VBAC Attack!

The babies are sleeping, Grandma and Grandpa took the big boys on an adventure and I find myself with a quiet moment in which to try and record the adventure of the twins birth.

For all of you who aren't up on obstetrical terminology a VBAC is a vaginal birth after Cesarian. They're a pretty safe procedure now days since most c-sections don't require the giant up and down stem to stern cut they used to give. The lovely "low transverse" scar I have is ideal for a VBAC. In fact when they were going to operate to save tiny Ciaran I specifically told the OB that I would have more children and to cut me so a VBAC was possible. She did, so things were looking good this pregnancy. Until I found out I was pregnant with twins. And one of them decided to be breech (feet first). And then vertex (head down). And then breech. And then transverse (lying sideways). Some of these during the same ultrasound. Lachlan "Baby B" was quite the flipper. Even at the end when supposedly they have no more room to move he was flipping around. Finally they decided to assign his position as an "unstable lie". Aidric "Baby A" was smooshed down and locked into his position early on in the pregnancy by his brother's antics. And thank goodness he was because if he had been breech it would have meant the knife for sure.

Lachlan's moving didn't seem like a big problem. It was more interesting to feel physically how he was thrashing around in there. My midwives were fine with continuing my care, although if Baby B did continue in his breech position one of their back up OB's would be present at the birth so that they could either try and turn him or deliver him breech. See, even though the American College of Gynecologists have declared that they don't like breech deliveries for a singleton baby or for a Baby A, it's still within professional guidelines to deliver a Baby B breech. Basically all systems are go as the first baby has already cleared a path as it were. I'd done my due diligence, I'd gone to my VBAC consult with my midwives back up OB's with an exhaustive 5 page question list (there were spaces to write down the answers so it's not quite as huge as it sounds) and all things were on track for the delivery even if Lachlan stayed breech. That is until about 32 weeks into my pregnancy.

I had been emailing with another woman in my exact situation; same care providers, pregnant with twins, Baby B breech. She managed to find out that in fact things were not as peachy as we had been told. After much digging by her and by our very startled midwives we were told that of the 5 doctors in their back up OB practice 2 of them would not deliver a breech Baby B. One wouldn't even try and turn the second twin. And the icing on the cake was that none of the other doctors would commit themselves to being available for the delivery. It was all a lot of, "You can call and if I'm free I could try and attend the birth." blah blah. So much for being a unified practice and all your physicians offering the same level of care. Good job Sleepy Hollow Medical Group. So I then had to decide if gambling with the on call lottery was worth staying with my midwives who I love LOVE LOVE or attempting to switch to a new provider with roughly 8 weeks left in my pregnancy. Or maybe just 4 since lots of twins can be born around 36 weeks.

I met with a couple of providers and was encountering the same problem of some will, some won't. Thanks to ACOG changing their breech guidelines medical schools are no longer teaching breech birth so even though there was no reason I shouldn't have the second twin breech doctors don't know how to handle it so they opt for the knife. Because heavens knows major abdominal surgery for the second time with its risks of bowel and bladder damage, infection, injury to one of the babies, oh and DEATH is no big deal.

Then one night I tearfully typed an email to my doulas telling them I still didn't know what to do. And my doulas did the single greatest thing they did during my entire pregnancy and delivery. They gave me a name. Don't get me wrong, I'm so glad that Jen was in the delivery room with me, but had she and Barbara not told me about Dr. McGroary things could have gone very differently. They too had had a former client in my situation, as had a colleague of theirs and both people had left their former practices and transferred to the practice of Dr. Dennis McGroary and Dr. Susan Malley.

So I saddled up once more and pulled out the old 5 page questionnaire and made the almost hour long drive up to Yorktown. That almost dissuaded me, but the minute I started asking questions Dr. McGroary kept giving me the answers I wanted to hear. But with real facts from their practice to back them up. He believed in VBAC! He believed in twins going past 36 weeks! (It probably helped that his wife delivered twins in her 39th week.) He believed in doulas! He even knew my doulas! He wanted me to write a birth plan for him! I could catch my own baby! (Turns out Aidric was born so fast this wasn't possible, but who cares, he said I could do it.) He went to medical school before the guidelines changed and was very comfortable delivering breech babies! And Dr. Malley felt the same. And since they were the only 2 who had a chance of delivering my baby I knew things would end up going the way I wanted. So at 33 weeks I made the very painful decision to leave my midwives (again, since I'd had to leave due to all Ciaran's complications).

And things chugged along and the babies grew and I was fantastically healthy with zero complications and ridiculously uncomfortable and at 39+ weeks despairing that these babies would ever be born. I'd been at 4-5 cm dilated for almost 2 weeks with only little contractions that petered out quick.

And then at roughly 2:30am on June 4 I awoke with some painful cramping every 2-3 minutes....

Below is the log that my doula recorded of events. The entire log. The sum total of high points of the delivery. Awesome!

3:05am – Dawnell calls to say she is in labor and that they are on the way to the hospital

4:00am – I arrive in the L&D room at NWH

4:25am – Dawnell and her husband Chris arrive

5:10am – Dr. McGroary performs a vaginal exam and reports that Dawnell’s cervix is dilated to 9cm; baby A is vertex and baby B is breech

5:56am – Dr. McGroary performs another vaginal exam and tells Dawnell that her cervix is fully dilated. He is concerned about some decelerations that are picked up on the external fetal monitor and suggests that its time to deliver the babies. Nurses transport Dawnell to an OR for birthing (this had been previously agreed upon by Dawnell and Dr. McGroary because of the VBAC/Multiple scenario).

6:21am – Baby A is born: 6 lbs, 12 oz

6:34am – Baby B is born (double footling breech, compound presentation): 6 lbs, 11 oz)

Did you check out those times? The first part sounded right to me, but I'm pretty sure I pushed for about 9 hours and the ring of fire lasted for about 6 of those. No says Chris. Alarmingly fast says Chris. My time warp perception is undoubtedly because as I so eloquently and understatedly recall saying during delivery, "This hurts really bad." Also because of that little extra nugget of information under the 6:34am entry. Double footling breech, meaning all 10 of Lachalan's tiny little toes were coming down and out and that second bit, "compound presentation" means his hand was up by his face. So not only was the biggest, ouchiest part of him saved for last, he decided to stick his hand up and increase his head circumference. Thanks son.

And then there they were. Both of them peeing up a storm upon entry and pink and perfect.

And that is why all the nurses knew who I was. Evidently twin VBAC breech no drug deliveries don't come along every day and I was considered something of a stud. Which, if I do say so myself, I am.

This is as close a picture as I can get to the day I delivered. Everyone told me that I should get a picture of myself on the day I delivered to remember how huge I was. However, as you may have noticed from the above description of delivery day, things happened pretty quickly and I was a little more concerned about not having an even more exciting story about giving birth in the car.


Size wise things are feeling a lot better now. Although it did take a week to feel like my organs were back where they should be. As Beckett likes to ask me, "Mom, can you run fast now? Mom, can you bend over and pick stuff up now?" To which I respond, "YES, I CAN!"