Homebirth and "Journalism"

I have a half-written post sitting in the queue that I've been piddling with for a week now (but haven't finished), but felt the need to post something that landed in my FB inbox today.

First off, a very, very precious twin mama friend of mine safely had her 9 pound 6 ounce baby in her home this morning, so I'm still basking in the afterglow for and with her, because I'm sure she is! Welcome, Ophelia!

And with that currently coloring my emotional climate, here it is:

Sept. 22, 2009

Dear Producers of The Today Show,

The Coalition for Improving Maternity Services (CIMS) and the undersigned organizations are disappointed with The Today Show’s misrepresentation of midwives and home birth that aired on Sept. 11, in a segment titled “The Perils of Midwifery,” later changed to “The Perils of Home Birth.” This biased and sensational segment inaccurately implied that hospitals are the safest place to give birth even for low-risk women and mischaracterized women who choose a home birth with a midwife as "hedonistic," going so far as to suggest that these women are putting their birth experiences above the safety of their babies. Neither could be further from the truth.

Unfortunately, The Today Show did not do its homework on the evidence regarding the safety of home birth and midwifery care. The segment featured an obstetrician who presented only the American College of Obstetricians and Gynecologists’ (ACOG) position in opposition to home birth, but it did not make any attempt to present the different viewpoints held by the many organizations that are committed to improving the quality of maternity care in the US. We are deeply saddened that the show did not take the opportunity to note that both CIMS and The National Perinatal Association respect the rights of women to choose home births and midwifery care, and that the respected Cochrane Collaboration recommends midwifery care because it results in excellent outcomes.

There is no evidence to support the ACOG position that hospital birth for low-risk women is safer than giving birth with midwives at home. What the research does show is that the routine use of medical interventions in childbirth without medical necessity can cause more harm than good, while also inflating the cost of childbirth. However, the current health system design offers little incentive for physicians and hospitals to improve access to maternity care practices that have been proven to maximize maternal and infant health.

“Birth is safest when midwives and doctors work together respectfully, communicate well, and when a transfer from home to hospital is needed, it is appropriately handled,” says Ruth Wilf, CNM, PhD, a member of the CIMS Leadership Team.

That is why the national health services of countries such as Britain, Ireland, Canada, and the Netherlands support home birth. In those countries, midwives are respected and integrated into the maternity care system. They work collaboratively with physicians in or out of the hospital, and they are not the target of modern day witch hunts. These countries have better outcomes for mothers and babies than the US.

Childbirth is the leading reason for admission to US hospitals, and hospitalization is the most costly health care component. Combined hospital charges for birthing women and newborns ($75,187,000,000 in 2004) far exceed charges for any other condition. In 2004, fully 27% of hospital charges to Medicaid and 16% of charges to private insurance were for birthing women and newborns, the most expensive conditions for both payers. The burden on public budgets, taxpayers and employers is considerable.

As US birth outcomes continue to worsen, it should come as no surprise to The Today Show that childbearing women are seeking alternatives to standard maternity care. After all, American women and babies are paying the highest price of all—their health—for these unnecessary interventions, which include increasing rates of elective inductions of labor and cesarean sections without medical indication.

To the detriment of childbearing families, the segment “The Perils of Midwifery” totally disregarded the evidence. Although the reporters acknowledged that research shows home birth for low-risk women is safe, that message was overshadowed by many negative messages, leaving viewers with a biased perception of midwifery care and home birth. CIMS makes these points not to promote the interests of any particular profession, but rather to raise a strong voice in support of maternity care practices that promote the health and well-being of mothers and babies.

One of the ten Institute of Medicine recommendations for improving health care is to provide consumers with evidence-based information in order to help them make informed decisions. The Institute recommends that decisions be made by consumers, not solely by health care providers. The Institute maintains that transparency and true choice are essential to improving health care. We remain hopeful that the medical community will soon recognize the rights of childbearing women when it comes to their choices in childbirth and will respect and support these choices in the interest of the best possible continuity and coordination of care for all.

