#388 | Twin Home Birth at 38 Weeks: Leaving High-Risk Care and Choosing a Midwife

I'm Cynthia Overgard, birth educator, advocate for informed consent, and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Show. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

I'm Victoria, and I had my twin boys at home about a year ago. Actually, they're 12 months now, and I started working with, like, the high-risk doctors at the beginning of my pregnancy and ended up switching about halfway into pregnancy to a home birth midwife. I was told that I was having MoDi twins, which is one placenta and two sacs. Was told I'm high risk, I'm gonna need a C-section, and I'm gonna need to visit the high-risk doctors every two weeks. So that was just, like, a lot of information all at once when you're meeting your babies for the first time, like on an ultrasound.

Was this your first pregnancy?

No, this was my second. I had my first at a private birth center.

How many weeks were you when you found this out?

I was probably around 10 weeks. MoDi twins is, like, a little bit rare compared to, like, di-di twins, which you have, like, two placentas and two sacs.

So you're 10 weeks pregnant. They tell you—you didn't know you had twins until this time, this moment. Okay.

Yeah. So that was just, like, a lot to process. We were actually at the birth center where I had given birth, and there's, like, this third-party guy who comes in. And so I knew that we were not going to give birth there because we were moving to Colorado at the time. We were in Oregon moving to Colorado, but we wanted to see those midwives. And you probably know that birth centers can't really work with twin moms, so I just accepted, okay, we're gonna have to go see the high-risk doctors because this is my only option that I have. So the second visit with the high-risk doctors, we were in Oregon. I was asked, "Hey, do you want to be pregnant, first of all? And then second, do you want to have twins? Because if not, we can dissolve one of them. If you're just not feeling it, if you only want to have one baby, we can do this."

What?

And that was just insane to me, like someone was asking me this. There was no medical issue, so I don't even know why they asked me this question. I was just—I was speechless. Yeah, I didn't understand that this doctor was, like, an OB, you know, helping people deliver babies, but asking me this question. And so that wasn't, like, the best care that I got. I was disappointed, I guess, in that.

It's terribly offensive. It's outrageous. And the nerve to use the word "dissolve" of your own child, it's dystopian, not to mention probably very risky to your pregnancy. And, like, this whole—anyway, that's very upsetting.

Do you recall what you said in response to him?

Yeah, it was a woman, and I had responded, you know, it might be a little overwhelming for me to process that I'm having twins, but I'm not going to—I don't want to have an abortion. I said something like that.

Yeah, let's call it what it is.

Yeah, let's call it what it is.

Wow.

So when we had moved to Colorado, I was going to new doctors. I was going to an OB and then also going to the high-risk doctors. And so that's every two weeks, and it's very expensive visiting them every two weeks. And also, I was experiencing a lot of fear and anxiety every time I'd go. They would tell me all the risks, and it was just this repetitive thing of, here are the risks. Maybe you can have a vaginal birth, but—yeah. So it was around 16 to 18 weeks, I had found a home birth midwife, and she had her own ultrasound equipment. And so the only thing she needed was an anatomy scan from the high-risk doctors just to get a little bit extra information. And so I canceled my appointments with the high-risk doctors, but went in for my anatomy scan, and I was cornered by three different people trying to convince me—who my new provider was. And I came in saying, I just want my, you know, past ultrasound files. That's all I need. I had three different people try to convince me to tell me who my new provider was, but I was just there to get my ultrasound files, and that was it. And they gave me the hardest time. It felt like I was cornered by the birth police.

When you say trying to convince you to tell them who your new provider was, that's what you mean. They were trying to figure out why you were leaving the practice and where you were going. They wanted you to disclose who was going to take care of you.

Exactly. Yeah. And finally, it was the actual doctor came in at the end. He, you know, said the same kind of thing, and he told me all the risks. And I said, "You know what? I've been here before. I know all the risks. I just need my files." And that was so hard. I think I was probably, like, shaking until I got home because it was very, very intense. But all that anxiety, all that fear was lifted off of me when I switched providers.

Did you have doubts? Did you feel like, what if I'm doing the wrong thing? What if this is a bad decision? What if something happens? What if one of these high-risk things comes true and I'm to blame? Like, what was your emotional state? Like, first of all, how did you even decide to come to the decision that you should have a home birth with your twins? Was that something you decided you felt really strongly about? Was it something—how did you go through that process? How was your husband feeling? How long did it take you to come to that decision?

