First set of twin, baby girls, born at the
Mother Health International birth clinic, November 2010.
I was up early and went downstairs to have some tea and was laying in the hammock when Sherline came down and said there was a laboring woman at the Dome. Marie Antoinette was up at the clinic helping the woman get settled in and told Sherline to send for me. So although Melinda was going to be considered "first-on" that day I figured I was up so instead of waking her to do a labor assessment I thought I would go up there to check in. I knew Sabine had had a multip birth in the night so I went up to check on everyone.
When I arrived I could see that the mom was in a good active labor (G4P2) - close contractions and vomiting - so I set up and settled in with Marie Antoinette and Sherline. It was about 6:15 a.m. at this point and the mom said that she had been in labor since 5 a.m. - so really not long at all.
Marie said she would like to catch the baby so I got her a pair of scrubs and put her in receiving position at the foot of the bed. I asked what she needed and Marie replied, "just to have you by my side."
The birthing mom's Godmother was there and I could see that she had a knowledge of midwifery, an inherent skill and sense of the mom and baby and the process - she had that energy and wisdom of a wise woman about her. I found out that she had attended births as a midwife over the years. I liked her very much.
The birthing mom said that she had felt the baby move but not really that morning and I thought I would check for heart tones just for reference but I was having difficulty finding where to hear them best so I am gently palpating her belly in between a couple of contractions and it's was a bit confusing - feeling for sure there's a back here but there also seems to be a lot of "fullness" on the other side as well but doesn't seem posterior (you know, that train of midwifery thoughts and "hmmmmms..." that go through one's mind).
I catch a bit of heart tone and it sounds good and labor is progressing really well so I just set back, get everything prepped and ready. I support the Mamma and Marie. Marie suggested to the mother to get off of her back and possibly walk or change position but the mother reported that she was shaking too much and couldn't do it. She had told Marie when she first arrived that this labor felt "strange", different from her other labors.
Sabine, who came up to check on her post partum mother, came in to help us out when she heard that the mother was pushing.
The mom starts pushing around 7:15 a.m. and it 's obvious progress but the baby isn't flying out, in fact, it's coming slow enough that I just consider the possibility of big shoulders (as the mom's belly was quite big) and then watch and observe. So slowly and beautifully a head emerges and after a couple of contractions and it rotates to an posterior position and comes out the rest of the way.....hmmmmm, I'm thinking, that sure is a small baby for a term gestation - a little baggy and wrinkly - possible IUGR - but it is a vigorous little baby and we put her on Mom's belly. It has a pretty short cord. She rests a moment and touches her babe when she seems to push again, or really, scrunch up her face as if she's getting an approaching contraction. Marie says, the placenta is coming and I think, "Gee, that's an awfully strong contraction for a placenta, and so soon after the baby!"
So I look down and I see a bulging BOW and a head behind and I say, "that's not a placenta, that's another baby!"
Marie was really surprised and jumped back a little reporting later that she didn't know what was coming - at first she thought, placenta but then thought something "worse" but she looked into her heart and told herself she would not be afraid, she would not run away, she would stay and do her job. So as the baby emerged out gently, completely in the caul, I received that babe and laid it on the bed and then removed the membranes. This child was the most peaceful looking babe in the caul - you could see her perfectly and you could tell she was doing great. The baby was small enough that it did not break the amniotic sac at all on the way out and the baby was completely encased in the sac. It was like getting a peak into the womb. The placenta came with the baby. She barely bled at all, uterus was great, I had given her some Yunnan soon after the first babe came out just to be sure we didn't get an extra bleeding but her body was really doing all the right things.
Second baby was smaller but actually "pinked" up more quickly than the first although both babies were really quite vigorous! We got them to breast pretty quickly and it was bit of a juggle but it was also all so smooth. One couldn't have asked for a smoother twins birth. Both baby girls, fused placenta, two amniotic sacs, both head down, baby #1 5lbs and baby #2 just over 4 lbs, and both babies and mom were so strong!
Looking back at her chart I saw that her last baby died because it came prematurely....she said that she already had 2 boys at home and her family told her not to come home with anymore boys so she was pretty happy that she balanced everything out with 2 girls! She got an extra spirit to come back to her after the loss of one - it was all just really beautiful. Sherline reports that the mother told her after the babies were born that she had had a dream earlier the morning of the labor of two girls, her girls, playing outside of her home.
I asked the Godmother if she knew there were two babies because I could just see that wisdom in her being and she said that yes, she could tell but that she never said anything to the birthing mom because, as is tradition to Haitian culture, you don't tell a woman because you don't want her to be afraid.
I looked back at her prenatal chart and no one had ever suspected twins and she had been measuring appropriately and she went to term.
Anyway, there was never any hitches and after several hours everyone was ready to go home. We talked about keeping the babies warm, nursing them plenty, and having them sleep together. They were the most vigorous little babes I've seen who were that small. I never once doubted their strength, or moms, it was all flowing smoothly.
The babies are now 9 days post partum and came in for their first visit since the birth. Both babies have gained weight and are over their birth weights by about 300 grams. The mother has no complaints and her body feels good. She says she isn't too tired and finds that nursing two babies is not too difficult. Everyone who was at the birth reports feeling blessed and thankful to have been a part of this beautiful experience. One couldn't have asked for a more perfect birth to welcome the first set of twins to Mother Health International, Haiti!
Emily Baker, volunteer midwife
