All photos by Britt Fohrman
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Maria Iorillo
Licensed Midwife

Thirty-Nine Weeks and Four Days….

I was excited. After my 3rd time through IVF (in-vitro fertilization) I was pregnant with a sibling for my older daughter Isabel. Isabel was also an IVF baby… her father had passed away from a rare and aggressive form of cancer before she was conceived. Since her father was not here on this earth it was important to

me that there would be a sibling for her to share her life with in addition to me. We soon found out it looked like she would be getting two siblings rather then just one – I was pregnant with twins. I was thrilled by the news yet I was sad I might not be able to do a homebirth. Every since the wonderful natural birth experience I had shared with Isabel I had been looking forward to doing a homebirth should I ever get pregnant again. However, like so many people I assumed all twins were born early and most required c-sections. I am glad I was wrong.

As I passed through the critical early milestones of an IVF pregnancy I started to investigate my options for the twin’s births. Through the network of doulas I had developed with Isabel’s birth I discovered it was possible to have a twin home birth if all the stars aligned and there was a wonderful midwife in San Francisco where I lived who had done twin homebirths before. Perhaps my dream could still come true.

I am thrilled to say that despite several bumps in the road I did manage to have a twin homebirth thanks to an amazing set of midwives and doulas who worked with me and my good friend Lori. All-in-all there were five midwives at the birth (one for me, a back up for me, one for each twin, and the midwife from my daughter's birth who came to provide me spiritual and emotional support). Additionally I had my doula with whom I had been working on relaxation yoga and most recently deep relaxation/hypno-birthing along with another doula who was taking photos and a midwife in training who documented the birth. It was a full house of incredible women for whom I am very indebted. The births were everything I had hoped for and more… "intense... loving... focused... relaxed... warm... spiritual... emotional...amazing...blessed." Following our birth story….

Three long weeks….
Overall I had a wonderful twin pregnancy until I hit the 37 week mark. This is the time I thought I would celebrate as it meant I could attempts a homebirth if no other issues came up. Unfortunately it became a very stressful time as an ultrasound measurement estimated twin B (my daughter) was under the 10th percentile in weight and there was an abnormal Fetal Doppler test result. The doctors at the back-up hospital I was being seen at immediately wanted me to be induced. I was not mentally, emotionally, or practically ready for induction (my older daughter was being dropped off at home in an hour – I had things to do!). After extensive conversations with my midwife and others in my support network I choose to leave the hospital and do increased testing rather then induce at this point.

I “knew” as they say a mother “knows” that my babies were fine in my belly. The non-stress tests I had been doing seemed to indicate twin B was very active (and I felt her move all the time outside of the tests as well). Unfortunately, there is a seed of doubt placed every time someone puts something in front of you that indicates there “might” be something wrong. Every time I went in for testing at the hospital they seemed to find something that might indicate something might possibly be wrong. Every time I assessed the information and determined there was not enough there to convince me my unborn children would be better being induced in the hospital then they were in my belly. Still, I did wonder in the back of my mind if I was putting my unborn children in danger… was I taking unnecessary risks?

To avoid being induced at the hospital, my initial reaction had been to try to more “natural” methods to speed the arrival of the twins (if speeding up a birth can be called natural) and still have a home birth. At 37 – 38 weeks I tried acupuncture, castor oil, pressure points, various labor inducing herbs…The babies were not coming. I was stressing myself out rather then taking care of them in my belly. After trying it all once I realized perhaps the twins just needed more time in the belly and decided to relax and do the best I could to help them grow and flourish in my belly before making their big journey into the outside world. The challenge to relaxing however was the continual testing I was being asked to do and all the seeds of doubt the doctors were placing in my mind about my placenta wearing out and twin B being at risk. To pacify the doctors at the hospital I did schedule an induction date though I hoped and prayed it would not be necessary.

Time continued to pass… 38 weeks…39 weeks… and I kept waking up each morning with a big belly and I kept moving my potential induction date at the hospital. After 3 or 4 changes, I finally came to a final agreement with my doctor that once I hit April 7th (almost 41 weeks) I would not move my induction anymore and at that point I would induce at the hospital. The plan for induction was to rupturing my membrane since I was already over 3cm dilated and had lost my mucus plug. The thinking of my birthing team was since it would be this easy to do this at the hospital we could also try the same approach at home. If the attempted induction did not work at home it would be easy enough to transfer to the hospital afterwards.

Four amazing hours….
It was March 31st… I was 39 weeks and 4 days into my pregnancy. At approximately 9:30pm I tucked up in bed after putting Isabel to sleep. I felt something funny in my belly and had to go pee. Sitting in the bathroom I began to think this was much more then I had thought was possible for my bladder to hold at this point. Additionally the water in the toilet still looked pretty clear after I was done “peeing”. I called my doula Rachel and told her my water “might” have broken – she listened to my story and said she was coming right over…Isabel had been born in 6 hours and if that had been my water breaking most likely there was not a lot of time to waste. With Rachel on her way I called my friend Lori and went to work to fill the birthing tub with limited success. Approximately 30 minutes later I welcomed the arrival of my contractions and my doula Rachel who quickly got me to focus on the contractions while she dealt with the birthing tub.

