Twins & Breech: Up a Creek Without a Paddle

Christmas brings up a lot of stuff for many, maybe because it's easy to pinpoint what was going on in our lives by using it as a benchmark throughout the different years. I don't speak of my twin pregnancy from three years ago often. Even though my website is called Maiden to Mother and I'm all about fertility, pregnancy, birth and postpartum, my twin pregnancy was my dark night of the soul that almost broke me actually, but I'll break the silence a little today because I'm reading the chapter entitled Birth Trauma in "Everything Below the Waist: Why Health Care Needs a Feminist Revolution" by Jennifer Block. I avoid labels so am not necessarily a feminist, though I'm very much enjoying the book. Its like a good bitch session with a really, really informed friend. Maybe someone reading this is carrying twins, a breech baby or some other variation of normal and will be able to relate to my experience or perhaps sharing it will bring light and compassion for someone they know that is currently struggling. This gets lengthy, so if women's autonomy in birth is not your thing, stop reading. I don't expect this to be everyone's cup of tea. • • I was incredibly stressed during my twin pregnancy so this is one of the only pictures that I allowed to be taken. It's actually a few months ahead, into the new year. There I was on the precipice; 33 weeks pregnant with twins that were sometimes breech and faced with a decision that led my brain around in endless circles ○ • • I was given two choices: • • a) book my "elective" c-section for 37.5 weeks with my OB, someone that I genuinely liked and has a reputation as a good surgeon. • • b) let my body go into labor naturally, at which point I would go into the hospital and accept my fate with whichever doctor happened to be on call. • • I was more inclined to wait for my body to go into labor naturally (and anyone familiar with Dr. Sarah Buckley's hormones of labor material probably knows why). I also was more than a little sketchy on the date of conception, so why not let my babies choose when they were ready to meet the world? • • ○ Endless Circles ○ • • I became a voracious reader of every study, birth story, website and book relating to twins and breech that came across my path. Podcasts too. I didn't just consume information for confirmation bias either, like some sort of magical thinking that if I only read positive fairytale outcomes and stayed away from anything negative, that I would "manifest" a perfect birth. I read the heartbreaking stories too. Real life sometimes has unhappy endings, both at home and within the hospital and I would rather hear both sides than be caught off guard when things don't go the way I thought they should, but that's just me. • • So, what did I want anyway? Something rare, but also something very simple; to have my twins without much intervention. No syntocinon/pitocin. No epidural. Free to labor AND give birth in whatever position felt right. No cervical exams. No coached pushing. No rush to clamp their little cords delivering their oxygen-rich blood. Certainly no c-section unless it was absolutely warranted. That all might sound too good to be true, but I just described the birth of my second child. I was not trying to be part of a movement or fit a certain label as some might assume from the outside looking in. I'm no activist. I'm a mom that loves new recipes, crafts, home decor, spirituality and, most of all, I love my family including my two new family members growing in my tummy. Women's bodily autonomy wasn't supposed to be my cause to take up, in fact, I would have much preferred it not be, but sometimes our cause chooses us and not the other way around. For whatever reason, it has been a recurring theme of mine which I might speak more about another time. • • My OB once amenably said, "Look Cassie, I don't care! We can do a trial of labor if you want." My heart skipped a beat. This was it! I just about fell off my seat in my attempt to hug her. I knew it wouldn't be perfect, but heck, I'd take the trial of labor. I did want her support. Then her face became grim and she followed that up with, "But the last breech mom I allowed to labor lost her uterus..." and I knew that her mind was already made up. There are OB's within my city that will allow a trial of labor for twins but, to my knowledge, not two breech babies. Like I said, they weren't always breech, but sometimes. Changing OB's in the 11th hour seemed like wasted effort. Trading one situation for more of the same or maybe worse or possibly making my OB angry with me, but then me still needing to rely on her in the end - it all felt risky. As within any specialization, the good ones get booked up well in advance and I felt lucky to have the one I had. Though I didn't like the situation I was in, I did like her as a person and I didn't blame her at all for the lack of choices available to me. She confided that she herself had had three unwanted c-sections and I reflected on how emotionally challenging and lonely it might have been for her to traverse the system as a patient among her peers. • • It became clear to me that the type of birth I sought was less of a physical challenge than it was a geographical challenge. I've known a handful of people with cancer or rare blood disorders who have traveled for medical care. They're even praised for being so innovative, taking their health into their own hands. Could