unmedicated twin birth?

Lots of women think they have to have a caesarean section with twins. In fact, more than 40% of twin births are vaginal. If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife
Niki and her husband, Brian found out they were expecting twins at an 8 week ultrasound in late . This was a complete shock to them. The twins were spontaneous, di-di twins, meaning they had their own sacs and placentas- the least risky type of twin pregnancy. Niki and Brian chose to have blood work completed to find out the genders and they were again shocked and excited to find out they were both girls! Their then 3 year old son Dante, was not so excited about the babies in general but he really warmed up to the idea as he could see them growing in “mommy | s tummy.”

The pregnancy went very smoothly. Niki attributes much of this to the dietary, exercise and lifestyle modifications she made based on the book When You | re Expecting Twins, Triplets or Quads. Niki also chose a high risk OBGYN as she wanted a practice where the doctors would allow the patient to attempt a vaginal birth even if one of the babies had a breech presentation. Her general OB said it would be an automatic c-section if either baby was breech. The high risk doctors agreed that as long as baby A (lowest baby) was head down, even if baby B was breech, they would allow a vaginal delivery. Niki wanted to have an unmedicated hospital birth, just as she had with Dante. Niki and Brian hired the same birth doula they had for their son, another postpartum doula and took classes on caring for and feeding twins. Niki | s goal was to tandem breastfeed the girls for at least 6 months.

The twin | s due date was November 19th, Niki stopped working in September as she felt too uncomfortable performing a lot of the physical requirements of her job as a physical therapist and she was concerned about preterm labor. She was having a lot of daily contractions at this point of the pregnancy, but every ultrasound, cervix check and doctor | s visit went perfectly. As the weeks rolled by, the OB began discussing induction dates as they wouldn | t allow twin pregnancies to exceed 38 weeks. The induction was scheduled for 6am on November 7th when the twins were 38 weeks, 2 days gestation.

The last 2 months of the pregnancy were challenging, to say the least! In September, the entire family came down with a cold but Niki was not getting better. By October she was having such terrible coughing spells that she fractured 2 ribs and ended up in the ER at 36 weeks. There was a minor pre-clampsia scare at the same time (one high blood pressure reading and one abnormal blood panel), but they were sent home from the hospital with antibiotics and a lidocane patch for the ribs. Slowly, Niki improved and was finally able to rest.

She had been practicing hypnobirthing meditations throughout her pregnancy and utilized positive imagery and daily meditation to get through her rib pain and illness. She was afraid that this injury would lessen the likelihood of having the unmedicated birth she planned.

As the induction date approached, Niki and Brian tried everything possible to self induce labor. She walked and hiked for miles, walked on uneven surfaces, danced, ate dates, etc. You name it, they tried! She was having a lot of contractions and had been dilated 3cm for over 2 weeks, but at her final OB appointment 2 days before the scheduled induction, it appeared these babies were not going to come on their own. This was such an irony to them because they spent the majority of the pregnancy worried about preterm labor and now they were worried about having to be induced! She asked the nurse to sweep the membranes in a final effort to bring on labor more naturally. When she did this, Niki lost the mucus plug.

That night, they prepared to leave for the hospital early in the morning. They had a final crab leg dinner with their son and said goodnight to him one last time as an only child. They tried to sleep. Niki cried before bed because things just weren | t going as planned.

At 3am, she woke up having heavy contractions and her water broke moments later. Brian was rushing her to leave the house and she wanted to make the bed, grab some snacks and make sure everything was ready. They left about 20 minutes after Niki | s water broke. They called the doula and she had an urgent tone to her voice about rushing to the hospital. Labor really picked up in the car! Niki used hypnobirthing meditations throughout and was amazed by how excited, exhilarated even, she felt. She was so happy to have gone into labor without being induced. She finally felt like the birth might actually go the way she wanted. Brian drove in a complete panic, asking Niki if he should run red lights, to which she yelled, NO!

When they arrived at the hospital, Niki and Brian knew she was very close to delivering a baby. Brian couldn | t figure out how to operate the phone to be buzzed up to the L+D floor and was panicking. Niki noticed another phone by the elevators, and that worked! As they exited the elevator on the L+D floor, the nurses were waiting and laughing saying “Niki, you | re over an hour early!” It was about 4am then and the induction was scheduled for 6am. The doctor on call, Dr. Roy Bergstrom, was the doctor Niki wanted. She knew he had a reputation for supporting unmedicated births and would likely let the doula in the room. Again, she felt excited and exhilarated by how well everything was going! The hypnobirthing meditations allowed her to feel a “bubble of peace” and drown out the sights/ sounds of the hospital and be in her own space with her babies. Between contractions, she would talk to the nurses about her birth preferences. She really wanted the L+D bed in the OR, where they make women deliver twins in the event that an emergency c-section is needed. The nurses pushed back on this one but said they would try. Dr. Bergstrom asked to call anesthesia to place a port- Niki agreed, though she knew she would not need the epidural. The nurses and Dr. Berg seemed a bit surprised when they checked her and she was 8cm and 100% effaced upon arrival. There was a big sense of urgency, but not panic as Niki was remaining very calm and relatively quiet. She was mainly standing by the bed and leaning over the bed when a nurse asked, would you like to “sit on the bed?” Niki asked to go on hands and knees. At that point, she was telling the nurses that she felt an urge to have a BM. They began calling for the doctor and without discussion, Niki pushed hard and out came baby A- Althea June Popper- dropping right into the mesh underwear and on the hospital bed! Brian described Dr. Bergstrom ran in the room and swept his hands under Althea just as she was dropping to the bed. They wheeled Niki, Althea and Dr. Berg all together into the OR. As they were going through the door, the nurse said in Niki | s ear, “That | s one way to get the bed in the OR.” They were laughing! The mood was so jovial. As they rushed into the OR, all Niki could see was the floor and tons of people | s feet shuffling next to the bed because she was still on hands and knees.

