As I had written about throughout pregnancy, I was hoping to give birth naturally to the twins. It turned out that this wasn’t meant to be, and I ended up with an elective Caesarean section. However, overall it was a very positive experience, and I can look back with good memories of welcoming them into the world.
I had spent the weekend trying to walk as much as possible, in the hope that it would encourage the twins to arrive on their own, but to no avail. On the Monday I had a pre-op appointment, to give some blood samples and talk to an anaesthetist about the procedure. I wasn’t feeling very positive about the prospect of a c-section, I honestly thought that labour would have started by now and I wouldn’t be in the position of having to make such a big decision about how the twins would be born. Tom was also getting fed up of being on standby whilst at work, so he decided to come with me for support and start his paternity leave half a day early. I had briefly spoken to the consultant at my last clinic appointment about what the alternative to a c-section would mean in terms of “waiting it out”, but as we didn’t know I’d get to that point, it was assumed that this conversation would come later. We weren’t sure if we’d get to have this conversation at the pre-op, but we were told then that we’d definitely get to have it before anything happened on the day of the operation (Tuesday).
So we arrived at the hospital nice and early at 7:30am on Tuesday. We were called in first (I’d been told that twin mums get priority on the elective list for the day). They did some obs on me, and of course my blood pressure was high. Not only was I in hospital, but incredibly nervous about the prospect of an operation. So this meant I had to stay in the obs room for monitoring – the midwife strapped two foetal heart rate monitors to my bump, took some blood and I did a urine sample. As I suspected, there was no sign of distress in the babies and no sign of preeclampsia in me, as usual.
Whilst I was there, an obstetric registrar came in with an ultrasound machine and asked if I wanted a scan to check the positions. Of course I said yes, and she looked closely at which twin was nearer the cervix. She said it was very close, but that the breech one was just slightly closer. Both were presenting very low in my pelvis, which doesn’t always happen with twins – often one is higher than the other. Without me asking, she then went on to have the conversation I was hoping to have about whether a c-section was necessary or whether I had the option of waiting it out. She was of the opinion that it depended how much I was keen to have a vaginal birth, to which I replied very keen! She talked about the possibility of a gentle induction – no hormone drip, just an internal examination with membrane sweep to see how far off labour I was, and possible breaking of waters if I was dilated enough. This sounded positive to me, and I was glad that she was open to the possibility of not just ploughing ahead with a c-section regardless. However, she said she needed to run this all past a consultant, before agreeing anything with me.
After a short wait, she returned. The consultant had picked up on something that she hadn’t thought of, and that was the risk of “head lock” in a vaginal birth. This is when the breech comes out first, with its bottom presenting first, but as the head comes past twin two, the chin of twin one locks onto the chin of twin two, which is near the cervix as it is presenting head down. As our twins were both so low, the risk of this head lock occurring was higher than if one twin was sitting higher up than the other in the uterus. If this head lock situation were to happen, it would mean a very fast emergency c-section, and even then the outcomes for twin one aren’t good at all. I looked this up myself from respectable sources I found on Google, as well as taking the doctor’s word for it. I decided that I didn’t want to take this risk, and that a planned c-section was the best option for us in this circumstance. I felt that it was meant to be that I hadn’t gone into spontaneous fast labour with them in this position, because if we had have found ourselves accidentally staying at home, or worse still in the car, the consequences of head lock could have been far worse than at the hospital with an operating theatre down the corridor.
Once the decision was made, it was time to get prepped for the operation. The midwife took the monitor off my bump, and I got changed into a gown and compression stockings. We then had a short wait in a delivery room until it was our turn to go into theatre. Tom also had to get changed into scrubs.
The midwife showed us down the corridor and into theatre. Everyone in there introduced themselves. There were lots of people, mainly because with twins they need two of some types of staff! But is was a bigger room than I was imagining, so it didn’t feel overcrowded. Everyone started to get their bit ready, and soon the anaesthetist asked me to sit up on the operating table and curl forwards over a pillow so my spine was rounded. She sprayed a cold local anaesthetic on me, then apparently put the spinal block needle in, though I didn’t feel a thing. Pretty soon my feet started to feel warm and fuzzy, and she checked that this was the case. They then pulled my legs up onto the table and I lay down. The obstetricians set up the screen in front of me, whilst the anaesthetist talked through what she was doing with me – attaching a drip and BP cuff. She then got a cold water spray, and sprayed some on my arm, then down on my abdomen, and asked me if it felt cold like on my arm. It didn’t feel as cold, which showed that the spinal block was starting to work. She also checked that I couldn’t move my legs, which was really weird – like my brain was trying to do it as I thought about it, but I couldn’t actually make them move! At the same time, one of the theatre staff put a catheter in, which I couldn’t feel. After a few minutes, the anaesthetist did more of the spray tests, until I could feel no cold right up to my chest, and also some pinching tests on my abdomen – I couldn’t feel a thing. We were good to go, as she put it.
