Emma planned a home birth for her twins, and gave birth to them shortly after transferring to hospital for slow progress.
While I was pregnant with twins, I read some birth stories entitled "Can a twin birth be a positive experience?". Now I'm on the other side I can safely answer Yes. Or should I say Yes, if you have the right midwifery support.
My twins were born at 41 weeks, at 7lbs and 6lbs respectively, with a lot of gas and air but no epidural. They weren't my first children, I also have a three year old son, and I did labour gently and slowly on and off for about four days before transferring to the hospital to have them. Within two hours of transferring, I was back at home eating bacon and eggs with two baby bundles beside me in bed.
One woman's birth plan is another's idea of hell, and mine included wanting to birth the twins naturally. Had I opted for an elective Caesarean I would have been whisked in without much fuss. But I had chosen the wrong hospital in Chelsea & Westminster to deliver my twins naturally, especially when twin two was presented breech. Yes, it was possible they said, but I was technically high risk and would be expected to deliver in theatre with a dozen or so people present. The prospect of having to perform in front of so many, with their knives at the ready, made me sleepless for a week. After meeting with the head of the labour ward, the head of the community midwives and my obstetrician again, none of whom could give me any real assurance of supporting for a natural twin breech delivery, I opted to pay privately for independent midwives. At £2,600 it was a loan that was meant for the bathroom. Getting rid of the avocado suite could wait.
Before I booked to deliver with independent midwives, I was in a state of fear. I had booked myself in at the Chelsea & Westminster because St George's Hospital, Tooting seemed too dirty and old and Queen Charlotte's was about to move premises. Unless you are in the catchment area for Queen Charlottes' one-to-one midwife scheme (and I did consider moving in with a friend who had had a very good experience on it), both hospitals had similar twin birth policies.
But time was running out. I had only discovered about hospital protocols at 30 weeks at the first appointment with the obstetrician where he mentioned that 36 weeks was what was considered term for twin pregnancies. I have since learnt that many normal twin pregnancies settle down and go to term when the women are relaxed about their plans for birth.
I spent the next two weeks before the second appointment with my obstetrician to find out whether I could deliver how I wanted to on the NHS. It seemed unlikely. There is no test case yet for a mother who has insisted on a home birth for twins, technically a women's right, because nobody has braved the prospect of having inexperienced midwives to delivery on the day. The traditional response is it is all for the safety of the babies which undermines the mother who would not only never sacrifice their babies' wellbeing but also wants her own considered. I wanted to be able to care for my babies the next day without feeling as I did with my first birth - epidural and stitches - like I had been run over by a bus.
Accepting that the obstetricians were bound by the hospital guidelines, I attempted to assert my right to opt for midwife only care . However the head of the labour ward had her hands tied, she told me that of the 70 or so midwives on their rota, only 7 were experienced with a breech twin delivery and there was no guarantee that they could bring them in for the day of birth. Bringing in an experienced Independent Midwife, by this time I had been talking to Mary Cronk - one of the most experienced midwives in the country - as a Bank Midwife for the day was also banned under the hospital policy.
I'd come to the end of the road with the NHS and so I decided to go pay for the care I wanted. The options were then to go for Caroline Flint and her birth centre adjoining St George's (around £3,500) or to have three independent midwives to birth at home.
I've always associated home births with joss sticks, whale music and sandal wearing, and thought I was an unlikely candidate. But the difference in having dedicated midwives, visiting me every other day in the run-up to delivery and being able to discuss in detail how labour might progress was immensely reassuring. Being a coward I wanted to know their drugs for pain relief - pethidine and gas & air - but on the day it really is true that you are more comfortable in your own surroundings and not frozen by the pain. The midwives also get to know the babies, how they lie, how they are presented so it takes the big drama out of being checked into hospital.
With hindsight, what with going over due by nearly a week, having a false labour (an early start) and going on and off the boil for four days, I would almost definitely have been under the knife in hospital. But with the midwives at home, we just made more sandwiches and tea (you can eat and move around at home) and carried on waiting.
I was also reassured to learn that the main reason for transferring to hospital is when labour is not progressing. There is therefore no particular need to call an ambulance, although if you are bluelighted in you are also likely to get the best care as all the relevant staff are put on alert for your arrival. In the end, my need to transfer was because I had dilated to 6 to 8 cms and then gone backwards. My waters still hadn't broken and the midwives were reluctant to do this at home because there was a very slim chance that the cord might come down first and safety came first.
Transferring to the hospital with two of the three midwives, my contractions started to increase to every five minutes. Having them at my side meant I had no fears about entering the delivery ward as they had telephoned ahead to ask them to prepare a room and had all my notes with them. It was like having two guardian angels either side with sixty years experience between them.
Because the independent midwives had kept in touch with the hospital midwives throughout labour, we were welcomed into the ward and whisked into a suite. My waters were broken and I got on my hands and knees like we had practised over the previous weeks. The gas and air was there on tap and was a useful tool for telling the midwives when contractions were coming, because I started sucking on it as soon as I felt them.
Within fifteen minutes Michael was born (yes, it bloody hurt - but only for a few pushes), and with the cord clamped but not cut he was brought round for me to admire. I had to stay on my hands and knees because the job was only half done, and after ten minutes of cooing at this shrieking little being (his apgar score for pinkness and alertness was 10-10 out of 10), the contractions returned. Millie was born five minutes later, and although instructions to push were difficult to carry out because the muscles in my stomach seemed to have disappeared with Michael (at home the third midwife's job is to hold the top of the stomach so you have something to push against), Michael had done all the work in preparing the way. Millie was born easily with just a couple of pushes, the breech delivery that had been the subject of so much talk and worry was over in five minutes.
Third stage, pushing out the placenta, was also done without need for syntometrine nor episiotomy. I had only lost 100ml of blood and it couldn't have gone better. I felt completely elated and the high from the birth lasted for a good few weeks. Plus, unlike my first birth, I didn't have a hangover from the different drugs so I was in better shape for the night feeding.
Because I hadn't prepared for a hospital birth, however, I had forgotten to pack nappies, babygros and car seats. The twins' first outing into the world was done with them wrapped in hospital blankets and the midwives' scarves. Well, you can't prepare for everything.
Emma wrote about her twin birth in The Times -
Before the birth.... (The Times, Saturday 13th January 2001)
And afterwards (The Times, Saturday 3rd March 2001)
Emma's birth story also appeared in the July edition of Prima Baby magazine.
FAssociation of Radical Midwives page on twin birth. At the bottom of that page you will find links to a number of other articles on the same subject.
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