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  • Josiah Hackney

Twin Breech Home Birth

Hannah and Phoebe have been a reminder of God’s Providence since before they were conceived.

With our first two daughters, I got pregnant as soon as we started trying.

This time Daniel and I put a lot of intention and work into preparing our bodies and lives in the preconception period, and it was frustrating when two weeks after we decided we were ready to grow our family, I got my period. And that happened for several months. I guess it took that long for the realization to really sink in that we can “do everything right,” but ultimately we have no control over the outcome; we can make our plans, but the Lord determines our steps.

This is Baby A...

I finally let go of the outcome, and in June 2021 I got a positive pregnancy test. We excitedly thought about the baby that would join our family in the spring. We decided to get an early ultrasound before we shared the news.

Fun story about when we were getting ready for that appointment - Daniel was looking for some shorts to wear and couldn't find any. I knew he had several clean pairs of shorts, because a few days before I had washed them, folded them, put them in a laundry basket, and handed them to him to be put away... and then said laundry basket was put on the floor and other things piled on top. So I told him where they could be found, and when he pulled a pair out I was being ornery and said, "wow! Where did these magic shorts come from?!" to which he immediately replied, "I hope we see TWO babies on the ultrasound." Who says that? I asked him what he was going to do if we did find out there were twins, and he just said, "laugh."

The appointment started out like the others with our daughters, but then there was a lot of scanning back and forth, back and forth. After what I'm sure was less than a minute, but felt like a very long, silent, confusing amount of time, we heard the words, "okay, this is Baby A"... A? We've never used the alphabet before at an ultrasound. Then the wand moved again and we were told, "and this is Baby B." I turned to Daniel, and, as he said he would, he started laughing. Followed up by, "this didn't JUST happen when I said I hoped there were twins this morning!" No, it certainly didn't.

Not just were they twins, they were identical - mono/di. That means one fertilized egg split into the two babies, so they shared a placenta, and each one was in their own amniotic sac. That’s certainly not something you can plan out. I went into a daze thinking about the logistics of nursing two babies, transporting two babies… we needed two more car seats. We needed a bigger car! I now drive a minivan and absolutely love it.

The news of twins was shocking, but did make me feel better about the fact I was already outgrowing my clothes. The pregnancy progressed much like my others, with the exception of the rapidly growing belly. I didn’t experience any back or hip pain, no morning sickness or even crazy fatigue. I was able to carry on in my daily life with my girls, Daniel, and work in the clinic, while growing bigger every day.

Heads Up!

Baby B was breech from the second trimester on. The position of Baby B isn’t as much of a concern as Baby A, as they will often move and change positions after Baby A is born. Our Baby A was head down… then she’d flip to breech before the next appointment, then head down again… At 34 weeks she was vertex for a few days, then back to breech. This happened in my last pregnancy and by 36 weeks she went head down and stayed, and that’s how she was born. So it was familiar, with the exception of the additional baby taking up space in there.

When a pregnant mama comes into our clinic and her baby is breech, we do the Webster adjustment (often multiple times a week) to ensure balance in the pelvis which gives baby room to turn, we encourage her to see an acupuncturist, massage therapist, check in with her emotions and stress levels. I was already doing all of that to support the pregnancy and prepare for birth... and my babies were breech.

At 35 weeks both babies were still breech. We had been talking with our midwife about all our options, the type of breech position they were in (complete breech - bottom down, and knees flexed), her experience and training (she just so happened to take a hands-on breech birth training a few months before), my birth history with two uncomplicated vaginal births, and decided to continue our plans of birthing at home. We discussed the option of an external cephalic version (ECV) - a manual procedure that attempts to turn a baby from breech into a head down position - but since I was already doing “all the things” that often help babies turn head down from a breech position and that procedure is not without risks, we decided the babies must be that way for a reason and chose not to do the ECV.

We had our home visit with our birth team - midwife, midwife’s assistant, second midwife, doula, birth photographer, as well as my parents and sister - and talked through scenarios and plans, knowing it was unlikely the babies' positions would change before labor. After that visit and setting up the pool it really sunk in that we were getting close to meeting our babies!

At 36 weeks I worked my last day in clinic before starting maternity leave. I was still feeling great and the babies were moving and sounding great, so I did my best to slow down, soak in the last days as a family of four, and wait until the babies and my body were ready for birth.

At 37 weeks my belly was very stretched out, with the marks to prove it, and the skin was dry and itchy. The itchiness started under my bellybutton and spread. I'll spare you the photos. A couple days later my entire body constantly itched. This was the first time I was uncomfortable the entire pregnancy, and I wouldn't wish that on anyone!

Preparing for Some Birthdays

A week later on February 23rd, in true Oklahoma fashion, there was a winter storm that made road conditions less than ideal so we closed our clinic and had a family snow/ice day. The roads were worse the next morning, which is when I, at 38 weeks and 3 days pregnant, felt my first contraction.

With my other labors I just kind of shrugged off the first contraction, knowing there would be plenty more before it was time for a baby, but since there were two babies and this was new territory for us, we made sure to communicate to our team there was activity.

