Ashlyn
24-04-2008, 21:53
Part 1
After a problem free twin pregnancy I was feeling pretty pleased with myself. Sure, I was huge and by 38 weeks I’d had enough but I’d come this far and I really wanted a natural, vaginal birth so I kept on keeping on. At my weekly ante-natal appointment, the doctor (I had a different one each time with the hospital’s ‘high risk’ clinic) told me I would be induced at 38 weeks as that was the hospital’s standard procedure for twin births. I asked to wait at least a week since there was no medical reason for induction and it was something I wanted to avoid unless necessary. The only reason for induction at 38 weeks was for the hospital’s convenience as twin births require more staff on hand. The doctor reluctantly agreed to allow me another week to go into spontaneous labour. At 39 weeks, and at my request, the doctor did an internal examination and informed me that my cervix was ‘very favourable’ and that I had dilated to 3cm. I was thrilled. I had been experiencing some pre-labour symptoms so obviously things were happening. Both babies were cephalic and presenting beautifully and Twin 1, my son, was engaged in my pelvis. Unfortunately, my blood pressure was up and I had already had two sessions of monitoring in the day assessment unit because of this so the topic of induction was brought up again. Since I was already dilating and effacing and I’d made it to 39 weeks I agreed. The doctor assured me that rupturing my membranes should be all it would take for natural labour to start, but if not; a synotcin drip would be administered. My birth plan included the request to be as mobile as possible during labour and to have intermittent monitoring to assist this. The doctor assured me that this was possible and every effort would be made to help me achieve my natural birth. This was Wednesday and the induction was booked for 7:30am Friday. Buoyed by this information and the knowledge that my babies were on their way, I left the clinic feeling positive and looking forward to the impending birth.
Thursday night was filled with fitful sleep. My 3 year old daughter, Freya, was at my parents’ place for the night and my husband Rolly and I had our bed to ourselves for what we knew would be the last time in a long time!
We arrived at the hospital right on time and then waited for an hour before anyone saw us. My first pregnancy was managed by a team of midwives. The Midwifery Group Practice was a pilot program at the time and I was assigned a team of 3 midwives, one of which was our primary midwife who would attend the birth. The experience was wonderful and empowering. The continuity of care was very reassuring and both Rolly and I formed a close bond with all three of our midwives that we maintain to this day. Because this was a twin pregnancy I was excluded from the MGP this time and really missed my midwives. Fortunately, they monitored my progress all through and my primary midwife offered to attend my twin birth in an unofficial capacity as a support person. I was thrilled at this prospect and she proved invaluable as an advocate when I felt too tired or vulnerable to argue for my self. Chris, my midwife, met us in the birthing unit and we met our assigned midwife Kylie who was herself 32 weeks pregnant! Kylie was supportive of my birth plan although she had to refer to the doctor regularly to accommodate my requests.
The CTG was strapped on to my belly and the fun and games of keeping track of two heartbeats began. After an hour of fiddling around and constantly losing the two separate heartbeats, Kylie applied a wire to Twin 1’s scalp to keep track of him whilst the CTG monitored Twin 2. I had a canula inserted and antibiotics administered as I had tested positive for Group B Strep. I was able to move around when the CTG was removed and Chris encouraged me to ask for regular toilet breaks so that I could be unhooked and allowed to move about.
