Episode 223 - Navigating Twin Pregnancy and Birth options: Part One
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host Dr Melanie Jackson. I'm a clinical and research midwife with my PhD and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth and postpartum journey.
Mel:
[0:24] Welcome, everybody, to today's episode of the Great Birth Rebellion podcast. Today, I am joined by three guests, but I actually have interviewed them all in two separate sessions, and that was intentional. Today's topic is about twins, the type of care you can access with twins, the challenges you have if you're pregnant with multiple babies, but also this is a story of hope and how you can overcome those challenges by picking the right care team. And today we'll be talking to Hannah Muller, who is the midwife in the story, Louise Gorham, who's the doula in the story, and also the woman, Natasha, who I'm interviewing second because I wanted to hear Hannah and Lou's story first. You'll see why. And now a huge shout out to Poppy Child from Pop That Mama, who has been a major sponsor for nearly a year now. Poppy believes in this podcast so much that she has invested a lot of dollars to make sure that it keeps going. She is an absolute queen. She's pretty much paid for your antenatal education.
Mel:
[1:32] The other thing that Poppy is, is a hypnobirthing practitioner and the creator of the birth box, which is a hypnobirthing online resource to help you get ready for birth. Because hypnobirthing is a technique, it's best to get the birth box during your second or third trimester so you have a chance to practice and put into place the habit of the hypnobirthing techniques and put the oxytocin bubble tracks on repeat. This means that when you are mid-contraction, your body and mind know exactly what to do and will automatically sink into the hypnobirthing technique so you can say focused. You can get the birth box in the link below in the show notes and Poppy is giving Great Birth Rebellion listeners a unique discount code. So click on the show notes below.
Mel:
[2:22] But today, I really want to focus on the fact that being pregnant with multiples, I feel like, is twice the amount of work. Two babies, two times the effort, and possibly three times the effort, once you hear this story. Welcome, Hannah and Lou, to the Great Birth Rebellion podcast.
Hannah:
[2:40] Hi, Mel.
Lou:
[2:41] Hi. Thanks, Mel.
Mel:
[2:43] Thanks for having us. Now, before we kick off, I would love to give you each a chance to introduce yourself so that everybody listening understands who you are. So Hannah, we might start with you.
Hannah:
[2:54] Amazing. Yes, I'm Hannah and I'm a private midwife that went predominantly into the home birth world. I started up my own private business in 2025. So yeah, I wasn't expecting to have a twin mum so early in my private midwifery walk. But yes, my role throughout the process with Natasha, we didn't find out she was having twins until 20 weeks. Did you have a dating camp? No, she didn't want any early scans. She was planning her third home birth and her fourth and now we know fifth baby.
Mel:
[3:30] No, she was pregnant. She'd had home births before and then she contacted you because she was just pregnant again and she's like, I want a private midwife. I want to have a home birth.
Hannah:
[3:39] Yes, that's what happened.
Mel:
[3:41] Okay. And so then she comes to her morphology scan and twins.
Hannah:
[3:46] She calls me and I was in another consult and she said, we're having twins. She hadn't even told her partner yet. So it was pretty amazing. She was super excited. But yeah, it changed the landscape of her care a lot.
Mel:
[3:58] Yes, and the landscape is what I'm really keen to talk about today. And Lou, had she contacted you? Lou, introduce yourself first, but I'm curious to know if she contacted you before or after she discovered she was having twins.
Lou:
[4:13] Great. So I'm Doola Lou. I've been a doula since about 2019. I've mostly supported births in regional Victoria and New South Wales. And I do a mixture of supporting women in a hospital setting and also in the home birth setting. And I also do birth photography, which is something that I'm really passionate about. And I've just started moving into a mentorship role as well, mentoring up-and-coming doulas and supporting them to get more doulas in the area, more choices, more support for women.
Mel:
[4:46] Had you worked with Natasha before for her other previous births?
Lou:
[4:50] No, I hadn't worked with her. I think we knew of each other because our home birth community is quite small, but she hadn't engaged any doula support before. And the phone call that I got might have been on the day of her morphology scan. I don't know who suggested getting doula support. Was it you?
Hannah:
[5:11] Yes.
Mel:
[5:13] So she discovered twins and Hannah's like, right, we're going to need a doula. Yeah.
Hannah:
[5:16] Yeah, Doolaloo also had supported a couple of twins before and it was on her website and after they had a chat, it was love at first sight.
Lou:
[5:23] Oh, absolutely. So, yeah, I supported a twin birth when I was a student doula, which was an interesting thing to, you know, sort of navigate that sort of early in my own journey. And then earlier in this year, I'd also supported another twin mum who had her seventh and eighth baby with her twins and who had also had a previous home birth. So she was then in this hospital environment that wasn't necessarily her first preference. But yes, not as experienced with twins, many more single babies.
Mel:
[5:56] Hannah, you're a private midwife. And so here in Australia, private midwives can just care for women all through their pregnancy as the primary care provider, which is, I assume, what you were planning on doing for this woman. And then Natasha discovered pregnant with twins. How did that change your next steps? Because prior to that, I imagine she hadn't
Mel:
[6:21] seen any other care providers. You were her main care provider.
Hannah:
[6:24] Yeah, it was a pretty wild transition, to be honest. We were having a lovely time the first 20 weeks, and we often joked about at least half her pregnancy was... Lovely and love intervention. So when she called me, obviously we went to a proper ultrasound place to do a full ultrasound on the twins. And then we talked about the fact that unfortunately, I don't have the skills and not many midwives in Australia do have the skills to support twin home birth. So we talked about having a hospital birth and she was quite overwhelmed, I think, with all of the information that's out there and, My role was really about navigating the different hospital options and we actually had a booking in appointment. We went to that appointment at the local, so there's two regional hospitals here that support women's birth in hospital. And we went to the first hospital and I said, I think we need to go to the other hospital. So she actually had across her care three different hospital bookings because we went to the second local one to get the best care that she felt comfortable with. Yeah.
Mel:
[7:30] And to make it even more kind of hairy, I suppose, you live in quite a rural location. It's not a city location. There's limited options to choose from. The further you get from a metropolitan area, the less choice you have. So you had one or the other hospital. So deciding on the second hospital, what happened at that appointment?
Hannah:
[7:54] So I guess there was my role really throughout was a lot of education, like just an insane amount of talking about all the things to do with twins. We linked up with Dr. Stu, who's the expert twin guy in America. And when we went to that second hospital, I guess it just felt more receptive and she felt more comfortable with it. We'd had an ultrasound that said they predicted the baby was small. So instantly the care changed to quite a fear-based conversation about constant concern about the baby's size and that led to weekly Doppler's being recommended. So she was being seen every week by the local regional hospital. And I was talking to her at every appointment, me and Lou and also another midwife involved. We were alternating who went to the appointments. So it was pretty wild. But I know that she really loved just having that sounding board and finding that line between pathological and normal physiology. She'd had three very genetically small babies. So the fear around the baby's size in the end turned out to be completely normal, which is what we were sort of talking about the whole time.
Mel:
[9:05] Well, we do know even from Singleton ultrasound, weight estimates, they're not particularly accurate for weight and size, but they do worry with twins because there's different types of twins and some types of twin pregnancies, they can have discordant growth for pathological reasons. So it's really tricky, isn't it? Because you're trying to work out, is this a normal healthy twin pregnancy? Because twins creates an additional complication, but they're not necessarily high risk unless there's actually something wrong with one of the twins or with the pregnancy. So this is really tricky to navigate, especially because obviously her philosophy was that she wanted to have a low intervention, low tech birth. That had been her experience of having home births. Was she hoping for a vaginal birth with these twins as well?