We urge The Today Show to provide childbearing women with fair and accurate coverage of this important issue by giving equal time to midwives, public health professionals, researchers of evidence- based maternity care, and especially to parents who have made choices about different models of care and places of birth.

Sincerely,
Coalition for Improving Maternity Services
Academy of Certified Birth Educators
Alaska Birth Network
Alaska Family Health and Birth Center
American Association of Birth Centers
American College of Community Midwives
American College of Nurse-Midwives
Bay Area Birth Information
Birth Network of Santa Cruz County
Birth Works International
Birthing From Within, LLC
BirthNet
BirthNetwork National
BirthNetwork of Idaho Falls
BirthNetwork of NW Arkansas
Choices in Childbirth
Citizens for Midwifery
DONA International
Doulas Association of Southern California
Evansville BirthNetwork
Harmony Birth & Family
Idaho Midwifery Council
Idahoans for Midwives
InJoy Birth and Parenting Education
International Childbirth Education Association
International MotherBaby Childbirth Organization
Lamaze International
Madison Birth Center
Midwives Alliance of North America
Motherbaby International Film Festival
Nashville BirthNetwork
National Association of Certified Professional Midwives
North American Registry of Midwives
Oklahoma BirthNetwork
Perinatal Education Associates, Inc.
Reading Birth & Women's Center
Rochester Area Birth Network
Sage Femme
The Big Push for Midwives Campaign
The Tatia Oden French Memorial Foundation
Triangle Birth Network
Truckee Meadows BirthNetwork

About Us
The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. The CIMS Mother-Friendly Childbirth Initiative is an evidence-based mother-, baby-, and family- friendly model of care which focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

References:
1. The Perils of Home Births,http://www.msnbc.msn.com/id/21134540/vp/32795933#32795933
2. Birth Can Safely Take Place at Home and in Birthing Centers,
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2409129&blobtype=pdf
3. Offers All Birthing Mothers Unrestricted Access to Birth Companions, Labor Support, Professional Midwifery Care,http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2409134&blobtype=pdf
4. ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence,http://childbirthconnection.com/article.aspClickedLink=790&ck=10465&area=27
5. Ratifiers and Endorsers of The Mother-Friendly Childbirth Initiative,
http://www.motherfriendly.org/ratifiers.php
6. Choice of Birth Setting,http://www.nationalperinatal.org/advocacy/pdf/Choice-of-Birth-Setting.pdf
7. Position Statement on Midwifery,http://www.nationalperinatal.org/advocacy/pdf/Midwifery.pdf
8. Midwife-led versus other models of care for childbearing women,
http://cochrane.org/reviews/en/ab004667.html
9. Evidence-Based Maternity Care: What It Is And What It Can Achieve,
http://childbirthconnection.com/pdfs/evidence-based-maternity-care.pdf
10. Lamaze Healthy Birth Practices,
http://www.lamaze.org/ChildbirthProfessionals/ResourcesforProfessionals/CarePracticePapers/tabid/90/Default.aspx
11. Millennium Development Goals Indicators, United Nations,http://mdgs.un.org/unsd/mdg/Data.aspx
12. National Vital Statistics System, Birth Data,http://www.cdc.gov/nchs/births.htm
13. Induction By Request,http://www.marchofdimes.com/prematurity/21239_20203.asp
14. Cesarean Birth By Request,http://www.marchofdimes.com/prematurity/21239_19673.asp
15. Crossing the Quality Chasm: A New Health System for the 21st Century,
http://www.iom.edu/CMS/8089/5432.aspx
16. The Mother-Friendly Childbirth Initiative,http://www.motherfriendly.org/mfci.php

Coalition for Improving Maternity Services
1500 Sunday Drive, Suite 102
Raleigh, NC 27607

Tel: 919-863-9482
Fax: 919-787-4916

www.MotherFriendly.org

Making Mother-Friendly Care A Reality
CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.

Ubermondo Interview

So, remember my awesome conversation a few days ago with an old friend? It's now available online at his podcast:

www.ubermondo.com

I had a great time talking with Dieter again, and hope it's as much fun to listen to as it was to record.

