Ixchel and Kali, a homebirth of twins

Tara: Choosing a homebirth for twins was a huge responsibility. Having an epidural was “highly recommended” (does that mean required?) at Kaiser. I asked my OB if I’d have to sign a waiver if I did not get an epidural, she said she didn’t know. With over 50% cesarean rates and nearly 100% epidural rates for twins at San Francisco Kaiser, I knew that the birth I wanted to have would be a struggle in the hospital. I didn’t want my birth to be a battle. Believe me, I’m down with the struggle and have spent the last few years organizing and speaking truth to power, but I didn’t want my birth to be a space where I was challenging and battling against the paridigm. I wanted to be supported.

I had started working with a midwife when I found out I was pregnant and was planning a homebirth. I decided to get my second trimester ultrasound. At 17 weeks I found out that I was pregnant with two babies—not just one. I remembered what my midwife had said, “I don’t do twins at home.”

I was dedicated to a natural birth. I read everything I could find, asked lots of questions (and compared answers), did yoga, ate for three, rested, left one of my jobs, took herbs, got acupuncture, chiropractic care and massage. It was the most wellness care I’d done in my life. I was determined to have two healthy babies.

I continued working with my midwife Maria, she was to be my doula. At about 30 weeks in my pregnancy, I started having crazy anxiety whenever I thought about birthing at the hospital. It was clear that I would not be supported in having a natural, drug-free childbirth for my twins at the hospital. I wanted to start the journey of childbirth at home, without a needle in my back, an IV in my arm and electronic monitors strapping me to the bed.

Maria: Tara was to be my second set of twins at home where I would be primary. But I don’t “do” twins and breeches at home and even if you can convince me, we aren’t “doing “ twins at home until the second one is crowning. With all of this in mind, I waited until 37 weeks for our first marker of possibility.

At 41 weeks, I found myself canceling a flight to Phoenix for a Midwifery Education Acreditation Council board meeting. The twins had not arrived yet. As we waited passed 41 weeks and passed acupuncture appointments that didn’t bring on labor, I was again feeling unwilling to admit to “doing” these twins at home. Everything had to be just right. With each day that passed, I felt the pitocin induction inch nearer. Castor oil twice, acupuncture, homeopathics, stripping her membranes, western herbs, and no babies. Until 41 and 3 days.

 

Tara: Birth is creation, not a mathematical equation. This became my mantra as I became “overdue” with twins. Something unheard of in the world of induction and cesarean, where we are taught to fear our biggest power—the ability to transform light into life.
After two rounds of castor oil, seeing three different acupuncturists, black cohosh, blue cohosh, and rounds of pumping, it was my prenatal yoga class that started my labor at 41 and a half weeks of pregnancy.

Maria: Contractions started around 12:15 pm., early labor. When Tara called, I was thrilled and cautiously excited. As the evening progressed and the phone calls continued, I finally decided to go over to Tara’s house. It was around 10 pm. She was 2 and a half cm dilated. The labor seemed early but I was willing to stay the duration. Or so I thought. I sent Dina, who would video the birth, home to sleep and phoned the other midwives to say that I was here, just a head’s up, not time to come yet. Contractions were every 3 minutes, but short and not strong enough yet.

Tara: I thought that labor would be like jumping into an icy swim hole—you’re either in the water or out of the water and it’s a second where you cross the line and take the plunge. But unlike a swim hole, I couldn’t just swim to the edge of the water and hop out—my pre-labor dragged on and on. It took me a while to find my focus. In the beginning were the sharp sparks of contractions highlighting the confetti of my thoughts. Thoughts going in all directions, without focus, what had I gotten myself into? I was excruciatingly pregnant and there was only one way out, through these contractions.

Maria: As the early labor continued, I slept on the couch, trying to half listen to the rhythm and intensity of the contractions. When Tara went into her bedroom and shut the door, I couldn’t hear much but was aware when she got up to pee almost every hour. Contractions were consistent and I fell asleep hard from 3 to 6 am. With the light, the contractions waned and despite my “labor acupuncture” and some homeopathics, by 10 am, Tara was not in labor, and I was headed home. She had progressed to 3 cm. I had plenty to do and occupied my day with Tyler, my son, and the school auction.

Tara: I had to rest and let my contractions ease up, before I found my focus. I spent the day napping. I’d lost my appetite. In the afternoon, we went for a walk in the park. I was huge with babies. It was so hard to walk. I hung from this eucalyptus tree and it took the pressure off. Every few minutes, we’d stop and rest. My contractions were back and gaining consistency.

These were the contractions—the rushes of energy I had been waiting for. I had to surrender to them, give thanks for each one, and let each one do its work. Now my labor became like walking up a big, steep hill. I didn’t look at the top, but just took it one step at a time, making the most of each stride. For the rest of the afternoon and evening, I just lay on my side in my bed focusing on each surge, letting them open my cervix. At one point I felt my cervix jump open. My contractions were coming on deeper, longer and closer together. I could still walk and talk through them, but I preferred to focus on them. I called Maria to check in and we agreed that she’d come back over in a couple of hours.