Lou:
[9:55] Absolutely. Yeah.
Mel:
[9:57] Was she given the option of doing that at this second hospital?
Hannah:
[10:00] I think a lot of the conversation early on was, was I said to her, you have to meet so much criteria to be allowed to have a twin vaginal birth. That includes the head being down. The particular hospital we were at, I had never seen or heard of a vaginal birth in recent times. So, you know, I was just giving her the awareness of like what the cesarean rate might be in her specific hospital. I actually mentioned traveling for birth quite early on because I know through liaising with other private midwives that there can be such different options in the cities so I mentioned that quite early but, I almost feel like with twin pregnancies sometimes you're having all these consults and they're like oh yeah we'll see we'll see and it's almost like they're waiting for something to, tick vaginal birth like to get it off the list but she was she was really passionate and educated and our birth plan meeting was yeah pretty pretty hectic.
Mel:
[11:00] So a few things that stand out to me was firstly that she had either one of her midwives or you Lou with her at every single one of her appointments absolutely yes and I think that is a major element of probably why what her experience ended up being was that she had advocacy and care with you guys I have a it's kind of a side hustle question or side question um side quest side quest like this is a pretty privileged situation to be able to hire a private midwife and a private doula to care for you for your pregnancy I was well I'm wondering what you guys did in those appointments that maybe if a woman couldn't get a mid like a midwife with her or have a doula with her What did you guys do that anybody could offer during those appointments to a woman who's trying to navigate a twin pregnancy?
Lou:
[11:56] Before one of the appointments that we went to, Natasha wanted to do some grounding. And so kicked off shoes, put the feet in the dirt. You know, we had a conversation beforehand, which I guess any support person could do if they understand the system and they understand informed consent. And it was just reminding her, like, one of the earlier appointments, she had said, oh, when I'm on my back and they're doing the Dopplers, I don't feel well. I don't like being on my back. And so I said, you can put yourself in a position that you feel comfortable and the care provider can work around you. So if you want to be on your side, you lay on your side and you say, this is how I'm laying. This is how comfortable you're going to have to work around me, you know, and just giving that information and that confidence for this mom, you know, she's in and she doesn't want to be in the hospital environment. She planned to have another home and so she's in a completely different environment that she's having to navigate which isn't her first preference and it's going you still get to run the show and you still get to
Lou:
[12:57] You know, speak up for yourself and you get to advocate for yourself and you get to say, you know, later on in that appointment, it was like, oh, we'd like to do CTG. And then it's like, okay, well, are you comfortable with that? Do you want CTG? And she was like, I'm happy for CTG, but only 20 minutes, you know, and her having that advocacy and having that confidence to speak up and just even having someone else in the room to just, yeah, ask those questions or write notes or just refer to the woman and say, do you have any more questions? Do you understand what they're offering? Do you need some time to think about it? All of those things, just having that person in the room to support.
Hannah:
[13:35] I think partners and mums and sisters have a really important role. If you don't have a doula or private midwife and also just research, evidence, podcasts, like this woman was, I don't know if every woman this would have happened to, like it was because Natasha was just so motivated and I could see her really getting reassurance from us that just helped her make the decision she felt was right, not us pushing her one way or the other.
Mel:
[14:01] Yeah, fantastic. So basically, she was preparing herself. She'd also selected a team and she carefully selected her support team. That means if you're out there pregnant with multiple babies, I do think you need to be extra prepared, like take responsibility for being extra prepared, because I do think there's extra challenges and the preparation does include education. Gathering a support team if you can pay for one like a private midwife and a doula amazing I think that is the ideal scenario actually for twin pregnancies but aside from that having what I call the robust support team that's going to be on your side and as invested in your journey as you are so okay so Hannah we're around sort of like second trimester discovered twin pregnancies sort of ruled out one of the hospitals, visiting the other hospital.
Mel:
[14:54] Was there any point in the pregnancy that it started to become obvious that maybe things weren't going to go the way that Natasha wanted them to go?
Hannah:
[15:03] Yeah, it was probably around 32 to 34 weeks. There were a lot of concern over the growth, but we kept plotting. This was sort of an example of what we were doing in the, growth percentiles on the twin charts that they use in I'm pretty sure most of Europe like the NHS twin charts and babies were almost always except for one above the 10th percentile. So that was sort of my little job with the second midwife is we were just providing reassurance. Obviously there was a chance that babies could have been growth restricted but given her history and difficulty with ultrasounds and twins that seems like the most likely scenario. So at around 32 to 34 weeks the babies were both breech so that was an issue with the regional hospital.
Mel:
[15:50] Can you tell us why two breech babies was a problem because for some people they're like okay two breech babies that's okay but why are two breeches a problem
Hannah:
[15:59] Well at our two hospitals here vaginal breech isn't offered for a singleton baby so i guess sort of similar if the first twin is breech that's considered, a breach birth that you need to be skilled in whereas usually there's a very strict policies around twin birth and the first baby comes out head down and then they'll go and extract the second baby unless baby comes out without any intervention but, that's what that's what I mean it's really not I don't it's like there's just this decided criteria and nothing outside of that is considered a reasonable request yeah so, yeah that that was sort of 32 34 weeks we brought up the possibility of going to melbourne at the birth plan meeting because i feel like i we all sort of knew the babies weren't going to move there's not heaps of space at that gestation, so the birth plan discussion was very juicy and we talked about the potential of an induction so our city hospital that we thought would offer this. We didn't really know, to be honest. It was all a bit of a figuring out as we went. About three and a half hours away from us and the woman had had previous experiences of two or three hour later's.
Hannah:
[17:16] So we didn't have any realistic options for spontaneous labour. So it was sort of a discussion around induction in Melbourne, which goes against, you know, my thoughts on inducing labour, but it was sort of the lesser evil to give her the best chance of what she really wanted.
Mel:
[17:34] Right. So she was committed to a vaginal twin birth. It became obvious that firstly having a twin vaginal birth is fairly unusual at a hospital anyway and then to add two breech babies to that scenario you'd have to find either a skilled or brave obstetrician who was willing to attempt this with the woman unfortunately it just turns out that not all care providers are skilled or confident in firstly twin vaginal births and adding to that breech vaginal birth so you were already in a fairly niche situation that most women would have been offered a cesarean section you're saying somewhere in the 34 week mark both babies are breached and you float the idea of what if we travel three and a half hours to Melbourne. And obviously pick the labour day by opting for an induction. Sort of logistically, you couldn't travel with her in labour because of her previous fast births. So tell us about the planning of that scenario.
Hannah:
[18:50] So one thing I probably missed is we actually connected, so really early when all of the massive shift in plans, we engaged with a maternal fetal medicine doctor in Melbourne, in the city, who's very well known for being a little bit, the one that all the home birth midwives talk to. So he was the man. So we connected with him really early. And I said to Natasha, let's just lock in an appointment close to term. So we had a consult together at around after the breech baby incident, and he just gave all the breech information. And he said, if you come to this hospital, we won't turn you away. All of the doctors here are skilled and confident well they're willing to do a breech birth, so that was game-changing because it just provided a little bit of reality like I think when you say oh we'll go to the city and have a vaginal breech birth it just seems so huge, but when we had this connection and I think that was really pivotal for the woman but another important thing it just sort of felt like this experience had so many points of derailment and then we were like sort of bringing it back on track. And obviously it could have gone very differently. So this is, but this is what happened. And I guess as midwives, we keep everything normal until it's not. And that's exactly what happened. But one of the regional scans was estimating the second twin was on the.
Hannah:
[20:16] And the other twin on the fourth percentile. So even the Melbourne MFM, he's like, no, the head could get stuck in the cervix. We don't think it's safe.
