Emma Parnell was adamant about planning a vaginal birth for her second pregnancy, even though she was having twins—and they were both breech. She tells Adriana Lozada about the strength she gained from her own body’s intuition.
What position was your baby in before labor? How did your care team support your desires for your birth experience? Tell us about your variation of normal @Birthful.
Related Birthful episodes:
- Why You and Your Care Provider Must Decide Everything Together, with Dr. Brad Bootstaylor
- Informed Consent, with Cristen Pascucci
Breech birth advocacy:
- The OptiBreech Project study, by Dr Shawn Walker, Consultant Breech Specialist Midwife (UK)
- Hands off that breech! from the Association for Improvements in the Maternity Services (AIMS)
- Breech without Borders
More information about terms from this episode:
- Variations of the breech presentation, from Medline Plus
- Breech Presentation, Médécins sans frontières (Doctors without Borders)
- Breech, Spinning Babies
- If Your Baby is Breech, ACOG
- Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study, BMC Pregnancy and Childbirth
- “Even though elective cesarean means reduced stress for second twins this seems not to be clinically relevant. Non-cephalic presentation of the second twin does not significantly influence the perinatal outcome of the second twin but might be a risk factor for vaginal-cesarean birth.”
- Labor and Delivery of Twin Pregnancies, Obstetrics and Gynecology Clinics of North America
- “In twin pregnancies, planned vaginal delivery is not associated with adverse maternal or neonatal outcomes, compared with planned cesarean delivery, assuming the obstetrician is experienced in twin delivery.”
- Planned Cesarean section for women with twin pregnancy, Cochrane
- “Data mainly from one large, multicentre study found no clear evidence of benefit from planned caesarean section for term twin pregnancies with leading cephalic presentation. Data on long‐term infant outcomes are awaited. Women should be informed of possible risks and benefits of labour and vaginal birth pertinent to their specific clinical presentation and the current and long‐term effects of caesarean section for both mother and babies. There is insufficient evidence to support the routine use of planned caesarean section for term twin pregnancy with leading cephalic presentation, except in the context of further randomised trials.”
- Delivery Room Tools Decoded, The Bump
- Birthing Positions (includes the birthing stool), Taking Charge of Your Health & Wellbeing, University of Minnesota
- The Evidence On: Birthing Positions, Evidence Based Birth
- Artificial Rupture of Membranes (shows the amni-hook), Médécins sans frontières (Doctors without Borders)
- Membrane sweeping for induction of labor, Cochrane
- The Evidence On: Membrane Sweeping, Evidence Based Birth
- Updated Evidence on the Pros and Cons of Membrane Sweeping, Evidence Based Birth
- Hyperemesis gravidarum, the National Organization for Rare Disorders
One thing you can do for you is to watch the documentary Heads Up: the disappearing art of vaginal breech delivery.
And the one thing you can do for the rest of us, is to support the efforts of Breech Without Borders, which is a nonprofit organization dedicated to breech training, education, and advocacy. On their website they even have a sample letter to help you advocate for breech options in your community.
[Birth Stories] Why She Pushed for the Unmedicated Birth of Her Breech Twins
Adriana Lozada: Welcome to Birthful. I’m Adriana Lozada.
Emma Parnell: I had my doula. I had three midwives. I had my doctor. I had his registrar. I had a student observer. I had the head of neonatal medicine. I had the two pediatricians in there at the end.
Lozada: That was Emma Parnell talking about the amount of people that congregated in her labor room for the planned breech vaginal birth of her twins. Some were there for support, some were there as a precaution, but most of all they were there to bear witness to her birthing power during frankly circumstances that are so unusual, very few if any had ever seen a planned vaginal breech birth.
Make sure you stay until the end of the episode for my two things to do, one for you, one for the rest of us. You’re listening to Birthful, here to inform your intuition.
So, welcome Emma, I am so thrilled to have you here and really looking forward to hearing your story and everything that… It’s such a roller coaster. But before we do that, can you tell me a bit about yourself and how you identify?
