almost 35 weeks of closed doors, a door finally opened that would allow a natural delivery. Praise God! Dr. Hall was humble and kind, he was informative and helpful, he talked with my husband and I for over an hour... Discussing breech birth, what it would look like, what the risks were etc. He even counseled my husband on how to deliver the babies should we not make it to the hospital in time. We talked about birth plans and how to facilitate this birth without having to make a drive in labor.

Dr. Hall asked us to come back at 36 weeks. The babies were both measuring big (6lbs) and the plan was have a gentle induction in Denver to rule out the risk of driving in labor (or going into labor in WY that would end in a C-section per hospital policy). At 36 weeks he would do a cervix check. If dilated we'd go ahead with the induction then, if not dilated, we'd hold out another week (37 weeks) and induce then. I wasn't thrilled with the thought of an induction, but considering the alternative (C-section) it seemed like the best thing.

At 36 weeks (a Thursday) we went down for my appt. I was dilated to 4cm, but Dr Hall was in surgery and was traveling out of town the next day. (still wish this had been timed better!) Dr. Hall's midwife told my husband and I that we should not go back to Casper, but should stay in Denver until Dr. Hall returned the following day. So we had a short "baby moon" and tried to relax and not do anything to get labor started, until our breech friendly doctor was home available to deliver the babies. It was a challenging few days for me-- it was hard to relax and wait, but we did our best! On Saturday, we started walking and actively trying to promote labor on its own. Sure enough, contractions began to get closer and more steady, coming every 3 minutes and hard enough to breath through. We didn't want to wait to long (we'd had a very fast labor with baby #4 and barely made it to the hospital) so we called Dr. Hall (he had given us his personal cell phone!) and headed in. 

As God had ordained it, the contractions all but stopped during our walk from the parking garage !! I was so disappointed I was crying by the time we got to L&D! Dr Hall was right there ready and waiting. They checked my cervix. I was still at 4cm 40%effaced, station -3) but they were not going to discharge me, pregnant with twins and a history of precipitous labor. 

We started the plan for a gentle induction, and all Dr. Hall did was strip my membranes, and tell me to start walking. We walked and walked. I rocked on a birth ball, hit the jacuzzi tub, practiced lunges in the hallway, but labor would not start up again. It was evening by then, and so we just went to bed. Contractions seemed to appear and get harder while I was lying down, but almost disappeared when I got up and moving. This was unlike anything I'd experienced! After a rough night trying to sleep in a not so comfortable hospital bed, I was ready to give up and go home the next morning! 

Dr. Hall came in again that morning. Did another cervix check, now 5cm, and 80%, and said he really didn't like inductions, especially not with VBAC's and breech births, but said given my situation (multi para, history of fast labor, twins, breech, distance to home) he couldn't think of a reason to send me home. We couldn't think of a reason either (except that I was still a little nervous about an induction, but really what else could we do than indefinitely wait in Denver for labor to start?) So we decided that he would let us rest a bit and then come back to break my water. 

Anesthesia came in to discuss my options during this respite, and I declined an epidural or any pain medication. I had been on the fence about possibly getting an epidural placed (but not used) in case of emergency and need for c-section, but truly felt that Dr. Hall would do all he absolutely could to deliver these babies naturally and if it came down to a section it would be a true emergency (not a convenience thing). And in a true emergency I was okay with being knocked out with general anesthesia.

When Dr. Hall came back and broke my water. Later that afternoon things progressed very quickly. They placed an internal monitor on breech baby A which allowed me to get out of bed and move around while still keeping track of my little breech baby. [This is not typical, but then, neither is a breech Baby A in twins.]

With my water broken, it took about 10 or 15 minutes before I felt regular contractions but then I dilated rapidly. from 5cm to 10cm in less than an hour. Maybe less than half an hour. 

We called the nurse when I hit transition and the Dr Hall came right in and checked my cervix (we later found out he has never left labor and delivery but stayed close by so he could watch the babies-- they say he loves his breech babies and twins). While he checked my cervix, they got the team ready to take me down. 

By the time we got to the OR I was ready to push but needed to wait until we got situated. There was a huge team of medical professionals (anesthesia and her team, pediatrics and their team, OR nurses, L&D nurses, my doctor and his team, and a handful of random medical professionals who just wanted to watch). And they all hustled to get ready. Once we were all set (this seemed to take a while, but it was really only a few moments), I was moved to the OR table, where I laid on my back, with my legs resting in stirrups (not my feet). This would allow for me to deliver the baby at an angle that would let the breech baby dangle. It was an awkward position, but we had agreed on it before hand and Dr. Hall thought it the best/safest way to deliver a first breech twin. 

Once on the table, I was given the okay to push with the next contraction. Dr. Hall had also instructed me to push hard and stay focused as he didn't want that breech baby getting into trouble. So when told to push, I pushed!! Baby A, our dear sweet Abigail, was born in just two pushes. She was born breech, with her hands raised up over her head as though in victory! :) it was truly a moment of victory and excitement! She was here! The breech delivery was by far the most painful of my births, but it was over so quickly and the reward so sweet, I've all but forgotten. 

They right away put her on my chest, and delayed cord clamping, but only for a few moments as it was Baby B's turn! 

Dr. Hall manually positioned Baby B, who had been sitting transverse/vertex and she came down head first. She was born just 3 minutes after her sister with just one push. Baby B, Elizabeth Hannah,  was put right on my chest and had delayed clamping her cord for quite a bit. Time stood still as we reveled in the joy of two healthy babies!

Next was the enormous placenta, which never got weighed, but it was likely the size of one of the babies. I was so wiped out I did not want to push anything again, but I did. Dr. Hall said he'd never seen such a healthy twin placenta. It had been two placentas, but they joined together during the pregnancy hence the large size. 

It was over! My twins were here and here safely. What joy and amazement! The hospital staff just about cheered, and people kept congratulating me as they packed up the OR. Dr. Hall gave me a huge hug and stood by me stroking my head and praising me for making him look like a breech specialist. It was a touching moment.

Both babies, though fraternal, weighed in exactly the same 6lbs 12oz each. I was commended again and again for the size and health of the babies, twins born at  36 1/2 weeks. The twins were so healthy and did not need intervention or NICU time. 

This took me weeks to type out, but was such a wonderful way to process the birth of these girls. Everything went so smoothly and in hind sight I don't think it could have gone better. Truly what a miracle it was to find a breech doc and then to have an experience like this with two beautiful healthy babies. 

Thank you, Jewel, for all your help and support in this process!! I'm grateful for you in so many ways. Despite the, often time, unsettling circumstances , God really showered his blessings on us and caused us to trust His plan. We are so thankful."

Gail adds: It's wonderful to read about breech and twin births
happening in a variety of settings.
Would you like to share a story with me? Email it in a reply here or start a new thread.
I like to include stories that show use of Spinning Babies topics, of course! This month we are sharing a happy outcome when Spinning Babies didn't work!  

1 comment:

Jewel Hernandez said...

I would disagree Gail, that the Spinning Babies techniques "didn't work". If the only intent was to turn those two babies, maybe. But what Spinning Babies does is so much more than position babies. In fact (and didn't I hear this from you?) it's not about positioning the babies at all, but about providing the very optimal environment (relaxed, soft, balanced pelvis) for the baby/ies to get into their best position.
I think in Kathryn's case the Spinning Babies techniques definitely played into how straight forward the babies came, how quickly and no tears or trauma. I have all my clients do the three sisters from the git go and I think it makes a huge difference. <3

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