Double the Joy: Clare's 40-Week Twin Home Birth with AV Heart Block
- Guest Contributor
- 3 hours ago
- 14 min read
“I need you to get out of the water.”
I looked up at my midwife, cradling one fresh, wrinkled wet baby on my stomach above where the other one still lay hidden, still unborn. I couldn’t pull my daughter any higher up on my body because her umbilical cord was so short.
“I can’t monitor your bleeding while you are in the tub. Can you come out of the water on to the bed?”
That’s how I found myself, holding one twin outside of the womb while carrying the other twin inside, feeling deflated from birth, trying to stretch my short legs over the wall of the birth tub while dodging my baby’s short still-attached umbilical cord. Like many other times during my pregnancy, I found myself wondering, “How in the world did I get here?”
Here’s how.
Like many other women who chart using a fertility awareness-based method, I found out I was pregnant about as soon as I could pee on the stick. Unfortunately, my pregnancy sickness also began around the same time, which was earlier than typical for me (this was my third pregnancy). I felt sicker than I ever had before, and threw up a few times with very strong food aversions, which again was unusual. I chalked it up to increased fatigue from having two young kids to chase after this time around, instead of one or none, and scheduled an 8-week ultrasound at the local pregnancy center (and cheers to them for providing free ultrasounds to women!).
As soon as the tech pressed the wand on my belly, she said, “Do you see what I see?”
“No...” we answered with trepidation.
“There’s two!” she cried, excitedly shifting the view so we could clearly see that, indeed, two little jelly beans gently wiggled on the screen in front of us. I started laughing, and my husband was flabbergasted, which I suppose sums up our collective reactions ever since. It just seemed so silly that we would be a twin mom and dad!
Of course, our brains were immediately whirling and just as fast came the questions from other people:
“Are they identical?”
“Do they share the same sac?”
“Is there one placenta? Or two?”
“Do twins run in your family?”
“Where are you going to give birth?”
“How far are they going to let you go?”
“Don’t twins come early?”
“Are you going to be induced?”
“Are you going to have a C-section?”
The more I spoke to those around me, the more I realized that there were a few underlying assumptions generally believed about twins: having twins was inherently high risk; twins always come early; they would probably be born by C-section, because even if my doctor “let” me try a vaginal birth, one of the babies would likely be breech (and very few OB-GYNs are trained in delivering breech); they would require time in the NICU for being premature; and breastfeeding would be difficult or even impossible, with formula becoming necessary to supplement. I learned to be cautious about who I revealed my birth plan to, as my desire for a homebirth was often met with aghast faces thinking that I was some kind of danger junkie. Birth is, unfortunately, often over-medicalized, but this is even more the case when two babies are present instead of one. This is the experience of many (if not most) twin moms that I know.
That isn’t to say my pregnancy was without some risks. When I was about 2 ½ months pregnant, I started having some very sudden and gushing bleeding. It was Christmas Eve; we had just returned to my mom’s house after having a celebration with my extended family, and I felt the gush as I pulled on my cozy pajamas. Of course, I thought I was having a miscarriage. I am so grateful that I was under the care of a midwife – my midwife was very accessible, even on Christmas Eve, and we were able to speak with her over the phone right away. She advised immediate bedrest, with cups of cinnamon tea to help stave off the bleeding, and ordered topical progesterone cream for me to begin applying.
I remember trying to gulp down the hot water with ground cinnamon in bed while hearing my children open up presents on Christmas morning in the next room over, trying not to lose hope while also bracing myself for loss. Amazingly, and perhaps because we were able to address things so quickly with my midwife, the bleeding stopped. A follow-up ultrasound when we returned to our home revealed two healthy babies and no diagnosable issues. (Interestingly, after I birthed the placenta months later, there was a large “scab” on one side of the organ that my midwife thought might have been the cause of the bleeding.)