Around 9:30 the registrar arrived to break my waters. He was the same doctor I had seen two days before and still seemed confident that I would not need much encouragement to go into labour. Lying on my back with two babies weighing an estimated 6lb each was very uncomfortable but having my membranes ruptured was awful. I did have it done during labour with my eldest daughter and so I knew it would hurt, but the doctor was having a hard time with my cervix which was moving about so it took longer than I’d anticipated. At this time, the obstetrician on duty came into the room and introduced himself. Dr.C, I will call him, chose this most inopportune moment to inform me of his intention to administer an epidural, hook me up to an IV of synotocin and continue to monitor my progress as the labour progressed. This was not what I had in mind for my birth. Gritting my teeth and trying hard to speak whilst having my waters broken, I told him this. He gave me a weary look and explained that it was the best way to proceed as twin 2 had moved to a transverse position since my last ante-natal appointment and would have to be turned head down following the birth of twin 1. without even mentioning an external version, or the fact that many second twins turn head down of their own accord after the first twin is born, he told me that he was going to have to do an internal version after the first twin’s birth which would place me in abject agony that I would not be able to handle and so an epidural was really not optional, but essential. Further to that, a cesarean was also highly likely in the event that the second twin could not be turned and so having an epidural already in place would save time and make the transition to the theatre much easier. It was at this point that I burst into tears. I asked him to please just wait a minute until the registrar had finished and then was able to sit up and through sobs explain that this scenario had never been discussed with me and that I was unaware that the hospital had a policy of performing twin births in this manner. I was under the impression that as long as the labouring mother was progressing normally, then the birth would be allowed to progress naturally and that any interventions would be discussed with me if and when they became necessary. I had already birthed a healthy baby without the aid of any sort of medication or intervention and knew how hard and painful it was. Dr. C. then started in on the scare tactics. If I didn’t have an epidural, I would not be able to cope with the pain of an internal version. If a cesarean became necessary, the theatre was at the end of the corridor and around the corner, it would take time to get there and time may be very much of the essence in the case of an emergency cesarean. Without an epidural, a general anesthetic would have to be administered which brought with it a whole new host of risks including my possible death! At this point, Chris re-entered the room after going to get a coffee and I watched a physical change come over Dr.C. He crossed his arms and legs and started to get very defensive when Chris asked why I was crying and what was going on. He explained to Chris what he’d just told me, but downplayed the fear factor quite significantly. For every point he raised, Chris had a counterpoint and suggested alternatives. He begrudgingly agreed with her and avoided eye contact with me. He then left the room so that we could talk about what he’d ‘suggested’. Chris calmed me down and reminded me that I did not have to agree to anything that I did not want to do. She amended my birth plan to include the fact that I had been offered an epidural, understood the risks and benefits and had declined one. I signed it and the issue was put to rest. Nevertheless, Dr.C insisted on having an anesthetist come in and explain in detail, and with diagrams, what was involved in an epidural and also in a general anesthetic. No mention was made of a spinal, except by Chris who assured me that in the event of an emergency c-section; I could be prepped for theatre and in there within 5 minutes and if time allowed a spinal could be done instead of a general.
Once Dr.C returned, we informed of our decision and Chris almost had to hold Rolly back from hitting Dr.C as he pushed again for an epidural and continuous monitoring. Eventually and after much arguing, he relented and allowed me to continue to labour as I saw fit
By 10:30 nothing was happening and so the synotocin drip was started. I was still being monitored but was able to use the fit ball, and walk around. I began having contractions but they were neither strong nor regular.
Chris set up the oil burner and Rolly massaged my back with the labour blend I’d made. The room was filled with jasmine and clary sage until we remembered that Kylie was pregnant and clary sage could have induced her labour too! The drip was turned up at regular intervals until I began having real, stop you in your tracks, can’t talk through them, contractions. Although the pain was quite intense, I was encouraged to think that things were finally happening and my babies would soon be here. Around 2pm I was examined and found to be still only 3cm dilated. I was so disappointed. I’d felt that I must have been making some progress, but I tried to keep positive. A couple of hours later, the drip was as high as it could be and I was starting to get tired. The contractions were regular and very strong; Chris was sure that transition was imminent and called the doctor to check my progress. Thankfully Dr.C had since gone off duty and so I was examined by a new, female doctor, also pregnant. I was still 3cm dilated and my cervix was ‘hard’. I couldn’t believe it. Why had the doctor at my Wednesday appointment told me my cervix was ‘favourable’? Did he just want me to agree to the induction? I have no way of proving it, but I suspect that was the case. She performed a stretch and sweep in an effort to get things moving. By now I was starting to get tired. I had eaten a sandwich at lunch but couldn’t stomach anything else. Chris and Rolly were great; they kept my heat pack warm, massaged me (now Kylie was off duty), changed the CD’s and kept me going. Chris grabbed some photos of Freya as a newborn that the MGP had in their photo album and stuck them on the wall opposite me as a focal point. I had to get her to take them down because they made me miss my daughter so much and reminded me of how different this experience was to her beautiful and natural birth.