Althea was tiny, but mighty and very healthy! 4 lbs, 15oz, 20 inches long. Brian held her while the nurses and doctor got Niki situated in the OR. Niki was asking to get back on hands and knees, but was told no as they were trying to get monitoring on baby B. They began signaling to Niki to push. She didn | t feel ready and she asked for more time. Barb, the doula arrived right then and said, “Niki- you can trust them. It | s time to push.” She wasn | t feeling the same urge to push and the position on her back was terribly uncomfortable- truly the first time in the birth that she felt real pain. She pushed for a few minutes and out came Avery Betty Popper- 12 minutes after her sister, clocking in at a whopping 7lbs, 10oz, 21 inches long. Everyone was absolutely shocked by the size discrepancy. At this point, the anesthesiologist finally came into the OR and joked “I got a call, brushed my teeth, and in that time, you had two babies!”

Avery seemed okay at first; big, crying, etc. But very quickly, Brian and Niki realized that she was struggling with breathing. Her oxygen levels were low. The team was ready to rush Avery to the nicu. Dr. Bergstrom took command of the OR and asked everyone to slow down and let Niki hold her babies. She held both of them to her breasts. Althea was rooting but Avery was struggling to breathe. Brian went to the OR with Avery and Niki cradled Althea in her arms and was wheeled to the mom and baby unit with Barb. Dr. Bergstrom reassured Niki, “This is a healthy baby- she | ll be back with you in a few hours.”

Brian and Niki didn | t see one another for several more hours. Niki focused on nursing Althea and pumping to try and drive up her milk supply. When she finally went to the nicu, she saw that Avery was on a CPAP and that she was not, in fact, going to be leaving the nicu anytime soon at all. This was such a devastating moment for Brian and Niki. Because it was flu season at the hospital, they were not allowed to bring Althea to the Nicu. Niki and Brian spent the next 4 days alternating between nicu with Avery and mom baby unit with Althea. It was incomprehensibly hard. After everything had gone so smoothly with the birth, Niki couldn | t understand how this happened. She attributed it to pushing too soon during labor.

They were told initially that Avery had “Big Baby Respiratory Distress Syndrome.” That these babies “get better quickly 48 hours after delivery when surfactant kicks in.” 48 hours later, Avery | s condition had deteriorated significantly and the neonatologists began questioning this diagnosis. In the next 2 days, Avery developed a collapsed lung, a small bowel obstruction and worsening oxygen levels. They intubated her, started antibiotics and stopped all feedings. They suspected at this point that she aspirated fluid and blood at birth. Blood neutralizes surfactant so her surfactant production was not sufficient. The doctors were continuously coming to the mom and baby unit to tell Brian and Niki about a new complication.

On day 4, Althea was discharged and Niki and Brian left the hospital with one baby- Niki | s greatest fear coming to life. It was a devastating moment. They continued sharing duties of being at home with Althea and Dante and rushing back to the hospital to be with Avery. Niki pumped enough milk to provide both babies with breast milk- Avery in a feeding tube and Althea at the breast or with a bottle. Brian and Niki | s moms took turns with the kids as well.

In total, Avery spent 11 days in the nicu. She was finally able to come home with oxygen on November 17th. Avery and Althea were so content being together at home, at last. Avery made a complete recovery and no longer has complications related to her difficult entry to this world. Althea grew very quickly despite being small for gestational age. Both girls are healthy and thriving 18 month olds now. Niki experienced some postpartum depression and anxiety that improved significantly after she started seeing a therapist. She was able to take over a year long maternity leave. In July of 20 she started her own physical therapy practice called Popper PT where she focuses on prenatal and postpartum care. Brian continues to work for Hello Fresh and they are a thriving, happy family!

Niki wanted to share her birth story because she loves hearing other people | s stories, she wanted to share about an unmedicated twin birth because those stories were hard for her to find and she sharing the story helps with her emotional healing from the trauma of the nicu. She hopes her story touches and helps other families as well.