Okay, clarification, Daniel communicated to our team.

I asked him to wait until I had at least a few contractions before sounding the alarm just in case this wasn't "it." I've done that every time, and every time it has been "it." This is why he doesn't really listen to me when it comes to acknowledging labor.

And just like in my other labors, I did things "just in case" it really was early labor. Last time I made cookies (and Daniel shared after the fact how ridiculous he thought that was. But we had hot snickerdoodle cookies to enjoy while snuggling our new baby!), this time I got out the mixer and started on some cakes with my daughters so we would have birthday cakes to celebrate when the babies arrived.

My parents and sister came over and brought lunch. Contractions were ranging from 5 to 15 minutes apart at that point, lasting a little over a minute, and felt like tightening of my belly more than anything else. The big girls went down for their naps and the rest of the afternoon unfolded quite uneventfully. My midwife, Dawn, came over after her day in clinic to check on me and babies. They were still wiggling and had strong heartbeats. Contractions still coming frequently, but still only feeling like tightenings.

Dawn asked if I'd like to have a cervical check. Though this was my third pregnancy, I had never been checked before. Cervical checks are just one way to assess progress in labor and there hadn't been a need to do that before. I told her I would like to be checked, so we'd have more information for making any decisions that needed to be made. She waited until a contraction ended and checked my cervix - I was dilated to 5cm, it was thin, and she could feel a bottom on the cervix. Active labor is defined as 6cm on. If the roads were better I probably would have encouraged my family to go home and sleep and come back tomorrow, but temperatures had warmed during the day and were going to drop again, so roads would probably be worse the next day. Everyone decided to stay, and Dawn let the rest of the birth team know it was a good time to head over.

My sister Anna helped the girls make frosting for the birthday cakes. My sister Elizabeth made the trek on the slippery roads from Dallas to be there. And my parents joined me in lunges and squats to pass the time.

The rest of the team arrived one by one that night. The big girls were so excited to have so many visitors! Contractions were still coming frequently, and still feeling only like tightenings.

It felt more like a gathering of friends than labor. We watched a movie, Dawn listened to the babies, I did more squats, Daniel adjusted me, I applied more cream to my dry skin.

Dawn continued to monitor the babies, and in the back of my mind I felt like I was wasting everyone's time because I didn't feel like I was in labor.

The big girls went to bed - their last night before everything in their world would change.

I attempted sleep... my skin was still very itchy and uncomfortable which made rest challenging; the contractions were hardly noticeable. In the morning Daniel made pancakes and eggs for everyone, and my tiny doulas got the best sleep of anyone in the house.

Definitely in Labor

Dawn asked if I'd like another cervical check. I was 7cm and she could feel little feet down with the baby's bottom. Okay, I was definitely in labor, even if it didn't feel like anything was happening. I did more squats, sat on a birth ball (which reminded me of the Little Tikes chunky chairs we had when I was a kid - they're listed on eBay as "vintage" now), and asked Dawn what else she recommended to support labor. Pumping. Using a breast pump stimulates the nipples which promotes the release of oxytocin, a hormone that encourages uterine contractions. We turned on The Office and Daniel and I sat in bed together while I pumped. Within a few cycles of pumping then taking a break then pumping again, the contractions were getting stronger, so I continued that for a couple hours. I went into the kitchen and that's when I had my first contraction that was intense enough I needed to focus on breathing through it, and I no longer felt like everyone was there for no reason.

I moved to the bathroom and sat backwards on the toilet (the dilation station, as it's known in the birth world) and had several more strong contractions. Everyone knew from the contraction in the kitchen it was time to fill the birth pool and we were going to be meeting some babies soon.

As soon as the pool had hot water in it, I climbed in. And my tiny doulas were right by my side. We knew we wanted our daughters to be at this birth; we wanted them to see that labor is intense, but not impossible, and that hard work has a beautiful purpose. We watched a lot birth videos before this day and talked through how the babies are born, the placenta, and the blood that doesn't mean mommy is hurt. We prepared as much as we could. I just didn't prepare enough for the range of emotions having my 5 and 3 year old would bring!

There was a pause in contractions after I got in the water, and in that silence Zoe, our 5-year-old, thought it a good time to share that she missed Papa (my grandpa who passed away two years ago). This was the only time in labor I've cried. It was a good release. Papa would have been so excited when he found out these two babies were more girls!

My first contraction in the pool was building and Evie, our 3-year-old, came up to me, said "who's ticklish?!" and reached out to tickle under my chin. I don't recommend laughing during a contraction.

After those first few contractions, they girls observed how Daniel and my doula Kaitlin were caring for me, and they followed suit. At one point Kaitlin was putting a cool cloth on my neck, so Zoe went and got a tissue and placed it on my forehead. I had the most amazing team and felt completely supported the entire time.