Subscribe via iTunes

Hypnobabies LIVE online radio show!

I recorded an interview last week with Kerry Tuschhoff, founder of Hypnobabies, for her online radio show. It airs tomorrow, and again Saturday, and then will be archived online. This interview is more about my personal birthing history, what led me to choose a twin HBAC, and a little about natural twin birth. I'm recording another one in a few weeks (that will air July 11) that will address specific tips for improving outcomes in twin pregnancy and planning for a natural twin birth.

Anyway, here are the details about accessing it if anyone is interested, copied and pasted from the Hypnobabies newsletter:

Birthing Twins Naturally!

This week, Friday June 13th at 9 AM Pacific Time (and Sat. 6/14 at 1 PM Pacific Time) on Hypnobabies LIVE at http://www.HealthyLife.net we have Christy, mother of 5 children, including VBAC, homebirthed twins!

Our show this week is very important since many women having multiples are told that their babies will be premature and must be delivered by Cesarean section. Not true! Christy's babies were 7 lbs each and born vaginally, at home and were a VBAC. Christy very candidly shares all of her birth stories; very personal journeys of self-discovery and growth....

Please join us for this very special show, and please pass this information on.

Hypnobabies LIVE is on at 9 AM Pacific Time, (Noon Eastern Time) on http://www.healthylife.net. (Link below also) It will be replayed the next day - Saturday at 1 PM (Pacific Time), and 4 PM (Eastern Time).

** If you are unable to tune in for the live show, each show will be ARCHIVED and retained at http://www.healthylife.net forseveral months. You will be able to access our Hypnobabies Live shows *at your convenience* and listen to our archived shows whenever you want. It will take a couple of days for each show to appear on the Archive list after it airs for the first time.

Here are some helpful hints about accessing the show:To hear our Hypnobabies LIVE show go to www.healthylife.net. (click on the link below) To listen you will need Windows Media Player if you don't have it there is a link in the upper right hand corner of their homepage that will allow you to download a free version. If you are going to listen to the program live you simply click the "LIVE listen here" button in the upper right hand portion of the homepage.

Wait a few moments for the program to load and make sure your speaker volume on your computer is turned up. After a short wait you will hear the show. Depending on when you log in the show may already be in progress. If you want to listen to an archived version of any past "Hypnobabies LIVE" show you will need to click on "Show Archives". This will take you to a list of past shows and you can select which one you want to hear.

(Edited to add: A few episodes later, I did a follow up interview where I talked in greater detail about improving outcomes with twin pregnancy and birth.)

Natural Childbirth of Twins and Triplets!

All is going well here. We're in the process of getting a few small family businesses off the ground (more on that later), but I still somehow found time to edit another fun video for YouTube. This one features over 20 moms who have had natural childbirths with their twins and triplets.

Homebirth FAQ

from http://otherhood.blogspot.com/2007/12/homebirth-faq.html

Homebirth FAQ

As this baby gets bigger and lower, I find more and more people are asking me questions about the upcoming birth. Most are particularly fascinated by the fact that I actually plan to have my baby in my house.

Q1. A homebirth! Is that safe?
A. Not particularly, but we're big, fat risk-takers.

Q2. Aren't you afraid or scared of having a baby in your house?
A. Not half as scared as I would be to give birth in the hospital. The midwife has less stuff with her she can hurt me with than the doctors have in the hospital.

Q3. How do you manage pain at home?
A. Screaming, a lot. Biting things, or people, if necessary. Lots of swear words. Sometimes, I hit people, especially my husband, whose fault this whole thing is, after all. Just like in the movies.

Q4. What if something bad happens? I've heard about horrible things that can happen during a birth.
A. We'd be really screwed. Once we get out into the woods by the fire and the drummers burning incense, we enter a force field and can't leave it to go to a hospital. Ambulances can't get in, either.

Q5. Is the midwife trained?
A. If you're lucky...but if not, usually one of the drummers (by the fire, in the woods) will drop his drum and put out his incense and come over to help in an emergency.

