Cassandra and Joe welcomed twin baby boys, Parker Matthew and Grayson Robert, on December 9, 2021! And Cassie did it in the unmedicated birth she had hoped for. But it didn’t come easy and wasn’t a sure thing. They already had two boys at home, so they were experts at taking care of babies and young children but throwing two in the mix on top of the two, would be an adventure. They are no strangers to changes, with Joe a submariner in the navy and moving the family when new assignments arise. But this assignment was like nothing they had experienced.

Cassie knew that to have a vaginal twin birth, her babies would need to settle into the head down position, well at least Baby A needed to. But at 24 weeks Baby A was in the breech position and Baby B was transverse. Cassie got busy with chiropractor appointments and did many positional things to encourage Baby A to rotate to head down. Thankfully, at her 28-week appointment, both babies were indeed head down! Now they just needed to stay that way.

Cassie’s providers recommended induction by 38 weeks if labor had not started on its own. She had hoped to go into labor on her own, but at the very least advocated for the latest induction date which landed her nearly to 39 weeks. She reported to the hospital prepared for the waiting game that is standard for inductions. Cassie called the unit on the scheduled day for ripening, December 8, but they didn’t have a room ready. So she waited an hour, and then got the call to go in an hour after that. 

Since her cervix was dilated 2 cm, her doctor decided to move right to induction with Pitocin rather than ripening. Cassie tried to get comfortable being strapped to so many things, but it was hard to get her head wrapped around everything wrapped around her belly. She knew the plan would be to rest as much as possible before labor began, but she had difficulty with that seeing as she was connected to so much. She struggled to rest that night, with little happening, including sleep.

By 7:00 the next morning, December 9, Cassie texted she was having contractions every 3-5 minutes, but she was resting through them, and was able to get some sleep that night. The doctor came in about 30 minutes later and broke the water for Baby A in the hopes it would be just the thing to get labor going. Joe reported that Cassie got a break and was able to take a shower. She was breathing and talking through the contractions and also working on a puzzle, so things hadn’t really ramped up yet. On occasion she would have a stronger one, but by and large they were mild.

Early that afternoon, just past 1:00, Cassie was still waiting for action, doing her puzzle, pacing around the room, sitting on a birth ball. They had started the Pitocin again and her contractions were getting stronger, but not so much that she couldn’t focus. A couple of hours later, an exam revealed that Baby A’s amniotic sac was not completed ruptured, so the doctor broke it completely. Cassie was dilated 4 cm and 80% effaced so the hope was that she would soon move to active labor.

Since her doctor had strongly recommended that she get an epidural just in case there was a need for a c-section, Cassie chose to have it placed without medicine flowing in it. This was a first for the staff, but they were able to accommodate her wishes, reassuring her providers there was epidural access, while giving her the freedom she desired for labor. The epidural was placed without any medication in it by 4:45 pm. And by 6:00 her contractions were strong enough that she had to focus and was struggling to talk through them. It was time! And with contractions 2-3 minutes apart, it was active labor. Remember that time: 6:00 pm was when Cassie’s active labor began.

At 6:26 pm, Cassie was battling nausea and laboring leaning against the bed. She felt pain in her lower back and counter pressure really helped. Her nurse was trying to keep both babies on the monitor as Cassie moved where her labor sent her. She stood and swayed, she leaned onto the bed, and ultimately ended up on her hands and knees on the bed. And at 6:30 she was dilated 6-7 cm. 

It wouldn’t be long now. Her nurse called for the OR team just in case they needed to move to a c-section, but Cassie would push her babies out in the OR as per hospital policy. She leaned over the cub chair on the bed and then she lunged her foot to the side at my recommendation. It hurt a lot and was difficult to do, but she did it. Cassie hit a wall and wondered if she had it in her. I reminded her she had hit the same wall previously with her other two boys and she climbed right over it. She knew it was true.

