Twins and lack of consent

AIMS Journal, 2012, Vol 24 No 3

Kate Cox describes her experience birthing premature twins

I arrived at the Delivery Suite at 32+3 weeks gestation having regular contractions. I was scanned on arrival as both babies had seemed transverse for most of the pregnancy. The consultant could see that twin one was now oblique breech and twin two complete breech, so recommended I start to prepare for an elective caesarean section birth. I was not happy to do so at this point, since despite the myth that there is not enough room, twins are notorious for turning even during labour. I had four children at home to look after, as well as the impending stress of caring for preemies in hospital, which I knew would require the best physical condition I could achieve and I also did not want major surgery just because I did not want major surgery! I wanted the best outcome for all of us.

I had read about breech birth and devoured everything I could on outcomes and best positions, so I upped myself onto all fours and swayed my hips, speaking to my babies, praying and gently swinging. Eventually we had a VE which showed I was 4-5cms and the energy of the staff increased a little, with more talk about surgery. Not long after I asked for another VE as I felt that I was very close to birth and I wanted to know the position of twin one at this point. The midwife could feel a scrotum, so I felt reassured that baby was sufficiently well positioned to continue as we were. The registrar appeared and I asked when we'd know for sure if it was safe to birth vaginally. He said, 'when baby comes out or not.' At which point I felt my body relax and twin one came out in his sack.

Sadly, his cord was immediately cut and he was taken away from me; no chance to see his face, stroke his skin or smell him before they essentially stole him away to SCBU and banned both my husband and other birth partner from accompanying him. I still can't see evidence for why all this was necessary and he later had to be ventilated, which I am sure is linked to the rude awakening from his cosy womb.

The commotion then increased for me to turn over so they could scan and check twin two, but the waves of contractions had mercifully started up again and she made an appearance just four minutes later, in all her breech glory. I felt her body born, legs unfolding, a pause, then the head released.

Again, she was immediately taken away from me but briefly returned once they had given her inflation breaths. She was by far the weaker twin, but never needed ventilation. A Mother's touch, smell, sound makes a humble but profound difference. I can not help but wonder if either twin would have needed inflation breaths if their cords had been left and they had been offered a more gentle transition.

I know my case is not a full term story, but it is a breech story of a minor victory in a sea of disempowerment that made everything afterwards more endurable. It also made me realise the vulnerability of parental choice over medical advice, even when there is research to back up our parental choice. One might wonder when evidence based practice will truly be implemented, rather than the following of comfortable protocol that treats everyone as a worst case scenario, regardless of the collateral damage caused along the way.

We all want live babies, but birth choice is not simply about this outcome. There is so much more to birth than life or death.