Was it 'undiagnosed' or just 'denial'? I still wonder.
Darling Sandy has 4 year old twins born in hospital, managed relatively unscathed, born vaginally without medication. She then went on to birth a very chubby singleton girl who is now two and a half, at home.
Sandy employed me to care for her in this her 3rd and last pregnancy. All the way along she suspected twins but I reassured her I could just feel one and she measured the right size for one. She dreamed of twins, I did once too. Sandy never wanted an ultrasound. As the pregnancy advance I began to suspect an unstable lie, one week breach, the next head down, lots of movement and activity.
I was fully prepared for my first breech homebirth and said I was happy with that and to just wait until she went into labour and we would trust and surrender to whatever came. The second midwife and I joked about being prepared for twins. I said I can’t promise what is coming first or how many.
Sandy rang me at 2am Sunday to say she had ruptured her membranes and there was lots of liquor. Labour started a few hours later and I arrived just after 8am. The palpation was still confusing to do. I could feel a head I thought in the fundus, and only confirm one back, or was that a head deep deep in the pelvis and this was another large baby. I waited for the second midwife and she thought twins but we couldn't be sure. In the end we said we cant 100% say its not twins but that she was in labour!
I dont usually do VE's in home birth unless a need and Sandy agreed it would be useful in this case to determine what was coming first. She didn't want to know dilatation. She was 7-8 cm with definitely a head coming first. We waited for a second sonic aid to be delivered to the home to try and differentiate 2 heart beats. We could definitely find it in 2 distinct places but the rate was the same and impossible to state definitive if it was one or two babies.
Sandy decided to get into the birth pool. I decided to stop analysing everything. I asked her if she was still happy, comfortable and feeling safe to birth at home, I would support her no matter what and she said yes. So we stayed.
There was a 3 hour latent phase where labour almost stopped between Sandy being fully and pushing. She had lots of emotional issues to process. I eventually asked her. "How are you feeling about having another baby in the house?" which opened a floodgate of tears. She felt she was burdening her husband, wasn't sure if she had the support for a babymoon and to manage 3 toddlers as well... CRY CRY CRY! It was great, she got back into the pool, time to birth now. We all sat in silence, and then a friend started singing to her. It was amazing. Picture if you will, Sandy and her family live 50 km form the nearest town (and hospital) in a tiny shed as they build their straw bale home, no power, just a long drop, sitting outside under a lemon scented gum tree Sandy in a plastic grape bin as a birth pool singing. Midwife still wondering how many babies were coming BUT NO FEAR! I was never afraid or worried.
After about an hour of singing and pushing Sandy felt the head born and her husband reached in and pulled their daughter up. Short Cord. I immediately knew something was holding her back, Sandy had to kneel up out of the water to keep baby above the waterline. I reached down to her tummy, felt twin 2. I got eye contact with her and asked her to put her hand down on mine. "Are you ready for this Sandy?" "What is it?" ... "Its another baby darling?"... "Twins?" ... I kissed her "Yes, it is twins" ... Sandy needed twin 1 removed so we clamped and cut the cord after explaining to baby mummy needed her to do this (she was a bit cross and screamed at us in protest) and handed her to her daddy. I tried to listen to twin 2's heart rate but Sandy got a contraction so I gave up. Another contraction and she could feel a bottom "Its a boy!" she whispered to me. Another push the whole body was out. I reached down into the water to check no arms were stuck up around his neck but of course all was perfect and just one push later Sandy birthed her breech son into her own hands 12 minutes after his sister. An hour later she calmly and easily birthed the two placentas, walked back inside and hopped into bed with the two babies. Then it was time to weigh the babies and check them out, feed everyone, laugh and cry with joy. The first few hours flew by then at about 8pm Lisa and I were dismissed! We left the property but needed to debrief. Standing at our cars we looked at each other in silence and decided a stiff drink was in order so drove to the Whitfield Pub. When we got there we were still in a daze, got out of our cars and I said to Lisa "What the @#&%,just happened?!"
Of Course it was twins! Sandy subconsciously knew it; part of me prepared for it during the labour, so why couldn't I diagnose it with conviction? Sandy and Christos say they didn't want to know, it would have opened up a dilemma for them that may have led them to considering transferring in labour. Part of me wanted to manage this, whatever was coming; my uncertainty but most of me just trusted the process, trusted Sandy. What an amazing birth, an amazing woman and an amazing birth team.
A note to any critics.......
Countless time I have gone over this birth and there is not one thing I would change. I have read and re-read my notes, sought independent counsel and spoken to the other people present at the birth. Sure hindsight is wonderful, but even knowing what I do now I would not change a thing. Questioning Sandy or her decisions was never on my mind. The choice for her to birth at home was never mine it was always Sandy's. My role was, and always is, to support the birthing woman's choice. My duty of care is to support birthing women, even when choices are made that I don't agree with. Every single day working in hospital I am expected to support women's choices that I strongly disagree with. When I do this, within the mainstream system I am a "good" midwife. Even if I had disagreed with Sandy's informed choice, which by the way I never did, I would not have withdrawn my care and abandoned her.
Unless you are actually present at a birth you cannot pass judgement on what happened. Unless you are a witness or participant, aware of the lead up to the event, involved in the interactions or decision making, how can you really know what happened? I could write pages and pages explaining the full story in minute detail and still it would be impossible to share the full essence of this birth. Unless you were actually there how could you possibly judge, yet judged I have been.
The ramifications and repercussions of this birth have been very interesting for me. I have been overtly and covertly criticized, bullied and harassed by people who were not there. My professional judgement and integrity have been questioned. My critics should now stand warned I am stronger than ever in my conviction to support women's choice to birth at home. My thanks go to those professionals who have supported me, particularly other Midwives in Private Practice and most especially Lisa Chapman. My heartfelt love and thanks to Sandy and Christos for inviting me to be their midwife and allowing me to bear witness to the birth of Zoe and Emilio.
[Sandy's account of her birth was published in Birth Matters Winter 2008]