So it was when we were touring the hospital around that time frame, right before I switched, where they told me—the nurse told me, "So at the end of labor, you're going to have to give birth in the OR." And I said, "Okay, hold up. Why do I need to give birth in the OR if everything's going great, if I have no complications?" And so after that appointment, I told my husband, "We're gonna have to figure something else out because I'm not gonna give birth in the OR." Of course, if there was an actual emergency, if I had a condition, if my baby had a condition, I would be open to that. And he was absolutely on board of finding a midwife. We wanted to have a home birth this second pregnancy anyway, and he was, I would say, even more supportive than I was, even more confident in having a home birth. So that was the main reason. I have never given birth in a hospital before, and I just know that they are trained to mess with you, and being in the OR will give you a higher risk of having a cesarean, even if you want a vaginal birth.

Well, just like hiring a surgeon for your birth gives you a higher risk of having surgery.

Just like giving birth in a hospital gives you a higher risk for C-section. Like, all these things, yes, your risk just keeps accumulating.

Women are hiring surgeons to support their birth, and then they're saying they want to have a natural birth. Well, you hired a surgeon, and every midwife has a backup surgeon, so it's like Plan A versus Plan B. Yeah, I find it very unreasonable that they expect mothers with twins to give birth in an operating room. It's like you'd think there'd be some kind of acknowledgement for her emotional and mental experience giving birth, but there isn't. And obviously they could transition a woman over there very, very easily if they really had to. But sometimes, because they're so extreme, it pushes women out into another model of care.

There's such a simple solution to it. I mean, there are birthing rooms that are very close to the OR. Like, you could be within 20 feet.

Oh yeah, and the difference for the woman is everything.

Oh yeah.

And to them, it's just not even a consideration. It's like, oh, no big deal. Like, give birth in the OR. It doesn't mean anything to them. It's more convenient to you. It completely changes your birth experience.

And then also, that doctor that might have skill in vaginal breech birth, they might not be on call, and you might have someone who has a high C-section rate. So you just never know.

Okay, so your husband was totally on board. Typical, typical second-time dad with all the confidence in the world. I always say that. Like, dads don't have much the first time around. Second time they're like, "Oh yeah, this is easy. We can do this." And women are starting from square one every time, especially with twins. But he was on board, so that had to make it easy for you to follow your instinct. What did you do next?

Yeah, so we visited our midwife, and she shared with us some twin home birth videos, and I just was crying the whole appointment. And I just was really praying for this opportunity, and I just was—it felt like a very full-circle moment finding this midwife who was skilled in vaginal breech, but also had a lot of clients who were twins as well.

Okay.

It was around 38 weeks when I actually went into labor. So, like, days before I actually went into labor, I was dealing with prodromal labor. I think that's what it's called.

Prodromal, yeah.

Yeah, and so I just didn't know if this was the real thing. But that night it was like seven or eight p.m. where things were definitely, like, picking up. I noticed that my contractions, though, were, like, not, you know, three minutes apart. They were just really all over the place throughout the entire night, but they definitely were getting more intense. So it was like three a.m. when I told my husband to call my father-in-law to pick up my toddler because I was focusing on birth, but then I was afraid my toddler was going to wake up, so my mind was, like, really split, and it was almost like stalling my labor where I couldn't focus. So after that, I noticed my contractions really, like, picking up. So it was about five a.m. I called the midwife to come. Six a.m. is when the midwife comes, another midwife, and then Monet. I don't know if you guys know Monet.

Oh yeah.

Yeah.

Yes, yeah. She's in Denver.

Yes.

She does incredible work.

Contractions are intense at this point. Six a.m., I'm thinking—I feel like I'm in deep active labor. I almost feel like real soon I'm ready to push. So I told my midwife, "Hey, before birth even started, like, you're welcome to do, like, low interventions to keep me from transferring as long as it's not an actual true emergency." So I was open to that. So she checked me, and I was one centimeter. And we all know that one centimeter means nothing, but something was not right because I felt, like, really close. Like, it was just intense contractions. So she noticed that there was some scar tissue that I had from my past birth that almost seemed like it was keeping me from dilating.

Wait, scar tissue from what? You had a vaginal birth.

I had a vaginal birth, and it was a deeper tear.

