Thursday, June 5, 2014

When Home Birth Intentions Meets High Risk Birth

Thank you to Amanda and Jose for allowing me to share their story. 
Amanda hopes it will help other parents.

My third set of vaginal twins has a unique story. Like many of my clients Amanda came to me committed to a natural vaginal birth free of medical interventions, including pain medication. She wished for a home birth but she knew that wasn't possible in our area because she was carrying twins. So she settled on hiring a doula and planned to turn down as much medical "help" as possible.

But of course life rarely goes as planned...

One day, WAY too early in pregnancy, she begin to be concerned about how her body was feeling. Being a smart mama she listened to her intuition and took herself in to see her OB. Yes, her blood pressure was climbing dangerously. Before she could really grasp what was happening she was admitted to the hospital and begun on medication to bring it down.

I begin to capture Amanda's journey with my phone camera.
I came to the hospital and we talked for a long time about all the natural ways she could support her system and help bring things into a better balance, including her blood pressure. I reassured her I would come to give her birthing classes in the hospital. We strategized over how to deal with a long hospital bed rest.

One week later her water broke. Her body decided it was time to have her babies, 26 weeks or not. With contractions came climbing pressures. When I walked in Amanda was laying in bed surrounded by and attached to more medical contraptions than I have ever seen before. Blood pressure cuff, IV meds for blood pressure, IV fluids, heart monitor for mom, contraction monitor and 2 baby heart rate monitors. A bewildering array. The nurse was glued to the screen giving her all the info from all the machines. Amanda had to remain horizontal for her labor.

Let me explain. I have seen lots of moms hooked to LOTS of things but NOT a mom who was birthing without labor stimulants and/or pain medication. Here was Amanda in the midst of a high tech, high risk birth doing it "au natural".

So we labored. We breathed. We visualized. We relaxed. I sprayed the room with lavender and smoothed essential oil on her feet. We massaged her shoulders and gave her sips of water. Absolutely no food because of the high potential of an emergency cesarean. When her back began to ache I showed Jose how to use my purple rebozo to provide counter pressure with a mom on her back in bed.

The sensations were coming closer and getting more intense. With such tiny babies, with tiny heads the magic number of 10 as a goal for dilation goes out the window. You are ready to push whenever the cervix is pulled back far enough for a head to slip through. I was pretty certain we were closing in on pushing. Then Amanda began to make pushing sounds and spoke of pressure. I alerted the nurse and she did a vaginal check. Yep. No more cervix. Time to push out baby A.

Now everyone began to scramble. I don't know why they were all so surprised.

Vaginal twins are unheard of in some areas of the U.S. but here moms can birth vaginally as long as the babies are positioned right. Amanda's OB, stuck to that promise although he had plenty of opportunity to use the situation to send the birth down a cesarean path. He never once brought it up. When things got tricky he stayed calm and talked mom through exactly what needed to be done, including the urgency of the situation, enlisting her help without scaring her.

But twin births are required to take place in the operating room, just in case. So here we go...
Heading down the hall at Sierra Vista on the way to the OR.

On our way to push out two babies sans pain medication or pitocin.


At the last moment they separated us and made Jose and I wait in the waiting room while they got mom "prepped". I nervously wondered what they were prepping her for? Usually they make us wait outside while they put in an epidural before a cesarean. Poor Amanda was told to not push, even though you can't stop your body from pushing once it begins. A doula can really make a difference when this chaotic circumstance arises, but there I sat in the waiting room, waiting. So I snapped this handsome photo of dad sporting his hazmat birth suit.

At last we were reunited. The room was FULL of people. They had to have the whole OR team as if she was having a surgical birth just in case it suddenly became a surgical birth; obstetrician anesthesiologist, surgical nurses, labor nurse, plus 2 sets of recovery teams for the babies, respiratory specialists, Neonatal Intensive Care Unit (NICU) nurses, and pediatrician. Jose and I squeezed our way in next to Amanda's side.

Pushing in the OR is very difficult. A mother has to block out everything going on around her and stay focused on her body's sensations. At the same time she has to tune into the directions she is given by her OB. It takes a tremendous amount of concentration. Plus she is flat on her back. Not an ideal position for pushing something out of one's body.

Keeping lovingly connected is also a challenge with so many on lookers; especially when your heart is racing with fear for your little girls. Jose's physical presence was a powerful support.

Soon a slippery teeny tiny Eleanor is born...

 to a room FULL of people ready to help.

A relieved Jose; one down, one to go!

2 pound 4 ounce Baby Eleanor gets help getting started

        Is there a baby in that bundle?

Mom meets Eleanor outside her womb room.
   Now we wait for Caroline to make her entrance...

Mom's blood pressure is up; Baby's heart rate is dropping.
Time to get serious about birthing this baby.

Forty minutes after her sister tiny Baby Caroline arrives;
 raising her fist in the air to say, "I made it!"

A very short cord makes for a very rough trip.

         Whew two babies born!            A relieved mom and grateful dad celebrate.

Two pound Caroline gets help getting started.
Preemies have no body fat and lose heat fast.  Saran Wrap traps heat.     
 Daddy gets as close as he can.

First father daughter photo with Caroline.
It's official! They're here.
I'm so blessed to be part of miracles.
I am grateful to all the many people who helped at this birth and who continue to help provide care to these teeny weeny babies. When I first began working as a doula these babies would have been flown to a hospital with a higher level of care than we had in the county at that time. Mom and dad would have been left behind to wait and worry until Amanda was healthy enough to discharge from the hospital.

Don't get me wrong. I still feel way too many babies born at Sierra seem to "need" to be taken to the Neonatal Intensive Care Unit. Almost all my clients have their babies spend at least a short period in the NICU for observation before being given the "all clear" to reunite with mom and dad. Please keep in mind most of my clients are not high risk and birth their babies vaginally. The conundrum for me is when a baby truly needs NICU care I am eternally grateful they can receive high quality, high risk care right her in our community. I am also grateful they are trying to move the NICU in a more family-centered, baby-friendly direction. 

Three days later I snapped this photo of an exhausted dad getting skin to skin time 
snuggled up with Caroline in the NICU.   
Shhhhh!!! Don't wake the baby.


Throughout it all Amanda has stayed strong. Threading her way through her increasingly complicated birth and postpartum period. She stuck to her goals of having as natural a birth as possible while never forgetting to safeguard her babies. The nurses at Sierra are blown away. They say, "You birthed preemie twins vaginally with no pain meds? Amazing!" It brings home for me the difference in our frame of reference because I never doubted Amanda a bit.

Twelve days old 
Cuddle time with mom at last!
 With all the stress Anna unfortunately ended up with a cold. 
She had to delay the sweetest of moments in a mother's life.


  1. Beautifully written. As a NICU nurse at SV, it's nice to hear the perspective from those who experience our hospital in all the various different ways - as doulas, parents, grandparents, friends & family....
    And I agree - it's great we have this resource locally when we need it, and it's equally GREAT we're heading towards a much more family-centered mode of care, which will be a fantastic benefit to all of our patients.
    I love the photos, you've done a fantastic job documenting the journey.
    Best of all? I love the kangaroo care photo with dad... lovely.
    Nobody wants their baby in the NICU, nobody wants that heartache and stress, but there are wonderful ways to make the best of it. Kangaroo care ranks as many parents' absolute favorite!

  2. Thank you Trish for expressing your support for my efforts to chronicle this family's amazing journey.