A Natural Twin Birth in Africa

When a mother is carrying twins it is possible to give birth naturally without harm to either the mother, or either of the twins. A mother needs to be healthy, the twin pregnancy needs to be free of complications and it is helpful when the twins are lying in favourable positions. A mother needs to be confident and take full responsibility for her personal health. How a woman herself was born also affects her perception of how she may give birth.

Many women believe that if their mothers gave birth by caesarean section, they are not able to give birth naturally themselves. This is not true. Way back into antiquity, the long line of mothers who birthed before us, to the beginning of time, birthed naturally. In fact, when a woman is herself born by Cesarean section she may feel the impulse to give birth naturally even more strongly.

Saba Douglas-Hamilton is one of these women, and her journey from nurture to nature is spectacular, despite the fact that she was born by caesarian section and carried twins in her second pregnancy.

This story begins three years ago in 2008, when I was contacted by Dudu Douglas-Hamilton to assist her at her birth. Dudu had been born by caesarean section; yet felt strongly that she wished to give birth as naturally as possible, with her family around her, and especially her sister Saba. Saba supported Dudu with her quiet, strong empathic presence and never lost her composure during this intense experience. After a vigorous active labour, Dudu gave birth in warm water to a now feisty little boy called Bundi. When Saba contacted me last year to say she was pregnant for the second time and to ask if I would assist at the birth of her TWINS I was delighted.

It brought back the memories of the birth of Saba’s first baby, one year after she had so ably helped Dudu. I was touched that Saba felt confident enough to reconnect with me and was delighted to embark on the birth journey with them. I gradually got to know Saba and Frank (her husband) during the antenatal visits and birth preparation sessions for the birth of her fist baby. Saba and Frank also attended a birth preparation workshop with Robyn Sheldon and prepared for a natural birth using the Mongan Hypnobirthing method. Saba felt most comfortable doing most of the ‘work of labour’ by being in nature and taking a walk with Frank and Dudu in the forests of Table Mountain.

Somewhere high up on a mountain path, she went into active labour with contractions 4minutes apart and by the time Saba arrived home, labour was well progressed and contractions were every two minutes. Saba, who is an accomplished wildlife documentary film maker and had experienced many physical extremes on her trips into the wild, applied herself to the task of birth single-mindedly. Saba had made sure she ate a healthy diet, exercised daily and kept fit. She flowed with the animal forces and instincts of her body, breathing and allowing the process of birth to develop with courage and their firstborn daughter, Selkie, was welcomed into the world in a tub of warm water under the fig tree at about 3.40pm on the hottest day of the year. After the birth and postnatal period, I discharged a healthy mom and baby from my care and sadly took my leave from the family.

Saba and Frank left for their home in Kenya, and my midwifery practice continued in Cape Town over the course of the next two years. I had increasingly considered relocating my practice to Kwazulunatal (KZN), another province in South Africa, about 1000km from Cape Town, where my mother lives on a farm with her herd of horses. By late 2010 it seemed possible to make this move by early 2011, however on the 23rd of November 2010 I received an email from Frank and Saba saying they were pregnant again and hoped for my services, and this time it was TWINS!! My heart sank, as I was scheduled to be in KZN at the time of their due date, the end of May 2011.

Kenya to Cape Town

Frank and Saba arrived in Cape Town at the beginning of April and I met them in their Cape Town home. Saba and I discussed the preparation for their twin birth, the possibilities of my presence and I asked permission to greet the twins through touch and voice. The minute I touched Saba’s abdomen, I ‘knew’ that I would be with them at their birth. How did they communicate their knowledgeand wishes to me? Was it the warmth I felt coming from Saba’s womb? Was it the way they responded to my touch? Was it the relationship with Saba and the history we already shared? It felt as if we were deeply connected and I was ‘called’ to be with them during their journey to join us on planet earth. What a privilege, yet how would we pull off the details of attendance when I already had a client booked in Kwazulunatal due towards the end of May 2011?