Mel:
[20:26] So this is part of the breech birth criteria. If babies are growth restricted, it rules them out for vaginal breech birth because there's a fear that as the woman's cervix dilates, that the smaller baby part will come through the cervix and then the head will get stuck. In the cervix and so what they're saying is oh we do do vaginal breached births for twins however these particular twins don't even fit that criteria for breached birth because they're small on the second and fourth yeah too small right okay
Hannah:
[21:03] Yeah and then something pretty funny happened um maybe maybe you can chat about what happened in um melbourne beforehand.
Lou:
[21:11] The The hospital visit
Hannah:
[21:12] Before the hospital visit.
Lou:
[21:14] So what week was that?
Hannah:
[21:17] It was just 36, like it was late 35 weeks.
Lou:
[21:20] Okay, so I don't know if it's funny, but Natasha went in to threaten preterm labour. So she was labouring and so went to the chosen regional hospital. She's got twins. They're both breech. They're both growth restricted at this point. They're both under two kilos. So it's like supporting someone who feels like a ticking time bomb, like coming in and everyone's just like, we can't, like, we don't have the facilities, we don't have the guidelines, we don't have anything, you know. So it's like on a plane and you're airlifted to Melbourne. And so that's what happened.
Mel:
[21:57] Whoa. Okay. So she got airlifted. And did you go with her, Luke?
Lou:
[22:01] Yes, I did. Yes.
Hannah:
[22:03] While me and the other midwife were at a breach education event.
Mel:
[22:10] Okay. So the two midwives were out getting breach training. Lou, you're with the woman who's in threatened from labour at a hospital that
Mel:
[22:18] does not have the facility or skill for that. And you've been airlifted to the belt.
Lou:
[22:22] And she's five centimetres dilated. And so that conversation was actually the day before the convergence, Mel.
Mel:
[22:28] They're talking about the Convergence of Rebellious Midwives Conference. Right.
Lou:
[22:33] So I was coming to Melbourne on the Friday and this was the Wednesday, the Wednesday or the Thursday. No, no, no. It was the Thursday. Sorry. So it was the day before. And so that conversation was, you know, if you're going to Melbourne to a tertiary hospital because you're in threatened preterm labor and you're going to have these babies and they're under two kilos and they're both breech, then what does a C-section look like? And how can we make that as women centered as possible two people in theatre birth photographer in theatre skin to skin delayed cord clamping lotus birth like what do you want and I remember the dad saying like oh wow I had no idea you could you could advocate for these things because they've never had a medicalized experience like that they've had home births so they don't know you know so it was it was a in between contractions it was let's jot some things down about if we get to Melbourne and you're having a c-section tonight and these babies are being born, how can we make that the most positive experience for you?
Lou:
[23:31] Um, and yeah, so I drove down and I saw her little airplane fly over the Hume. I was like, there it is. So I'm driving down and she was so chill, such a champion. Like this woman was just incredible navigating all of these twists and turns with, you know, just being such a champion. She was just awesome the whole way through and just navigating every single step as best she could. Obviously wanting for her babies to be safe and everyone to be well, but just advocating and, again, educating herself and, you know, having these conversations. So, anyway, drove down to Melbourne. We went to a different tertiary hospital, not the one that she ended up giving birth in. They were absolutely beautiful, so welcoming, so supportive, so women-centred, like the language was really positive and amazing. The labour stopped. She wasn't in labour anymore.
Mel:
[24:26] But can I start? Does that mean that this was a fourth hospital that was involved?
Hannah:
[24:30] Yes, it was four.
Lou:
[24:32] Yes, four hospitals, yeah.
Mel:
[24:34] Because she had the first that you went to first and went, oh, this isn't the one for us, we're going to choose the second rural option. Then there was the Melbourne City Hospital that she ended up giving birth at, but this was the Melbourne City Hospital that she went to for threatened prem labour.
Lou:
[24:50] Correct. On an aeroplane, yes.
Mel:
[24:52] On an aeroplane, okay.
Hannah:
[24:55] And it was pretty funny. Sorry, I can say funny. It was not funny. Interesting? It was pretty interesting that that moment was massively pivotal in the birth, the birth trajectory. Yes. So it all settled down, obviously. We went on to the convergence for the weekend.
Lou:
[25:11] Which was epic. Highly recommend. Checking our phones. Is she labouring again?
Mel:
[25:18] You were in Melbourne. That's handy.
Lou:
[25:21] Yeah. We were like, yep, we're going to be here all weekend. If you want to hang around and have a baby, that might be a good idea.
Hannah:
[25:28] Yeah, so they were obviously recommending a caesarean, but the labour stopped. So we're like, oh, they thought let's keep you pregnant for a little bit longer. So she was only just 36 weeks.
Hannah:
[25:37] Wen and had a growth ultrasound, and this is where it all changed. So this was the first tertiary ultrasound. All the other ones were regional with the same provider, but seemed to be quite inaccurate compared to the tertiary scan. She would have had at least four growth scans in the regional area. So this one showed both of the babies so the 20 15th to the 20th percentile and 20 to the 25th percentile hey so she, they're still breached but that experience for her because she had ctg she had, cannulas like she had all these like medical intervention during this preterm term labor.
Hannah:
[26:20] She came back and she's like my babies are completely normal like she felt like they were the whole time. I received all of that medical intervention and it showed her what she didn't want for labor. So it was actually really interesting. She sort of came back from that and was like, nah, I know what I want. I know that my babies are fine. And this is where the decision-making got a bit tricky because she knew she wanted the vaginal birth. We knew it was like a great option, but it was more just getting the skilled hands. So there was probably a couple of weeks where we didn't really know. We're like, oh, do we go to the hospital and rock up with a reach baby? Like, what do we do to get this option to, on the table for her.
Lou:
[27:00] But it's not like locally it's a pleasant option to just rock up in labor with a breech baby because the language is we don't have the skills here we don't have the trained person who can actually manage the birth if it needs that you know that that skilled care provider they're like we don't do it we've never done it before so as a laboring woman obviously I wasn't, but I could imagine that as a woman in that scenario, you're not really given a lot of confidence. Like, I'm just going to rock up in labour with this breech baby, but the person on the other end could actually cause more damage
Hannah:
[27:35] Or maybe not know what to do.
Lou:
[27:37] Yeah, it's not conducive.
Mel:
[27:40] No, and this is the challenge. Firstly, with twin pregnancies, for women who want to have anything other than a cesarean section, they have to make extra effort to find the right facility and the right care provider who's firstly going to be confident in vaginal twin births to start with, layer onto that, there is a particular different skill that goes along with breech births. And if the breech birth goes well, the clinician doesn't have to do anything extra. The baby will just come. The problem happens where the unskilled care provider either puts their hands on an uncomplicated breech birth and does something that's not necessary and causes damage or doesn't know how to act in an emergency because the manoeuvres are quite specific And if they don't know how to act in an emergency, it could equally do damage. And so women are presented with this situation where caesarean does appear to be the safer option because any obstetrician can do a caesarean section, but not any obstetrician can attend a breech birth. Unfortunately, they all should be able to, but unfortunately it's become this situation, particularly in Australia and in other places in the world. And this is what made it so complicated for her is that she was looking for type of care that's very rarely accessible in a hospital.
Mel:
[29:01] And she had the extra additional possibility of these smaller babies, but that's off the table now. So you described it, Lou, to me earlier as just this roller coaster of change and having to adapt and pivot. So Prem Labor stops. Does she go back home? So did she drive herself?
Hannah:
[29:22] Yeah, so she husband drove her.