Okay, so they had sutured you internally, like a third-degree tear or something, and there was scar tissue from that.

Right. So the midwife that I had in Oregon, she said, "Okay, this tear looks a little bit deep, so we're gonna have you go to the hospital." And the nurses, whoever it was, they were like, you know, "It's too dark in here. We're gonna go in the OR." So it was this whole ordeal. They sewed me up too much. I believe it was a vaginal third-degree tear.

You had a severe tear in the vagina, in the vaginal wall, not the cervix. That's the main distinction I think we're trying to make here. And you had a heavy amount of stitching that led to excessive scar tissue. That shouldn't hold your cervix back from dilating, though.

Yeah. Basically, she just kind of pulls it out of the way as if you're really doing a cervical check. I didn't really notice a difference, and my body opened up and went to nine centimeters, which is just so insane.

How quick? From one to nine in the moment?

And my body was, like, one to nine.

So something was like that.

Doesn't make any sense.

It doesn't make any sense. It's quite remarkable. But is it because something was actually holding the cervix in the position it was, and then when she freed something, it all opened? Is that what the implication is?

That is what she had told me, that the scar tissue was, like, almost covering it, in the way of my cervix dilating. And so when she pulled it out of the way, it opened my body up to wherever it was.

Maybe your cervix was somehow attached to the scar tissue and couldn't open.

Maybe.

I don't know. That's fascinating. But whatever she did, it worked.

The joy of having midwives.

Yeah, I feel like if I was in the hospital, I would have probably been labeled failure to progress because, you know, I'm not progressing at all. And probably—you never know—but I could have had a C-section if they didn't check, okay, something's not right here, there's some scar tissue here. So that was, like, wild to me. So after that, I went into the birth pool, and I noticed that being in the birth pool—I was in and out—it did kind of slow down my labor a little bit. And so I wasn't in it a whole lot, but it was very relaxing. So from six—babies are born at 9:30. Midwives come at six. Around, like, 8:30-ish, I am using this, like, squeezing tool to help with the contractions because it's a little bit more intense at this point. And so right before I am feeling like I need to push, I'm feeling stuck, and so I tell my midwives, "I'm going to go in the other room with Stephen, and we're going to get all snuggly." And so I needed that oxytocin, just wanted to get that comfort from my husband to help get through labor. So after that, I'm noticing about 20 minutes after that, I'm noticing things really picking up, and I'm feeling this urge to push. And it's like I feel like I need to poop, and I, like, hate that feeling. Like, the contractions were not too bad, but now this feeling that I'm having feels like there's a bowling ball, and it's just very uncomfortable. I could feel one of the babies moving downward. And so I'm going from squeezing this thing, and I need to focus downward. So I stop using the squeezing tool, and we notice that baby A, I'm having trouble pushing him out because his forehead is presenting rather than his chin, like, tucked down. So it took a good 30, 40 minutes to push him out, where he was crowning for a while. So I'm sideways. I'm not in the pool, and I push him out sideways. So we have baby A come out, and like I said, I told my midwife, you can do some low interventions. I'm okay with this. So she puts one finger in and then puts the other hand on my belly and does a position, like pushes him in the right position, baby B. And so then I have one contraction, and four, five minutes later from when baby A was born, baby B is born, four or five minutes later after that one contraction. And I have the fetal ejection reflex with baby B, which I've never had before, so that was a whole different thing, where baby A took some time and baby B just came right out. When I was pushing out baby B, my husband was holding baby A, which was sweet. And so it was so interesting having, like, a cord attached. And then we had decided ahead of time just to do Pitocin, just because you're a bit higher risk when you have twins of bleeding. So she just gave me Pitocin right after, and my placenta came out just fine.

What does it feel like to have that little—you had a short wait—but what does it feel like in the in-between, after you give birth to one baby? And then for most of us having just one baby at a time, then we're worried about the soft placenta coming through and imagining, like, oh, I can't possibly put something else through my vagina. But a placenta is not really too big of a deal. But what does it feel like in that moment to be like, oh my gosh, I have to push another baby out?

Yeah, I would say, like, even before giving birth, I'm like, I don't know how I'm gonna do this. Like, I had never obviously experienced that before, so it was, like, foreign to me. I was very grateful that baby B was quick, and it was probably because my midwife helped.

What did your babies weigh?

Six-seven and six-twelve.