Parnell: Sure. I’m a Sydney-based mom of three young children. I’ve got a four-year-old son and two-year-old boy-girl twins. I work in the health regulation sector, so my job involves assessing applications for registration for all health related disciplines across Australia. Yeah, so I’m busy juggling that with being a mom. I’m also very passionate about living a healthy, plant-based lifestyle, and I’ve been vegan for about 24 years now. I’ve had two healthy vegan pregnancies in that time, including my twin pregnancy.
Lozada: And so, we’re gonna be talking today about your birth of the twins that are now two, but let’s take you back to three years ago when you were pregnant. How was that pregnancy?
Parnell: Well, it was actually pretty awful. The whole pregnancy I was very… I had hyperemesis gravidarum, which is very severe pregnancy sickness, so it basically means you’re nonstop vomiting. I couldn’t, like I had to stop working, I couldn’t really get out of bed. I couldn’t even shower without holding onto the shower. I couldn’t… I don’t think I even washed my hair for about four months. I ended up in ICU for a week and ended up fracturing a rib from all the vomiting.
Lozada: Hold on. You fractured a rib from the vomiting? It was that intense and that constant.
Parnell: Yeah. It was that intense. I must have been vomiting like 20, 30 times a day, every single day, for about the first five or six months.
Lozada: And that is a very severe case of hyperemesis. Yeah. Did it let up at any point?
Parnell: It did after about the first… I’d say probably five and a half months. I started to feel a little better and I could actually start keeping a bit of food and water down after that. I could start going out for walks again and slowly start to get back into exercise and the gym. But then it sort of… It did come back a little bit later in the pregnancy, and that’s when I went into hospital.
Lozada: Well, and if that wasn’t enough, then you were also having these surprises of first finding out that you were having twins, right? Because that was a surprise.
Parnell: That was a huge surprise. Because there’s no twins in my family and the pregnancy itself wasn’t even planned, so to find out that not only was I having one baby, but two, was just… I was in shock. I couldn’t speak for a couple of days after I found out it had been.
Lozada: And usually, I mean, you’re going through all this, the sickness, and throwing up during the first five months, and then you get a chance to enjoy your pregnancy a little bit and connect a little bit more with your twins. When in that process did your care provider start being concerned about the fact that they were breech?
Parnell: Well, I actually started with a different obstetrician to the one I ended up with in the end. The obstetrician I had initially, he was great. I had him for my first birth, and he was very supportive of all my choices. I wanted to have a natural birth, and no drugs, and all that sort of stuff, and I wanted to exercise through my pregnancy, and he’d been very supportive of all my choices then, so I kind of thought he would be supportive of my choices to have a natural birth with the twins, as well. But unfortunately, that wasn’t the case. It just seems the way that… As soon as your care provider finds out you’re having twins, everything becomes high risk. All these sorts of interventions are discussed. You’re not given a lot of choices or a lot of options. And that’s what I found with him.
So, I ended up looking around and getting second opinions, and so that’s how I ended up with the second obstetrician who actually happened to be a breech birth specialist. Obviously, I think it was around the 32, 33-week mark. Both the babies were still breech and that’s when everyone sort of started getting a bit concerned and telling me I’d probably need to have a C-section. I think it’s just a blanket rule with obstetricians. Well, the vast majority of obstetricians, and care providers, is once you know you’re having twins, most obstetricians will say you need to have an epidural. There’s a high chance you’ll need to have a C-section. So, all these kind of rules are laid out and you’re not really given any choice, like I was pretty adamant with my first obstetrician that I wanted a completely natural birth, I didn’t want to use any sort of pain relief, or drugs, or epidural, or anything like that.
So, I found I guess a more women-centered obstetrician who was happy to listen to my concerns and he was willing to support a drug-free birth with twins. So, he’s been practicing breech birth for many, many years, even before I saw him. It turns out that my doula, I had a doula for my pregnancy and birth as well, and she actually was a twin mom herself, and she actually delivered her twins through him, so that just made me feel a lot more confident and like I was in the best hands.
Lozada: Yeah. I imagine. And so, things aligned for you very well in the sense that that was the obstetrician that you decided on and was the perfect fit for your wishes with your babies being breech. But were you trying to, like when did you find out that they were breech and were you trying to do things to turn them?