Another risk we had to assess was that of bleeding post birth (hemorrhaging). Years ago, when I was first married, I was diagnosed with a heart condition called atrioventricular heart block (AV heart block). I only happened to receive this diagnosis because I had gone to the ER with a bad stomach bug and they saw that my heart rate was low. I’ve always had a low resting heart rate, in the 50s (“normal” is defined as ranging from 60-100), but didn’t think about it enough to let medical professionals know beforehand. So they took an EKG of my heart and discovered the AV block. After being hospitalized, undergoing other tests, and meeting with various cardiologists, it was determined that I’ve always had this condition but that I am just asymptomatic. I can live my life normally, just like anyone else, so long as no symptoms like shortness of breath, palpitations, dizziness, etc. appear.
I had already given birth twice with this condition (once in the hospital and once at home), so when it came to considering homebirth with twins, I didn’t think twice about the heart block. But we discovered late in the pregnancy that if I were to start hemorrhaging after birth, my heart could go into failure. I had never had issues with post birth bleeding before, but having twins threw things up in the air a little bit – what if the placenta started to separate before Baby B
was born? What if my heart had difficulty dealing with the extra blood and fluid volume? Well, after many days of prayer, weighing our options, and considering the layers of risks and benefits, the choice was clear. On one hand was the hospital – the benefit was immediate help in case of post birth hemorrhaging (which was a possibility of happening, but not necessarily a high chance), but the risks were an environment where I was not comfortable, the likelihood of being pushed to receive interventions, and a good chance that it would all end in C- section anyway, because if one baby happened to flip breech at the last minute, there were no doctors in our area who would know how to assist.
On the other hand, I could stick with my vision of a homebirth, and be able to give birth in my own space, surrounded by people I trusted, and in the water (which I knew from experience was way more relaxing and would help prevent major tearing). I would be in the hands of a highly skilled midwife who was trained in breech delivery and had assisted in many twin births. Yes, I might be risking heart trouble if I were to bleed too much after birth, but wouldn’t major surgery (because, let’s be clear, c-section is major surgery) cause a great deal of strain on my heart as well? Why would I assume that a cesarean is the safer option, given this reality and the whole host of other risks associated with it?
Even the medical community agreed with me – I had the backing of my cardiologist (who had years ago cleared my for childbirth and any other normal activities), my family doctor, and the doctor with whom my midwife was consulting, who happened to not only specialize in high-risk births but also taught how to deliver breech babies safely. In fact, this last doctor had told my midwife that, in his opinion, I would be much safer at home than in a hospital simply because of the one-on-one care I would receive from her.
In the end, the choice was clear – but it was, down to the wire, a decision that was tested. At 38 ½ weeks pregnant, as my husband was helping me insert evening primrose oil vaginally (part of my routine for softening the cervix and preparing my body for birth), he paused as he was about to insert the capsule and said, “What is that?!” Not the words you want to hear at that moment! Well, after texting frantically (on my part) back and forth with my midwife, she finally determined to make the hour and a half drive to come examine me. It was 11p.m. “It could be one of three things,” she told me, “the head, the umbilical cord, or your bladder.” And then she was on her way, while I alternated between side-lying and knee-chest positions in case it really was the umbilical cord and I needed to take the pressure off of it so Baby A’s oxygen wouldn’t be cut off. I was anxious, but I managed to drift off to sleep, and when she arrived, she examined me in her calm and gentle manner as she always did, despite the late hour.
The diagnosis was bladder prolapse, which was one of those things that apparently happen during pregnancy that I had never heard of before. To my knowledge, it seems relatively harmless, at least when it happens during pregnancy, and indeed, it resolved itself after birth. But once more I found myself thanking God that we were under the care of a midwife. What else would I have done in the hour before midnight if I was under care of a conventional doctor? Would I have driven to the ER and waited for thirty minutes only to be seen by someone who has no idea of my medical history and has never seen me before? Find someone to watch my kids in the middle of the night so my husband could go with me, in case it was something serious? Paid a medical bill for something that would only resolve on its own? Instead, she responded to my concerns immediately and drove out to see me in my own bed. For no extra charge. That is true women-centered care.
