Suzanne's story - giving birth to twins at home

We found out we were expecting twins, our third and fourth babies at an early pregnancy scan at 7 weeks (which I was offered due to a miscarriage three months earlier). To say we were shocked is an understatement - it took several weeks for the news to sink in, and emotions ranged from horror to excitement as I had 3 year old and 2 year old boys already.  The prospect of four under five was very daunting!

We planned to have our first son Fynn at home in 2013 but my waters broke at 40+3 and unfortunately there was thick meconium so we transferred straight into hospital where I was induced with syntocinin and he was born back to back, 11 hours and one epidural later. He needed help breathing at birth and had a lung infection from the meconium and then developed jaundice so we had to stay in hospital for a further week - which I found incredibly difficult. After his first 12 hours in high dependency and no skin-to -skin we battled to get breastfeeding started and it took several more weeks to get him off hospital-mandated formula completely. When I became pregnant 9 months later with our second son Ben, I was determined to have a different birth experience - with as few interventions as possible.

Ben’s birth was very different - a lovely peaceful homebirth with our wonderful doula Kate and the hospital homebirth team who were amazing. I felt empowered and in control.

I realised very quickly after finding out we were expecting twins that homebirthing twins seemed to be incredibly rare, and actively discouraged by the NHS . Twins were ‘high risk’ and a homebirth would be outside of medical guidance, moreover something the homebirth team had no experience of. I started looking into my options and unfortunately found no research around place of birth for twins, and research that did exist supporting early induction and other interventions were all based on medically-managed births in a hospital setting. They often did not separate di-chorionic/di-amniotic twins (non-identical twins with two sacks and two placentas - the lowest ‘risk’ twin scenario) from identical twins.

The pregnancy progressed incredibly normally and apart from extreme tiredness in the first trimester I remained very well. I realized that if homebirth was to be an option for that I was going to have to use private midwives. I was recommended Neighbourhood Midwives by Kate and met with Cheryl and Sharon at around 16 weeks. They explained their model of ante-natal care which seemed very comprehensive - with monthly then bi-weekly checks, and weekly visits towards the end of the pregnancy - all at home.

I was given advice about how to make sure my diet supported healthy twin growth and above all - was encouraged and confident that twin homebirth was not only possible but something Neighbourhood Midwives had lots of experience with. I seemed to be receiving very different messages to those from the NHS - for example that there was no reason I wouldn’t carry the babies past 37 or 38 weeks and with continuity of carer and a careful diet there was no reason I shouldn’t carry to 40 weeks - term and beyond!  From that point on I was very careful to eat enough, and made sure I ate lots of protein daily and a good amount of spinach to boost iron levels. From 36 weeks I also planned to have 6 dates a day as I’d read this could shorten labour.

Private midwifery care was a commitment financially but even ante-natally it became clear that it was worth it, as I felt so supported and it was fantastic being able to message Cheryl and a Sharon with any niggly worries, questions or doubts I had.

Alongside the care from Neighbourhood Midwives, I continued having routine scans at the hospital, and obstetrician appointments, which Cheryl or Sharon also attended, and although it was made clear the ‘risks’ involved in a twin homebirth, I initially felt that both the consultant obstetrician and consultant midwife remained open to my choices, both to use Neighbourhood Midwives and my choice to have the twins at home.

The pregnancy continued progressing well, and was remarkable only in its normality! I generally felt well, apart from very bad heartburn for which I was taking ranitidine twice daily.  Twin ‘1’ was head down right from the start, and was the presenting and larger twin - twin ‘2’ was variously transverse and breech, finally turning cephalic at my 34 week scan.

I was continuing to attend obstetrician appointments every few weeks but started to find them increasingly difficult as the ‘risks’ of a homebirth were repeated despite all the scant research being based on hospital-managed births.  I was recommended to have an induction at 37 weeks as I was told that the risk of still birth increases after this point.  We talked through various scenarios which would require transfer in, and I was encouraged to consider a ‘halfway’ house by birthing in the midwifery led unit.  I felt, however that when the time came I was unlikely to be ‘allowed’ to birth there as the resources to support a twin birth there would divert staff away from the labour ward, and generally I felt pressure mounting.  It was made clear I was choosing a route that was not recommended, against medical advice and dangerous.  At one appointment when my usual obstetrician was not available I saw another who told me horror stories about what would happen if I didn’t deliver the second twin within 10 few minutes and if the second twin was breech how they would turn him, “and believe me you’ll want to be in hospital for that”.