Parnell: Oh my gosh. I tried everything. I think, like I Googled how to turn babies 100 different times. I think I did all the Spinning Babies techniques every single day after I found out they were breech. I did chiro, I did acupuncture, I did headstands in the pool, I think I even did the whole ice on the belly and music playing at my crotch thing. But yeah, nothing worked, and I think with twins it’s harder to once they get to a certain point, because there’s not much room for them to turn.
So, that’s what I found. They were just stuck in that position and they just would not budge.
Lozada: So, after doing all those things, trying to turn your babies, at what point did it get to be like, “Okay, this is it. It’s just gonna be breech and let’s focus on that.”
Parnell: Honestly, it was probably at the last minute, like right up until… We waited I think until about 37 weeks, which is like… I mean, that’s considered full term with twins, and most twins are born around that stage or just after, so my doctor sort of wanted me to have them by about 38 weeks. So, yeah, I was quite devastated at 37 weeks when I found out they were both still breech. Yeah. I think I burst into tears in front of the doctor, and all the midwives, and that’s when my doctor said, “You know, it is still possible to have a natural birth if both babies are breech.”
Lozada: That sounds very comforting of him and confidence building, right? Which is… Because that’s not usually the response that people receive.
Parnell: No. No. Definitely not. I was actually surprised, and even knowing that he was a breech birth specialist, I was surprised to hear that from him. Because it’s very, very uncommon to have two, to give birth to two breech babies naturally. That’s something we also had to consider, was the exact position, the type of breech that the babies were in. Because I know if Twin A, my little boy, the first twin who came out was a footling breech, I would have definitely needed a C-section, because there’s a risk of him getting the cord wrapped around his feet when he’s coming out, that sort of thing.
So, luckily he was in the frank breech position, which means his bum is sort of facing down and his legs are up, so luckily, yeah, he was in that position and he was able to come out bum first, bottom first.
Lozada: So, and you said your provider was very adamant that at 38 weeks you would have to have the babies, and it’s at week 37. What was that week like?
Parnell: Yeah, I was very nervous. I think that the whole week I sort of had this feeling of like there may be an emergency C-section looming above me, just not knowing if the baby might move his foot and get into slightly the wrong position, and then I’d have to have a C-section. Just a lot of unknowns and a lot of anxiety about it all, really. And also, the fact that my doctor was adamant that I should have them at 38 weeks and no later. With twins, there’s a high risk of having a stillbirth if they’re born after 38 weeks, so he was… Yeah, he was quite adamant about that. All that was sort of playing on my mind that last week.
Lozada: So, did you have to go in for an induction or how did it all start?
Parnell: Literally the day before the 38-week mark. I had a stretch and sweep, and the doctor was sort of hopeful that that would get things started, so I stayed in hospital that night overnight, just in case labor did start. But if that wasn’t successful, I knew that the next day I would be having them no matter how it happened, like if I was to have a medical induction, or whatever happened, they’d be born that next day. So-
Lozada: Yeah, so let’s explain a stretch and sweep for listeners if they’re not quite sure what that is. So, it’s the sweeping of the membranes and what that means is that they sort of… You have to be a little bit dilated and they insert fingers, gloved fingers, and sort of sweep their fingers around the inlet of the cervix, right? Of where it connects with the amniotic sac, and it’s kind of separating that a little bit is what the sweep is. And in that stretching, it might… Some practitioners might do a little bit of messing with the cervix to try to stretch it. Others might just do the sweep itself, but that’s the membrane sweep. Yeah, so that was done the night before the 38 week and you were in hospital and ready one way or the other.
Then what happened? Yeah.
Parnell: Yeah, so I woke up the next morning and they took me down to the birthing suite and the doctor asked me how I was feeling, and I said I’d been having some sort of period-like cramps, which was apparently a good sign that I was going into labor fairly soon. He then ruptured my membrane, so that’s where they get this… It’s almost like a little hook thing, like it sounds scary but it’s not, it’s just like this little thing-
Lozada: It’s like a plastic crochet hook.