Mel:
[29:25] So three and a half hours back to home, but you guys are in Melbourne at that time. Dancing it up.
Lou:
[29:32] Loving life.
Mel:
[29:33] Dancing up the convergence.
Mel:
[29:36] When did the option of going to this other Melbourne hospital get put on the table? When did it become obvious like, hey, A, we may actually be able to have a vaginal breech twin birth somewhere else?
Hannah:
[29:48] So I think in that two weeks, so she had her baby around 38 weeks. And in those two weeks between that, it was very unsure. She was like, I'm not having a cesarean, but I don't know what I'm doing. So, you know, meanwhile, I'm scrambling, came back from time off call and holidays, and And I'm just trying to think of options for her. And I think I felt a bit of pressure to bring up Melbourne again because I just felt like this woman has gone through so much. She's navigating all this stuff. And I almost felt guilty mentioning it just because of everything that had happened. And I didn't know whether she would want that. I didn't want to keep pushing for something that I wanted, but I wanted to support her and something that she wanted. And if that was a cesarean locally, like that option would have absolutely been fine. And I would have supported her through that. So I was just at the park with my toddler and I thought, I'll give Natasha a call. And I said, what do you think about the option of going to Melbourne for an induction? And she just like lit up. And she was like, yes, absolutely. Like let's, she obviously went and chatted to her husband, but she was just like, wow, could we do this?
Hannah:
[31:01] So literally within like 24 hours, she was like, yep, let's do it. Let's try. Obviously, we didn't really know. Like now looking back, we know how amazing the hospital was and how seamless it all went. But at the time, it was all unknown and we were just navigating it. So that's where the connection to the MFM was so helpful because he, we saw him privately, but he worked at this hospital. And we sent the referral to this hospital in Melbourne and we also sent it to him. And I think he was like, oh, like he felt really bad that the growth scan was so different. And he was like, oh, yeah, absolutely, let's get you in. And he really like pushed it along on the back end.
Mel:
[31:45] So basically you had, so this obstetrician at Maternal Fetal Medicine, and this is a really big piece of the story and something that really struck me is how well the whole care team worked with each other. You all understood what the woman wanted because obviously you were listening and she was able to express to you, I want a twin vaginal breech birth. That's what I want. And everybody got on board to go, right, how can we make this happen? And pivoted so much. And this is something that I just think is quite incredible as well about you two, that you were just willing to go with the woman wherever it was she had chosen. If she was opting for a cesarean section, right, how can we make this as good as we possibly can? You know, like Lou, you were talking about, how do we optimize this experience of the 36-week prem labor? We're not in the hospital we wanted to be at. This is obviously not ideal, but how can we make the most to this and then Hannah you're like hey why don't we all just go to Melbourne obviously the induction was a logistics thing because you couldn't have made that three and a half hour trip in labor given her history you know having had babies before and especially with twins if each of the babies is a bit smaller could as well end up having a much faster birth as well
Mel:
[33:08] So you were both willing to just do whatever was necessary to help Natasha get what she wanted.
Lou:
[33:16] Yeah, that first phone call with Natasha, she's like, I've had a vaginal birth in hospital, I've had two home births, now I've got twins and I want a vaginal birth. I'm like, I believe in you. Yes, let's do it. You know, you don't exactly know what the journey is going to look like but you're committed and you're invested and, you know, you learn to just love these families. And just knowing what kind of family they are, their values, you know, what feels safe to them. It really is about like deeply listening to the woman and she's telling you what she needs. She's telling you, you know, my growth scan is telling me that my babies are
Lou:
[33:55] Growth restricted or small. They're using a singleton chart, by the way. They weren't using the twin chart, but she's going, but everything, but I feel huge and I feel well and my babies feel really good. And so, you know, you've got to listen to those things as well. Like the mum is telling you what she needs and how she's feeling. And we did. We really believed in her. And it was just, yeah, working together, collaborating. I think that that's like Hannah is amazing. Like just if I could say such a collaborative midwife, so women-centred, just so incredible to work with as well, you know, in the hospital environment and the home environment as well. And a midwife who's willing to sort of build up those connections with obstetricians and go, hey, can you come on board and this is what we're trying to do and just a very collaborative approach which is just benefiting the women.
Mel:
[34:46] Yeah, and that comes through. And so this obstetrician with maternal fetal medicine is It sounds like you kind of met each other on this collaborative bridge between the locations and the woman had a more seamless journey. She's like, right, we are going to Melbourne to have an induction and I'm imagining you all scurrying in the background trying to kind of get everything ready. But to the mum.
Hannah:
[35:15] Yeah, but to the mum.
Mel:
[35:16] We're like, oh, you're a good trip.
Lou:
[35:18] Yeah, yeah.
Mel:
[35:19] We'll go out to dinner. Yeah, park the car.
Lou:
[35:23] Airbnb, it's fine, yeah. We'll go to DFO, it'll be great. You're going to have a great time.
Mel:
[35:28] So we're ending in being in Melbourne. You've spoken to the obstetrician at Maternal Fetal Medicine who's kind of become your gateway into this new, unvisited before Melbourne hospital. I'm just wondering, like, are you just hoping this was a good plan?
Hannah:
[35:48] Lou kept saying to me, this is so weird. Like we're at an Airbnb with our client in a three-bedroom Airbnb and we all went out for dinner and she's like, this is so weird. I'm like, it's just crazy that we are in Melbourne. How did we get here? And, yeah, so I was really down for it. I absolutely loved this client and I loved her desire to fight for what she wanted. Yeah, I would have done anything. I would have gone to Sydney. I would have flown somewhere. It was logistically very difficult, but I just, I feel like Breach is so difficult to become, confident in offering that I felt like as well as absolutely loving the woman and wanting to support her, I really wanted to build my experience as well.
Hannah:
[36:33] So yeah, we're all in Melbourne. We're staying, we're planning an induction for the next morning. I woke up and Doola Lou was getting photos of the woman with her belly right before she was about to have her babies in front of the city lights um so it was a really unique and special experience we.
Lou:
[36:50] Were kind of secretly hoping she'd go into spontaneous labor that night in the in the airbnb like in the morning she was up quite early i was like are you having niggles are you contracting she's like no i'm like it's all right i was like please
Mel:
[37:04] I mean i'm looking at the team behind this i imagine that she had support crew back at home caring for her other children and household while you were all ferrying her across the country to access the services that she wanted and tell us about the reception. At this Melbourne hospital.
Hannah:
[37:30] Yeah, pretty amazing. So after we sent the referral within 24 hours, the hospital obstetrician, so like the head, I think she's the head of obstetrics or she's some big name who's very passionate about breech. She called Natasha before we went down there and Natasha said, I don't want CTG. I want to have a, I just want my waters broken. So she went through all of her preferences. She didn't want an epidural and the obstetrician on the phone was amazing. Natasha was like, and I said to her, are you sure you weren't talking to a nurse or like the admin lady? Like, are you sure you were talking to the obstetrician? So Natasha actually felt really confident in what she was going to walk into. We were walking through the Melbourne hospital with our Great Birth Rebellion merch on. And we must have looked like we were from the country because we rocked up when we finally found the birth suite. So we're sitting in the little waiting room and this very nice looking lady said, oh, are you guys from Wodonga, like where we live? And she's like, oh, I'm an obstetrician caring for your twin mom. She's in room, you know, whatever. And she's like said to us in the hallway, oh, these babies are just going to fall out. So we've gone from.
Lou:
[38:40] But she was so excited. She was like, welcome. So, you know, I've just got to go do thing. I'll be in 20 minutes. We're in this room. And she was like, we're going to have the best day ever. These babies are just going to fall out.