a woman travel to a care provider that knows how to deliver twins and breech so she can possibly avoid unwanted major abdominal surgery? As I began to explore more choices outside of the free (taxpayer provided) medical care available to me, I became more open minded and educated about what I was looking for in a care provider. I absolutely wanted someone that knew and carried with them the tools for neonatal resuscitation. Someone who knew how to perform the Louwen Maneuver was also an important criteria. The Louwen Maneuver is a technique developed by Frank Louwen in Germany that safely dislodges a breech baby without creating traction that can be dangerous to a baby when they're stuck in the birth canal, but on that note, someone that appreciated hands off breech was preferred. Someone who knew how to stop postpartum hemorrhage (PPH) because two placentas leave a larger surface area exposed making PPH a more common risk for twin mamas. I was invited to Arizona where a sympathetic and skilled midwife was willing and waiting, but preferred not travel to me having just had a baby herself a few weeks earlier. I was also invited to California where there is an amazing OB who often delivers breech babies and twins within his clients' homes. I would have loved either of those two options, but wait a minute... how would I get my babies home to Canada without passports and how long would that process take? What if we did need to transfer to a hospital while in the US? Those kind of medical bills could easily bankrupt and devastate a single income family. Within my own country, over 3000 kms away in Ontario there is a sweet midwife with international reknown for her skill in delivering twins and breech babies. After a late night 90 minute phone conversation with her, she made no guarantees that it would not end in c-section. She also said that I would be paying to have two obstetricians on staff when I entered the hospital because I did not have healthcare coverage in that province. Also, and maybe because I was not so easily dissuaded, she timidly expressed concern about the political ramifications of opening up the floodgates. She worked in a small hospital and they were not equipped to handle higher capacity. If they said yes to me and word spread, where would it end? When you know that women in your same situation (whether twins or breech) are having vaginal births because their care provider has developed the know how, you get a little bitter. The protective mama bear can't help but be activated a little. • • Trapped by my body, my world was closing in. I became estranged from many I thought would always be in my corner. They hadn't spent the late nights reading the information that I had. They hadn't walked in my shoes. Their truth and my truth no longer matched and many just fell away, writing me off as foolish, unable to relate. Family members gossiped behind my back and went so far as to call my mom and say, "Vicki, you need to get that daughter of yours in line. Tell her to behave herself." Her 38 year old daughter. My mom, to her credit, remained by my side, a gentle shelter from the storm. Isn't it fascinating how pregnant women in our society are often infantalized? From their caffeine consumption to their choices involving medical procedures, suddenly they are in the spotlight and folks, both young and old, strangers and loved ones alike can suddenly feel compelled to tell them what they can or cannot do. Somehow this behavior is assumed to be perfectly appropriate because the woman has a baby bump and has apparently lost all ability to think for herself. Incidentally, that same person that called my mom in order to "get me in line" was also the only one offering to put their life on hold for six weeks and come live with us for awhile to help out. I felt that one factor in avoiding postpartum depression was to have good boundaries and be particular about who entered my postpartum space. A c-section isn't just a c-section. It would carry with it layers of consequences that I (and I alone) would have to live with far beyond the birth of my twins. My postpartum wellbeing would have been at the mercy of that volatile person. I'd like to hope that they would have put our differences of opinion about my body on the shelf for the sake of an easier postpartum, but what if they abused their role as my caretaker and lorded that over me? Those first six weeks are such a vulnerable, tender and precious time. I didn't want my postpartum to feel like a power struggle with that element in my home and me, once again forced to lay flat on my back, take what's given and be grateful. Thank you for offering, but no thank you. Not if I could help it.

• •

We wonder why there are such high rates of postpartum depression and postpartum anxiety. I'm not saying this is why, but what if it's because everything I just expressed is considered unladylike and completely inappropriate in our culture. Lay down, take what you get, be grateful, keep the peace, shove your resentment down... but maybe it seeps through the cracks and burbles up in other unanticipated ways. • • ○ Never-ending circles with no viable solution in sight ○ I'm trapped ○ What to do? What should I do?? ○ I will wait... I will keep reading, inquiring, pulling every loose thread... shaking every tree... and I will hope that an acceptable solution presents itself before I run out of time ○

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