By 5pm, the head obstetrician visited. He informed me that he believed my labour was not going to progress on its own and because my waters had been broken, I would need to have these babies fairly soon. He proposed a cesarean, but was willing to allow me another four hours, maximum to labour on my own before he would insist on surgery. Again, I cried. I felt like this was not my birth anymore. My worst fears were coming true and the experience was being taken out of my hands. However, Rolly and Chris talked me round and reminded me of my goals and so I kept on for another hour. There came a lull even though I was now moaning and groaning through the contractions and begging to be let off the bed. Chris threw the straps off my belly and said ‘just do what you need to’. I walked around a bit and suddenly felt like my veins were filled with ice. I was filled with fear and dread and I could hear my heart pounding in my ears. Something was wrong. I started to panic. I told Chris to get the doctor because something was wrong with the babies. She and Rolly thought I was just tired and emotional and tried to calm me down and reason with me. I became more insistent and so they got the doctor and a midwife to come and see me. The CTG was fine, but I was adamant that something was wrong. ‘What do you think is wrong?’ they asked me, and I couldn’t answer. It was nothing specific, and I can’t remember now exactly what I was saying, but Rolly remembers me repeatedly telling him ‘something’s not right. It doesn’t feel right. It doesn’t feel like with Freya.’ Chris reassured me that no two births are alike but that wasn’t what I meant. With Freya, I was scared and in pain but I knew I could do it and that everything would be okay. I didn’t feel that now. In the end, an ultrasound machine was brought in to check on the babies’ positions and to reassure me that they were indeed okay. The doctor pointed them out to me on the screen but by now I was in full panic mode. I was sobbing uncontrollably and begging for a cesarean. The doctor was more than happy to oblige but Chris and Rolly tried to talk me out of it, thinking that I would regret it later and that I was feeling pressured by the doctor. I wasn’t, I just knew somehow that these babies needed to be out as soon as possible.
After a problem free twin pregnancy I was feeling pretty pleased with myself. Sure, I was huge and by 38 weeks I’d had enough but I’d come this far and I really wanted a natural, vaginal birth so I kept on keeping on. At my weekly ante-natal appointment, the doctor (I had a different one each time with the hospital’s ‘high risk’ clinic) told me I would be induced at 38 weeks as that was the hospital’s standard procedure for twin births. I asked to wait at least a week since there was no medical reason for induction and it was something I wanted to avoid unless necessary. The only reason for induction at 38 weeks was for the hospital’s convenience as twin births require more staff on hand. The doctor reluctantly agreed to allow me another week to go into spontaneous labour. At 39 weeks, and at my request, the doctor did an internal examination and informed me that my cervix was ‘very favourable’ and that I had dilated to 3cm. I was thrilled. I had been experiencing some pre-labour symptoms so obviously things were happening. Both babies were cephalic and presenting beautifully and Twin 1, my son, was engaged in my pelvis. Unfortunately, my blood pressure was up and I had already had two sessions of monitoring in the day assessment unit because of this so the topic of induction was brought up again. Since I was already dilating and effacing and I’d made it to 39 weeks I agreed. The doctor assured me that rupturing my membranes should be all it would take for natural labour to start, but if not; a synotcin drip would be administered. My birth plan included the request to be as mobile as possible during labour and to have intermittent monitoring to assist this. The doctor assured me that this was possible and every effort would be made to help me achieve my natural birth. This was Wednesday and the induction was booked for 7:30am Friday. Buoyed by this information and the knowledge that my babies were on their way, I left the clinic feeling positive and looking forward to the impending birth.
Thursday night was filled with fitful sleep. My 3 year old daughter, Freya, was at my parents’ place for the night and my husband Rolly and I had our bed to ourselves for what we knew would be the last time in a long time!
