The new year came and the horrendous trauma of 9-11 still prevailed in the news. Thousands of lives were lost, and the clean up of the twin towers was underway. Susan and I had developed a good working routine, and we alternated our schedules between the Floyd Knobs and Jeff offices, with the midwife in Jeff being on call as well. My daughter Tara was expecting another child, and her morning sickness was about to get the best of her. Medications seemed to have no affect on the severity of it, and her weight loss was starting to concern me. Still she trudged along each day, trying to have the energy to keep up with her 4 year old son Tyler.

Having twins myself had peaked my interest in twin pregnancies. In midwifery school I had done a research project on twin pregnancies, and I did not shy away from them in my practice. While they were higher risk than some midwives were comfortable managing, I loved the challenge and co-managing them with my physician colleagues. This year I had diagnosed twins on 3 of my patients, each having their 4th pregnancy! One day while working in the Jeff office one of my patients expecting twins came in for her regular prenatal visit. Jen was an accountant, working in a group with her husband and father, also accountants. We had joked about her poor timing for her pregnancy, being due to deliver during their busy tax season. We laughed over her need to file extensions for everyone to allow her more time to complete their annual tax returns in case the babies came before she could get their returns filed. She requested a cervical check at this appointment because she had been having some irregular contractions, and she felt they might come soon. She was 8 cm dilated! And not in labor. I expressed my concern for her advanced dilation, and likelihood that when labor came on she would deliver quickly, and recommended that we admit her to the hospital, break her water, and wait for labor to start. After discussion with her husband she agreed with the plan and proceeded to the hospital for admission. At lunchtime I checked in on her and with her admission completed we moved ahead with our plan and I broke her water. Now we would just wait for contractions to get stronger and closer. A debate broke out between me and her labor nurse regarding visitors in her room for the birth. There was an unwritted hospital policy which allowed 2 visitors in the room for a birth. I pushed this policy many times, and had gotten approval from the manager allowing my patients to have as many visitors as they desire. The nurse on duty for this patient was not comfortable with extra people in the room with a twin birth, and a debate broke out between us regarding the risk for contamination of the sterile table with the addition of extra supplies and equipment, along with the visitors. Jen wanted her family present for the birth, and I wanted her to have what she requested.

Jen had done natural childbirth with her other babies, so she was accustomed to freedom of movement with her labors, having intermittant monitoring of the baby as an option. Twins posed a higher risk, and with the inability to continuously monitor twins with a telemetry monitor, she was left to labor in or near the bed. After several hours of waiting, she was becoming extremely restless and frustrated. I tried using some hypnobirthing techniques to calm her, but her emotions got the best of her and she became weepy and voiced her frustrations. With her cervix nearly completely dilated, I suggested that she get up to the bathroom for a few minutes, empty her bladder, and then try pushing the baby down to cause the cervix to move and get these babies born. She liked that plan, so her husband and I helped her to the bathroom. I felt that she needed a few moments alone to escape that feeling of being watched, so we waited outside the door for her to finish. His worried look was evident, and he confided in me that this was not the birth she had hoped for. In hushed tones I conveyed to him my understanding of her feelings, and that we would investigate this further before proceeding with the next step. All of a sudden we heard a scream from the bathroom, and upon opening the door I saw her standing in front of the toilet holding a baby by the neck while it dangled toward the floor. I raced to her and grabbed the baby, telling her husband to help me get her down to the floor, while another family member had alerted the nurse at the desk. As I kneeled in front of her, holding this wet baby, barehanded, a voice over my shoulder asked sarcastically, “do you need a doctor?” It was the nurse. “No, I need a clamp and a pair of scissors,” was my response. After cutting the cord I handed the wet, crying baby off to the nursery nurse that had just entered, and put my fingers inside to see if the other baby was coming. I felt nothing. My mind was reeling. What do I do now? “Help me get her up,” I said to her husband. “We are going to the bed.” She cooperated and we got her to her feet and quicky walked her to the bed, positioned her, and after donning my gown and gloves over my already wet shirt, checked inside again to determine the position of the next baby. I felt feet. Placing one hand on her abdomen and one inside I pushed the feet up and pulled the head down turning the baby into the head down position. The door to the room opened and Dr. Grady came rushing in. He grabed the ultrasound and placing it on her abdomen stated, “it’s head down, break the bag and have her push.” I did as he had instructed and she delivered the crying, vigorous 2nd baby. “Good job,” he said as he left the room to head back to the office. Looking at the nurse, I knew what she was thinking, he had no idea what had just transpired in this room. “I’ll tell him the story,” I said, knowing full well that this would be talked about for quite some time, and that I might never be allowed to deliver another baby. When I returned to the office I recounted the story of the birth ordeal with Dr. Grady, and after taking a minute to absorb the details, he smiled, chucked a bit, and said, “Well it turned out alright I guess. Good job.” Jen was happy, she had her babies, and her family had been present for the birth. I had accomplished my mission, and I still had a job.

Tara’s pregnancy was difficult for her. Her nausea never seemed to go away, and her weight gain was extremely low. She started to complain that she just wasn’t feeling movement with this pregnancy as she had with her first one. One day she went into the Floyd Knobs office for her appointment and she saw Susan. After evaluating her in the office, Susan called me at the Jeff office with her concern for size and movement, and told me that she was sending her to the hospital for a non-stress test and ultrasound. I received a call from one of the nurses a short time later, informing me that Tara was there, and asking me to come right over. The fetal monitor strip looked ominous. The baby was having regular decelerations with minimal variability. Tara was only 32 weeks along. Dr. Stamm was the physician on call with me that day, and I could not make myself call him about this. I called Dr. Grady instead, “This is my daughter, will you come and look at this and help me decide what to do?” Within minutes he was at my side evaluating the situation. “She needs a section,” I said. He agreed. I quickly explained the situation to Tara and Rob, and the nurse started to prepare her for the surgery. Normally the midwife would assist the surgrion in a cesarean on one of our patients, but this was my daughter! And my grandchild was in trouble! Another physician was on the unit, and the nurses enlisted his help to assist with the surgery in my place. In the operating room I tried to console Tara and help her with positioning for the spinal anesthesia. After several attempts at the spinal, I gave a pleading look across the room to Dr. Grady, and he mouthed to me, “Do you want her to go to sleep?” I nodded my head. “Put her to sleep,” he said to the anesthesiologist. I’ll never forget that tiny baby in Dr. Grady’s hand. When Zoe was born she was small but mighty. That little bitty 2#7oz baby girl came out cryig, with good tone and color. The nurses and pediatrician were amazed. They dried her, gave her some oxygen blow-by, and she was stable. They took her to the nursery while the surgery was finishing up, and I went to see her once I knew Tara was ok. The pediatrician explained that they were going to transfer Zoe to the children,s hospital just in case she tired out and needed ventilatory support in a few hours, but that she hadn’t needed anything up to this point. Rob went with her to Nortons, and I stayed with Tara. Zoe never needed ventilation, and was released from the hospital after 3 weeks at 3#2oz. We wrapped her in a handerchief for a blanket, and dressed her in doll clothes for a few weeks.

Over the years I have taken care of many of my family members for their pregnancies and births. While it adds a degree of excitement to the event, and to family gatherings as the birth stories are retold, the added responsibilty for the outcome of family members adds a degree of anxiety to the event. Even still, it fills my heart with joy and pride when my family and friends trust me with their births.