Baby Van and Baby Claire: A Combined Delivery at 39 Weeks with Twins
My first “official” doula client (meaning, my first client to hire me for my doula services, I have served at some capacity or another as a doula in almost every other birth photography client in the past), and this momma was pregnant with two bundles of joy! This couple had asked me something in our initial meeting, and it has stuck with me since then. I was talking about how exciting it was that she, Esther, was carrying twins, and wanted to hire me as I’m new to my doula career and will be certifying this year with Angela Gallo’s Dynamo Doula Training.
I can’t remember who asked this question, but they both looked intrigued when they said in response, “Oh, because then you can say you have experience with twins?” My response was, “No. That’s not it. I am just fascinated by a woman’s body to carry life, but this is different. This is just extremely special.” This experience certainly was not to check a box off of my “list.” Esther needed me, and I her. She had goals in mind that she wanted to achieve, so I set out to give her the best chance at doing exactly that…
She had a lot of preferences she would have to fight being that many of those preferences went against hospital policies, but nothing prepared us for what an unmedicated, vaginal birth would be like in an Operating Room (OR). I think deep down Esther wanted to prove her own strength to herself in that she knew what she was capable of, but never got a chance to prove it with her prior two birth experiences. She was younger when she birthed her first boys, and back then didn’t know the benefits that came with an unmedicated birth. She wanted this to be different, and wanted to avoid pain medication this go around if she could help it.
Tuesday | January 29th | 39 weeks
It was about midday when she called me, informing me that she would not be leaving the hospital, and that they decided to manually rupture her membranes (break her waters artificially/AROM) after an ultrasound revealed the assumption that the twins were suddenly two pounds off in their weights, when all throughout their pregnancy they were ounces off from each other. The fear of one baby not doing as well as the other was present, and after a few natural attempts to induce labor over the weekend had failed, they decided this was the best option.
I began making arrangements for my kiddos, so that I would be ready at a moments notice, and waited to hear the details of when exactly they would attempt to move forward with AROM. It was around 2:00pm when they made the first attempt, and I decided to ask if they felt ok with me hanging close-by in case things picked up quickly after they ruptured her membranes with Baby A (first baby to be born). I planned to get something to eat nearby, and wait a bit to give them space to see if things progress. I arrived at about 3:00pm, and they told me to head up and hang for a bit, so I parked and went in to find their room.
When I arrived, I learned that their doctor was not sure she successfully broke the waters, so they would try again in about an hour. Esther explained it was extremely painful, and she wasn’t able to relax at all. I prepped her a bit on how to relax for the next attempt by closing her eyes and relaxing every fiber of her being starting with the top of her head down to her toes. It is fascinating to witness a body respond to what the mind tells it. She was able to relax through the second attempt, and the waters were successfully ruptured! She was 5-6cm dilated, and now we would wait to see what happens.
The hospital room was full of love with Jonathan, of course, as well as Esther’s sister, niece and sister-in-law. I decided I would stick around for a bit to see if anything picked up, and began contemplating heading back home for the night to let them rest. I was texting a couple of other birth professionals in the meantime while the family circled around to play a game of cards, momma comfy and content on her birth ball. I knew we were on a time constraint of 18 hours when they ruptured her membranes before they would introduce Pitocin (synthetic oxytocin) to bring on contractions, which would have been 10:00pm the following night. A (wonderful) doula friend of mine reminded me of the time clock my momma would be on per hospital policy from the time her membranes were ruptured. I quickly realized I needed to double check what that time restraint would be (usually 24 hours) with this hospital, and headed out of the room to check in with Esther’s nurse. I learned that if things didn’t pickup by 10:00pm tomorrow night when they would introduce Pitocin, that there would then be only 6 hours left before a cesarean was pushed, around 4:00am 2 days later. I quickly realized this family was either going to be absolutely exhausted by this point, or that we could attempt to move things along. I double checked that Esther wasn’t having any contractions before I left the nurse’s station (she wasn’t having any that she could feel or we could notice), and her nurse informed me she was having a little something every 10 minutes.
I headed back into the room, and let Esther and Jonathan know the details of the conversation I had with their nurse, and gave them two options. “I can either go home, and you guys try to get some sleep tonight,” I said, “Or, we can try to get this show on the road while I’m here because you are having a contraction every 10 minutes and that’s something.” Esther asked, “Ok, so what do we need to do?” and I responded with, “Well, first we need to change this environment a whole lot.”
At around 6:00pm the family members present, except for Jonathan, all headed out, and we got to work. Esther and Jonathan went for a walk together through the halls, while I stayed back and dimmed lights and picked up a bit around the room. They came back, and Esther’s contractions were coming on a little bit stronger already, but nothing official yet. We asked for a breast pump (nipple stimulation is a great way to encourage contractions by increasing the natural hormone oxytocin in our bodies), and that was delivered to us by her wonderful nurse relatively quickly. Contractions seemed to be increasing in the meantime, E and J staying very near to each other (also increases the natural flow of oxytocin in a powerful way). She asked to be checked for dilation, and was surprisingly at 7cm. This was shocking to me, because she was SO calm and collected during the contractions she was experiencing.