At 6:45, after seeing Cassie move and sound like it was time to push, her nurse felt just a lip of cervix. That’s when things got a bit crazy. A team came in the room to roll her bed into the OR for pushing. Joe was dressed in the paper bunny suit, and I waited behind in the empty labor and delivery room for their return. I could hear Cassie pushing from across the hall since the OR was very nearby. And after some time, I heard a baby cry! Parker Matthew was born at 7:12 pm on December 9, 2021!

I waited to hear clues of more pushing, but instead I heard voices in the hall. It was Cassie! They wheeled her back into the labor and delivery room to push out Baby B! There was a midwife in the OR who advocated to get her back to her room with her doula and for that we will always be so very grateful. Baby Parker was wheeled in as well, and lay content in the bassinet a few feet away from his mom who was gearing up to push out another baby.

Her cervix had reduced to 7 cm so there was a second round of laboring to do. Can you even imagine? Cassie gathered her strength from deep inside and she labored through those three centimeters again. She moaned and growled like a warrior until she felt the familiar sensation of needing to push. It was a high mountain to climb but she knew she had no other option but to do it. Her doctor encouraged her, her nurse encouraged, Joe encouraged her, I encouraged her. We all knew she could do it. And just in time, her on-call doctor, who was previously unavailable, was able to step in and relieve the doctor who was present for the birth of Baby A.

And Cassie pushed with such strength and stamina! She wasn’t excited to do it and she voiced her discontent to her doctor but quickly apologized. Of course her doctor did not mind and responded with even more encouragement for Cassie. And she quickly brought her baby’s head in sight and after a little more pushing, Baby B, otherwise known as Grayson Robert, was born at 8:38 pm! Grayson weighed 7 lb. 1 oz. and Parker weighed 5 lb. 6.8 oz. That’s a lot of baby!

Photo Credit: Heidi Calma Photography

Cassie sobbed as she held Grayson. Her body was spent, and she had literally given it all she had. Joe expressed his love and admiration for her. We were all so proud of her. Her doctor helped with the rest of the delivery and clean up. Cassie snuggled with Grayson while Parker slept, and she soon brought him to the breast.

Photo Credit: Heidi Calma Photography

As time passed the nurse came in to do some newborn checkups, which gave Cassie the chance to have Parker in her arms for a bit. As she recounted the details and we praised her for all her hard work, she realized even though her boys were twins, they had different births. They ended up born in two separate rooms with two different doctors, for starters! And the finer details of the births had their own uniqueness too. Her labor went fast and furious once it got going, taking her from active labor to Baby A in just 1 hour 15 minutes, and Baby B born about 1 hour 30 minutes after that. That’s active labor and pushing out two babies in just under 3 hours!

Cassie was a trailblazer that day. She followed through with her hope of vaginal births for both boys, and she did so without any pain medication. Her doctors don’t see unmedicated births of singletons very often, but they rarely see twins born in that way. Birth teaches us a lot as mothers and as birth workers. I hope this birth taught Cassie that she is strong and capable, and her body is wonderfully and amazingly equipped to grow her babies and to birth them. Recently, we had our postpartum visit and Cassie shared with me that she feels proud of what her body was able to do. I’m so glad for that! We were proud of her, but it’s even more important that SHE is proud. I was honored to be there in service as she worked so hard. Mothers are powerful creatures!

Rebecca and Jason, repeat clients of mine, welcomed their twin girls, Noelle Elise and Evelynn Rose on July 21, 2021! Their arrival was a far cry from the birth of their big brother, who came barreling into the world quickly via an induction at 38-weeks. Rebecca knew that carrying and birthing twins would be different, but she maintained her desire to birth them vaginally with as little intervention as possible. She was hopeful for the chance to birth them without pain medications too, just as she had done the first time.