With Rachel’s help we worked on welcoming the contractions as they helped prepare my body for the birth of my children. We even had a brief moment of comedy when Rachel suggested I take a deep cleansing breath between my contractions. She noticed I was not taking any deep cleansing breaths and after a moment or two she asked if I was having any breaks between my contractions… there was almost a slight chuckle from me as I indicated “no.”

My midwife Maria was the next to arrive and she put in a hep lock (the preparations for an IV) as I was undergoing serious contractions so that I would be ready to have an IV should I need one after the birth. It is never fun to get a needle put into your arm – particularly when one is undergoing contractions. Furthermore my veins roll so it took Maria three times but her persistence paid off and she was successful (good thing too as I did need the IV in the end).

My girlfriend Lori was soon to arrive as well... my recollection of this being the relaxing massage she was giving my lower back as I breathed into the contractions which seemed to come one right after another. Lori had helped me through the birth of my elder daughter and that experience paid off – she was well skilled at how to help keep me relaxed and supported.

With the hep lock in place, the birthing tub full, and my progression going very quickly I was invited to get into the water. Being a water lover this was a heavenly experience beyond words. As the water lifted the weight off my bones I focused deeply on Rachel’s guidance around relaxing and breathing my son down the birth canal. Between the intense sensations my body would swim in the water. As my son moved down it was time to push … before I knew it, with a few very focused and intense pushes I had my son Desmond in my arms. Per the midwife’s notes “He made a strong cry at 12:56am.” It was beyond my imagination, my son (who was a grand 7lbs 3ozs) was in my arms, on my chest, and practicing his first latch with great expertise.

After a few minutes it was time to refocus as my daughter still needed to complete her journey. To help engage her in the birth canal we decided it was best to have me get out of the tub and move to the bed. With my son on my chest nursing, I focused on helping my daughter through the last stages of her birth. As she moved down it became time to push. A few intense pushes, approximately 40 minutes after my son’s birth, my daughter Abigail emerged … It was 1:37am as she slid out of the birthing canal, was given some oxygen and was wrapped in a warming blanket as she was handed up to me. In contrast to her brother she was a delicate but strong 4lbs 10 ozs.

It was hard to believe that both these little people had just moments before been living in my belly. I now had Desmond and Abigail in my arms and everyone was fine…this truly was a slice of heaven on earth. We had done it!

The Placentas….
After having some time to bond with Desmond and Abigail it was yet again time to focus – this time on birthing the placentas that had given them their nourishment during the almost 10 months they were in my belly. Unfortunately, as with the birth of my first daughter, I was having a hard time birthing the placenta. As I was not bleeding very much I took some time with the newest additions to my family and working with my extensive birthing team on various different ways to potentially birth the placentas. We tried lying down, squatting, pulling, and lying down again. The birthing team helped me with visualizations and relaxations and nothing seemed to bring success. In the end we decided it would be best to transferred to the hospital to have the placenta manually removed in the Operating Room rather then risk infection or an incomplete removal from trying to manually remove the placenta at my home.

Fortunately I was only 10 minutes from the hospital and they were ready and able to take me in very quickly once we arrived. As we were checking in the nurse asked who I wanted to bring into the OR with me. When I told her both my midwife and my doula she said I had to pick. I calmly told her I was planning on both of then coming and my doctor had said it would be ok. She needed to check with the attending physician which was fine with us. In the end they both came with me which was wonderful as I needed both their support for the procedure I was about to undergo.

As explained to me by the doctors in the OR, removing the placenta would involve manually reaching inside the uterus and separating the placenta from the uterine wall. To make sure everything was removed they would take a scraping tool to clean off the walls of the uterus. It sounded like a rather unpleasant experience and it can be very painful. Fortunately for me, Rachel worked with me on a very deep relaxation as we went through the procedure and we were able to get the placenta out on the first try and with no drugs.

After the procedure as we were brought into the recovery room where the nurse informed me the hospital wanted to keep me for observation for a little while since I had lost a lot of blood during the procedure. When I found out a “little while” to them was around 6 hours or so I calmly let them know that would not be possible, but that I could probably stay 30 – 60 minutes. I then began to focus on eating and getting my energy back so I would be allowed to leave and return to Desmond and Abigail who were waiting for me at home.

Fortunately I was able to quickly “pass the tests” and was allowed to leave the hospital after signing some more forms indicating I was doing this against the hospital’s recommendation. Soon, I was back at home with my babies. As I walked into the room and saw Lori holding one of the babies she said “They are going to be so happy to see you – they like sucking on my fingers and all but …” Soon I was tucked up with the two of them suckling on my breasts….what a heavenly place to be!

The stars aligned…
I feel very fortunate to have had a natural home birth with twins as this requires a lot of things to go right. I was fortunate that I had di-di twins with their own placentas …both my babies were heads down with the bigger baby position to come out first…. the babies and I were all in good health…I had an amazing team of people to support me during the pregnancy…during the birth… and after the birth. We had their father up above in the heavens shining down on us. We were and we continue to be very blessed.