Q6. Why do you want a homebirth?
A. Because I'm a control freak. Why else?

Q7. Shouldn't babies be born in hospitals? They're sterile and everything.
A. If the mother or the baby is sick, a hospital is the best place for them. Then when they catch MRSA, it won't matter so much because they were sick to begin with.

Q8. What about the mess? Isn't the birth messy?
A. You obviously haven't seen my house. Blood stains, medical waste, an errant placenta...it all blends in over here.

My Birth Video

So, I finally got around to editing and uploading my video. It has been EXTENSIVELY edited, so it should be fairly safe for families and work. You see my legs (OH THE HORROR) and about as much cleavage as you would if I were in a tacky tube top. Which is a lot. But no nip. (Sorry, pervs.) ;-)

My Twin VBAC/HBAC Birth Story

Okay, so I wrote out my birth story 2 days afterwards to share on some of my birth boards. I cleaned it up a bit and took out some of the more gory details so I could share it here. I figured that some of my online pals may be curious about it, and hope that some of the folks finding my blog by searching about twin pregnancy will read this, be encouraged and inspired, and know that natural birth IS a safe option for women having multiples.

So, here it is-- the birth stories of HM and BN. Enjoy!

The background (skip it if you just want the birth details):

I guess it really begins with the birth of their older brother, my third child, born in 2001. I had planned a homebirth, as I had really hoped to avoid unnecessary hospital interventions. As things would turn out, I ended up transporting to the hospital and having an emergency cesarean due to transverse lie. When I transferred to the hospital, they were clearly in no rush to get me on pain relief, and I labored flat on my back until I was 9 cm dilated. During the surgery, the doctors all laughed loudly and joked with each other, not paying any attention to my crying. When I had a medication reaction and didn't think I was breathing, nobody could hear me whispering for help between their music and loud talking. I spent most of the surgery afraid that I was dying, and was amazed at the hospital's dehumanizing treatment of me and my baby. Before his birth, we had wanted a large family one day. Afterwards, I was so devastated by the loss of the birth I had planned, and so overwhelmed by fear that I would never again experience natural childbirth due to a prior cesarean, that my husband and I decided we didn’t want any more children.

Just last year, things shifted in our thinking a bit. I had researched vaginal birth after cesarean (VBAC) enough to know that it is a safe option in situations where induction, augmentation, and other interventions could be avoided, and we decided to try to conceive our fourth child. After I was pregnant, I began my search for a provider, and found that several local hospitals no longer allowed planned VBACs, and that none of the local doctors would be fully supportive of a VBAC. I looked into homebirth with a direct entry midwife, only to learn that the midwife licensing board made it illegal for direct entry midwives to deliver VBACs in my state as of 2004, even though they had successfully been attending VBAC homebirths for many years before then. Only a CNM could deliver a VBAC at home, and no CNMs in my state could find a backup OB to support them in a VBAC homebirth.

Through referrals from our many friends who had given birth at home near us and online acquaintances, we found a very naturally-minded midwife in a nearby state who used to work our area before she moved away. While she was not willing to drive all the way to SC (a several hour drive from her) while I was in labor, she was willing to take me on as a client provided we were willing to drive for appointments and for the birth. We agreed, and began our search for somewhere to stay for two weeks before and two weeks after our due date, so that we would already have a temporary home to have our homebirth VBAC (HBAC).

A month after securing our midwife’s services (but just before our first appointment with her) and feeling confident with our course of action, we went in for a non-medical ultrasound to find out gender, and were SHOCKED to learn that we would be having both a little girl AND a little boy. The sonographer took several extra pictures for us (including several showing that we had two placentas, which later proved valuable information), and later that day we panicked, calling our midwife and letting her know we would be finding an OB and switching providers. We were just too scared to go through with a twin HBAC.

