Tuesday, August 02, 2005

Brief Synopsis of Twin Birth

Quick nice labor, pushing in the water, head born and then no movement. Mom stood and lunged. No movement. Mom helped out of the pool (watch that head!) and lunge again - no movement. Mom squatted deeply - no movement. Mom helped to lean back, and then back further as midwife felt for shoulder position and baby began rotation. Born 3 minutes after head. He had a nuchal cord.

Baby boy recovered well with stimulation and loving ensued.

I was in charge of listening to fetal heart tones of Baby B, so was right on him as soon as A's feet were out of the vagina. His heart rate was great, then good, then okay, then sad, then scary... so we moved her to the bed and got oxygen on her and the midwife felt for position (and cord) and he recovered within a few minutes.

We waited for contractions to return, mom nursed baby, and then nipple stimulation to bring on a contraction. Pushing began again about 30 minutes after the first baby's birth, but the baby didn't come down so easily, so we got her standing again and she pushed while we waited.

(On the bed, I had to lay on my left side - my horribly painful side - and collapsed at one point as mom readjusted her position and she also fell some - both of us right onto her husband's leg. He was a trooper and barely screamed in pain.)

As birth was imminent, I began photographing again and that's why I have pictures of Baby B coming out, but not A. He did great as he was born - nuchal hand/arm.

More loving happens. Joy! Happiness! Health abounds.

Then bleeding.

Then no placenta despite Angelica and later pitocin. Eventually, manual removal of the placenta is done - with too many clots.

Another midwife sutures as one starts an IV with pitocin.

We clean up the area, stay with mom who's hungrier than I have ever seen a woman be in the birthing time. (She ate about 3000 calories during labor - and continued eating postpartum, even amidst the bleeding.) We ran out of Chux (a first).

The placenta was amazing (as seen below) - Baby A was 8 pounds 8 ounces; Baby B 6 pounds 4 ounces. Baby B's side had a velamentous insertion (see photo below, too), but it all worked out great. The placenta looked rather old, too... very used up. No wonder mom ate so much!

Mom nurses - all seems pretty stable, but she is some weak, but keeps eating and drinking.

We had a CNM, 3 LMs, & an apprentice at the birth. One LM and the CNM left 90 min after the placenta birth. I left 2 hours after that.

I went home and cleaned and sterilized the midwife's instruments and slept during the cooking. I got up, showered, dressed and went back to the woman's home where I found out she'd been to the bathroom to pee, but had been carried there! She had to pee again and was put in an office chair and wheeled there.

Red flags!

Around 6 hours postpartum, she had a slight fever, so another IV was started with antibiotics.

Her vitals were good, then poor, then good again. It was time to go in.

We called EMS (after discussion with dad, mom, then family) and they transported mom via ambulance; the twins went in the car with Auntie (mom's identical twin). Auntie followed me in my car. (Her midwife was so wiped she couldn't see, so I offered to go in for her. She was extremely grateful. Shoot, she'd do it for me!)

Admission went well. Respect seemed apparent, but I have a feeling the staff had an in-service or two about pretending to be nice to our faces - their dealing with us later. Initial bloodwork showed mom's Hemoglobin of 6. With informed consent, mom accepted blood - 2 units. Mom also had a temp again, so antibiotics were started.

Mom and baby were never separated. Yay! She continued nursing well. Peds came to check the babies and they gestated out to 44 weeks (dry, peeling, skinny, soles of feet totally covered in creases, hard cartilage in their ears, etc.).

And she nearly fainted from being NPO while they waited to decide whether she needed surgery or not (manual exploration? D&C?). Once permitted to eat, I saw her tray on the nurse's station and asked the nurse for it. She said she'd have to check first if it was hers. I suggested she find out fast before mom eats one of the mattresses in the room. "Take it!" the nurse said. So mom began eating again. (Mom is a vegetarian and had NO processed food in her home - they ate magnificently. When I put my Diet Coke in the refrigerator I thought an alarm might go off or it be ejected into my face or something. It was to her, and the babies', benefit that she ate so much and so well.)

And they put a Foley in and there was 1600 ml of urine!!!!!! She easily peed that much at the house (an hysterical story all on its own - her peeing), but she was so swollen and immediately began ridding her body of it all.

Once stable and settled, I made sure they were good and left about 3 hours after arriving at the hospital.

Her midwife and I went to the hospital today and they are great. Mom is still on antibiotics, but should be home by tomorrow night.

The babies are so wonderful and loved... and their sisters are missing them lots. It will be good for all to be together again.

Funny, this birth, while twice as odd/scary/fierce as the one 2 weeks ago, didn't scare me nearly as much as that one. Probably because it wasn't my client? Because this family was gushing with respect and kindness? Because the client decided not to transport when the placenta wouldn't be born... because they were comfortable with their waiting... not sure yet all the reasons why.

Processing still.

Interesting that I continue believing that birth works. Talking with others, I watch limitations and boundaries fly up - no more twins! no more long placentas! no more than minimal bleeding! no more dizziness!

Sometimes this is so confusing.

And it wasn't so brief after all.