VBAC Triplet Birth at Home

The medical community has woman so scared of their bodies and giving birth that its no wonder woman either put it off all together or stop at one or two. I was watching the new show Deliver Me on Discovery Health last night and it was awful. So far I have seen only one woman give birth without having a C-section, it was really quite alarming watching how much fear these Dr's put into the minds of the woman under their care.

Then I came across this beautiful story of a mom who delivered triplets (thought to be twins) at home, a full seven days after her due date, all average singleton weights. Enjoy!!

By A. Midwife
Here is the story of Eleanor and her triplets. I was her midwife and have been inclined to be pretty quiet about it for a couple of reasons: 1) what I am doing in this town is clearly illegal, and I don't want to draw attention to it, and 2) although it may not seem so from this story, I think of myself as a relatively cautious midwife and don't want to encourage other to do high risk births lightly.When I first started seeing Eleanor, she seemed quite low risk to me. She's a healthy, active woman, and she and her husband seem very solid and reliable. Her first child had been born by C-section after a positive herpes culture at term. I don't encourage VBAC (Vaginal Birth After Cesarean) home births, but will help with them if the parents are very clear about their decision. With a healthy mom, I don't think there's any significantly increased risk after one lower segment transverse C-section, but there is no medical backup available. Obstetricians here treat VBACs as a "trial of labor" and do a repeat C-section as soon as the mother varies even slightly from textbook "normal." Family practice doctors are not even allowed to deliver VBACs at the local hospital. It looks to me that the odds of actually having a vaginal birth after a C-section with local obstetricians are not all that good.

Early in pregnancy, I thought Eleanor's dates were wrong because of how big she was getting. By 25 weeks we were sure it couldn't just be an earlier baby--she was growing so fast her belly looked like 32 weeks, but her arms and legs were still thin. So, Eleanor and Gary, her husband, and I talked for a long time. I told them I had never caught twins before and wasn't entirely comfortable with the combination of VBAC and twins. I had helped with unexpected breeches often enough that it wasn't the chance of one being in there butt first that worried me. As we talked and gathered information, we realized that no local obstetrician was likely to allow her to even attempt to have the babies vaginally. The standard treatment for twins in a mother with a previous cesarean (locally) is repeat C-section at 38 weeks (so the uterus doesn't grow too big and rupture).So I agreed to help them do their prenatal care and see what things felt like when she got closer to term. I didn't feel right sending her off for a lot of obstetric technology she didn't want and a C-section she didn't need, so we started looking for ways to make it feel safe at home.

First, we discussed adding even more protein and calories to her already excellent diet. I gave her The Brewer Medical Diet for Normal and High Risk Pregnancy, which she read and followed. Then we decided to ask the other local midwife to help, so we'd have two experienced people at the birth. Later we decided to call another ex-midwife we knew out of retirement so that we were sure we'd have plenty of minds and hands for whatever developed.We all studied what we could find about twins. After reading one book, Gary asked if I thought there could be more than two. I thought it was a joke: triplets are pretty rare [outside IVF], and by that time, I could clearly feel two babies and hear two heartbeats. I told him an ultrasound might show, but they didn't want one and I really didn't take the possibility of more than two babies very seriously. We all watched the Farm video of a twin birth. It seemed a bit more conservative than we were being. I wished we had a nice out of hospital birthing center staffed by midwives. But since Eleanor had Gary couldn't travel for the birth, it seemed our choices were either home or the whole technological obstetrical scene. I began to feel more certain that we were doing best by choosing home.