Parnell: Yeah. Yeah.
Lozada: It’s kind of longer, but yeah.
Parnell: Yeah. Yeah. And yeah, so he used that to rupture my membranes, and once that happened I basically went into labor straightaway, like that kickstarted all my contractions and everything, so everything kind of went really quickly after that point.
Lozada: So, how did things go in terms of what were you doing to work through contractions, to manage the sensations, the intensity? Because you said it was quite a fast labor.
Parnell: Well, I mean fast, I guess from start to finish it was around six, six-and-a-half hours, so I don’t know if that’s considered fast or not, but it was definitely quicker than my first baby. I was in labor for 36 hours. So, compared to that, it was definitely a lot quicker, and the contractions came on a lot faster and a lot more strongly a lot quicker than my first birth had, as well. Before having my first baby, I’d done an active birth skills course. It’s basically using different techniques to sort of distract yourself from the pain, different visualizing, using your breath, using stress balls, doing squats, all those different things you can do to distract yourself from the pain. And it’s about as well realizing that labor pain is different from the type of pain you’d have if say you broke your arm. It’s like healthy pain, so it’s kind of like saying that over and over in your head. That’s what I did. That was kind of my mantra, was healthy pain, and focusing on my breath, and my stress balls.
So, I had these two stress balls, one in each hand, and I literally… I squeezed those so hard, by the end of the labor I had yellow ink on my hands from where it had rubbed off from the balls. So, as I mentioned before, I had a doula, so she sort of knew where to… The right spots on my back to massage through the contractions, so I found that very helpful. And yeah, that was basically it. I didn’t use any pain relief or any medical… no epidural or gas, or anything like that to manage the pain. It was all just… Yeah, it was all just basically distraction techniques, I guess.
Lozada: Yeah. And considering it was moving quite fast, six hours I would say is fast.
Parnell: Yeah. Okay. Okay.
Lozada: From start to finish, six hours seems, yeah, like a good, a very good amount. How did you know it was time to push and how did things change, or did they change at all in terms of how the providers were taking care of you or guiding you?
Parnell: Yeah. Well, initially it was just my midwives there with me, and they just kind of basically left me alone. As the labor progressed, more and more people sort of popped into the room. I had the head of neonatal medicine come in to check on me while I was in the floor. I remember her and I remember going, “How much longer?” She’s like, “Oh, not that much longer.” During the pushing stage, I had a packed room. I had a lot of people in there.
I mean, with twins, you always have more people anyway, because you always have the two pediatricians, one for each baby. But yeah, I had people knocking on the door, wanting to come in and watch the birth happen, too. People who just wanted to see a double breech birth, I guess. Yeah, I had my doula, I had three midwives, I had my doctor, I had his registrar, I had a student observer, I had the head of neonatal medicine, I had the two pediatricians in there at the end, so-
Lozada: And a partridge in a pear tree.
Parnell: Yeah. Exactly.
Lozada: I think that sounded about 12 people there.
Parnell: Yeah. Yeah. Yeah. That was a lot of people.
Lozada: And so, because it’s such a unique position of having twins and having twins that are breech, can you walk us through a little bit more how that pushing went? What that looked like in terms of very few people get to hear just how twins are delivered, so Baby A, and just the fact that they call them Baby A and Baby B, A is the one that’s further down or is gonna come first. And so, Baby A, their amniotic sac was broken, because that’s t the beginning, that’s how labor got started.
Parnell: Yeah, so my doctor being a breech guru, he suggested the birthing stool, which is… I think it’s like the preferred way to, at least for Baby A, to get the first twin out. So, it basically… It’s kind of like… I don’t know how to describe it, really. It’s kind of like a seat, but without the actual seat part. So, it’s kind of just there to support you while you kind of stand or almost squat there, I guess. So, it’s about letting gravity do its work, as well, so gravity sort of helps pull the baby out as well as your pushing. The doctors had to sort of coach me when to push. The doctor and the midwives, I never really felt the urge to push. I think it was about maybe seven or eight pushes, like really strong pushes, to get him out.
