This is a long post…..
Exactly 12 days back at 11:30 pm on 1/6/2010, a baby boy was born to one of our moms at our Healthy Mother Birthing Center, the Sanctum. That he was born after almost 15 hours after mom’s bag of waters (BOW) broke, or that he was born with a nuchal hand (hand placed near his neck and face as he was born), seem to be a part of any routine labor and birth.
What makes his birth special is that he was the first of the twins to be born. His sister (now we know that the second twin is a baby girl) was still happy to be inside mom’s belly, and she waited happily there for the next 23 hours to be born. She was finally born on 2/6/2010, at 10:15 pm, to much joy and awe of both parents and our team.
Between 11:30 pm on 1/6/10 and 10:15 pm on 2/6/10, we waited, watched, monitored, occasionally examined, discussed various options and scenarios, helped the first twin breast feed (several times!), believed that the mom’s body and the baby inside had the wisdom and knew what to do, tried a few different things to get labor started again, and waited .. and waited … and waited … for mom to start her contractions, so that her second baby could be born.
Through this time, initially after the first twin’s birth, mom rested a bit. Then our OB, who had been present for the birth of the first twin, in case her expertise was needed, did an intrapartum ultrasound, to determine the position of the second twin. We knew from antenatal check-ups that the second twin was in breech position. We were hoping that with the birth of the first baby, she would turn head down with the additional space now available to her. However, she continued to remain in breech position till her birth. The parents had already been counseled and given full information on the pros and cons, and the risks involved in a vaginal breech birth, and they had opted to try for it. This made it easy for us to wait, watch and monitor.
In the early morning hours of 2/6/10, mom wanted to move around and walk to see if she could help get labor started again. Though we (Rinn, me and her husband) took turns walking with her, helping her with pelvic rocks and tilts, and many trips to the restroom – no labor. Baby was such a trooper and happy as a clam that Mom was joking – “This baby did not have enough space inside me before; now she is enjoying her share of time and space!”
By mid-morning, mom had her breakfast. I suggested more walking, and some small sideways lunges with pelvic tilts and some mini-squats to see if we could move things along, which mom did. We also started some herbs. Mom was slightly anxious about labor not getting re-started, and I found myself singing the Gayatri Mantra to her, and her husband joined in, and I think this helped her relax a bit. As Rinn slept a bit, I started some pressure points and homeopathics, which in addition to the upright postures, seemed to help get a few more contractions – but still, no labor rhythm. We discussed with our OB about the option of starting a slow Pitocin drip to see if we could give a gentle push to get the contractions more into a labor rhythm. At this point, though none of us were wanting to do anything major, it was still unchartered territory for all of us – 12 hours had elapsed since the birth of the first twin and still no contractions! Parents chose to go with the slow drip; but mom’s body was still not ready. Some stronger contractions, but no labor. After a couple of hours of the drip, we decided to turn off the drip and let mom sleep for few hours, as sometimes a few hours of sleep will rest the body and signal the uterus to start contractions again. Mom slept soundly for the next 4 hours, while Udaya, our doula, monitored baby periodically. I wanted to sleep, but could not – anxiety?!? But, I did get a much needed break.
Early afternoon saw a well rested mom, but no signs of labor still. My OB partner (and friend!) was by now being tested with all our “patience”, “baby is well”, “mom wants to wait” approach. She consulted several of her colleagues, all of whom were skeptical about the whole process, and were telling her that the best course of action after so long would be to do a C-section to minimize risks to the baby. She did another intrapartum ultrasound, which showed that the baby was still in breech, and was still doing well. Rinn did an internal exam, which showed that the cervix was 7-8 cms, but very stretchy, and bulging bag of waters.
So, we had a long round of discussion with the parents and talked to them about their options:
1) No interventions. Baby is doing well. Let mom start labor when she does. This could be a few hours or a few days – who knows?!? Risk – If infection sets in, or baby does not do well – then, emergency c-section would be the only option.
2) Re-start a Pitocin drip, get a complete team scrubbed and ready, break the bulging BOW, hope that the contractions pick up, baby descends and complete a breech vaginal birth. Risks – those associated with cord compression and any vaginal breech birth. May need to go in for an emergency C- section if things did not go well.
3) Go for an elective C-section. Risks – those associated with the surgery.
Parents chose to go in for the second option. So, a Pitocin drip was re-started. This time around, the contractions were longer, stronger and rhythmic, but to our surprise, mom had very little pain. There was slow build –up of contractions, rhythm and intensity over the next 4 hours. Mom was having more lower abdominal discomfort and some mild back pain with the contractions. After monitoring mom and baby through several contractions, an entire team was assembled, an epidural was put in place, in case we needed to go in for an emergency LSCS, and Rinn broke the BOW. The contractions increased in strength, the baby started to descend buttocks first; Mom was encouraged to push, which she did beautifully. And finally with some assistance from both Rinn and the OB, the baby was born. A beautiful 2.3 kg baby girl had finally made her journey earthside!
There would be more events thereafter – manual removal of two placentas, which were slightly adherant, postpartum hemorrhage that needed some controlling and such – so, it was a complete team effort. All credit to the OB and her team for not only waiting patiently with us, but helping us at the birth as well as managing the immediate post-partum so well. In the meantime the baby girl was hungry and latched on to mother’s breast with ease, and we could all only wonder at the miracle of birth!
I have waited a while to process the whole experience and write about these births, simply because I did not want to come across as if we were doing something out of norms, or weird, or extraordinary – depending on whose perspective you look at it from!! People in birthing circles and care providers have asked me – “How long would you wait for the second twin to be born?” Honestly, I have no answer. In this birth, the birthing energies were right. Mom and the second twin were doing well. The first twin had been born without too much difficulty. The mother (who is really the key and integral part ot any birthing process) was confident and had a gut feeling that her body would start laboring, and that she would have her baby naturally. Dad and family members were very supportive of the process. We had a very supportive OB and an entire medical team on call at all times; this was our safety net. We were monitoring closely and very cautious at all times, even though we were confident and hopeful for a natural birth for the second twin as well. Had any of the above factors been absent, we would have probably had to intervene sooner.
In the end, all of us marveled at nature’s own way of preparing and enabling the mother to give birth to her twins. We were happy to be part of this family’s incredible journey to parenthood.