Maria: Around 7:30pm, Pedro, Tara’s partner, called to say that Tara’s mom wanted to talk to me. She reported that the contractions were much longer (over 60 seconds) and stronger—every 5 minutes. I thought that this sounded like a much more functional labor pattern. I spoke with Tara and asked her if she wanted me to come over. She said maybe in an hour. I told her I would be there at 9 pm and she said that would be perfect.

At 9:15pm, Dina and I arrived at the house. Kenda, a friend, and Tara’s other sister, Sarai, were already there along with her Mom, sister Zarine and son Oscar. Because of the number of people there, the excitement was high. In Tara’s bedroom, Tara was calm and chatty, almost normal except for a quiet concentration every few minutes. She was eager to be checked.

When I checked her, it was not what I expected. And when that happens, I always “check again,” trailing my fingers back and forth, reading the contours that define midwifery information. I couldn’t feel any cervix, just a loose bulging bag and a baby’s head with a very large fontanel and mobile parietal bones. When I called the midwives, I was still unsure of my conclusion. How could she be complete if she is so calm and with no pushing urge? I had to go with the only conclusion I had though, and told all the midwives to come. NOW.

Tara: Maria arrived and we listened to the babies’ heartbeats, everything sounded great. She did an internal check of my cervix and got the funniest look on her face—I was fully dilated. She immediately began calling the other midwives.

We lit the altar and Pedro smudged me with sage and purified the space. I hung out in the birthing tub until the other midwives arrived. It was the dream team, so much wisdom and grace, the perfect gateway for life. They arrived like the four directions, in perfect timing. Everyone who was supposed to be at the birth quickly arrived. It was such an empowering feeling; I had arrived at the peak of the birth without realizing it. It was intensity and beauty.

Maria: I quickly ran around setting things up, asking Tara not to push until at least one of my midwives arrived. Please. Tara calmly reminded me that this is what I had dreamed. Yes, of course—I had 2 dreams that the babies were coming so quickly that I was the only one at the house, scrambling to get everything ready.

By 10:30 pm, the midwives were arriving and Tara was on hands and knees in the tub, blowing through her beginning sensations of pushing. With all of the midwives there, we also tried having Tara sit on the edge of the futon bed. Ultimately, on the toilet, Tara felt the familiarity of pushing and started to bring the first baby down. With only a few pushes to go, we moved to a birthing stool in the living room.

Tara: The next two hours were super intense. I had full trust in my babies to be born, in Maria to guide me, and my body to birth the babies. My body knows how to give birth; my babies know how to be born.

We were chilling, until a drop stained with heavy meconium dripped from me. So the pushing was on.
Maria: The meconium was liquid black, like what I would imagine crude oil looks like. A good size drop landed on the white chux, making its presence known. I still felt a bulging bag though on Baby A. With a few deep decels, I felt that it was time for the first baby to come.

Most people call me the quiet rock in the corner. I think it is apropos. And then, I am known to give “the Maria pep talk.” When I am firm, the moms know.

Tara: Within an hour I pushed Ixchel out through the intensity, through the pain. She lay on my belly, silver body with black opal eyes glistening. Her head was warm against my lips. I looked down and saw she was our baby girl. But she was barely crying, she was having trouble breathing. One of the midwives took her and started clearing her lungs and giving her oxygen.

Maria: Tara birthed Ixchel Elena Yolanda soon after I told her it was really time for this baby to be born. The baby was small but cried in the first minutes. She would settle into an uneasy, but steady breathing pattern.

In the meantime, my attention turned to Tara and Baby B, as Cindy, one of the assistant midwives, took over Ixchel’s care. With my hand inside Tara’s vagina, I searched for a presenting part. Instead I found a “hamburger” like prominence—the placenta. Was I told that the placenta was low-lying? We had about 2 cups of blood already in the bowl below the birthing stool. Without much time to really process the catastrophic impact a partial separation of the placenta might have, I held the placental lobe up against the uterine wall long enough for the second baby to come down and begin her descent. Her heartones were strong throughout.

Tara: Maria brought my focus back to the second baby. It was such an odd feeling to have one baby on the outside of my belly and one on the inside. Another of the midwives put all her pressure on the baby in my belly to keep her from going breech. I looked down, my belly was covered in blood from the first birth (or so I thought). I was walking the line—a fragment of light that separated life from death. Yet, I knew I was in the light, never did I doubt for a moment that the three of us walked in the light of life.

Maria: As the presenting part arrived at my fingertips, I could feel that it was bumpy. Was this something else that was common to twins that I just didn’t know about? Again, the sweep back and forth of my fingers, trying to read the braille of a baby’s face. Nostrils, the globe of an eyelid, gums and chin. But there is only one way that a face can be born. And this wasn’t it. I pressed on the chin, trying to flex the head but with a better exam, I realized the occiput was too far back to come forward. Again, firm words to Tara to push and my fingers rotating from the inside, brought the baby into correct mentum anterior alignment.

Tara: The energy in the room was thick and intense. I was having trouble feeling my contractions and they seemed to be slowing down. Maria told me I had to push as hard as I could when she told me to, with or without a contraction. I later found out that she was rotating the baby internally; I couldn’t really even feel her fingers all up in me. With all my force and focus I pushed—deeper and longer—I could feel the baby moving down.