But I digress. Did I mention that I was 38 ½ weeks pregnant at this point? No one (except for maybe my husband and my midwife) believed that I would make it that far. My in-laws, who we had asked to stay with us for a while to help out prior to the birth and during it, came a whole month early because they expected the twins to come sooner!
The question became more annoying than the pregnancy itself – “Has she had the babies yet?” And yet, this is the cultural expectation. According to “Help! I’m Having Twins”, the range of average gestational age for twins is 28 to 40 weeks, compared to 35 to 42 weeks for singletons. I suspect that much of it is due to forced early inductions and c-sections. I’ve even heard of some OBs who will “recommend” (read: command) that twin mothers be induced as early as 34 weeks! Another factor could be inadequate nutrition, which in turn could cause a whole host of other problems. After my bleeding incident early on, my midwife told me I should be eating 120 grams of protein daily to keep up with nourishing both my babies and myself! I stuck to this regimen very faithfully, as adequate protein can help prevent gestational diabetes, preterm birth, low birth weight, and preeclampsia, to name a few. And I do think, in my case, it did wonders for the health of both me and my twins.
So there I was, waking up each morning to yet another day of pregnancy as we marched closer to the 40 week mark. My due date was June 30 – well, actually that is not strictly true, as we were given two different due dates at the very first ultrasound. Baby A was due June 30, Baby B was due July 3. I had thought that this was because of the size difference on the babies, but my midwife speculated that it could have been because of the babies being conceived on different days! Who knew that was even possible!
June 29 arrived, and a friend of mine called me with an invitation to walk around Ikea. “Where can we take Clare to walk where it’s cool?” she told me, laughing, as it was the middle of Ohio summer and it was humid. So we brought our kids and made a day of it, hoping the exercise would induce labor. As an extra effort to get things going, these same friends bought us spicy Thai food at a new Asian restaurant in our area. We had a great time, but alas, no contractions.
I woke up on the due date feeling the same as I had done for weeks – like I had exchanged a bowling ball for my belly and my hips were sore from the weight of it. “I guess these are going to be July babies after all,” I told my mom on the phone. We went to church in the morning as usual (it was Sunday), and put our kids down for naps in the afternoon. That’s when I started to notice some pressure increase along with faint contractions. Nothing regular, and things seemed to go away whenever I lay down, so I didn’t think much of it.
Finally, at 6:47p.m., I texted my midwife that I had noticed some minor contractions now and then. She encouraged me to rest, and I went about my evening getting the kids ready for bed. Two hours later, I texted her again because I could feel increased pressure and occasional contractions; I still wasn’t confident it was the real thing, but she said she would start to head my way (she was a good hour and a half away). Soon after, I asked my doula to come over as she lived only a few minutes away, and that’s when things really started going. It was around 9 p.m.
By the time the doula arrived, I was already pausing during contractions and pacing the room. I found that bending over the edge of the bed was the most helpful. The doula helped my husband get the birth pool inflated and filled. Twinkle lights bathed the room in cozy light, peaceful praise and worship music played softly in the background – everything was ready. I got into the regular bathtub while I was waiting for the birth pool to be filled, and the midwife found me there when she arrived at 10:53 p.m. They all helped me transfer to the birth pool, where things started to get much more intense and I was grateful for the soothing tranquility of the water. I remember saying over and over as I got into transition, “There’s so much pressure!” My eyes were closed, but I could hear my midwife quietly reminding me to breathe through the contractions instead of clenching.
I started to feel pushy and wondered if I was feeling it too soon, if it was only my reaction to the pressure because I wanted to do something about it. I felt like I hadn’t been in the pool for that long. But sure enough, during one contraction, I started to feel myself yelling, that guttural, animal roar in response to an instinct deeper than we know. “I think the baby’s coming,” I gasped out to the midwife, and she deftly checked me from her position beside the pool (another reason to love midwives – they rarely ask you to lie on your back for checking dilation and baby’s position!).