However, this pregnancy required a lot of changes for Rebecca. The providers who had taken such excellent care of her during her first pregnancy, were unable to take care of her this time due to a recent type 2 diabetes diagnosis. Rebecca switched providers but was left feeling unheard and unsupported. But that wasn’t even the half of it because a month later, Rebecca and Jason learned that they would be welcoming twins! This catapulted Rebecca’s pregnancy into a completely different high-risk category. Her pregnancy was riddled with extra ultrasounds and NSTs, not to mention elevated concerns that were voiced simply by virtue of the fact that she was growing two babies. Rebecca did not let the risks get to her and she continued the journey of awe and wonder at two new lives, while also feeling the shifting and stretching of her own body to accommodate her girls. There was her firstborn to take care of too, still a toddler himself. Rebecca’s aching body was stretched thin with the daily tasks of mothering in addition to the pregnancy. Jason was a huge help, but he couldn’t carry the babies for her.

Continued red flags inspired Rebecca to switch her providers again. She was 6 months into her pregnancy, but she felt much relieved after making that change. (It’s never too late to follow your instincts, mamas!) Unlike her first pregnancy, Rebecca’s cervix remained closed, a herculean task considering it dilated significantly before labor for her singleton pregnancy! It was especially critical since her uterus housed two babies. Her cervix really stepped up this time and held those babies in nicely.

Then Rebecca was hit with another surprise. Her babies were in the breech position. Both of them. She tried to do everything within her power to encourage them to rotate head down, but they simply wouldn’t budge. And the more time passed, the bigger they grew, and the less likely they were to turn. Rebecca had to face the reality of a c-section for the birth of her girls, a very different birth than the one she imagined for them. She did great job of embracing the change in plans and marveled in the miracle of growing and birthing two babies, by whatever means. Her cervix remained closed for the twins, unlike with her first, and she managed even better bloodwork too. As the weeks ticked by with no change in position, the c-section was scheduled for July 21.

Just prior to 37-weeks, Rebecca’s blood pressure was high at a prenatal appointment. Thankfully the labs came back fine, and she went home to wait out the last couple of days before the scheduled c-section. She was left waiting all the way to the end! Then on the day of the c-section the labor and delivery unit was hopping. It was a popular birthday! And another woman requiring a more urgent c-section cut in front of Rebecca, leaving her waiting even longer to meet her babies. But she was so patient. After all, she had already waited months, what was another couple of hours?

Finally, the OR was available, and it was Rebecca’s turn. Baby A, Noelle Elise, was born first at 3:57 pm. She was smaller but very strong. Evelynn Rose, Baby B, was born second at 3:59 pm. She was larger but had some breathing struggles at first. And the babies were two very different weights! Noelle was 5 lb. 12 oz. and Evelynn was a whopping 7 lb. 12 oz.! Turns out there was a very big reason why their weights were so disproportionate. Noelle’s umbilical cord was attached to the placenta by a velamentous cord insertion, which means the veins were attached to the membranes of the amniotic sac before they joined the placenta. This meant that Noelle was close to potential danger the entire pregnancy with her lifeline extremely vulnerable to a kick or really anything, and it also helped explain the 2-pound difference in their weights. It was a very good thing she was born by c-section and there were no attempts to rotate her externally. In the end, it was a godsend really, because it kept one more risk factor out of the picture and out of Rebecca’s (and her providers’) mind. And as if that wasn’t enough, Evelynn’s cord was a marginal insertion to the placenta, which isn’t the sturdiest by any means. Two babies. Two miracles for so many reasons!

Noelle snuggled with her mom in the PACU while Evelynn got the breathing support she needed in the special care nursery. She remained there for several days but made it home with her family that first week. The first night at home with everyone was an experience indeed. Family support and flexibility would be their best resources in the early weeks, much like during the pregnancy.

Rebecca struck a balance between advocating for her preferences and making decisions for the safety of her babies. She relinquished control and let go of a lot. She sacrificed so much growing two babies and even ended up with a very different birth experience. But at our postpartum visit, she was tired but happy. She had family at home to help, and her babies were thriving—all three. And to this day she is still breastfeeding. I am so proud of this mom! And I will not soon forget her story and how both of her babies were miracles who were protected from potential grave harm the entire time. Now that is a true miracle!