Prepare for a positive birth with The Birth Class

Episode 476

Georgie – surprise breech, breech vaginal birth, DCDA twins, twin vaginal birth without epidural

I know I say it a lot, but you’re really going to love this episode. Georgie details her positive physiological first birth, her second that was a surprise breech (birthed vaginally!) and a DCDA twin pregnancy with confronting fragmented obstetric care. Georgie’s three births emphasise how vital education and advocacy really is, especially when confronted with coercive care providers. In her three births she was surrounded by supportive and strong midwives who really backed her when she needed it most. If you’re pregnant with twins and you’re planning a vaginal birth without epidural, consider this a must-listen.

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“We weren’t planning our first pregnancy and my husband is from Argentina so it was quite stressful getting his visa and permanent residency. I went through the MGP programme at our local public hospital and I wanted to have a low intervention birth and I felt really supported by my team of midwives, especially Sam and Gen. I went into labour the day after my estimated due date. My waters broke at midday and I just couldn’t believe how much fluid there was and it just kept coming. I called the MGP line and Gen answered and she was very calm and told me to take my time coming to the hospital and reiterated that I would probably end up going back home. But within twenty minutes my contractions started and it was on from then.

“We headed to the hospital at 3pm and contractions intensified really quickly; they were really consistent. Gen was shocked at how quickly I’d progressed since I called her. She took me straight to the birth suite and I started vomiting; I was okay in myself but before long I was going into myself, not talking much. I stood under the shower, riding through the contractions and I told my midwives I needed to do a poo. Sam asked if I felt okay having a vaginal examination and she told me it was time to have my baby so I got straight in the birth pool which was such a relief. It was very fast; Manuela was born at 7:50pm and I was so amazed that I’d done it. I was shocked that it worked out exactly how I had planned it

“I got out of the bath and got on the bed. I wanted a physiological third stage but nothing was really happening so Sam suggested I get on the toilet and let gravity help and it came out. I had a second-degree tear and the stitches helped more than birth. We had a really straightforward breastfeeding journey too and I fed her for fifteen months.

“My second pregnancy was a surprise, too. I was concerned about what other people would think but I look back now and think I really shouldn’t have thought like that. In all my pregnancy appointments, the midwives emphasised that birth is unpredictable but they also told me second births were generally quicker and I should be prepared and have towels in the car.

“I got a stretch and sweep in the week after my estimated due date and I felt quite anxious and I was spending all my days waiting, waiting. At 41 weeks I started having contractions; I was having them all day but I didn’t tell my partner. I stayed in my bedroom swaying, trying to keep the contractions going and they did progress but it was very slow. Sam was having a break from midwifery but she was supporting me in a doula-role so she arrived at the hospital at the same time as us. The walk into the hospital was very uncomfortable but I had my midwife and student midwife there, even though we were still restricted by covid protocols. I walked in the door, lent on the bed and within five minutes my waters broke. The bath was full and I got in there and was riding the contractions. It was about 7:30pm at that point and that’s when Sam asked if it was okay for her to have a look or feel and it was quite dark. Sam looked back at Katie and said: he’s breech. Everything changed then – everything. Sam, Katie and my student midwife protected the space really well considering how dramatic it was. They pressed the emergency button and about ten people came into the room and I was taken straight to the bed. An obstetrician came in and asked Sam if she had assisted with a breech vaganal birth before and she said ‘no’ but she also said she was confident in my ability to do it.

“The obstetrician and midwives encouraged me to get on all fours so I did that. I was pushing and he was coming out but it wasn’t progressing as quickly as they’d like. It was a bit slow so they encouraged me to get on my back and my legs were in stirrups and his bum came out then legs and I kept pushing and I was so hot; that was probably the shock. In the next contraction I pushed and they got one shoulder out and then the next shoulder and then I pushed and Valentino was born and they put him straight on my chest. From the moment we discovered he was breech to his birth was twenty minutes.

“We planned our third pregnancy. I went to the ultrasound by myself and I must admit, I had an inkling it may have been twins because I was so much sicker in this pregnancy. The sonographer asked me if I had twins in the family and I just swore, I didn’t know what to do. She showed me baby A and baby B and I was just in shock. I left and sent my partner a text asking him to call me and I told him it was twins; I was crying and he couldn’t stop laughing. We’d just bought a seven-seater car and we’re of the mindset that you don’t need a lot; we’ll figure it out along the way.