It wasn’t long before I could feel the doctors rooting around inside me. A very odd sensation, I could tell they were in there, but felt no pain at all. The next thing I knew, there was a loud cry from a baby! We had made sure they knew that we wanted to discover the sex of each baby ourselves, and the midwives were brilliant in this respect. The baby was passed to them, given a very brief check over, and within a minute was brought around naked, still attached by cord to the placenta, to our side of the screen. A boy! He was taken back over to the baby table, weighed, wrapped up in a towel, and Tom was asked if he wanted to cut the cord. He didn’t want to, so the midwives did it.
Meanwhile I could still feel the doctors rooting around inside me, and pushing quite firmly on my bump. Then, two minutes after the first cry started, we heard the second cry. Again the baby was quickly brought naked to us – a girl! I couldn’t quite believe that! What was more shocking though was when we were told her weight. It was in metric – 3.3kg, and although this doesn’t mean much to me, I did remember that the boys had been roughly 3.4kg and 3.5kg, so i knew she must be about 7 and a half pounds! I was not expecting a girl twin to be almost the size of my boy singletons. But then I thought maybe in my anaesthetised state I wasn’t computing that properly. The midwives confirmed though that she was big for a twin, as they cut the cord and wrapped her up in a towel.
Whilst the doctors stitched me up, the babies were brought to us to hold. Tom held the boy whilst I had the girl across my shoulder in my arms, supported by the anaesthetist who had remained by my head throughout and was great at explaining what was going on. Once I was ready, it only took a few minutes to transfer me to a bed. Meanwhile Tom went with the babies and midwives to the recovery room first, followed shortly afterwards by me. Within 10 minutes of birth, the midwives were encouraging us to unwrap the babies and get them skin to skin with us. At first we had one each, and I fed the one on me. They both latched brilliantly straight away and had a good suck. I was really expecting this to be an issue if they’d been born smaller, so I was so happy that they were able to do this pretty much as quickly after birth as the boys had done.
The babies had routine tests of temperature and blood sugar done, and the little boy was a bit cold and had one low sugar reading, so the midwives got me to do skin to skin with them both at the same time, and wrapped us all up together in several blankets, whilst we continued to feed. They continued to monitor them, and they warmed up as well as maintained good blood sugar levels, so they didn’t need admission to special care.
I was monitored for about an hour, and was offered some toast and lunch in that time. It felt so amazing to want to eat again! I don’t think I remember exactly when the sickness left, like when I delivered the placenta after Joel was born, probably because there was so much going on in theatre. But I knew I wanted to eat, and simple white buttered toast never tasted so good! Then I enjoyed a tasty pasta bake a little later.
I was losing quite a lot of blood, which is pretty normal for twins because the uterus has a long way to contract back down. But as a precaution the doctor who reviewed me wanted to keep me down on the delivery suite in a room so that I could have one to one midwife care for a few hours or so rather than going straight up onto the ward. I felt fine in myself, and my BP was stable in the normal range (not too high or low).
We spent the afternoon just the four of us with occasional midwife visits to check all was well and to do obs. It was a really lovely time to be able to chat about names and enjoy those first hours uninterrupted. We weren’t sure that we’d get to have this in a busy hospital. And we hadn’t had this time after the boys were born because it was the middle of the night and we were both tired so tried to rest in the birth centre. So in the end we managed to come up with our final name choices more quickly than we’d imagined. They are called Samuel John and Naomi Grace.
The boys came to visit with Granny and Grandad in the early evening. They were very impressed with their new brother and sister, and seemed to enjoy their brief trip to see us all. Not long after they’d left we were moved up onto the postnatal ward. We had our first glimpse of what it’s like to have twins in public, as the midwives wheeled me on the bed holding the twins in my arms through the reception area to the lift, and we turned lots of heads and got several “ah twins” comments.
Tom stayed with us in the ward into the evening until around 10pm. The night shift midwives on the ward introduced themselves and told me to call if I needed any help lifting the babies to me. The cot was right next to my bed and at the right height, so actually I found it quite easy to reach across. The effect of the spinal block was wearing off and I had most movement back in my body and legs. Not that I was able to get up out of bed yet, mainly because I had the catheter attached to me and the bed still, so I tried to rest as much as possible in between feeding the twins who were quite sleepy now. It was the other noises on the ward keeping me awake, like snoring, other babies crying, monitor bleeps etc., then it got completely light by 5am.
All in all it was a very positive experience, and one that I can look back on and feel that the twins were born in the best possible way for them given the circumstances. I still would have preferred a vaginal birth like my previous experiences, and I can’t deny that the unavoidable positions of the twins means I’m a little disappointed at this, but I’m glad that modern medical techniques like the c-section exist to help in cases where natural birth may lead to seriously poor outcomes. We don’t know, we might have been alright, but I was glad that I’d been through the surgery in a calm and planned manner than having to do the same in an emergency.
I was especially pleased with the amount of uninterrupted skin to skin time we got, which is important for babies born via c-section in terms of seeding their microbiome – vaginally born babies get their seeding of “good bacteria” as they pass through the birth canal, whereas c-section babies don’t, so we should try and make up for it in other ways such as being skin to skin with mum and breastfeeding. I’m hoping that both these things will have given the twins as good a start as possible despite the c-section.