The Dr. Brewer Pregnancy Diet
Story #3
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VBAC Triplets at Home!
The Birth Gazette
Vol. 3 #4

This article was received by NAG (Nutrition Action Group) on August 10, 1987, and Tom Brewer sent it on to me. It is reprinted here by permission from Ina May Gaskin.

If your experience has been like that of our editorial staff, you have never before heard of a triplet birth at home following a previous cesarean of the mother. This account of such a birth is told by midwife and mother.

Our inclusion of this remarkable birth story should not be taken to mean that we advocate that all mothers carrying twins or triplets should give birth at home, whether or not they have had previous cesareans. But we do believe that both mother and midwife have some important things to say about why there was such a good outcome with this birth. We have altered names to protect identities.

By A. Midwife

Here is the story of Eleanor and her triplets. I was her midwife and have been inclined to be pretty quiet about it for a couple of reasons: 1) what I am doing in this town is clearly illegal, and I don't want to draw attention to it, and 2) although it may not seem so from this story, I think of myself as a relatively cautious midwife and don't want to encourage other to do high risk births lightly.

When I first started seeing Eleanor, she seemed quite low risk to me. She's a healthy, active woman, and she and her husband seem very solid and reliable. Her first child had been born by C-section after a positive herpes culture at term. I don't encourage VBAC (Vaginal Birth After Cesarean) home births, but will help with them if the parents are very clear about their decision. With a healthy mom, I don't think there's any significantly increased risk after one lower segment transverse C-section, but there is no medical backup available. Obstetricians here treat VBACs as a "trial of labor" and do a repeat C-section as soon as the mother varies even slightly from textbook "normal." Family practice doctors are not even allowed to deliver VBACs at the local hospital. It looks to me that the odds of actually having a vaginal birth after a C-section with local obstetricians are not all that good.

Early in pregnancy, I thought Eleanor's dates were wrong because of how big she was getting. By 25 weeks we were sure it couldn't just be an earlier baby--she was growing so fast her belly looked like 32 weeks, but her arms and legs were still thin. So, Eleanor and Gary, her husband, and I talked for a long time. I told them I had never caught twins before and wasn't entirely comfortable with the combination of VBAC and twins. I had helped with unexpected breeches often enough that it wasn't the chance of one being in there butt first that worried me. As we talked and gathered information, we realized that no local obstetrician was likely to allow her to even attempt to have the babies vaginally. The standard treatment for twins in a mother with a previous cesarean (locally) is repeat C-section at 38 weeks (so the uterus doesn't grow too big and rupture).

So I agreed to help them do their prenatal care and see what things felt like when she got closer to term. I didn't feel right sending her off for a lot of obstetric technology she didn't want and a C-section she didn't need, so we started looking for ways to make it feel safe at home.

First, we discussed adding even more protein and calories to her already excellent diet. I gave her The Brewer Medical Diet for Normal and High Risk Pregnancy, which she read and followed. Then we decided to ask the other local midwife to help, so we'd have two experienced people at the birth. Later we decided to call another ex-midwife we knew out of retirement so that we were sure we'd have plenty of minds and hands for whatever developed.

We all studied what we could find about twins. After reading one book, Gary asked if I thought there could be more than two. I thought it was a joke: triplets are pretty rare [outside IVF], and by that time, I could clearly feel two babies and hear two heartbeats. I told him an ultrasound might show, but they didn't want one and I really didn't take the possibility of more than two babies very seriously. We all watched the Farm video of a twin birth. It seemed a bit more conservative than we were being. I wished we had a nice out of hospital birthing center staffed by midwives. But since Eleanor had Gary couldn't travel for the birth, it seemed our choices were either home or the whole technological obstetrical scene. I began to feel more certain that we were doing best by choosing home.

Eleanor's belly grew enormous! At almost every visit, we would marvel at how big she was getting and tell her to eat even more, because her arms and legs were still very thin. The two babies we could feel and hear were obviously active and healthy. One was head down, with the head nicely in the pelvis and that baby was obviously coming first. Another, very active baby was head up, in front and a little to one side of the other one. Both babies felt big, so we guessed she was going to have 8 1/2 to 9 lb. twins.

In her last month, Eleanor's blood pressure stared to creep up, and she was spilling a little bit of protein in her urine. We visited her at home and found her blood pressure was normal lying on her side, and her reflexes were all normal. We sent a 24 hour urine test to a local lab, which came back all right. We advised her that she spend most of her time lying on her side, getting 200 grams of protein a day, and eating almost constantly. We visited every other day and always found Eleanor's blood pressure all right. Her husband took off from work the last few weeks and spent all his time feeding her*.

Eleanor called me at 1:00 am, one week after her due date*. She wasn't sure it was labor and wanted me to come over and check before calling out the entire crew. She hadn't timed contractions yet and could still talk through them, but they'd been intensifying for about one hour. When I got there (about half an hour later), two babies' heart tones sounded good, Eleanor's blood pressure was normal lying on her side, and her cervix was 6-7 cm, completely effaced, with the water bag bulging. Contractions were harder, and she breathed with them. It didn't seem like there was any need to get her up to make things go faster, so she stayed in bed, except when she had to pee. She had had her third dinner at about 11:00 pm and was drinking tea with honey. I called the other midwives.