Mel:
[38:51] So she was way on board. She's like, yes, whatever it is you want. We're going to have a breach between birth. This is going to be great. She's going to nail it. She was pumped. Amazing.
Lou:
[39:02] It was the best. And Hannah and I were in shock. We just sort of looked at each other and we're like, what? It's just not your typical conversation maybe with an obstetrician.
Mel:
[39:14] What were you expecting? Because this is, I think, important. So you were shocked. Were you like, no way? have we just stumbled across this unicorn obstetrician who is actually on board with this woman's plan. Firstly, she's actually listened. Secondly, she's excited. It seems as though she's advocating. She's welcomed you guys with open arms, which can be a real challenge. Going in as a private obstetrician and as a doula into some hospital settings can be terrifying because you don't know how they feel about you. Sometimes people are threatened by care providers coming in into their, in inverted commas, their facilities. So is that kind of where the shock came from is, oh, my gosh, firstly, she was just so nice to us and you could have been greeted with a lot more hostility. Secondly, she is on the same page as the woman and as you guys. Was there anything else that you were kind of like shocked about?
Hannah:
[40:16] I think the total environment was so different. You know, we work in regional hospitals all the time and obviously everyone's doing their best, but it felt just really positive. They obviously chose the midwives that were with her and... Usually you give your birth preferences and it's like no you're not having that no that's not our policy.
Lou:
[40:37] There was a
Hannah:
[40:38] A really respectful conversation and yeah it is hard being like we're both support people we're not clinically and especially me as a midwife although I'm a midwife I can't clinically act as a midwife in the hospital because of um yeah we don't have visiting rights but it's like they respected us even though we were support people which I feel like generally like you said Mel isn't the case. So, we handed over then birth preferences, which was the opposite of what a twin protocol would tell you to do. It was like a home birth plan in a hospital room, birth preferences. Yeah.
Mel:
[41:13] Because a protocol for a lot of twin scenarios in hospitals,
Mel:
[41:19] they do want women to have continuous CT gene monitoring. A lot of clinicians will be asking the woman for kind of a prophylactic epidural so that if they need to do any kind of manoeuvres that the woman already has an epidural and there's no delay or if they need to immediately switch over to the plan to have a cesarean section there's less delay they'll often ask the woman to be lying on her back they don't give the woman access to water birth often if she's having twin pregnancy they just really are quite terrified of of a woman with two babies inside of her and they're like right don't do anything except for please just have ctg monitoring and an epidural and we will plug you in and get the babies out it's kind of the usual experience of a twin birth so what did she want what what was natasha's like dream scenario to
Lou:
[42:14] Go into labor with no intervention no epidural she declined ctg she didn't want a cannula she did have access to water she wanted her to support people there there was like even time frames of like if we do rupture of membranes how much time before we would then go on to the next offer of the induction and what was so beautiful in that consult in the morning before the induction happened is Natasha did all of the talking we just sat there she she advocated for herself she'd been through the plan she was very confident in her choices so it was just a discussion between her and her obstetrician, who was obviously going to be her primary care provider. So yeah, I guess Hannah summed it up perfectly in that it was like the closest thing to just, obviously she was, she did have her membranes ruptured. But other than that, it was the closest thing to physiological and yeah, as close to a home birth without a monitoring and the pain relief and all of that stuff.
Hannah:
[43:10] So waters were broken. We didn't end up meeting or wanting the oxytocin drip. But I think for me, so I've only ever seen one other twin birth in the hospital, but it is medically managed. So we had a physiological placental birth. Yeah, it was stark opposite and just so, respected and not, because specifically on the CTG and the cannula, like the doctor, the obstetrician was so beautiful and amazing, and she communicated to the woman, she said, I would really feel more comfortable if you had the CTG, and I would really feel more comfortable if you had the cannula. Thank you. And then Natasha just sort of delayed a little bit and said, oh, I'll have a think about it. And then that was the end of the discussion. It was almost like this, the way it should be, like you should offer what you would feel comfortable with. But she just accepted her decision. And Natasha would have absolutely accepted all of the intervention if it was the best and safest. But obviously, we know CTGs don't necessarily reduce bad outcomes. And when you see how it played out in the birth, it was really nice for her to be able to move and the babies were monitored with intermittent auscultation and their heart rates were always perfect.
Mel:
[44:25] So you guys went in. The only thing that kicked off the labour was that her waters were broken artificially and she didn't end up needing any of the oxytocin drip. You mentioned, Hannah, that a lot of midwives, particularly here in Australia, just the way our system is set up not all private midwives can just go into any hospital and keep going with midwifery care and at this particular one you didn't have visiting right so you were both kind of in the role of a doula I suppose within this setting and then it was Natasha and her partner and this obstetrician and then the hospital had obviously allocated to you probably one or two midwives as the care providers during the labour.
Mel:
[45:11] Can you talk to us about how the labour unfolded and what happened there?
Lou:
[45:16] Well, it was swift. It was a very brief labour. Was it 40 minutes?
Hannah:
[45:21] An hour max. You'll have to get the news from Natasha. Yeah, it was very quick.
Mel:
[45:26] So they broke her water and I assume she just started having contractions.
Hannah:
[45:31] Yeah. So we were getting set up. We got straight in the bath because we could see that maybe she was a little bit anxious, just about a thought. She never had an induction, I don't believe. So it was really, she kept saying, this is really weird. Like I'm just going in to have a baby. So the bath felt like the right choice to relax. And Lou was in there getting photos. And then she walked out to go get something and the woman started to make more noise. And I said, Lou, I think we should hang out out here. They were in the bath. They had their cushion music on like I just felt like she really wanted to be private and alone yeah.
Lou:
[46:07] Read the room get out
Mel:
[46:08] You know yeah that
Lou:
[46:09] Kind of thing run the bath do your job it's all set up and then get out and then as soon as I left the room she was like vocalizing immediately
Mel:
[46:17] Right and then so water's broken and then off you go into the bath and we will just private close
Lou:
[46:22] The door we're gonna have a snack we'll have a banana we'll have a drink of water and just chill out in the birth suite and leave you to it
Mel:
[46:29] So you created actually an oxytocin nest for her yeah a safe space she felt she would have felt nice and safe and contained in that bathroom and then in the bath and then with her partner with the sounds that she wanted I can only assume the lights were turned down low and then you got out of there which I mean is the perfect scenario to allow oxytocin to just flood in
Lou:
[46:56] And it was like
Mel:
[46:57] That
Hannah:
[46:58] Yeah so we were happy dancing in the corner of the birth suite as we heard her become uh there was sort of one in ten contractions and you know we were just loving it and they really left us alone in the room which was lovely like the medical, team because I don't think they knew she was in labor probably a lot of the labor so we were just sort of hiding away she was hiding away.
Lou:
[47:21] Close all the doors
Hannah:
[47:22] Yeah and then, similar to what happened with her other births all of a sudden they were two minutes apart and she knew where she wanted to be she's like after I have a bath I'm going to the toilet the old um dilation station as they call it, so it just once it hit that two minute mark then obviously we were required a bit more and we went in and supported and she was on the toilet and I knew I'm like this is active and strong and I knew she was about to start pushing soon still no one in the room like we were sort of yeah hanging out together like we would at a home birth yeah.
Lou:
[47:53] Her midwife came in and she was like, how's she going? I'm like, she's great. She's fine. Thanks. You know, just like lots of space.