That's fantastic. At 38 weeks, they'd been eight-pound babies.

Yeah, so they were 38 weeks and one day. But yeah, if they were singletons, for sure. Yeah, so they are healthy, healthy boys.

That's pretty perfect, really, for twins. That's, like, perfect size, perfect gestational age. Not that, you know, later wouldn't be imperfect, but that's great. They weren't preterm. They were really healthy size. Did they breastfeed okay?

They did. Yeah, I did a mix of having donor milk. I had a mix of donor milk, but I also breastfed them just about every two hours. And, you know, at this point they're 12 months. We don't do a whole lot of breastfeeding, but every once in a while, like if they are sick.

What was your technique with breastfeeding? Did you tandem feed, or did you do one at a time?

Yeah, there's this, like, twin pillow where you have them, like, football position. So I did that. That was great. And then when they were about three-ish months, four-ish months, I'd lay down and I'd have them on the side, and I'd kind of have a pillow to help lift their heads a little bit. So that was fun. And then now they'll, like—we'll do it anyway. They'll, like, sit up.

Oh yeah. Well, now they have—they'll do gymnastics while they're—

Gymnastics. Yeah.

Did you assign one breast to each baby, or did you swap? So you did tandem feeding, one on each side in football hold, and did they each have their own side that they always went to, or did you sometimes change that?

Oh, it was too much to assign a side. I just—whatever baby's awake, I'm like, we're in survival mode. Whoever's awake, yeah. Nice. My daughter, I was trying to, like, reduce feeding her because she was not quite two, and so it was hard for her to be like, they're taking away my milk. So that was kind of a transition for everybody.

Yeah, that's a lot to feed a two-year-old plus two babies.

Yeah.

Victoria, when you were in labor, did any of those fears that were planted in your brain by the OB early on come up for you, or was there any medical risk or concern that sort of just, like, stuck with you? Sometimes women will have a fear of postpartum hemorrhage or that they're going to get preeclampsia. Is there anything that you really struggled to work through?

Yes, for sure. With my daughter, it took a while for her to come out. She was maybe—she was, like, sunny-side up, so it was kind of a weird position. And so she was crowning for a long time. And so when Aiden, baby A, was crowning for a long time, I was having those same fears that we're not going to get her out—or get him out—just like my daughter. And so that was the main thing that came up. But, like, the fears of my baby dying or, like, the baby not breathing right after birth and having to, like, rub their backs, that actually—I felt like my eyes were like, you know how a horse, when you're running a race, you're like this—

Blinders.

Blinders. Yes. That didn't come up for me, and I'm grateful because looking back, I know that's a thing that can happen with any baby, but especially twins. The second twin is one they look out for. But yeah, I felt like those blinders were on. But when baby A was crowning, I was having those fears coming up because it was taking a good 30, 40 minutes from when I started kind of feeling pushy.

Well, that is not a very long time, especially for a baby with a forehead presentation. That's a very hard position to get a baby out in. So that 40 minutes is actually quite impressive for that head position.

Yeah.

Was there anything in your pregnancy—you had very good-size babies and a very nice, healthy, long gestation—was there anything specifically that you did in your pregnancy?

Oh yes. So the Brewer diet. The moment I found out I was having twins, that midwife from Oregon shared that with me, of having, like, 150 grams of protein daily. So I really focused on that because, you know, preeclampsia, when you are having twins, there is a little bit of a risk, more of a high risk there, so I was able to avoid that. I'm not going to say, like, 100% that will take care of it, but I did feel better this pregnancy even more than my first, my singleton. So that was, like, a big thing, really getting that protein in and minerals, just taking, you know, electrolytes, and even doing some movement, like just trying to be active, even if it's just, like, walking.

Yep, those are all the things.

Yeah. Also playing my, like, worship playlist and doing my, like, pregnancy stretches and inviting God into, like, the whole process, like inviting Him to process any fears, just to invite Him into the whole process. So that was just another thing I tried to do daily. So spiritually, physically, mentally, all of that.

Did that involve praying, like praying for certain outcomes, or do you mean prayer? Do you mean something else?

Yeah, prayer. Praying for certain outcomes, like I feel like that's there, but also, like, open hands, of, like, I'm inviting you into this process, and you're here with me, and then walking through fears and other people's opinions and their fears maybe attaching to me, and just all of that. But yeah, lots of prayer for sure.

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