“They’re DCDA twins which means they have their own sacs and placentas which are the lowest-risk so that was very fortunate. You have a lot more appointments with a twin pregnancy and I was quite nervous about having obstetric-led care; in retrospect it was a really big part of my pregnancy, my hesitancy to have obstetric care. In the second trimester I requested appointments with midwives and I got some and then when I attended the hospital for reduced foetal movement, the midwife asked me if I wanted a student midwife so I had that continuity of care along the way. I was begging for it! It’s hard not to have continuity of care when you’re going through a twin pregnancy. From the get-go it felt like everything was against me. My very first appointment was with a registrar and within three minutes she basically said caesareans are the presumed birth for twin pregnancies and if I hadn’t gone into labour by 37 weeks, I would be induced.

“There were two amazing obstetricians though and they were fully supportive of my preferences but then in the other appointments, I was met with really confronting language and opinions from other obstetricians. I knew I couldn’t pick or choose my obstetrician and that was really daunting. My student midwife came to all my appointments – I couldn’t do it without her – and I also hired a doula for the birth.

“There was a specific registrar who was adamant I book in for an induction, who didn’t have any evidence to support her suggestion and she really coerced; it was awful. I had a constant battle about whether the induction was the right or wrong choice. I was big, uncomfortable, and I had my birth plan and decided to get induced. I’d had a stretch and sweep the day before and I was already 3-4 cm. My preference was to just have my waters broken. I had beautiful midwives with me and felt really supported. The registrar came in and he was really confident in me and wanted to support me but he did warn me that the lead obstetrician did not feel confident in my choices and I knew who she was; she was the one that I didn’t get along with in pregnancy. She got on her knees and she had my birth preferences in her hand and she was immediately dismissive of my choice not to have an epidural, to get in the water and was very risk focussed.

“I felt educated and knew I wanted to stay strong. I told her that I respected her and her job but I reiterated that I wanted to follow my birth preferences and I wouldn’t choose intervention as a precautionary step, even though I would accept it if necessary. She was really taken aback by that. I also told her that I was happy to go home and return to the hospital when one of the obstetricians who supported my choices was on. We ended up compromising; CTG monitoring in the water and an ultrasound after twin A was born to check on twin B’s position. She stood up, high-fived me, and wished me good luck. Everyone else was incredibly supportive and I just had to lean on them.

“The midwife broke my waters and I knew that if I wanted to resist the syntocinon drip I needed to stay active. I was comforted that my other labours had really ramped up after my waters broke. Within 40 minutes I was bouncing on the ball, I was stimulating my nipples and contractions started; they were hard and fast. In my mind I was saying: “I’m doing it, I’m doing it and I don’t need the drip.”

“I kept bouncing and swaying and my doula and my partner were massaging my back and my midwives were just so supportive. They filled up the pool and before I knew it I told them I was going to start pushing; they were shocked at how fast it had happened. Within twenty minutes of the contractions starting I reached second stage. I was leaning over the bed and my student midwife told me she would catch my baby. I birthed Florencia and I pulled her up and I felt like I’d ticked that box. I was quite overwhelmed and when you’ve got another baby inside you’re quite uncomfortable and her cord was short so I couldn’t hold her easily. The obstetrician came in and told me she needed to do the ultrasound and this was amongst the midwife trying to delay cord clamping and I was also trying to latch Florencia to encourage contractions. She put the ultrasound on and said: ‘Yep, as expected, twin B is transverse.’

“My doula said: ‘Can you give her a minute?’ and the obstetrician continued saying: ‘transverse, transverse, what are we going to do?’ – I knew hospital policy allowed thirty minutes between twin a and twin b so I just told her I was going to stand up and before I’d even done that Raphael had moved into the pelvis head first. He stayed here in the ideal birth position so I passed Florencia to my partner and they were doing skin to skin. My doula and student midwife were with me, they kept telling me I was nearly there. I was breathing and focusing so hard on my breath, I was feeling euphoric and weak but determined. Before I knew it he was out and they passed him to me and it was amazing; I couldn’t believe I’d birthed twins. I knew I was on a timeframe to get the placentas out but I was surrounded by people who were just so proud of me. I felt like I got double the oxytocin hit. I sat on the toilet, both of the babies are latched and the placenta came out; the placentas had fused.

“I look back and I wish I could tell myself that induction doesn’t have to be negative because in the end, it was how I really hoped the birth would go, it was everything I wanted.”

Topics Discussed

Breastfeeding, Breech Vaginal Birth, DCDA Twins, Four babies, MGP, Physiological birth, surprise breech, twin vaginal birth without epidural

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