Hannah:
[48:00] Yeah. So after that, when she started to involuntary bear down, obviously there was, the team came in probably 10 or 15 minutes before that. The other thing on her preference is that she didn't want any extra people in the room. And that was another thing that was totally respected. Like my experience is that usually there's like a whole pediatrician team. One twin birth I went to, there were at least 15 people in the room. And although she was wanted to also educate, especially in relation to breach, I also think it's okay to say that you don't want any strange faces in your birth room. So she was tucked away in the corner. The obstetrician was sitting on the floor, which I swear I've never seen. In the corner of the bathroom and she started to push. There were, so there was two, there was a student midwife and midwife and then the receiving midwife and the doctor. So there were four medical staff in the room, which I think was very reasonable.
Lou:
[48:59] Pediatricians outside of the room.
Hannah:
[49:01] Well, I didn't even see them if they existed.
Lou:
[49:02] They might not have been called yet because she labored so quickly, but that was her preference was that the pediatricians are welcome to wait outside of birth suite and, you know, if required, they can be invited in.
Hannah:
[49:13] And, yeah, so after that, I don't know how to explain how she had her babies. She was in an all fours position and I was really keen to video the birth because obviously being a breech birth, I really wanted to show her and I really wanted to show others. It was just an absolute textbook. So this is baby boy who's twin A. He came out bum first, Frank breech, and rotated and, yeah, came out really quickly. It was very smooth.
Mel:
[49:41] On the toilet?
Lou:
[49:41] Very, very quickly.
Hannah:
[49:43] No, so we're on all fours on the floor.
Mel:
[49:46] The bathroom still?
Hannah:
[49:48] Yes. So we were all cozied in there. Very, very cozy. And the heart rates were monitored like during the pushing stage by two different midwives with two docklers. So you could hear them perfectly separate. And, yeah, it was very interesting to watch. But basically, I don't know what to say except for the baby came out really perfectly and easily.
Lou:
[50:10] You know, we're in the home birth environment and you see a lot of, like, physiological processes and it just unfolds and it's just really normal and sort of, like, uneventful in a way. And that was my, like, obviously, it was amazing that there was twins. Like, there was two, which was also, you know, once one was born, you're kind of like, oh, there's another one coming. but it's like it was just a normal baby coming out but its bum was first and it just was so straightforward.
Mel:
[50:36] It's like, yeah, just straightforward. So uneventful. Uneventful. Just she forced the baby out and then the baby came out. Was there any discussion during the pregnancy about sometimes there's a big concern about the interval between births and how long that should be? Some of the evidence suggests you shouldn't wait any longer than half an hour for the next twin. Did the obstetrician give any indication of what criteria she had in her mind for when she might actually intervene today? In this birth?
Hannah:
[51:06] She actually did not talk much. It's like she knew that this woman just had, like we had spoken about the intervals, about the epidural, about like every possible twin policy thing. So she actually, she just said, I want to do an ultrasound after twin A, which Natasha was fine with, but it's, there wasn't really a pause. Like one baby came and then.
Lou:
[51:28] Eight minutes.
Hannah:
[51:29] Yeah, it was eight minutes later, the other baby came. And I think Natasha really needed our support in that moment like I think it was a little bit of oh my gosh I'm in a hospital this is yeah I think having us there during that point it felt really important, like for her like I felt that connection a lot during that period where things were really intense also the logistics of having who's holding the baby while there's another baby coming while the partner is trying to provide reassurance to the mother it was logistically a lot I actually don't know what you would do without a doula.
Lou:
[52:02] I was taking photos as well. And Hannah's like, can you take photos and take video? And I'm like.
Mel:
[52:08] Did they leave the cord attached on the first baby, on baby boy? Yes. Yeah.
Hannah:
[52:13] Ball attached. Yes. Physiological placental birth.
Mel:
[52:17] Yeah. So both ended up coming breech. Foot.
Lou:
[52:22] For the second baby. Foot from the second baby.
Mel:
[52:24] Foot from the second baby. Right.
Hannah:
[52:25] So that was a really key point. The doctor, so she was a BABE instructor, which is Andrew Bissett's course. So she was passionate. She was hanging out with Andrew Bissett's and Betty Ann Davis the week before.
Lou:
[52:37] We're in good company when that happens, you know, we were just like, where are we? Exactly.
Hannah:
[52:44] Yeah. So I think of another pivotal moment. And I honestly just don't know how you would navigate this in a less supportive environment because there were so many things that could have been like blown out of proportion. So she did a really quick ultrasound and she saw that they were feet down. Even that moment, I'm like, like the baby obviously would have came out anyway, but like the misdiagnosis of foot lean breech, she was like, oh, it's a foot. But it was, you know, incomplete, which is when they've got a foot under their bum. So –, She just was knowledgeable and knew what that was. And then after that, she just progressed and had her second twin. So she went to the bed, had like one contraction on the way, went to the bed, quick ultrasound, and then pushed out her second baby. Because we were on the bed, and that was only because the woman didn't want to move at that point. It wasn't that the doctors weren't supporting her to move on to a different position. So that baby did just need a little bit of help to provide gravity because she was on her back but by no means did the baby get stuck so basically that's what happened the second baby came out with just a tiny little bit of gravity assistance, and when Natasha was pregnant both of the baby's heads were like up in her ribs and one of the real moments for me that I thought was just so beautiful is the babies were placed directly on her skin with their little heads together and You could just see that they had been together,
Hannah:
[54:08] for nine months and that they were now just on mum's chest.
Mel:
[54:12] So the babies obviously had no delay in getting back to Natasha, to their mum, after being born. So immediate skin-to-skin, no cord clamping and cutting, so they had all their own full blood supply as they should, as every baby should. And then physiological placental birth. So for anybody listening, one of the risk factors for a postpartum hemorrhage is if you have a really big placenta, which happens with twins, because it's two placentas, or I imagine, Hannah, I haven't asked you what type of twins they were.
Hannah:
[54:50] Yeah, so a di-di, which is the lowest risk if we were going to say that, and then placentas had fused together, but they had their own.
Mel:
[55:00] Right. So essentially if you've got twins and you're hoping for a low intervention birth, a di-amniotic, di-chorionic pregnancy is kind of the most likely chance you're going to get that because basically each baby has their own membranes, their own placenta, and you've just got two of those. Which means they are sort of functioning fairly independently. As far as they're concerned, it's a singleton pregnancy experience for each baby. But obviously, there was a point where the placentas met each other and fused. And there are some twin pregnancies where they're actually sharing a placenta. And this is kind of the more problematic ones where you might expect more complications is where two babies are sharing one placenta, which was not the case in this scenario. So fused, which means, yeah, the size of two placentas, which just creates more surface area on the woman's uterus to have a bleed. So I can understand why clinicians are a little bit nervous about the placental birth for twins and are keen to get it done quickly. And often they'll do preventative strategies like immediate oxytocin injection to bring out the placenta Yeah.
Mel:
[56:18] What we call actively managed placental birth. And I have also seen them put up IV oxytocin, again, as a postpartum hemorrhage preventative, but obviously she didn't even have a cannula or anything. So this obstetrician was willing to wait for physiological placental birth, which essentially is just waiting for the placenta to come. And the woman gives birth to the placenta under her own efforts in the same way she would have given birth to a baby. And did that go well the placental birth
Hannah:
[56:50] That was a huge element that I was like wow I cannot believe like the doctor left the room she didn't even stay in there and wait for the placenta and I think my, idea of physiological placental birth just like you said Mel is like the babies were born and yes we did have the waters broken so it's not like it wasn't any intervention but your body knows how to birth placenta and that's what we see at home all the time so it was just that Natasha was like, I just want to see if my body will do it, which is the most likely scenario. And if things become concerning, then we have the medications to rely on, which is exactly what we do in a home environment. So it took a little bit of effort and time. And I think it was six. Yes.
