Originally published at When Sally Met Sally
I couldn’t believe it when my induction date rolled round and I still hadn’t gone into labour. I’d had all these rosy images of me bouncing on my birthing ball in the living room, whilst my wife helped me count and breathe through the contractions and we watched a funny film and drank tea.
Instead my entire labour would be spent on the labour ward. But when it comes to multiple pregnancies, these are the kind of things you have to accept. My ideal birth plan was flung out the window months ago because a “high risk” twin pregnancy precludes all sorts of options. Still, my main concern was to get those babies out healthy and happy, so we were prepared to keep an open mind and listen to the doctors’ and midwives’ suggestions.
I had been booked in for induction on the evening of Monday 16th July, but as a labour ward can be an unpredictable place, I needed to phone the ward at 6pm to check a bed was definitely available. As it happened the ward was particularly busy at the time and I had to wait over an hour for the ward coordinator to call me back in order to establish whether or not there definitely was a bed. Finally we left home at about 9pm, hospital bag in the car and a real sense of apprehension and excitement. I was panicking that I had forgotten something essential.
We arrived and were shown to a room in the induction suite. We met our midwife for the night and her student and they checked and double-checked they had all our details. They explained the induction process: a gel would be used vaginally to help kick start the labour process. It was unlikely anything would happen overnight and then they would apply the gel again in the morning, possibly repeating the dose a further 6 hours later. They explained that it was possible that labour could still take days to really start and become established.
We had an ultrasound to check the babies’ positions and thankfully they were both still cephalic (head down), with twin 1’s head being quite low down into the pelvis. The doctor then performed an internal examination to feel my cervix and check whether it had started to soften and dilate in preparation for birth. I have to say, I found this agonising. I don’t think my experience is particularly common – I’ve never heard anyone complain about the examination process – but the doctor did comment on my cervix being very posterior (far back) so possibly this is why I found it so painful.
She finished the examination, telling me my cervix was tightly closed and explaining that she would apply the gel but it really might take a long time for labour to start. It was late by the time I settled down to sleep and my wife went home to get some rest too. We knew the doctor would be back early in the morning to examine me, so we would only get about 4 hours sleep.
I felt a few twinges during the night, but by around 7am I was feeling real contractions that were coming only a few minutes apart. This meant that I wasn’t given another dose of the gel, but that they would continue to monitor me to see when I was ready to have my waters broken. They wired me up to a machine that measured both babies’ heart beats and my contractions and examined me again. I had progressed, but not very much – my cervix was 1 centimetre dilated.
They gave me some codeine to combat the pain of contractions and that, combined with a lack of sleep the night before, meant I soon drifted off for a couple of hours. This period of inactivity caused my contractions to slow right down and when I woke I spent a lot of time bouncing on a birthing ball to try and get things going again. This helps as it encourages the baby’s head to make contact with the cervix, stimulating production of the hormone that causes you to go into labour. It worked and my contractions picked up the pace again, coming every couple of minutes. My wife helped me count through them – a technique I had learned at my NCT yoga class, which really helped. I was offered gas and air (oxygen and nitrous oxide), which causes a slightly “tipsy” feeling and helps to distract you from the pain. I tried it a few times, but ultimately felt my counting and breathing method to be a better distraction.
Time became somewhat meaningless, but at some point that afternoon I was examined again and was finally 3cm dilated. This meant I could be transferred from the induction suite to the labour ward, where I would have my waters broken. Twin 1’s waters were broken and my contractions continued. That evening the midwife and student I had had with me the night before returned and this time my wife was allowed to stay as I was now in established labour. I reached 5cm dilation, but although my contractions continued, my cervix didn’t seem to want to cooperate any further. Apparently it has become very soft and stretchy, but seemed stuck at 5cm. Just before midnight the doctor came to talk to me about what they wanted to happen next.
I had been in established labour for some time and it’s not in the interests of either mother or babies for it to continue too long as all three of us would become exhausted. They wanted to give me a synthetic hormone drip that would cause my contractions to speed up and become much more intense. This would be incredibly painful so they wanted to accompany it with an epidural. I had been told that the medical recommendation would be for me to deliver the babies under an epidural, but I was reluctant to have one. Friends of mine who had epidurals had struggled to deliver without intervention (forceps, ventouse) and I had heard it was far more likely you would tear without control of your pelvic floor muscles.
However, the doctors were also concerned that twin 1’s head was turned slightly to the side and may have needed some manoeuvering, which again would be easier with an epidural. I talked to my wife and, although I really hadn’t wanted an epidural, we agreed that under the circumstances, if it was what was being recommended by the doctors, we should go ahead with it. The midwife and the doctor also explained that what I would be given wouldn’t numb me completely. I would have the ability to control any top up doses and could administer a boost every half hour. This meant that I could also allow the drug to wear off before delivery and have more control over my body when it came to pushing. It also meant that I would probably be able to get some sleep once the epidural had taken the edge off the contraction pains.