Eleanor's belly grew enormous! At almost every visit, we would marvel at how big she was getting and tell her to eat even more, because her arms and legs were still very thin. The two babies we could feel and hear were obviously active and healthy. One was head down, with the head nicely in the pelvis and that baby was obviously coming first. Another, very active baby was head up, in front and a little to one side of the other one. Both babies felt big, so we guessed she was going to have 8 1/2 to 9 lb. twins.In her last month, Eleanor's blood pressure stared to creep up, and she was spilling a little bit of protein in her urine. We visited her at home and found her blood pressure was normal lying on her side, and her reflexes were all normal. We sent a 24 hour urine test to a local lab, which came back all right. We advised her that she spend most of her time lying on her side, getting 200 grams of protein a day, and eating almost constantly. We visited every other day and always found Eleanor's blood pressure all right. Her husband took off from work the last few weeks and spent all his time feeding her*.

Eleanor called me at 1:00 am, one week after her due date*. She wasn't sure it was labor and wanted me to come over and check before calling out the entire crew. She hadn't timed contractions yet and could still talk through them, but they'd been intensifying for about one hour. When I got there (about half an hour later), two babies' heart tones sounded good, Eleanor's blood pressure was normal lying on her side, and her cervix was 6-7 cm, completely effaced, with the water bag bulging. Contractions were harder, and she breathed with them. It didn't seem like there was any need to get her up to make things go faster, so she stayed in bed, except when she had to pee. She had had her third dinner at about 11:00 pm and was drinking tea with honey. I called the other midwives.

The babies and Eleanor continued to do well as contractions intensified. She started to feel an urge to push around 3:00 am, and we were glad to see the rest of the crew arrive. She was completely dilated with the head in occiput posterior position. A half hour or so of pushes and the head rotated, the water bag broke and the baby came down slowly. A healthy, nice-sized baby boy was born just before 4:00 a.m. (we made up exact times later). He was alert, with an Apgar of 10. I cut the cord and checked for the presentation of the next baby. One of the other midwives was taking care of the first baby, who was calmly looking around. The second baby was confusing; I thought I could feel both head and feet up pretty high through intact membranes. But as I checked, the head started coming down and a baby girl just squirted out, with the membranes breaking as her shoulders emerged. I cleaned the fluid off her face, and she breathed and turned pink and looked at me, obviously fine--another Apgar 10.

I was a little behind Eleanor, and her friend, who was holding up her leg, obstructed my view of her belly. After the second term size baby came out, Eleanor said her belly was still big. She was looking at her babies. I didn't realize right away how big and thought about blood collecting from a detached placenta. Then she bled about a quarter of a cup of blood all at once. I put on clean gloves to reach in and see what was going on and felt a foot way up high. I told Eleanor and Gary there was another one and asked Eleanor to feel her belly and be sure it felt longitudinal. It did. I pulled the foot down gently (still in bag) and found the other foot and brought that down. My partner couldn't find fetal heart tones, so I reached in (the baby was face up), turned her to face down and brought her bottom down to the perineum (feet out). Then a 7 lb. girl was born with Eleanor pushing and my partner putting pressure on the head to keep it flexed and me freeing the arms all at once. She was a little depressed, with a good strong heartbeat, starting to breathe, but a little pale and floppy. I handed her to my partner with instructions to get her going (instructions weren't needed). A little stimulation got her pinked up within a minute and crying and active by five minutes.

Eleanor was bleeding, so I worked with the cords while she pushed and got out one single and two stuck together placentas. Bimanual compression of the uterus and 2 amps pitocin, IM, stopped the bleeding before she had lost enough to bother her. With all the fluid and blood and meconium all over everything, it was hard to tell exactly how much she bled, but she felt fine when she sat up.There was a small, first degree midline tear.

All three babies nursed within the first hour. When we finally settled down enough to weigh them: the first boy, 6 lb. 7 oz.; the first girl, 6 lb. 14 oz.; and the second girl, 7 lb.Eleanor had a little trouble peeing right at first, which cleared up within a few hours after birth. She also had trouble getting her balance to walk for a week or so, because her skin was so loose that her belly swung around back and forth when she moved, which felt weird.Four months later, all three kids are still alert and obviously healthy. They are entirely breastfed and are growing and developing better than average.