We did a little more research, though, and found that twin VBAC moms are no more likely to suffer uterine rupture than singletons, learned that twins with two placentas have minimal complications (if any) compared to singletons, and began to wonder if it was really necessary to resign ourselves to a mandatory cesarean at the hands of a surgeon. I called my midwife back and asked her what her experience had been with twins. It turned out she has delivered tons of twins when working in hospitals, and almost 20 sets of twins (including many twin VBACs) since switching to a primarily home-based practice over a decade ago. All twin births were successful, none required transport. We switched back to the original plan, and began preparations for a twin HBAC.

Labor Begins:

For WEEKS I had been having strong and uncomfortable contractions-- so many so that I was terrified of preterm labor. Somehow I made it to 36 weeks (the earliest my midwife would attend a twin homebirth) and we relocated. My husband stayed with me and the kids Fridays through Mondays, and went home every Monday to work a full week. In spite of regularly growing contractions, I made it past 38 weeks, and when I was 38 weeks and 1 day (with a fundal height measuring 50 cm), my husband went back home to work his week. That night, I tossed and turned, having contractions in my sleep. Tuesday morning, May 8, around 3:30 am, I was awakened with painful contractions coming every 2 minutes. This had happened before, so I tried all my usual tricks to make the “false labor” go away. I had a glass of diluted wine, drank lots of water and rested on my side, and around 4:15 am I gave up and got into the bathtub to see if that calmed them. At 4:45 am, still unsure if I was in real labor or not, I called my husband and asked him to come be with me just in case it was time. At 5:00 am, I called my midwife and let her know what was going on. She told me to call my other labor assistants and get everyone on their way.

Around 5:30 am, as I was making the bed and getting my birth pool ready (I had really wanted a water birth), my water broke and things intensified. Around 7:00 am, the midwife arrived and said it was fine for me to get into the birth pool to take the edge off the contractions, and the water was SO soothing! By 7:15, the midwife’s assistant arrived, and by 7:30 my husband was there. Things get a little blurry after that point, since I was in a good bit of pain. At first, I did really well, breathing through the contractions, relaxing, staying calm. My doula and friend from back home would pray with and for me during the tougher ones, helping me to stay focused and peaceful. By around 9:30 am, I was thrashing about so badly during the worse contractions that it took four people holding my arms to keep me from drowning myself! At that point (in transition, obviously), I was exhausted already, and moved to the bed so I could lay down.

The births:

Soon, I told my midwife I thought I might be feeling the urge to push with contractions, and that it actually made me feel a little better to push a tiny bit. So, with the next contraction, I began pushing. As things would turn out, I pushed a LONG time for a little baby who had spent the last two weeks at a +1 station. It didn’t take long for him to crown, but then he couldn’t make it any farther thanks to an overenthusiastic episiotomy repair from a previous birth. I was crying, worried about how this was affecting the baby, but my midwife checked his heart tones after each contraction and reassured me that as long as his heart rate was good, we were okay. Finally, after 15 minutes of pushing with very little progress, my precious little son was born at 10:46 am. He was crying as soon as his head was out, and was nursing like a little barracuda 20 seconds after he was born! He pinked up right away, and they delayed clamping and cutting the cord until it had stopped pulsing. He weighed 7 pounds, 4 ounces, and was 20 inches long.

We left him at the breast, since the nursing might stimulate contractions to get baby B into position, and from the time he was born until the time his sister’s head was firmly engaged in the birth canal, my midwife’s assistant held her in place from the outside so she wouldn’t flip. After a few minutes, contractions started up again but they shortly became uncomfortable again and I asked someone to take my little angel boy so that he would be safer than I felt he was in my arms, with all the discomfort I was in. I switched to using a breast pump between contractions to keep things going, and soon enough I knew it was time to push her out. I was exhausted, and not very enthusiastic about it at first, and couldn’t bring myself to push that hard. Plus, I was expecting that after just birthing one baby, the second one would be easier, so I don’t think I was expecting the challenge she became. At some point the midwife suggested a squatting position to push for a few contractions. It was so hard to support myself, that once the baby’s head was engaged, I was begging to lay back on the bed again. So, I pushed for the next several contractions propped up in a half-sitting position. She wasn’t moving down very much, and I was getting discouraged, so I forced myself to get a little more energetic about the pushing (since that’s what my body was telling me to do anyway). After several contractions, there wasn’t a lot of progress, and I was in pain and needed to get back on my side again. My midwife, for the second time during the births, asked everyone to take a moment and pray with me. At that point, things started to move along, and after a VERY long pushing stage, my precious daughter was born, posterior and forehead-first, with her cord wrapped around her neck and shoulders, at 12:49 pm. Her posterior position had contributed to my extended pushing phase and slow descent with her. She was a little slower to pink up, and took a little longer to figure out how to nurse, but soon enough was alert at my breast like her brother had been! She weighed 7 pounds and was 21 inches long.