The pushing began. I don’t know how long it lasted, but it wasn’t long. My midwife reminded me keep my sounds low and my jaw loose, my husband softly whispered encouragement by my side. Finally, with another yell, I felt drawn out of this animal world I had entered with the words, “Clare, reach down and grab your baby!”
Somehow surprised, I looked down at the baby in the water below me and snatched her up. I could feel the utter relief at feeling her outside of my body instead of inside, but in the midst of this oxytocin-induced glow, I could feel the sense of being unfinished. And that’s when the midwife said to me, “I need you to get out of the water.”
My son was born “on land”, as they say, on my back on the bed – not the position I would have chosen as the theoretical birth planner, but one I was grateful for in the very real moment of bracing myself for birthing a second baby. When I got on the bed with my doula on one side helping me hold Baby A and my husband on the other side, the midwife began looking for Baby B’s heartbeat inside me. She was having trouble finding it, and I could tell she was beginning to be concerned. She said to me, “If I can’t find his heartbeat soon, we may need to transfer to the
hospital.”
What happened next is hard for me to describe. It was as if my body made a decision without any sort of consultation with the thinking part of my brain. As if in response to what she had said, I felt the biggest urge to push that I have ever felt in my life, and I went with it. He was born very quickly, and from what my husband told me later, he came out looking a bit blue from
the shock of it. But our midwife quickly and calmly stimulated him and did what she needed to do to revive him, and he was placed on my chest and all was well.
Cue baby glow number two. As I rested, feeling that mix of surprise and relief that all is
over, I realized something.
“What time is it?” I asked the midwife.
“12:01 a.m.,” she said to me with a smile.
“Wait a minute,” I said, “that means he was born at midnight? So they have different
birthdays?”
“Yes,” she said, “and even different months.”
For indeed, Baby A was born on her due date, June 30, and Baby B was born a few days before his, on July 1. I think they will enjoy this fact about themselves as they get older. I’m sure one birthday will be filled with princesses and pink and sparkles, and the other one will have dragons and swords and knights.
So in the end, all was well. I had minimal tearing, and no hemorrhaging whatsoever. It was overall a fast birth, comparable to my other two singleton births, and of course, it was my twin birth at home that I had hoped for. My recovery went smoothly – I made a point of planning a full six weeks, or forty days, to have help and stay at home with the babies so I could focus on rest and recovery. From the beginning, my twins were exclusively breastfed, and we have had no issues.
My twins are now nine months old, and still breastfeeding, although I have also started to give them raw milk as a supplement in between feedings as well as increasing their solid food intake. Around 7-8 months they started acting very hungry, especially during the night, and I wanted to increase their nutritional intake during the day to see if I could avoid waking every two hours to nurse one of them!
Twin mom life has not been easy, but neither has it been bitter. It is full of joy, double the joy, truly. To see two completely unique, utterly different personalities develop and grow side by side is amazing. They showcase new aspects of our family dynamic that we didn’t realize was there. They have opened doors for numerous new ways to plug in to our local community, whether through making connections with other twin parents or simply asking the community for help because we need it! Our other two kids are four years old and two years old, so we definitely have our hands full; but as my husband likes to add, “Full of blessings.”
Twin homebirths have made recent news with the publication of a study showing good outcomes for twins born at home. I applaud this wholeheartedly. I hope my twin homebirth story will be likewise empowering and hopeful to women, especially those who feel that birth at a hospital means an inevitable c-section. Hopefully it is clear that, oftentimes, twin births are simply just a variation of “normal” birth, and that every mother deserves to have woman- centered care that truly works for her well-being. I pray my story will play a small part in making this a reality.
Clare lives in Ohio with her husband of five years and their four children, two of whom are twins and all of whom are under four. In her “spare time”, she works as music director for their church, bakes sourdough bread for the family, and occasionally writes for Natural Womanhood.