Breech birth is I guess a very hands-off birth, so the doctor didn’t actually touch the baby until I pushed him basically all the way out, so he’s kind of like his little body was dangling there while his head was kind of still stuck in. And just kind of at the last minute, as his head’s coming out, the doctor stuck his finger in the baby’s mouth, just to pull his chin down so his head didn’t get stuck. It’s very hands off, breech birth, so you really have to push to get that baby out. There’s no one helping you at the other end.
And I think at one stage I said, “Can you just pull this baby out of me?” And he’s like, “No, no. Just keep pushing.” And he was very, very calm, and very comforting to have that, because I was quite panicking a little bit. You know, “Just pull this baby out of me.” But no, he was very reassuring and good at coaching me through what to do.
Lozada: And so, once baby came out, how long was it before they cut the cord? Did he go to you?
Parnell: Yeah, to be honest, that bit’s a little bit of a blur. I know, like they did leave the cord to pulsate a little bit, but then there’s also the kind of urgency to get the second baby out, so they can’t… I mean, they do delayed cord clamping as much as possible, but there’s also the need to get second baby out, so they can’t… They probably didn’t do it for as long as I would have liked. But yes, they cut the cord after a few minutes, and the baby came up to me initially, and then like while the baby was on me, the doctor was checking me to see where Baby Twin B was, and her position, and then when the pushing stage came for her to come out, the first twin went onto his dad. He took the baby on his chest while I sort of moved up onto the hospital bed and got ready to push the second baby out.
Lozada: And did they want you on the hospital bed?
Parnell: They did. They wanted me on the bed just in case I needed… Because I think Twin B is the complicated… Well, not complicated, but there can be complications in terms of the baby getting into an awkward position once the first baby’s come out. It’s got a lot more room in there. It can turn into a different position. It might need some manual manipulation, so I think they wanted me on the hospital bed just in case any sort of intervention needed to happen, which luckily it didn’t. Yeah, the doctor checked the position, and she was ready to come out the same way the first baby had, so she was also bottom first, so the doctor broke the amniotic sac for the second baby and then it was just basically the same process as the first baby, like I was coached to push, when to push. I really, really had to push a lot. I used all my strength to push to get the second baby out, as well. And there was no urge to push. It was just all coached pushing.
And I think she took about four or five pushes to get out. Yeah, he did the same thing for her, so I pushed her all the way out. Again, I had to push her completely, just about all the way out until… and then he stuck his finger in her mouth to pull her chin down a bit so that her head didn’t get stuck, and then she just popped out quickly after that. So yeah, it was pretty amazing. I’ve got videos of both the twins being born and it’s quite amazing to watch them back and how it all happened. And what the doctor was saying to his registrar, guiding him through what to do and stuff.
Lozada: I can imagine.
Parnell: Yeah. It’s kind of nice to have.
Lozada: Yeah. That’s so good. Did she come up straight to your chest?
Parnell: She did. Yeah. So, they put her straight on my chest and that was a really special moment, like I felt so relieved, like that was the best feeling ever. Just so relieved, so happy that it had all gone perfectly. It was like a textbook breech birth and both the babies were happy, happy, and healthy, they didn’t need any medical aid, or intervention, or anything like that. So, I was over the moon when they came out and it was all over. There was no more stress about worrying, possibly needing a C-section. There was none of those worries anymore, so it was… Yeah, it was a very good feeling when she was finally out and on my chest.
Lozada: Yay. And did you get both… How was breastfeeding? How did that go?
Parnell: Yeah, so they both went up, like when she came up for a little bit of a feed, and then they brought my little boy twin over, and so I was just feeding them both together. They both took to breastfeeding really, really well, so they both… No problems with latching or sucking or anything like that, so that was another good thing. Because I had been worried about that through the pregnancy, whether or not I’d be able to breastfeed twins given how sick I was and breastfeeding twins itself is quite taxing. You need quite a big milk supply. But yeah, I had no trouble whatsoever breastfeeding.
Lozada: That’s wonderful. Oh, my goodness.