Having the epidural put in was about as pleasant as having a cannula put into your back sounds. It’s a fairly stressful process as you have to keep absolutely still whilst someone pokes needles into your back. Still, it was over fairly quickly and soon the painkilling effect started to kick in. I did manage to get some sleep and I let the epidural wear off as much as I could bear before boosting it again.
Around 6am I felt a weird pressure low down, which the midwife had told me to look out for as it was a good sign that things were progressing. In the meantime they had examined me a few times and, frustratingly, I had remained at 5cm dilation for ages, despite the hormone drip. Discussions had started about a caesarian section as things had been going on a long time and the babies needed to come out soon. It was all hinging on the next internal examination: if labour was actually progressing and my cervix had dilated more then fine; if not I would be given a full spinal block and taken to theatre for a c-section.
I told the doctor and midwife about the pressure I was feeling and the doctor examined me. She sounded fairly surprised when she told us I was fully dilated and that she could feel the head. I was ready to start pushing within the hour. I suddenly felt a surge of emotion well up inside me, knowing we were almost there and our twins would soon be born. Our midwives and the doctor were pretty gutted as it was just coming up to shift change meaning someone else would be taking over just in time for delivery. Natural twin deliveries are fairly rare and they were really hoping that it would happen before they had to leave.
The shift changed and we were introduced to our new midwife and her student. I was letting the epidural wear off and by the time they wheeled me to theatre – standard procedure when delivering twins in case of an emergency c-section – I was in quite a lot of pain. The contractions were constant – almost overlapping – and although I continued to control my breathing throughout, I was now moaning on the exhalation. We got to theatre at 8:40 and my wife scrubbed up and was stood beside me, holding my hand; in return I was squeezing hers very hard.
By 9:00 everyone was ready and it was time for me to start pushing. Because the epidural hadn’t worn off in its entirety, I was laid on my back, with my feet in stirrups. This was a birth position I’d hoped to avoid, but I accepted that this was how things were going to be and was excited to know that it wouldn’t be long before we met our babies.
The midwife was excellent and talked me through the delivery process with lots of encouragement. I pushed and pushed, at times feeling like I would never get this baby out, but eventually after an exhausting half hour, including an episiotomy where a controlled cut is made into the perineum to prevent a more serious tear, twin 1 was born and plopped down on my chest. I looked up at my wife with a huge smile on my face and squeezed her hand as her eyes teared up. It was a girl.
They took her off to weigh and perform other checks and then my wife brought her over and showed her to me. In the meantime, we waited for twin 2 to get into the right position. I had to push a couple of times to encourage twin 2’s head down towards my cervix and then the head was low enough for the midwife to break my waters for the second time. This delivery was much easier and after only a few pushes, twin 2 was born – another girl!
I was given an injection which would cause the placentas to be delivered quickly and as I lay there I could hear the midwife explaining to her student how to gently pull the placenta out. Suddenly, things got a bit intense. I was bleeding, quite a lot, and I heard the midwife and doctor discussing the fact that part of one placenta had been left in my uterus. They were swabbing up the blood and weighing the swabs to get an indication of how much blood I was losing. The epidural was amped right up and the doctor managed to remove the remaining placental lobe, once all feeling had left my lower body. I clearly was losing a lot of blood however and “code red” was called. The room was flooded with people and someone was calling up for cross-matched blood.
My memory of this part is hazy at best. I came over incredibly tired and my wife held my hand and told me to stay awake. Then I started throwing up. All this time the doctors and midwives were doing whatever they needed to do. The consultant appeared and took over from the doctor who had been there for the delivery. They stitched up several tears I had sustained and the hormone drip was increased again in order to cause my uterus to quickly contract, which would help to stop the internal bleeding.
By the time they were ready with the cross-matched blood and about to give me a transfusion, they had managed to stop the bleeding. I had lost around 2.5litres, which is a pretty serious amount. However, I had taken so much iron leading up to labour and delivery, having been told I was anaemic during pregnancy, that I had actually started off with very high levels of haemoglobin, so they decided a transfusion wouldn’t be necessary at that point.
Eventually I was all stitched up and starting to recover from the nausea and drowsiness. My wife was sent off to change back out of her scrubs and go be with the babies, and shortly after I joined the three of them in the recovery room. I got to hold them and kiss their little faces – and my wife, of course, who had been through a pretty traumatic experience herself. But the worst was now over and our little family was complete.
Claudia Isabelle – born 9:34am, Wednesday 18th July 2012, 5lb 2oz
Imogen Sophie – born 10:03am, Wednesday 18th July 2012, 5lb 5oz