I birthed the placentas at 1:09 pm, and although there were clearly two separate placentas, they had fused together in the middle and came out in one giant piece that likely weighed between 5 and 6 pounds-- almost like delivering a third baby, but without the giant head! I needed one stitch to fix a small tear from my difficult second birth. I was bleeding heavily, and over the little while after the birth had one intravenous shot of pitocin and two shots in the hip. I was also given my first dose of methergine (which I took for 2 days postpartum), and given a lot of blood-building and iron supplements to help replace what was being lost. I also had several clots remaining that my midwife manually removed, and after the clots were pulled out my bleeding began to subside. Apparently, excessive bleeding is a bit more common with twin pregnancies since my uterus had two raw areas from two placentas instead of just one.

Thoughts on the experience:

So, I have now had my first completely unmedicated, natural birth, my first home birth, my first VBAC, and my first twin birth. What an experience! I feel so good about how it all happened, and am so thankful that we chose the path we did because I KNOW that I otherwise would have been forced into an unwanted, and completely unnecessary, cesarean. Although I worried a bit before the birth about the toll that being so big was going to take on my uterine scar, during labor I never once questioned how my scar was holding up. I have no regrets about my birth experience, for the first time ever, and feel only positive about how it all went down-- not exactly easy, but definitely uncomplicated.

My babies were at the breast within minutes of being born, and my precious husband was able to be more involved in this birth than any other-- what a wonderful support he was! My other children were able to come in shortly after each birth to see their new little siblings, and the babies’ first night was spent bonding with their parents and siblings, rather than being poked, prodded, weighed, and messed with all night long. I’ve been able to rest when I need to, recover in a way that feels best, and avoid being poked, prodded, and beeped to death during an already exhausting and physically challenging time. I am SO THANKFUL for these beautiful little babies, their curious little eyes, and their sweet little cries. They are beautiful, precious, sweet, and fun to watch and be with.

I am thankful for my incredible midwife, her guidance throughout the pregnancy, her competence and patience during the birth, and her friendship postpartum. I am thankful for my birth team, my incredible midwife’s assistant, and for my friends who drove up from back home to be a part of that experience. I am thankful for my family, for my precious children for their excitement and awe of these babies. I’m thankful for my sweet husband for being there for every moment, holding my hand, stroking my hair, and kissing my forehead; for encouraging me, believing in me, and helping me out; and for being a complete and active partner in the birth process. And most importantly, I’m thankful to God.

Many times during this pregnancy, I prayed for this pregnancy to be safe, to protect us during this uncertain time, to guide us as we made choices about our birth plan, to keep me and my unborn children safe and healthy throughout the pregnancy and birth, and to help us to somehow fit all the pieces together for the birth to come together according to the Divine plan. I committed that if all went well, and my babies were born safely into the world, I would give back to others planning for their twin births. Ultimately, it wasn’t just me, or my midwife, or my birth team, or my husband who brought these children into the world. It was pure Spirit, whose wisdom guided every aspect of the experience. I truly believe that the universe provided the perfect people to surround me during birth, the perfect place for me to birth, and the perfect babies to hold in my arms, grateful for the opportunity to parent two more little ones and in awe of the divine aspects of motherhood. What a blessing!