Parnell: Yeah. I breastfed them right up until just before they turned two. And I recovered very quickly from the birth, and that was one of the reasons that I really wanted to have a natural birth, was just recovery. I could have probably gone for a jog I think half an hour after I’d given birth. I just felt so good and it just sort of made me feel more confident in my choices and in listening to my own gut feelings about things, and in what my body was capable of. Yeah, I felt amazing after it was all over.
Lozada: What would you say was the hardest part of it all, Emma?
Parnell: Oh, gosh. Definitely the pregnancy and the sickness. I can’t tell you how, like I thought I was dying every single day. It was… Yeah, that was probably the worst experience of my entire life, I think, that pregnancy sickness. And then obviously finding out that the babies were both breech and having to stress about how the birth would pan out and all that sort of thing. Yeah, I guess the entire pregnancy, I would say.
Lozada: Usually, when I ask that question, it’s the other way around. People say, “Oh, the labor, and the transition, and other things.”
Parnell: Oh, no. Oh my gosh. No, that was all a piece of cake. I would take that 10 times over than having the whole pregnancy again. I think that’s by far the worst. Yeah, the worst part for me was the pregnancy.
Lozada: Was the sickness all gone, the throwing up, after the babies were born? Did it go away immediately?
Parnell: Oh, immediately. Immediately after, like I felt so much better and I wanted to eat again. I barely ate anything the whole pregnancy. I lost a lot of weight. I became anemic. But as soon as the babies were born, I just wanted to start eating again, and I needed to because breastfeeding twins you need to keep up your strength and you need to constantly be eating and drinking to produce all the milk that you need to.
Lozada: What would you say to listeners out there that are pregnant and maybe facing a breech or not, maybe facing twins or not?
Parnell: I would say don’t be afraid to get a second opinion if you’re not happy with what your care provider is telling you. If they’re not giving you options. If there’s anything that you’re not sure about, don’t be afraid to get a second opinion, or a third opinion, or fourth opinion, till you are completely comfortable with the advice you’re getting and the care that you’re being given. That would definitely be my advice. I know I did a lot of research and having an obstetrician who is a professor, as well, gave me access to all the sort of… all the research on breech birth and having twins and all that stuff, so do your research as well. Do your research. Read up. Read up as much as you can and talk to as many people, talk to other parents who’ve been through similar things, join different groups, and ask questions.
Lozada: That was the amazing Emma Parnell sharing her twin breech birth story. I hope your main takeaway from this conversation is that the work you do during pregnancy to set up an experienced and supportive birth team that values shared decision making is key to how your birth experience will unfold. One thing you can do for you is to watch the documentary Heads Up: The Disappearing Art of Vaginal Breech Delivery, and you can search for it at reelhouse.org, and that’s Reel as in R-E-E-L.
And then the one thing you can do for the rest of us is to support the efforts of Breech Without Borders, which is a nonprofit organization dedicated to breech training, education, and advocacy. On their website, they even have a sample letter to help you advocate for breech options in your community. Go to BreechWithoutBorders.org to learn more.
Mighty ones, we want to know more about you, so we’ve created a survey. Go to Birthful.com/Survey and as a bonus for filling it out, you’ll be automatically entered to win a $100 AmEx gift card. Tell us what you think at Birthful.com/Survey.
Lozada: Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Virginia Lora is the managing producer. Cedric Wilson is our lead producer. Kojin Tashiro mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen. And come back next week for more ways to inform your intuition.
Lozada, Adriana, host. “[Birth Stories] Why She Pushed for the Unmedicated Birth of Her Breech Twins.” Birthful, Lantigua Williams & Co., January 20, 2020. Birthful.com.
About Emma Parnell
Emma Parnell is a Sydney, Australia-based mum of three, including a four-year-old and two-year-old twins. She has an Arts degree in Psychology and is currently working in the health regulatory sector while juggling being a mum to three young children. She is deeply passionate about living a healthy plant-based lifestyle, ethical veganism and sustainability. She has been vegan for 24 years, had two healthy vegan pregnancies and two amazing unmedicated births, including a double breech twin birth. Her interests include travel, diving and exploring the natural world.
You can read her recount of her birth story, with more details, at her blog Sun Moon and Stars
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