Maria: Throughout, the second baby’s heart tones were good. My later assessment would be that the part of the placenta that had separated was her sister’s and that Kali’s placenta had always remained firmly attached until she was safely delivered. As Tara pushed, a dark bubble began to emerge that fooled some people into thinking they were seeing another head of hair coming through. I knew though that a baby’s face was just behind the curtain. I didn’t want to tell Tara, fearing she would lose her confidence. I didn’t want to tell Amrit, the midwife to Tara’s left, fearing she would lose her cool. Right before Kali Paz was born, Amrit asked me, “Do you have a presenting part?” I quietly told her, “It’s a face.” Tara heard too. In a crescendo of midwives’ pleadings, Tara brought the face to the opening. As I broke the bag and the opaque curtain came down, a perfect, little, upside-down, vernix-highlighted face crowned. Kali Paz was born quickly after and breathed well.

Tara: As she entered the birth canal, I heard Maria say “face presentation.” I knew that I couldn’t mess around. I pushed deeper and longer and Kali was born, like a comet facing the world, her face coming out first. Our older son, Oscar, cut Kali’s chord.

I birthed the placenta with ease and then hemorrhaged. I was quickly given pitocin and an IV.

Maria: The large conjoined placentas were born quickly after with no initial excess bleeding. It was only after an initial welcoming moment of joy and wonder that we needed to turn our attentions back to Tara. Amrit and I had already planned the scenario. She would hold the uterus while I inserted the IV. As soon as Griselda thought aloud that Tara could use an IV, the plan was set in motion. I placed the IV smoothly and quickly into her left forearm, we added pitocin to the bag, and kept her in a side-lying position until the nausea subsided and again Tara was chatting away with us.

Tara would briefly feel shocky for a second time in the postpartum that prompted a dose of IM methergine and later an oral dose that she continued throughout the first 24 hours. In all she lost between 8 and 9 cups of blood. It wasn’t until 14 hours after the birth that she could actually walk to the bathroom to pee.

Throughout the initial 2 hours postpartum, Ixchel had a hard time breathing. She had grunting, flaring, and retractions. Her color was dark and her tone was low. Cindy at first tried to warm her up or to use PPV to clear her lungs. Ultimately as we approached the 2 hour mark with her breathing not improving, we decided she needed to go to the hospital. Having used up 4 oxygen tanks already between the decels during 2nd stage, Tara’s feeling shocky and blood loss postpartum, and Ixchel’s needing PPV and blow-by, we decided to call EMS to take the baby. They would be able to give her oxygen en route. Cindy, Pedro, and Michelle went with Ixchel to San Francisco General Hospital. There she received excellent care for meconium aspiration and we also learned that she had polycythemia, explaining her darker color. Polycythemia is elevated levels of hemoglobin. Her hematocrit was in the 80s. Most interesting is that this is often due to chronic hypoxia, prematurity and placental insufficiency. Ixchel definitely didn’t look like a 41 and a half week baby. Her parietal bones were still mobile and her anterior fontanel was wide open. She looked more like 36 weeks. These babies knew all along that they needed to cook as long as they did.

Tara: Kali and Ixchel’s birth was not with out complications. I was grateful that we could transfer Ixchel to the hospital, when we knew that her breathing had not stabilized. Yet, if I had birthed in the hospital, I know that I would probably have had an epidural and maybe even a c-section. During my labor, I never even thought of needing a painkiller. I don’t remember pain or discomfort really being that much of a focus. It was intense work. I give thanks to Maria and the incredible team of midwives she put together. I also give thanks that we had access to a hospital where Ixchel got the care she needed to get the meconium out of her lungs.

Giving birth to Kali and Ixchel is the most sacred powerful event of my life. A homebirth with twins, natural birth from my own power is a truly revolutionary act in our society that fears women’s power of creation. Where science is the religion and technology is worshiped. I give thanks to Maria and other midwives for holding the space where birth can be honored as a ceremony—a transformation, instead of being seen as a medical procedure.

Giving birth is the most sacred ceremony. You become the energy of both death and life—they tug at each other and you must believe in your power to give life. Giving birth you face your fears and your doubts, you must transcend these—then true transformation is yours.


Here is the poem Maria wrote for Tara afterwards:

For Tara— the mother of goddesses

Blessed are the births
of those who trust life,
of those who trust the babies,
of those who trust themselves.

Blessed are the births
of those who are willing to stand
at the precipice of life,
acknowledging our vulnerability,
and the uncertainty of tomorrow.

Blessed are those that stand at the edge.
Blessed are those that call out to the universe
in celebration
and wonder
despite the fear of falling.

We embrace the edge with arms outstretched.
From here,
we see out to the horizon of possibility.

A strong gust of wind could knock us off balance,
or
our feet
firmly planted
can hold us in place
facing the truth.

Blessed are the births
of those who trust life,
of those who trust the lessons,
of those who trust within.

Blessed are the births
of those who stand together
of those who are willing to stand alone
of those who call birth: peace
and hope
and love.

Blessed are the births.