If anyone reading this has heard any of the usual doubts cast upon the ability of twin or VBAC moms to birth safely, please know that there are options. Natural twin birth or natural VBAC (or a natural twin VBAC) may not be the right choice for everyone, but it can be the right choice for some women, and it can be done safely. I have proof!

(And there's now a video to go along with the story )

An open letter

Any of you who have read this blog for long, or know me and my husband in real life, know that we are research-oriented. I'm not sure how much of that is natural inclination, how much is background and experiences, and how much is based on the years we've spent in service to the higher education machine. Suffice to say, however, that before undertaking ANY major decision about our lives or our families, we are very likely to research the heck out of it. That's how it's been with major decisions about our parenting and family philosophies, and it's how we've been about our approach to becoming debt-free (something we've been working on these past 3 years, and we're now completely debt-free except for student loans and haven't used credit in over 6 years).

For those of you who haven't heard this yet, on September 14, 2006, we found out we were expecting! Back in May of last year, we began making plans for us to swap out yet again, hoping that by fall my husband would be working full time again, and I would once again be a stay at home mom. It was around that time that we decided that if I was able to be home full time again, we'd love to have a 4th child. Well, my dear husband began working full time the end of July, and we knew it was time. I believe strongly in the safety of VBACs, and many of our local hospitals have either banned VBACs or make them terribly and unnecessarily complicated (thus leading to an increase in failed VBACs and increased complications for mothers and their babies). So, we spent a couple of months researching our options, trying to find the one that would be safest for me and for our unborn. After much research, seeking referrals from friends, and reviewing our options with each other and in prayer, we knew we had found our perfect provider! We selected a certified nurse midwife in a neighboring state who we felt had the natural approach to childbirth we desired, while also having the experience and medical training we felt would be essential to our comfort level with the birth plan, and we began making plans to temporarily relocate to a city near her as the due date approached.

Then, in December, we found out we're having twins! Talk about a surprise, since there is not a family history of twins, and we have never needed any fertility assistance! Of course, our first reaction was shock. I believe our second was fear.

I spent much of the next 24 hours reading and researching about twin pregnancy, and much of what I read was fear-based. I read that 60% of all twins are born prematurely (before 36 weeks). I read about complications that can arise in twin pregnancy and birth, including complications for the babies as well as increased maternal complications such as pre-eclampsia, pregnancy induced hypertension, gestational diabetes, and more. I read that most twin pregnancies are induced before 38 weeks to prevent placental deterioration and reduce the risk of stillbirth. I also read that many twin pregnancies end up in cesarean births.

Because I believe that all other things being equal, natural childbirth is best and safest for mother AND babies, these statistics scared me. Disappointed (both for myself and worried for the safety of my babies) I called my midwife the day after we found out it was twins, told her I didn't think we could go through with it, and told her I'd be looking for a new provider.

And then I continued my research. I began to learn that the 60% prematurity figure includes both identicals (who are at risk increased complications including twin to twin transfusion syndrome) and fraternals, and mothers who have other complications of pregnancy. My babies are fraternal (boy/girl, two separate placentas for nourishment, thus no risk for TTTS), and I've never had any pregnancy complications. I learned that nutrition can often prevent pregnancy complications such as pre-eclampsia and gestational diabetes, and began to follow a modified version of the Brewer diet, a diet for healthy pregnancy (although I increased my own protein intake above Brewer's recommendations, to provide adequate nutrition for my twins). I learned that one of the greatest risks to otherwise healthy twins is low birthweight, and that adequate protein intake could increase twin birthweights significantly. And I also learned that nutrition is the single biggest factor contributing to placental deterioration. I ordered books about natural twin pregnancy and birth, and followed the recommendations as well as I could. I also learned that twin VBACs are at no higher risk for rupture than singletons, which was reassuring.