Lou:
[57:31] Who's holding who and who's holding, yeah.
Hannah:
[57:33] Yeah, it was really lots of things happening. So much cord, placenta and baby.
Lou:
[57:38] So many babies.
Hannah:
[57:40] So we were like, I was holding a baby. Lou was getting photos. The other midwife was holding like half the placenta came out and then there was sort of there was still like more to come but there was half coming out so it just it required all the midwife strategies like we went to the toilet we, fed mom fed the babies I was holding the other baby close we went in the dark, dark room with her partner so we were incorporating all of the things again that we would at home and, yeah they waited patiently her bleeding was completely normal the placentas came out it was probably like an hour, Yeah, probably an hour, so even the labour.
Lou:
[58:19] I mean, longer than the labour. The labour was bigger than the placenta.
Hannah:
[58:22] Which seems to happen a bit, actually.
Mel:
[58:25] Yes, placentas. Yeah, sometimes they're really rude, but that's incredible because even in singleton birth, I've seen midwives and obstetricians freak out at half an hour and go, oh, that's it, the placenta's stuck, we need to go to theatres, it's all too long. So that's extraordinary in itself.
Lou:
[58:43] But this mum was extraordinary. She was so capable, you know. She had everything that she needed. And as you said about just having the team around, the team were all on the same page. We were all supportive of her. And, yeah, she was so capable to do it. She's done it three times before. She can do it.
Mel:
[59:00] Yeah. And when I speak to Natasha, which will be next, I would love to ask her, and she can tell me all about this, is how she became so capable because I do think that all women have it in them to be able to do what she did and to advocate for themselves and to be confident and to resource themselves with the things they need and she did it so I'm super interested to ask her like what education did she do how did she become so confident why did she choose midwifery and doula care and obviously adapted her care as her needs and the needs of her baby changed which is what women do because we're not idiots and you know women are so clever as to only like they will choose what they do what they need to do to get the outcome that they want to get.
Lou:
[59:53] It's just given the opportunity it's like women just want the opportunity to give it a go and understanding that yep things might progress and the plan might change along the way which you know everyone was on board with like we made the c-section plan and we talked through that option on the day that she had her induction she had a c-section booked locally so you know it wasn't like every single option was, you know, closed off to was like an open mind and just exploring those things. But ultimately just sticking with her plans, staying really confident and just keeping going down that path that was right for her.
Hannah:
[1:00:27] One thing that was mind blowing to me is that all of the conversation locally was C-section, C-section, C-section. And I can't help but feel like most women would have had a C-section for her fourth and fifth baby. But it was because Because she like put in the work and like we were just sort of a team and we did it together. And it's not, you know, the local hospital was actually really, really happy for her in accessing the care. So it's not, but it's just crazy to me that there could have been that recovering after having your fourth and fifth baby by cesarean or what she had, which was so empowering and pretty much a home birth in a hospital room. So it it does make me a little bit mad about the regional inaccessibility that we have women should not have to drive for hours and have to have a medical intervention because they're not close enough, to a hospital so it did highlight that for me but I guess just try and fight things the way that we can and yeah unfortunately women sometimes have to make
Hannah:
[1:01:29] hard decisions for the best outcome for them for what they want yeah.
Mel:
[1:01:33] And what I can see that you guys offered was to help her turn every stone and you resourced her and advocated for her to turn every stone to discover and this is what I always encourage women to do discover the range of things that are on the menu for you however ludicrous they sound like how can you access the things that you want what barriers are there what way can you open that up how can you navigate this situation to actually you curate the type of birth that you want and for her it meant having locked in and committed care providers who were like what do you need us to do absolutely nothing's off the table we will travel for hours get an airbnb whatever you want to do she had a lot of things on her side that she'd obviously resourced herself to do but it is completely understandable that another woman might look at the menu option. And for any other woman who didn't have these resources, the option would have been, you can have a cesarean section or you can accidentally come in in labor and be presented with just the skill level of what we've got. But we agree that this is not the ideal scenario. And it's not that your local hospitals were evil.
Mel:
[1:02:55] It's just the reality of maternity care is that each hospital can offer such different things and it's up to women to find the one that suits their needs and unfortunately for her it was four hours away
Mel:
[1:03:09] It does highlight that not everything is available to every woman all the time. And there's some creative work that needs doing if you want to put every option on the menu. And that's what you guys did is you put all the options on the menu so that she could make the choice that felt right for her. And then she got to choose what she was willing to do. And it's a unique scenario that she had people at home who could hold on to the life over there that was happening without her. But it is sad that women need to be moved away just to access respectful maternity care, which is exactly what she got. And Lou, you said earlier that the obstetrician, we haven't named the obstetrician because she doesn't want to be ousted for being incredible at this time.
Mel:
[1:03:58] But I wish she would allow us to name her so that we could, you know, Praise her efforts. But she is intending on writing this case up as a case review for an academic journal. And when that happens, I'll make sure it goes into the resource folder and then maybe you guys will find out who she is. But she does sound like a skilled and respectful, lovely obstetrician. And that's not always the case, unfortunately, but you guys really landed in this. We hit the jackpot. Yeah, you hit the jackpot. But isn't it a shame? I know, but it's a shame that it's like you have to hit the jackpot in order to get respect for maternity care sometimes and to have all the things available.
Hannah:
[1:04:41] I think for me it felt like, wow, this was actually so easy. Not easy, but like. For the hospital to be respectful it felt easy like when we were there it didn't take much it just took not that, that fear language or like taking all options like they're in control and it's not a unique human that's going to keep their babies alive for a very long time no one wants to put their, you know you're not gonna go put your child in the middle of the road and leave them like it's the same in pregnancy we all want the best and safest outcome and I think it's absolutely doable. And it actually filled me with hope as a private midwife. I'm like, yes, we can do this. We can have respectful care. And when the plan changes, we can have a team that are going to champion that. Very possible.
Lou:
[1:05:26] That's what Hannah said on the drive home. She was like, that was so easy. We could do that again. Like we can do it. It's fine.
Mel:
[1:05:33] Yes. And it's not, the hard part is usually not caring for the women. The hard part is when you You experience hostility between the care team and then the challenge comes trying to keep the relationships intact enough between the care team to get through the woman's labor and birth care so that the woman doesn't feel the impact of a disconnected team. But it does feel easy and it feels actually incredible. And like you said, Hannah, with hope, when everybody in the scenario treats each other respectfully, we all benefit. the woman, the maternity care system, all the care providers benefit. And you go home thinking, oh my gosh, I could do that again. Whereas what's happening out there is a lot of midwives and a lot of private midwives are thinking, oh my gosh, I just hope I don't have to do that again, have to deal with that hospital again, or have to deal with that obstetrician again, or deal with that venue again. Because we can have some really
Mel:
[1:06:35] Difficult situations from a clinician's perspective as we're trying to give women care. So it does feel like respectful maternity care is not that far away. All it is, it's the difference between one individual that you guys were able to connect with some key people, the male, the obstetrician from MFM and then this other obstetrician who was just like, yep, we can make this happen and was completely respectful to you guys, completely respectful to the woman. In exchange, you were respectful to her, I imagine. And I mean, everyone's happy. I don't understand what the issue would be. Why can't we just do that?