We drew up several birth plans for different eventualities - spontaneous labour before 37 weeks, spontaneous labour after 37 weeks, plans in case of a medical need and non-medical wish to transfer in, and the hospital had a copy and informed all the key staff. I felt confident to go ahead and try for a homebirth only if the babies and I were healthy and I went into spontaneous labour after 37 weeks.

Although I had no intention of consenting to an induction at 37 weeks, I agreed with the obstetrician that we would reconsider in a week’s time as the babies and I were healthy and doing well.  I felt I had already done my research, made an informed decision, and didn’t need to be left with negative and catastrophic images when I was trying to focus hard on a healthy delivery of twins at home. I decided not to attend the planned appointment at 38 weeks and attended only the scan and a chat with the consultant midwife afterwards, who said that I could come for a CTG the following week to monitor the heart rates although she reiterated it wouldn’t really tell us much about the babies’ prospective health other than a snapshot of the heart rates at a point in time.  As it happens, the midwife never followed up with a CTG appointment and I didn’t chase - I was beginning to feel like I wanted to ‘hunker’ down and just surround myself with only positive opinions and anecdotes about birth.  I borrowed a book from a friend containing powerful birth stories from empowered women making real choices and the more I read the more relaxed and confident I felt.

I was starting to prepare for the birth, creating a birth space with all the homebirth bits and pieces I’d need, and put up my birth affirmations in my room.  I’d bought an aromatherapy diffuser which I was using and even started to sniff a bit of clary sage when I was having particularly strong Braxton hicks contractions which were frequent now.  I met the third midwife who would be attending the birth as a backup - my tummy was measuring 49cm at 38+2 and I was starting to feel incredibly large and uncomfortable - even walking 400m to do the school run was a struggle!  My youngest son had started going to nursery for a few hours in the afternoon so I began having a daily nap, and frankly needed it to get through the day.  It was early December, twin 1 was now engaged, the Christmas tree and decorations were up and I was ready...

At 2.30am on the morning of December 5th, the day before my ‘due’ date, I woke to a loud ‘pop’ - and felt like twin 1 had punched a hole in the amniotic sac!  I made my way to the bathroom and sure enough, my waters had broken and I had lost a considerable amount of the mucous plug.  I called Cheryl ten minutes later as although contractions had not started I was definitely feeling niggly/twingy.  I called Cheryl back at 3.15amsaying that I was definitely having surges around 3 minutes apart.  I felt a mixture of relief that I was going into labour, excitement at the prospect of meeting my babies, but also some trepidation that the surges were coming so quickly right from the off.  

Cheryl called the second and third midwife at 3.35am when I called back again saying the surges were getting stronger and regular now.  I then called Kate, who had so kindly agreed to come and support us during the birth despite not practicing as a doula anymore as she had begun training to be a midwife.  I then called my friend Dee who was on call to come and sleep upstairs and be there for when our older boys woke up. When Kate and Dee arrived around 4am I was sitting on my birth ball in the dimly lit kitchen, practicing my hypnobirthing breathing and trying to relax, listening to my hypno CD.  

Adam busied himself putting up and filling the pool in his he lounge.  Cheryl arrived just after 4am, brought all the equipment in, and listened to the babies heartbeats who were doing well.  By this time I was losing a lot of amniotic fluid and was feeling intense pressure around the symphysis pubis.  It was really hard to get comfortable at all except for sitting on my birth ball.  Cheryl called the hospital triage to let them know I was in labour.  Sharon and Eleanor, the second and third Neighbourhood Midwives in our team arrived just after 5am.  Twin 2 was lying in front of twin 1, making it hard for the midwives to listen to his heart rate.  Largely I was unaware of being monitored, but every so often I would ask them to stop or wait until I was more comfortable.

By 5.35am the surges were getting more intense and were now every 2 minutes apart.  I was concentrating hard to stay relaxed, but admittedly it all felt like it was progressing much quicker than I had anticipated, and I felt like there was not much time to rest and recover between surges.   It felt like the pool was taking an age to fill and for the temperature to be just right - I was desperate to get in. By 6am I was getting lots of pressure and the surges were lasting over a minute.  Kate gave lots of counterpressure around my pelvis which helped ease the intensity.  I didn’t remember labour being so intense (but of course it probably was) and so I felt a bit scared that I wouldn’t be able to cope.  