I started to think I might be able to go with my original plan, so 2 days after calling my midwife to drop her, I called her back and asked what her experience with twins had been. Turns out, she's attended vaginal births of dozens of twins, both in and out of hospitals, including twin VBACs. She's had positive outcomes with every one, and has only lost one baby in her 20+ years of being a midwife (and that wasn't at a twin birth). She wanted to be sensitive to my needs and concerns, so she recommended that I begin nutritional changes that could enhance my pregnancy outcome. She also suggested that instead of feeling like I had to make an immediate change, to take a few weeks to continue researching, meeting with twin mamas, and praying for God's guidance regarding our birth plans. We agreed that I would call her back in almost a month and let her know what we had decided, and she agreed that she would also be taking my situation into prayer to make sure she felt confident taking me on as a patient.

I began drinking a gallon and a half of water per day, eating well over 120 grams of protein a day (usually more), and taking adequate daily supplements (prenatal vitamins, vitamin C, iron supplements, liquid chlorophyll, alfalfa, fish oil, flax oil, and probiotics). And my husband and I met (online and in real life) with several women who had safely given birth to their twins under the care of a midwife, with minimal interventions. We both carefully read the twin books I had ordered. And we discussed and prayed about my pregnancy history, which has never included any of the common twin complications that can often lead to preterm birth or birth complications. After carefully and prayerfully considering our options for a few weeks, we called our midwife back and made plans to meet again soon.

Since then, I have received competent, professional, considerate, compassionate, and personalized care from a my wonderful midwife, who clearly views this not only as her profession but as her spiritual calling. Because twins are typically considered term at 36-40 weeks, we've moved up our relocation date to late April. We have VERY carefully researched, prayed about, and considered our options, and are solid in our conviction that we are doing what is safest for me and for our babies. If at any point something comes up that makes this plan risky or not suitable, we'll change plans. Until then, we feel we are doing the right things. And we have chosen not to discuss our decisions with anyone who can't bring anything supportive to the table. We simply don't need the stress right now!

So, if you feel you can be supportive of our choice and respect our decisions, we will gladly include you in our planning process, let you know when we're in labor, and keep you posted on how things go! If you feel you disagree too strongly to remain supportive of our plan, we'll be happy to call you after the babies are born to let you know how it went, but we'll have to request that you refrain from discussing our birth plans with us in the mean time. So far, everyone we've talked to has been wonderful and supportive, and understands that we would never take lightly our responsibility to choose the safest options for our children. We just felt it was appropriate to let folks know some of what has led us to the choices we've made, so that you can be reassured by the actual facts about twin childbirth (as opposed to myths and fears), just as we have been reassured by them.

Birth Research

Here are some of the research and articles we've found online that have influenced our birthing choices. Some of these are medical research articles about the safety of birth issues close to our hearts. Others are news, commentary, or opinion pieces that reflect our beliefs about birth as a normal, natural process. Of course, we've done a good bit of research that isn't available online as well, but wanted to share some of the online information that is available.

About Natural Childbirth:

Does the United States' Higher Rates of Intervention Lower Morbidity?

Mothering.Com

Gentle Birth

The Assault on Normal Birth by Henci Goer

About VBAC (Vaginal Birth After Cesarean):

Relative Risks of Uterine Rupture

Uterine Rupture in Pregnancy

The Integrity of Uterine Scars

Vaginal Births After Cesarean Decline

VBAC.COM

About Twin Birth:

Optimal Gestational Age for Twin Delivery

What is the Optimal Gestational Age for Twin Delivery

Bedrest in Hospitals for Multiple Pregnancies

Vaginal Birth Safe in Twin Pregnancies

New Theories Emerge on Nonvertex Twin Deliveries

Vaginal Birth with Second Twin Breech

About Twin VBAC:

Twin VBAC Not Associated with Increased Risk of Rupture

Twin VBAC Research Review

About Cesareans:

International Cesarean Awareness Network

Weigh Risks to Mother, Infant, When Planning Cesareans

3x More Babies Die in Elective Cesareans

About Homebirth and Freestanding Birthing Centers:

ACOG Opposes Safe Birthing Practices

Outcomes of Planned Home Births

Video:

Born in the USA: PBS Documentary About Birth (select browse videos, and choose Born in the USA)