Saba was seeing her obstetrician, Dr Douglas Dumbrill, for regular checks at the Vincent Pallotti Hospital in Cape Town.  The twins were dizygotic (two ova were fertilized), each twin occupying a separate amniotic sac, and both twins were lying in a vertex position (head down). This was good news for attempting a natural birth, as it meant that the twins were not going to get entangled with each other and each placenta was individual to each twin, positioned separately on the uterine wall. Every mother has fears about her pregnancy and the health of her babies, so Saba had double concerns. She had also recently heard that one of her good friends in the United Kingdom had attempted a homebirth and had lost the baby. Apparently the baby was born with the cord wrapped tightly around the neck(nuchal cord). This occurrence of the cord being around the neck of the baby is common and usually does not lead to the demise of the baby, but is easily unwrapped after birth.

However this news about her friend’s loss came at a tricky time and increased Saba’s anxiety about the wellbeing of her twins, especially during labour and birth. Saba addressed her fears by attending a healing session with Robyn from Mamabamba and during her meditation, saw and felt a vision of a huge Lioness come and lie next to her body. It was  as if the Lioness melted into Saba’s body and infused her with a sense of strength and confidence. The twins moved frequently and vigorously in the womb every day and continued to do so right until the labour.

Dr Dumbrill monitored the twins regularly by obtaining a graph of the heart rate of each twin (CTG) and it appeared that there was no cause for concern. I knew that Saba was 37 weeks and twins often come early but could only return at the end of May 2011 to Cape Town. Saba spent May keeping fit by swimming and walking on Table Mountain in Cape Town, caring for her daughter and preparing for the twins birth.

In the meantime, I spent May 2011 in KZN, settling in to my new home, and giving a birth preparation workshop. I also saw Megan James, my first KZN client, for antenatal visits. Megan also decided to have a homebirth and Ginny and David Oosthuizen opened their home in Hilton for her birth. Megan was unaware of the twins’ impending arrival, but by Tuesday, a week after her due date, she was eager to meet her baby. Megan and Russell received their little girl into the world (my first birth in KwaZulu Natal) and I had, in the meantime, changed my flight from the previous Friday to Wednesday the 25th. Russell kindly took me to Durban airport once he had had a chance to hold his new daughter skin-to-skin in Kangaroo-Mother Care position on his chest.

The Days of Waiting

Relieved that I was flying to Cape Town, albeit at the eleventh hour, I arrived exhausted, called Saba to let her know I was available and we all relaxed, waiting for the twins. The twins seemed very cosy inside the womb! Day by day the tension rose. Saba was so eager to get things going as her obstetrician was beginning to talk about induction of labour. I reminded Saba that her due date was only on the 31st May and that there was every good reason to wait for the twins to reach term. We checked their wellbeing frequently. Twin A was already deeply engaged in the pelvic bones and Twin B was snuggled above, on the right side.

Saba took to the Table Mountain again over the weekend, hiking the contour paths and up Lions head with gusto, joined by a supportive gaggle of friends and family. Tuesday the 31st came and went and still no labour. On Wednesday the 1st June Saba went for a three hour walk through Newlands forest alone with her husband. It was a very quiet and spiritual walk, where she felt she entered a trance-like state. She felt contractions around the top of her uterus which at times were strong enough to slow her stride, but by the time she got home again they had petered out.

By the early evening Saba was almost tearful and there was no sign of labour. We checked the twins; I took my aromatherapy ‘magic mix’ with me and massaged her body for a good hour. Frank took over and continued the ‘magic mix’ massage after I left working on acupressure points on her hips thighs and pelvis . At 1.30am on Wednesday the 2nd, Frank called to say that her waters had broken and labour was established. I flew round to their home and after checking the twins both Saba and I agreed it was time to move to the Vincent Pallotti Hospital.

We transferred to the birth unit there and ran the bath, moved the medical model delivery bed out of the room and placed mattresses on the floor so that Saba could be comfortable in any position she chose. Frank and Dudu posted pictures on the wall of lionesses and cubs in the wild so that Saba could be reminded of her inner strength. I called Dr Dumbrill who was as excited as I was about the birth of the twins and he came to check on progress and then humbly waited outside the room so as not to disturb the labour process that Saba had laid out.

Saba swirled her hips in a standing position for a while, then entered the warm water for pain relief and when the birth was imminent climbed out of the bath. The room was warm and peaceful. This meant that the hormones of labour, oxytocin and endorphins could be released at optimum levels without disturbance or interference. Lydia Du Toit, my assistant midwife and I monitored the twins for a short period (15min) with the cardiotocograph monitor and then with separate hand held doptone machines. Lydia, a pillar of calm and strength, supported and encouraged Saba, while Saba squatted between my knees and I supported her arms.