My midwives continued to monitor the babies, and were so good at keeping a safe space for labor to unfold as it needed. I was able to move into whatever position I felt like I needed to for each contraction, and they moved with me. I've been asked if this labor felt different because the babies were breech. Honestly? All labor is intense. To this point it felt similar to my last labor with Evie. But I do remember having a conversation with myself in my head that went something like, "Okay, this is ridiculous. Whose idea was this? I'm definitely not doing this again! SO MUCH PRESSURE. Okay, deep breath. You're doing it. Just focus on this moment..."

As the contractions grew stronger, I became louder. Minutes before our first baby was born, I let out a deep groan and Evie ran over and said, "Mom! Don't freak out!" She followed it up with "you're doing great, Mom."

My team did an excellent job communicating with me and each other. They gave me helpful cues when they saw me holding tension in an area, and hearing them say they saw the rump let me know I was so close to meeting this first baby.

My midwife saw her feet, turned her head to tell the person next to her the feet were out, looked back and the feet were gone... in that short moment, at 12:41pm, all 7 pounds of Hannah Ruth torpedoed into the world feet first. We had another girl!

I laugh when looking at the photos around the time Hannah was born. They go from me in a contraction, straight to a baby in my arms. It happened so quickly!

I will never forget the moment I was holding our third daughter for the first time and looked over from the birth pool to see my Daddy sitting at our kitchen table smiling with tears in his eyes. I know having a whole room full of people at a birth isn't for everyone, but I am thankful every single person in that room was there and part of our girls' story.

We had so many members in our birth team because there were three of us to be monitored; right after Hannah was born someone was checking on her, someone was checking on me, and someone else was responsible for checking on Phoebe.

Everyone was doing great, and so as we had talked about before, we continued to allow labor to unfold without intervention. They asked if I wanted Daniel or someone to hold Hannah while Phoebe was being born, but I couldn't imagine letting her out of my arms yet. Within a few minutes contractions began again. I held Hannah and moved back into the position that I spent most of labor in; it just felt like where I needed to be. I was tired. By this point Daniel was literally supporting me by holding me and Hannah up.

Phoebe was also in a breech position and her amniotic sac was still intact as she was being born. She was sitting cross-legged as she came out, and for a moment was suspended between the home she'd known her whole life and the one waiting for her like a floating genie. She extended her leg and broke her bag of waters, then continued her descent all the way past her belly to one of her arms being born. The other arm needed a little help getting out, so Dawn did a sweep to move it and encourage her to flex her head, and at 12:56pm - 15 minutes after Hannah was born - all 7 pounds and 7 ounces of Phoebe Christine emerged.

Baby feet!

Second-born twins commonly have a lower initial APGAR score, and take a little longer to transition from womb to world, and that was the case for our Phoebe. Her heart rate was good from the beginning, but it took a few minutes for her to pink up and cry like her sister did. My team was calm and controlled as they swiftly supported her in that transition.

On February 25th, after being pregnant with twins for 38 weeks and 4 days, our third and fourth daughters were welcomed into the world in our living room, surrounded by so much love!

A few minutes after both babies were in my arms contractions began once more for the placenta to be birthed. Since they were identical, they shared one placenta. And just because I never want to forget - I asked them to weigh it: 2 pounds 11 ounces! Between that and the babies, it makes sense that I ended the day 20 pounds lighter than I started it.

Daniel took Hannah and did skin-to-skin while I had time with Phoebe before her cord was cut.

Phoebe was handed to Daniel so that I could get out of the pool and move to my bed; this was the first time, but certainly not the last, the baby girls would feel what it's like to be held in the strong arms of their daddy.

The girls and their aunts finished up the birthday cakes for Hannah and Phoebe.

And the party moved into the bedroom where both babies had their first latch.

These are just a few of the many things I love about birthing with a midwife at home: right after birth I was able to be in my own bed, I had food that I love, my other children were there (Zoe did some skin-to-skin with the twins too), my babies and I were not separated and were all examined when we were ready, and it's just so calm and comfortable.

The newborn exams were performed at the foot of our bed while I ate lunch and took in the sight of all these amazing people caring for our family.

A major concern we had when we found out they were identical twins was mixing them up! Every twin mom I knew told me that wouldn't happen, and that I would just know. But still, to be on the safe side, I crocheted different cord ties for the babies to at least get us through the first few days of knowing who was who. Hannah is our sun, Phoebe our moon.

Hannah Ruth's exam was first:

While patiently waiting for her exam, Phoebe decided to go ahead and get that first poo out of the way. Our midwife Brandy was kind enough to take care of that for us!

Our birth team made sure we were settled in, everyone's vitals were strong, reminded us of what to keep track of in the first few days with the babies, and made sure I knew to do everybody's favorite fundal "massage." They cleaned up the space like birth fairies; you'd only know babies were born in our living room because Daniel tells everyone who comes over.

After everyone had hugs and birthday cake, the birth team left one by one, just as they had arrived the night before. And we, now a family of six, took a nap!

I'm so grateful to my birth team for being educated on and supportive of a physiological breech birth; labor progressed as it needed, the babies were born vaginally without issue, and I didn't even tear! This experience has left us with two more beautiful daughters, a new perspective on breech births, and a wonderful reminder that God is in control.


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