We arrived at the hospital right on time and then waited for an hour before anyone saw us. My first pregnancy was managed by a team of midwives. The Midwifery Group Practice was a pilot program at the time and I was assigned a team of 3 midwives, one of which was our primary midwife who would attend the birth. The experience was wonderful and empowering. The continuity of care was very reassuring and both Rolly and I formed a close bond with all three of our midwives that we maintain to this day. Because this was a twin pregnancy I was excluded from the MGP this time and really missed my midwives. Fortunately, they monitored my progress all through and my primary midwife offered to attend my twin birth in an unofficial capacity as a support person. I was thrilled at this prospect and she proved invaluable as an advocate when I felt too tired or vulnerable to argue for my self. Chris, my midwife, met us in the birthing unit and we met our assigned midwife Kylie who was herself 32 weeks pregnant! Kylie was supportive of my birth plan although she had to refer to the doctor regularly to accommodate my requests.
The CTG was strapped on to my belly and the fun and games of keeping track of two heartbeats began. After an hour of fiddling around and constantly losing the two separate heartbeats, Kylie applied a wire to Twin 1’s scalp to keep track of him whilst the CTG monitored Twin 2. I had a canula inserted and antibiotics administered as I had tested positive for Group B Strep. I was able to move around when the CTG was removed and Chris encouraged me to ask for regular toilet breaks so that I could be unhooked and allowed to move about.
Around 9:30 the registrar arrived to break my waters. He was the same doctor I had seen two days before and still seemed confident that I would not need much encouragement to go into labour. Lying on my back with two babies weighing an estimated 6lb each was very uncomfortable but having my membranes ruptured was awful. I did have it done during labour with my eldest daughter and so I knew it would hurt, but the doctor was having a hard time with my cervix which was moving about so it took longer than I’d anticipated. At this time, the obstetrician on duty came into the room and introduced himself. Dr.C, I will call him, chose this most inopportune moment to inform me of his intention to administer an epidural, hook me up to an IV of synotocin and continue to monitor my progress as the labour progressed. This was not what I had in mind for my birth. Gritting my teeth and trying hard to speak whilst having my waters broken, I told him this. He gave me a weary look and explained that it was the best way to proceed as twin 2 had moved to a transverse position since my last ante-natal appointment and would have to be turned head down following the birth of twin 1. without even mentioning an external version, or the fact that many second twins turn head down of their own accord after the first twin is born, he told me that he was going to have to do an internal version after the first twin’s birth which would place me in abject agony that I would not be able to handle and so an epidural was really not optional, but essential. Further to that, a cesarean was also highly likely in the event that the second twin could not be turned and so having an epidural already in place would save time and make the transition to the theatre much easier. It was at this point that I burst into tears. I asked him to please just wait a minute until the registrar had finished and then was able to sit up and through sobs explain that this scenario had never been discussed with me and that I was unaware that the hospital had a policy of performing twin births in this manner. I was under the impression that as long as the labouring mother was progressing normally, then the birth would be allowed to progress naturally and that any interventions would be discussed with me if and when they became necessary. I had already birthed a healthy baby without the aid of any sort of medication or intervention and knew how hard and painful it was. Dr. C. then started in on the scare tactics. If I didn’t have an epidural, I would not be able to cope with the pain of an internal version. If a cesarean became necessary, the theatre was at the end of the corridor and around the corner, it would take time to get there and time may be very much of the essence in the case of an emergency cesarean. Without an epidural, a general anesthetic would have to be administered which brought with it a whole new host of risks including my possible death! At this point, Chris re-entered the room after going to get a coffee and I watched a physical change come over Dr.C. He crossed his arms and legs and started to get very defensive when Chris asked why I was crying and what was going on. He explained to Chris what he’d just told me, but downplayed the fear factor quite significantly. For every point he raised, Chris had a counterpoint and suggested alternatives. He begrudgingly agreed with her and avoided eye contact with me. He then left the room so that we could talk about what he’d ‘suggested’. Chris calmed me down and reminded me that I did not have to agree to anything that I did not want to do. She amended my birth plan to include the fact that I had been offered an epidural, understood the risks and benefits and had declined one. I signed it and the issue was put to rest. Nevertheless, Dr.C insisted on having an anesthetist come in and explain in detail, and with diagrams, what was involved in an epidural and also in a general anesthetic. No mention was made of a spinal, except by Chris who assured me that in the event of an emergency c-section; I could be prepped for theatre and in there within 5 minutes and if time allowed a spinal could be done instead of a general.