The Twin Birth

The fetal-ejection-reflex became stronger – no-one ever said the “push” word – and Frank received the first twin into his waiting hands and laid her down on the towels on the floor. Keeping the baby below the mother after birth facilitates the best passage of oxygenated blood via the placenta to the baby after birth as it uses the force of gravity to assist the infusion of placental blood through the umbilical veins to the baby. In fact current evidence states that “immediate cord clamping became routine practice without rigorous evaluation. There is now a body of evidence suggesting that immediate, rather than deferred, clamping may be harmful for both term and preterm births” (http://www.rcog.org.uk/clamping-umbilical-cord-and-placental-transfusion). In other words, leave the cord alone and attend to the baby!

Saba rubbed the baby’s dainty back with her gentle hand and the first twin breathed, coughed and opened her eyes. When she was pink and responsive, Saba picked her up to her chest and she let out her first cry. On hearing her cry from his chair in the next door room, Dr Dumbrill came into our room and we all observed the ecstatic scene: Saba seated on the towels holding her firstborn twin with Frank at her side exactly three hours after the start of labour. Frank cut the (now non-pulsating) cord and the firstborn twin was free. The part of the cord attached to the placenta remained inside Saba until after the birth of the second twin. The firstborn twin soon started rooting, Saba moved into a position good for latching her onto the breast and it wasn’t long before she was latched and suckling avidly. Breastfeeding the first twin before the birth of the second twin stimulates further uterine activity. The mother’s body “knows” there is another task to perform and about 20 minutes after the birth of the first twin, contractions recommenced and the first twin was handed to Dudu, Saba’s sister, as Frank and Saba proceeded with the next part of their incredible journey.

The second twin was positioned fairly high in the uterus and the strong painful contractions impelled the second twin to move down towards the pelvis and uterine opening. Soon the membranes were visible and bulging and with Saba’s permission, I popped the ‘bag of waters’. The head was not far behind. Saba was now in the bath for pain relief, and Frank was seated on the edge of the bath, supporting her in a squatting position from the back. Soon Saba began the expulsion of her second born and it seemed to require a tremendous effort. We knew the second twin was larger than the first. The head was born and it felt like forever before the shoulders rotated and appeared from under the pubic bone and the second twin slipped into the water.

I lifted her face out of the water and held her below Saba, who was still squatting, until she breathed, cried and grasped my fingers. Saba reached down to lift her and brought her close to her heart, supported in Frank’s arms. What joy there was as Dr Dumbrill came in and called for us to record the times of birth! It had been one hour and ten minutes between the birth of the first twin and the birth of the second twin.

The Twins Breast Feeding After Birth

Both twins were positioned on Saba’s chest and breastfed to stimulate contractions for placental expulsion. I had also given Saba 10 units of syntocinon via intramuscular injection on account of her feeling dizzy and the uterus needing a boost to contract effectively. Twenty minutes after the second twin was born, Saba delivered one placenta and ten minutes later the second placenta and suddenly felt much weaker (I remember feeling weak after giving birth to ONE baby!). I offered juice and water to Saba and she drank eagerly to replace her strength. We weighed the babies and the first twin weighed 3,10kg, the second twin weighing a whopping 3,57kg! A total twin weight of 6,67kg! We then popped Saba and the twins into bed and wheeled them to Saba’s postnatal room for a well deserved rest. Frank and Saba later moved into a double room where she, Frank and the twins spent their first night together.

Champagne was served all-round in the morning and word was out that a successful all-natural twin birth had taken place (increasing numbers of twins are presently delivered by caesarean-section). We celebrated Saba and Frank’s success with them and their beautiful little girls, whose temporary names are Moja and Mbili meaning ‘one’ and ‘two’ in Kiswahili. Saba and the twins were discharged the next morning and went home to bed, home cooking and lots of help from family and friends. Gratitude abounds for Moja and Mbili’s safe arrival!

Useful Links about twins:
http://www.raising-twins.com/twin-birth-videos.html
http://www.multiplebirth.com