Being a doula for twins was one of the most memorable experiences in my birth career. I met Helen at the pregnancy circle I was running. This was her third pregnancy with a new partner, Rowan, and she had planned a homebirth. Her first baby was born in hospital by caesarean following a long and traumatic induction. Her second ended in a vaginal birth, but it too was induced. The homebirth she had long for though appeared to be slipping away from her when she discovered early in pregnancy that she was expecting twins.
Booking a Doula
Helen had felt that she was being bombarded with ‘risk’ talk constantly not only from the midwife but also from all those around her including work colleagues, friends and family, with “So when are you booking your caesarean?” being a regular conversation starter.
Rowan unconditionally supported Helen in her choice to want as natural a birth as possible and felt that the additional support of a doula would be beneficial to them both. They planned to have the babies in hospital but had strong feelings about not wanting to be induced and to recreate as homely an atmosphere as possible. They felt that having a doula would be an encouragement for their plans, and enable them to feel that they weren’t alone on their journey.
Getting to Know You
During our antenatal sessions we talked about their birth plan, and I was able to lend them some information booklets about twin birth choices, and induction, plus a copy of Midwifery Today packed with a breadth of beautiful twin birth stories. There was one session where I showed Rowan some techniques using a rebozo to support Helen in pregnancy and early labour, but this was going to be journey of exploration.
The possibility of induction, recommended from 37 weeks by her consultant loomed in the forefront of our discussions.
Helen felt strongly about going into labour by herself. We talked about her previous experiences of induction, where she felt unsupported and was left alone at times. She felt she was treated like a child, and had all choices taken from her.
Using exploratory open questions she was able to reach her own conclusions about what was important for her in this pregnancy and what she wanted to do when reaching the end of the pregnancy. I witnessed the unfolding of strength that lay deep within her to make her own choices, and hold her ground when the pressure to conform was strong.
I am still in awe of her determination to decline the constant pressure of induction, as she finally went into labour around 40 weeks. The challenges she faced included being told that one of the babies was not growing adequately, an arranged induction for Boxing Day, which
she declined following a repeat scan. This scan then showed adequate growth of both babies. None of us were surprised.
Through the doula mentoring process I felt more aware about how I was engaging with Helen and what my role could be. As a midwife, although I always aim to give balanced information and informed choice, I realised that exploring issues is something different, and enables the woman to find her own answers that are not through facts and information as such, but through remembering, soul searching and coming to her own understanding of previous experiences.
The issue of induction had raised so much anxiety for her, with such poor previous experience. I attended the hospital appointment with her and Rowan as an induction had been booked before Xmas so on Boxing Day they went in for a check-up with the intention of declining. It was incredible. She appeared to be coming from a place of real strength when declining induction this time, rather than a place of fear of what induction might hold for her.
Helen rang me at 23.00 to tell me her waters had gone. She had some tightenings during the day and earlier in the week, and these were slightly increasing now. She rang the hospital and was planning to go in when they were increasing. Very soon they were so she let me know they were going to the hospital and that they would like to meet me there.
At 00.15 we arrived at the hospital and met up before going into the delivery suite. Helen had already written a detailed plan as the usual care for a twin birth was very medicalised. She declined continuous monitoring but was happy for a short period of monitoring at the beginning of the labour and then accepted intermittent monitoring following this.
I helped Rowan set up the room according to Helen’s wishes, with subdued lighting, and music.
It appeared that the CTG was continuing for a longer time than expected so we asked for this to be removed and Helen moved off the bed.
Around 01.30 the anaesthetist was present to ask to site a cannula – Helen declined this as stated in the birth plan, and it was obvious at this point she was retreating from the world into her labour.
Soon there were no gaps in the contractions. Rowan was very intuitive to Helen’s needs and I feel my doula role was to be a quiet presence supporting them discreetly while Helen used hypnobirth techniques.
At about 2am she moved from standing onto the floor where we set up a mattress and the ball, her back to the door. I helped Rowan choose an appropriate homeopathic remedy to help with some of the sensations. Helen stayed in this position kneeling, whilst leaning over the ball. She breathed comfortably through the contractions and Rowan supported her as she wanted at her head. A second midwife was called into the room to assist at the birth, the delivery suite coordinator hovered quietly and also a registrar crept in. Everyone respectful of the calm and quiet atmosphere – some birthing music was playing on the CD and the lights remained low.
Soon Helen was pushing and Rowan moved down to see the top of his baby’s head.
I stayed at Helen’s head or side throughout the second stage, quietly encouraging at points where she felt fearful or seemed tense.
At 04.03 her first twin was born; Orin. Helen sat back on her heels as he was passed through to her and she looked triumphant. At this point I stood back and actually grabbed a camera soon after to capture the elation on their faces. Rowan and Helen were so together.
Everyone else in the room was quiet and respectful, which at that point included her own consultant who happened to be on duty that night. Helen was so surprised and also pleased to see her as she later told me that she had no awareness of other people in the room during the labour and birth.
She later told me that she felt a strong gravity pulling sensation, which felt really good and then just a burning as she birthed her baby. She couldn’t describe it as pain.
The registrar asked if she could scan her to assess the position of the second baby, which Helen consented to, and which was carried out on the floor. The baby was transverse so the consultant recommended turning the baby via an ECV. Helen used the gas for this and the ECV was successful resulting in the baby being head down. At the beginning of the second stage of twin two, Rowan was holding his first baby and I was supporting Helen and then I realised that perhaps Rowan wanted to do this, so I offered and he accepted. I held baby Orin at this point whilst Helen birthed her second baby in a side lying position.
At 05.36 Arlo was born. Helen says she felt exhausted and tired at this point, more than previously, but she still describes the experience as pain free.
This was an incredible experience for me. I do not have much experience in supporting twin births previously as a midwife so it was an absolute learning curve in terms of understanding more about twins and a mothers’ thoughts about mothering and giving birth to twins. Each step of the way I tried to remember and implement new ways of being with women that enable dialogue and discovery rather than just information sharing. It definitely felt different listening and questioning more. This was a true doula journey for me. I observed Helen starting out as fearful and anxious about what may be ‘done’ to her, which evolved into being strong and decisive, with courage in her own choices. Not through anything I had done or said – but just through understanding herself and where her anxieties were coming from.
A true learning experience and a birth never to be forgotten.
Twin birth Choices
Although having twins means that women have enhanced care during their pregnancy, it should not mean that the possibility of autonomy and choice is removed. Many women want to make choices that are both safe, but respectful of physiology. It can be difficult to find information to make an informed choice around twin birth as we lose midwifery skills that recognise twins as a ‘variation of normal’ (Mary Cronk, elder midwife). See here for a detailed description of traditional midwifery care and birth of twins.
TAMBA recognises that giving birth lying down is not the only option available to women.
Excellent article here written by a mother of twins, and health researcher regarding the use of intervention and its’ potential impact on physiological birth. Examines the basic issues well.
“Unless the woman knows who will attend her in labour and trusts that the midwife will create and support the conditions that facilitate normal birth, having a doula or other birth supporter to protect those conditions is likely to be very helpful. The woman’s partner may find it difficult to support her through labour whilst at the same time protecting her birth space.” Are twins always high risk? AIMS, 2011, Vol 23, No 4. Joanne Whistler.