Lou:
[1:07:16] I know, just do it. Just all get along. Collaborate. It's easy. Yeah. Yeah. I think midwife and doula is a match made in heaven too, just as like a little side note. And I don't really feel like, I'm trying to word this well, but not all midwives understand the benefits of a doula. I've had this conversation a lot with midwives like, well, what do you offer that I can't kind of thing? And I think it's just having like we have separate skill sets. They're both benefiting the woman and they're both working together and we can actually collaborate. There are a bit of crossover like we both care for the woman. We're both passionate about birth. You know, the more that we can build up those relationships and work together, the better the outcomes are for women. So it's like, doulas work well with midwives. They're not an enemy that you're needing to like push away or fight with or question. It's like, you know, build up those relationships, bridge that gap between maternity care and the woman and the family. And yeah, it's just that collaboration and vice versa, you know, midwives going, let's work with doulas. Like we've got skills and stuff to offer in those scenarios.
Mel:
[1:08:23] 100% I agree. I don't yeah I don't think any there was there was not too many people in this scenario if you know what I mean I think everyone needed to be there just even the logistics that you described with the birth and the placental birth is exactly why you need extra hands extra advocacy like there's extra practical needs for women but also everybody in that scenario is human like we all have human limits to our energy our emotional capacity you know everything we all have to eat we all have like we all get sore arms from massaging and doing like why not have an extra person in that space who is comfortable in a birth space who knows how to advocate for women who is capable of providing some additional education supporting the partner like navigating logistics so little of a birth care is actually clinical as well and so yeah doulas make
Lou:
[1:09:26] A good cup of tea too
Mel:
[1:09:28] We make you know how to
Lou:
[1:09:29] Put the kettle on make a cup of tea
Mel:
[1:09:32] But even like you know if hannah needed a nut and she's confident like lou has got this you know in that scenario and i was a chauffeur
Lou:
[1:09:41] Too by the way i did all the driving down to them
Hannah:
[1:09:44] I needed to preserve my energy.
Mel:
[1:09:47] But that's like taking mental load from the midwife too yes to just sort of go yeah you know do you know what I can't think of this right now can you navigate so I agree and
Lou:
[1:09:57] Hannah couldn't Hannah couldn't make it to all of the appointments there was a weekly appointments in this pregnancy and and you know they're important that there was someone there so sharing that
Mel:
[1:10:07] Load as well
Mel:
[1:10:09] Yeah, absolutely. Good on you guys. I just wanted to showcase this, that even in this current maternity care system, wherever you are in the world, it's possible to curate the type of birth that you want. And I think it does rely on having the right people in your camp, robust support people, whether or not you have to hire them or whether or not they already exist in your life. And then from care providers, it's just about being respectful and prioritizing the woman above policies and procedures. Just listen to the woman, hear what she wants, provide as much education as you possibly can, and then accept what her choices are and do your absolute best within that. Because the women will have restrictions on their care providers, just like the system restricts women's choices. But if we flip it the other way around, where the obstetrician's like, look, I really would love to put a cannula in and a CTG on. And the woman's like, well, my policy is no cannulas and no CTGs. And so the obstetrician had to go, well, look, I don't really feel comfortable, but as part of respectful maternity care,
Mel:
[1:11:21] And obviously, the fact that she's an autonomous woman who has to give consent
Mel:
[1:11:25] to everything, I'll go along with this. And that's, I mean, that's respect for maternity care. Guys, is there anything else you want to really highlight in this story that stood out for you or that something you want to tell the women listening if they're pregnant with multiples?
Hannah:
[1:11:40] I would just say not letting the place that you live or the lack of options to predict what you want your birth to look like. We know that we remember our births for the rest of our life and most people want that to be a really positive and empowering experience. And also just give yourself grace to however your journey looks like, making decisions that feel right for you, not keeping everyone else happy, your doctor happy, even your home birth midwife. If you're like, no, that's not, it's not what I want to do. It's about your long-term family. But yeah, I would just keep pushing. And if we don't fight back on things like this, you know, maybe in a couple of generations, breach, unconvinced breach will become more normal. We have to keep fighting or things are going to stay the same. Just like in the olden days where women were strapped down and babies were pulled out. We've come a little bit of a way and we need to keep going.
Mel:
[1:12:36] What about you, Luke?
Lou:
[1:12:37] I would say in supporting women, their intuition and their instinct and their intellect, The I in the BRAIN acronym is really important. It's like you've been given the benefits, the risks, the alternatives, and you're weighing up all of your options, but then what do you believe? What do you feel? What's your instinct telling you? I think in the new Safer Care framework, they might have taken the I out of the BRAIN acronym. I think it's just brands now.
Lou:
[1:13:04] Fact check that but it's please check it um I did read it somewhere as like a brand acronym and I'm like no the I is central the I is so important for women to tune into what their instinct and their you know their gut is telling them yeah just backing up what Hannah's saying it's like explore your options if you're only being given one option you're not being given respectful maternity care you're actually not being given informed consent if the only option is a c-section 38 weeks that is not informed consent you're not being given the options so explore the options and one more thing on women too it's like women sometimes have a tendency to like not want to put people out it's like even when you've employed people to support you and it's like oh no no no we don't need to like let's not bother I'm putting people out and you know there might be too much travel and what about your kids and what about your family it's like you know maybe some of that people pleasing comes out and people don't want to put people out but it's like no put yourself first and put what you want first even if that means that people need to shift and change their plans and work around you it's like you're not inconveniencing people you need to put yourself as number one
Mel:
[1:14:18] Yes that's such a good point but also if somebody in your care team is feeling inconvenienced by you that's a really clear sign that they're not the right person and so actually who you need to hire is people who will say, whatever it is you need, I'm going to do my absolute utmost to meet it. There will be, again, human limits. You know, you guys as well in the background, I know what it takes. You all have households as well. And I remember when I used to have to, you know, when I was leaving for birth when my kids were little and there was this whole team of people ready to be activated just to make sure that my home life was still ticking away. Bye.
Mel:
[1:15:01] Uh while while while I was out so the same thing happens and it's about though you know if either of you couldn't have been there I know that there would have been another backup plan that you could institute so that this woman still had all the care she needed and you're right with the people pleasing behavior if any time in your life yeah I think that's it I think if there's any time in your life where you will just not be a people pleaser even if it's not in your nature just take your birth and early postpartum as the first and only opportunity, if you're never ever going to do it again, to be completely prioritizing your needs over those of everybody else's. Now in the show notes below, I'm going to put Hannah's details and Lou's details if you want to explore them. If you are anywhere near Aubrey Rodonga and you're thinking, whoa, these are the women I want in my life. Go for it. And next week, we're going to talk to Natasha and ask her about her experience of this same story. But I did want to get
Mel:
[1:16:05] Your the the kind of your story first because we we often hear women's birth stories but we never get to hear what happens in the background of their care and how impactful that is to the woman's experience because Natasha will have her own story of her birth but you've got a story of her birth as well because you guys were there and and part of it thank you so much for sharing it And I do hope that this magical unicorn obstetrician
Mel:
[1:16:34] Will publish that paper about respectful maternity care so that we can literally oust her for all the right reasons. And, yeah, a big shout-out to those Melbourne hospitals. But good on you for making this happen and helping Natasha achieve the birth of her dreams, really, in this scenario.
Lou:
[1:16:53] And thank you to Natasha. Yeah. What a privilege to support this woman. What an incredible birth, incredible woman. So, yeah, it's just such a privilege to actually be invited to support and be invited into these spaces and have the opportunity to experience that.
Hannah:
[1:17:09] Yeah, awesome. Thanks, Mel. It's amazing to share what's possible. All right.
Mel:
[1:17:14] Well, that is this week's episode of the Great Birth Rebellion podcast. Hang out for part two. And we'll speak to Natasha in next week's episode. To get access to the resources for each podcast episode join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me mel @melaniethemidwife on socials and the show @thegreatbirthrebellion all the details are in the show notes
This transcript was produced by ai technology and may contain errors.
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