I sipped isotonic drink throughout to keep my energy up, and the surges were now so strong I was becoming vocal, and was very relieved to be able to get into the pool, where the warm water felt so comforting.  I remember thinking “I’m never doing this again!”.  I asked for gas and air shortly after getting into the pool, but unlike with my previous homebirth, where it really seemed to take the edge off the intensity, I just didn’t feel like it did this time, and the mouthpiece and tube made a loud sound every time I inhaled which distracted me - it was becoming harder now to stay in my zone, and I asked that the room be kept quiet so I could concentrate.  There were lots of people in the house so I was generally aware of lots happening in the background!  By 6.30am the contractions were nearly constant and I felt they were really intense around my lower back.  Cheryl talked to me quietly - sort of a pep talk and that really helped as I was beginning to feel like I couldn’t cope.  I had been joking during pregnancy that surely these babies would ‘pop’ out - this certainly wasn’t the case!

I began pushing with the surges by 7am, and was very loud and vocal, and I was getting really hot.  I was given some cold water to drink and some cold water was added to the pool.  I felt like I needed to go to the loo so intense was the pressure and shortly after I felt the baby rotating.  The midwives thought twin 1 was back to back and I became more upright in the pool as the surges now lasted 2 minutes.  Sharon started telling me to concentrate on what she was saying and that I wouldn’t want to but that after the head was born I’d have to sit back straight away so she could stabilise the second baby to prevent it from flipping to breech position.  

At 7.45am
 the first baby’s head started to emerge and the body followed immediately afterwards - Sharon was only just able to stabilize the second twin in time. I drew the baby up onto my chest, although the cord was so short his mouth was barely above the water line.  I caught a glimpse as I drew him up - a boy!  The pool became quite bloody so the cord was clamped and cut straight away - I could barely keep hold of the baby so asked someone to take him.  The midwives helped me out of the pool so they could assess where the blood was coming from, and the hospital was advised that The first baby had been born!  Surges returned within 10 minutes and I was now leaning over the sofa - exhausted and already pushing again, as Adam cuddled our new son, Nathaniel. His cord had partially snapped hence the blood in the pool.

The midwives examined me and I heard them questioning very calmly whether they could see a placenta in front of the second baby’s head.  By this point I didn’t feel worried, I was so in the moment to moment business of riding the wave of surges and I felt completely confident in the care of my midwives, who had called 999 for an ambulance (they had been notified in advance that we were planning a homebirth and it was part of our plan to have them on call).  Very quickly the midwives realised that it was the bag of waters not placenta in front of the baby’s head and they asked me for consent to rupture the waters, which I agreed to.  The ambulance crew arrived at 8.10am although they didn’t come into the lounge where I was labouring, but busied themselved doing obs on Nathaniel.  The midwives asked me to keep trying different positions to help the baby descend, and I was really tired now.  It was only when I moved to lying down on the sofa that I felt that things were progressing.  The baby’s head emerged face up and with the next push he was born at 8.34am - another boy!  He was a bit floppy and shocked but came straight up onto my chest.  Adam brought in Nathaniel and he and the second baby who we named Caleb were reunited our first cuddle all together.  I agreed to the injection to release the placentas as I was getting strong afterpains, and was still using gas and air.  There was only minimal blood loss - 350ml, less than my singleton births which I was surprised about given that there were two placentas, and post partum hemorrhage was one of the things the obstetrician was worried about.  The ambulance crew were not needed but they popped in anyway as they were interested to see the placentas! 

Both babies latched straight away and our 3 year old Ben came downstairs to meet his new baby brothers - Fynn was feeling a bit shy with so many peple around and wanted to see only me. The babies were weighed and Nathaniel, born first weighed 8lb 1oz and his brother Caleb only slightly heavier at 8lb 6.5oz. I had a small second degree tear and after chatting with the midwives decided not to have stitches.  Cheryl and Kate helped me upstairs, into the shower and into bed with the babies who were keen to feed.  The older boys had a day off school and were very chuffed to go to the park with Auntie Dee, and by midday we were on our own as new parents of twins - very surreal! I felt very lucky to have been able to access the tremendous care I did.  I feel very sure that had I decided to birth in hospital that I would have ended up with medical interventions and felt so relieved that I had experienced midwives who felt confident in helping me birth my twins at home.