She used the breast pump and was able to pump an impressive amount of colostrum in one 10-minute sitting, and then we went for another walk all together. Things picked up hugely on this walk, and she had one contraction that made me realize, “Yep, this is it. She’s doing it.” As things intensified, she wanted to be back in her labor room so we headed back that way while the contractions kept coming. Once back in the room, she was hitting her breaking point and most certainly experiencing transition (the hardest part of labor, but usually the quickest and the next step is pushing). We waited for her doctor to return as she felt the urge to push and fought it with everything she had. She amazed me, absolutely amazed me. Even in her breaking down in those moments, she stayed strong in what she wanted.
Her doctor checked her dilation, and she was a complete 10cm. This was no longer than TWO hours after we first began attempting to get things moving, this Momma went from 0-60 and did it with incredible strength.
This is when things got significantly more difficult, as the hospital policy with birthing twins is if you desire to deliver vaginally, then you must deliver in the OR. Momma wasn’t permitted to push yet, and had to wait for the OR to be prepared for her. Her contractions weren’t going to stop at this point, of course, and while she waited she coped through that struggle of fighting what her body knew it needed to do. Our venture to the OR began, and Esther wanted to walk there. Jonathan supported her through contractions while they made their way down the halls, and I followed along beginning to document as we ventured into what none of us were quite expecting.
We entered the strange environment of the OR full of people rushing around, back and forth, clearly not ready for this mother who was clearly ready to birth her babies. She removed her gown again at this point (as that was most comfortable to her by the time the contractions really kicked in, completely normal) and was leaning into the table as she squatted through more contractions, waiting to be given the permission to push.
We quickly learned that she would not be given the choice of how she would push and that it would be on the table, slightly reclined, with her legs in stirrups. I point these things out, because as the reality of this unfolded before our eyes, we all realized we were not prepared for this. We were not prepared for the environment we would face in the OR as an unmedicated mother would push through the uncomfortableness that was being surrounded by watching eyes as she hunkered down and birthed “Baby A” baby into this world.
I could see this was not easy for her. I could see the shock within all of us that something was just very out of place. This environment was NOT setup to support an unmedicated mother, delivering vaginally and experiencing a physiological birth. I hurt for her, and what she was experiencing because (as happens time and time again in the hospital environment), this wasn’t unfolding how she wanted and there were not very good reasons at all that things were unfolding that way. Hospital policies do not support a mother desiring a physiological birth, even though most women have the ability and desire to experience birth in that way.
She pushed on, and did it. Esther birthed her baby and absolutely rocked her birth, despite the uncomfortable situation.
Baby Van was covered in “cheese” (Vernix) and absolutely perfect!
For a moment, I think we all forgot that there was another baby that needed to be born, but Esther’s face made that clear while her doctor realized that Baby B was no longer head down, and had flipped breech. This particular provider had made the agreement with the family that she would only attempt a breech delivery of Baby B if she had the right support of an additional obstetrician (OB). This option wasn’t available to us, and a Cesarean was quickly decided upon for Baby B’s birth.
Jonathan and I would need to leave the OR with Baby Van, for Esther to be prepped for surgery. We headed down the hall into the recovery area of the OR, and began waiting.
It felt like we waited for a very long time, as nurses from the OR headed in and out. At some point, one person came in saying that Esther was asking for her sister, Hannah. Jonathan both realized we left our cellphones in the labor room, and didn’t have a way to contact her. I quickly remembered that I had saved her phone number in my phone, and had my Apple Watch on (as I always do on call and during births) so I would be able to call her! She answered very quickly and sounded so relieved that we had called. A nurse talked into my wrist to her to let her know where to go to get to where we were, so she could be there. We all knew ahead of time that all three of us would not be able to fit in the OR together, and that either Hannah or I would be waiting outside of the OR while the cesarean was performed in the event that is what happened.
Baby Claire was born via belly birth soon after Jonathan went back into the OR with Van and I sent Hannah in with my camera to capture what I couldn’t be present for.
Hannah did wonderful documenting memories while she was in the OR with them, and I’m so glad she did so that this gallery could be complete for them all.
It felt like eternity waiting outside of that OR, feeling like I wish I could be doing more than sitting on my hands while the rest of this birth story unfolded. Being able to hear everything, but not hold some kind of supportive space wasn’t easy for me. But, I could hear the joy and contentment beaming out of that room, and I am so grateful for that. The OR was setup for exactly that.
I adored the way Esther moved her head back and forth, an absolute natural at caring for these babies (of course, they’ve been inside of her for nearly 10 months, she knows exactly what they need) as she soaked it all in with so much love. I went with Hannah to gather all of their belongings from the labor room, and then soon after headed home when I knew they were settled.
This experience taught all of us a lot, and I couldn’t be more proud of this family for their strength and persistence, and their ability to cope with the curves that were thrown their way. Birth is beautiful, and difficult. Getting through it with the kind of peace, joy and acceptance Esther carries around with her is one of the most beautiful things I have been able to witness and support.