Once Dr.C returned, we informed of our decision and Chris almost had to hold Rolly back from hitting Dr.C as he pushed again for an epidural and continuous monitoring. Eventually and after much arguing, he relented and allowed me to continue to labour as I saw fit
By 10:30 nothing was happening and so the synotocin drip was started. I was still being monitored but was able to use the fit ball, and walk around. I began having contractions but they were neither strong nor regular.
Chris set up the oil burner and Rolly massaged my back with the labour blend I’d made. The room was filled with jasmine and clary sage until we remembered that Kylie was pregnant and clary sage could have induced her labour too! The drip was turned up at regular intervals until I began having real, stop you in your tracks, can’t talk through them, contractions. Although the pain was quite intense, I was encouraged to think that things were finally happening and my babies would soon be here. Around 2pm I was examined and found to be still only 3cm dilated. I was so disappointed. I’d felt that I must have been making some progress, but I tried to keep positive. A couple of hours later, the drip was as high as it could be and I was starting to get tired. The contractions were regular and very strong; Chris was sure that transition was imminent and called the doctor to check my progress. Thankfully Dr.C had since gone off duty and so I was examined by a new, female doctor, also pregnant. I was still 3cm dilated and my cervix was ‘hard’. I couldn’t believe it. Why had the doctor at my Wednesday appointment told me my cervix was ‘favourable’? Did he just want me to agree to the induction? I have no way of proving it, but I suspect that was the case. She performed a stretch and sweep in an effort to get things moving. By now I was starting to get tired. I had eaten a sandwich at lunch but couldn’t stomach anything else. Chris and Rolly were great; they kept my heat pack warm, massaged me (now Kylie was off duty), changed the CD’s and kept me going. Chris grabbed some photos of Freya as a newborn that the MGP had in their photo album and stuck them on the wall opposite me as a focal point. I had to get her to take them down because they made me miss my daughter so much and reminded me of how different this experience was to her beautiful and natural birth.
By 5pm, the head obstetrician visited. He informed me that he believed my labour was not going to progress on its own and because my waters had been broken, I would need to have these babies fairly soon. He proposed a cesarean, but was willing to allow me another four hours, maximum to labour on my own before he would insist on surgery. Again, I cried. I felt like this was not my birth anymore. My worst fears were coming true and the experience was being taken out of my hands. However, Rolly and Chris talked me round and reminded me of my goals and so I kept on for another hour. There came a lull even though I was now moaning and groaning through the contractions and begging to be let off the bed. Chris threw the straps off my belly and said ‘just do what you need to’. I walked around a bit and suddenly felt like my veins were filled with ice. I was filled with fear and dread and I could hear my heart pounding in my ears. Something was wrong. I started to panic. I told Chris to get the doctor because something was wrong with the babies. She and Rolly thought I was just tired and emotional and tried to calm me down and reason with me. I became more insistent and so they got the doctor and a midwife to come and see me. The CTG was fine, but I was adamant that something was wrong. ‘What do you think is wrong?’ they asked me, and I couldn’t answer. It was nothing specific, and I can’t remember now exactly what I was saying, but Rolly remembers me repeatedly telling him ‘something’s not right. It doesn’t feel right. It doesn’t feel like with Freya.’ Chris reassured me that no two births are alike but that wasn’t what I meant. With Freya, I was scared and in pain but I knew I could do it and that everything would be okay. I didn’t feel that now. In the end, an ultrasound machine was brought in to check on the babies’ positions and to reassure me that they were indeed okay. The doctor pointed them out to me on the screen but by now I was in full panic mode. I was sobbing uncontrollably and begging for a cesarean. The doctor was more than happy to oblige but Chris and Rolly tried to talk me out of it, thinking that I would regret it later and that I was feeling pressured by the doctor. I wasn’t, I just knew somehow that these babies needed to be out as soon as possible.