Friday, March 13, 2015

A Family Physician's Path to Home Birth

Today, I'd like you to meet Jeanelle, a family physician in Illinois. Her story of finding out she was pregnant with twins and the challenges that came with that is nothing short of beautiful. Sometimes the path to our birth choices is a difficult one. This mom took the time, questioned the norms and navigated the obstacles  to arrive at the best birth plan for her family. 

I always knew I wanted more than one child. I was an only child and did not wish that on anyone; I was very lonely growing up and would often pretend to have siblings to play with.  My husband and I agreed we both wanted three or four children when we got married and I continued hoping that God would bless us with at least that many.
When our son was close to two we decided to try for a third child despite our son and daughter beginning to be very demanding. It took some time and since I was having heavy, painful periods, unexplained nausea and what I worried were signs of interftility we had a work up for endometriosis. My work up was negative, except for high progesterone, however I did not consent to a diagnostic laparoscopy at that point.  

We conceived naturally the month after the work up. When we found out we were expecting we were surprised, excited and nervous at the same time! 

I am a family physician by training so I tend to wait as long as possible to begin prenatal care since I often find myself arguing with my providers about what is and isn't necessary in pregnancy management. My first appointment with the mainstream hospital midwife was at 12 weeks. I decided to go with a midwife rather than an obstetrician for my third pregnancy since I had had two natural hospital deliveries and full term uncomplicated pregnancies. At my first appointment all was well and my exam showed my uterus to be about 12 week size according to the midwife. My husband and I practiced fertility awareness so I knew when we conceived and did not feel the need to have an ultrasound until 20 weeks but the midwife insisted just to "check dates". The ultrasound technician put the ultrasound probe on and just as I was trying to figure out what I was seeing she announced, "Well, you're having twins!" I could not believe my eyes or ears! I never entertained the possibility that I would have twins; there are no twins on my side or my husband's side of the family. I was in a state of shock the rest of the day and I think my husband has been in shock since, he still can't believe we have twins. I was immediately transferred to the care of the obstetrician team at the same clinic since midwives here do not manage twin pregnancies. I had dichorionic diamniotic twins which are considered the lowest risk so I did not have to be referred to maternal fetal medicine/high risk OB care. I chose my main OB provider to be the same one who cared for me during my last two pregnancies.

My pregnancy was uncomplicated, at our 20 week ultrasound we found out our twin A was a boy and twin B was a girl, I was thrilled about that not only because I wanted a boy and a girl so my daughter had a sister and my son a brother but also because I knew I wanted a vaginal delivery and knew my twin A had to be larger than my twin B to convince my provider to let me do that. Baby boys are often larger than girls.  My twin A was vertex at the 20 week ultrasound so I was confident a vaginal delivery wasn't going to be a problem since my provider agreed that a vaginal delivery was possible even if twin B was breech as long as twin A was vertex.

My provider insisted that I have ultrasounds every 4 weeks for twins starting at 24 weeks, I was adamant after doing my own research that starting at 24 weeks was not necessary with my type of twins so my next ultrasound was at 29 weeks. Much to my surprise both my twins were breech at the 29 week ultrasound. I was very depressed during and after this ultrasound since I knew I would be told to have a cesarean birth if twin A did not flip to vertex soon. I immediately researched natural ways to flip a breech baby, focusing on twin A since twin B's position didn't seem to matter to my provider since she could change positions after twin A was born. I started chiropractic care with a wonderful chiropractor in my area trained in the Webster technique. She was confident my twin A would flip however she admitted that she didn't have twin experience. I was worried but pretty confident at that point that twin A would soon be vertex. I continued seeing the chiropractor twice to three times a week, doing inversions and pelvic tilts as I'd seen on

Once it was confirmed at my 33 week ultrasound that twin A was still breech I tried moxibustion, swimming, music and my husband talking to our twin A to encourage him to flip but nothing was working, twin B was vertex and twin A still breech at our 37 week ultrasound. At this point I began to accept that twin A would not be flipping but would stay breech likely due to lack of room with his sister in his way. 
I struggled with anger at my body, God and even my precious unborn baby for forcing me to accept a surgical birth. After much prayer, research, and discussions with my husband, supportive friends, my chiropractor and natural twin moms on Facebook I decided I wanted to try to have my twins vaginally even if my twin A continued to be breech, he was in a complete rather than a footling breech position and I had had two prior vaginal births to babies larger than these twins likely would be. 

I was convinced after much research that the Term Breech Trial that convinced the obstetric community to stop doing breech vaginal births, was overall a study with many problems and follow up studies did not confirm the findings but rather showed that vaginal breech births may be just as safe as cesarean births for breech babies and safer for the mothers.  

I hired a doula and wrote up a birth plan. Since I work part time in the same clinic system as my provider I decided to email her to tell her my plan rather than wait until my next appointment. I explained my reasoning to want a natural birth rather than a cesarean even though twin A was breech. She took her time getting back to me and when she did, she made it very clear that she and the rest of the OB team that may attend my delivery would not assist me with a breech twin A birth due to the risks to the baby (she named them all including twin interlocking, a very rare complication which she said was unique to my twin's positions- breech/vertex) and their lack of training with breech vaginal births.

Up until this point I was thinking even if my provider did not agree to let me try a breech birth I was going to labor at home as long as I could then show up at the hospital pushing and refuse a cesarean. She asked in her email response that I not put her or her colleagues in a difficult position where they must do something they are not comfortable with. Since I work at the same clinic and would have to face her again, and I didn't want someone that  uncomfortable with breech vaginal birth attending my birth in case my baby needed assistance, I decided there was no way I could do that now. My provider did offer to refer me to another local clinic's maternal fetal medicine department since they likely had more experience with high risk birth but she said they would recommend the same thing she was recommending, a scheduled cesarean section at 38 weeks. I decided not to go with this referral after I found out that they would be doing a 2 hour ultrasound at 37 weeks for no apparent reason other than policy and if I delivered in a hospital with an OB their breech experience would be limited since the hospitals here in Central Illinois do not allow planned breech birth and my birth would be very managed. My research showed that the complications in breech vaginal birth are caused mainly by errors in the management of a breech birth not the mode of delivery itself. I figured at this point I had no other option besides cesarean or so I thought.

In my devastation I was talking to a close friend of mine who values natural birth as much as I do; she reminded me that she had a home birth with an independent local midwife with her second child. I had never entertained the idea of a home birth, I didn't think it was safe, being a physician myself with some obstetric experience, and I did not think my husband would be supportive.  Since I realized I had no other option at this point if I wanted a natural birth I looked into it. Independent midwives are not recognized in Illinois, in fact home births are just short of illegal. I was already 37 weeks along so it was unlikely I would find a midwife who would be available and willing to take my case. I prayed that if this was where God was leading me, it would all work out. The midwife took two days to think and pray about it before agreeing to take me on, she had no twin experience and very little breech experience. She told me she had a preceptor who had been in practice for over 30 years and had a great deal of twin and breech experience but she doubted she would be available at such short notice. Much to our surprise the preceptor was available and willing to take my case! 

I knew at this point this was God's answer to my prayers for twin A to flip to vertex. I finally had peace and no longer felt angry that my twin A was persistently breech. I remembered that God does not always answer prayers the way we want Him to, but he does promise to work things out for good for those who trust in Him. So we planned the home birth, my husband reluctantly wrote the check for $3300 to cover the home birth and the two midwives. We are on a strict budget since I work part time and do not get paid when on maternity leave so this was tough but we knew it was worth the sacrifice we would have to make. We met with the midwives once and I felt immediately comfortable with them as a team. 
Up next: The Birth Story 

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Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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