The babies and Eleanor continued to do well as contractions intensified. She started to feel an urge to push around 3:00 am, and we were glad to see the rest of the crew arrive. She was completely dilated with the head in occiput posterior position. A half hour or so of pushes and the head rotated, the water bag broke and the baby came down slowly. A healthy, nice-sized baby boy was born just before 4:00 a.m. (we made up exact times later). He was alert, with an Apgar of 10. I cut the cord and checked for the presentation of the next baby. One of the other midwives was taking care of the first baby, who was calmly looking around. The second baby was confusing; I thought I could feel both head and feet up pretty high through intact membranes. But as I checked, the head started coming down and a baby girl just squirted out, with the membranes breaking as her shoulders emerged. I cleaned the fluid off her face, and she breathed and turned pink and looked at me, obviously fine--another Apgar 10.

I was a little behind Eleanor, and her friend, who was holding up her leg, obstructed my view of her belly. After the second term size baby came out, Eleanor said her belly was still big. She was looking at her babies. I didn't realize right away how big and thought about blood collecting from a detached placenta. Then she bled about a quarter of a cup of blood all at once. I put on clean gloves to reach in and see what was going on and felt a foot way up high. I told Eleanor and Gary there was another one and asked Eleanor to feel her belly and be sure it felt longitudinal. It did. I pulled the foot down gently (still in bag) and found the other foot and brought that down. My partner couldn't find fetal heart tones, so I reached in (the baby was face up), turned her to face down and brought her bottom down to the perineum (feet out). Then a 7 lb. girl was born with Eleanor pushing and my partner putting pressure on the head to keep it flexed and me freeing the arms all at once. She was a little depressed, with a good strong heartbeat, starting to breathe, but a little pale and floppy. I handed her to my partner with instructions to get her going (instructions weren't needed). A little stimulation got her pinked up within a minute and crying and active by five minutes.

Eleanor was bleeding, so I worked with the cords while she pushed and got out one single and two stuck together placentas. Bimanual compression of the uterus and 2 amps pitocin, IM, stopped the bleeding before she had lost enough to bother her. With all the fluid and blood and meconium all over everything, it was hard to tell exactly how much she bled, but she felt fine when she sat up.

There was a small, first degree midline tear.

All three babies nursed within the first hour. When we finally settled down enough to weigh them: the first boy, 6 lb. 7 oz.; the first girl, 6 lb. 14 oz.; and the second girl, 7 lb.

Eleanor had a little trouble peeing right at first, which cleared up within a few hours after birth. She also had trouble getting her balance to walk for a week or so, because her skin was so loose that her belly swung around back and forth when she moved, which felt weird.

Four months later, all three kids are still alert and obviously healthy. They are entirely breastfed and are growing and developing better than average.

Mother's Story

I have a five year old son. His was a cesarean delivery because I had a herpes lesion when I was a week overdue. I had known my midwives for about four years. They knew that I had wanted a home birth with my first baby. Now that I was pregnant again, they said they felt like a VBAC delivery wasn't such an outrageous thing. As long as I took really good care of myself, they were willing to do it as a home VBAC.

My not having an outside job took a lot of the stress out of my pregnancy. I felt like this would be my last pregnancy, so I was really going to enjoy it. I had the luxury of being able to take naps when I wanted to and eat when I wanted to.

My pregnancy continued, and I grew larger and larger. Around the six month, I thought, This isn't normal. But there was a lot of denial. This pregnancy was unplanned, and we were in the process of trying to relocate to another part of the country. It was scary thinking that I might have more than one baby in there. I think my midwives suspected something around then, too, but we decided to have a "wait and see" attitude.

At seven months I felt really huge. My fundal measurement was 32 cm, about as big as I was full term with my previous pregnancy. But I felt good. We took a trip to Disneyland. When we got back, my midwives said that they could hear two heartbeats, and they laid out options of what we could do. My midwife was very honest with me.

I had really decided that one reason that I hadn't had the home birth with my first baby wasn't just that I got the herpes. I felt that I wasn't determined enough to do it, that I didn't have enough confidence in myself at that time. Now I knew the midwives better, and I had attended a home birth as a photographer, and I had educated myself about a lot of things.

My midwife gave me the Tom Brewer book on diet and high risk pregnancy. My husband balked at it at first and said, "Your diet is good," but I did read the book. Even though I didn't follow everything in it, I found it excellent for giving us good sources for protein during pregnancy and snacks I could eat that were rich in protein and carbohydrates.

I told my midwife that I didn't want to go to the hospital or have an ultrasound. I felt that if I did that, it would be over with. As long as I was healthy and the babies were healthy, I wanted to continue as I had. If anything was going wrong, I wanted to use the technology. Otherwise I wanted to go along and have my home birth.

One of my downfalls with my first pregnancy, which went two weeks overdue, was that I got worried. This worry contributed to a herpes outbreak. This time I made up my mind that if the babies were late, I wasn't going to get worried about it. Of course, now that I was expecting twins, everyone expected me to be early.

The midwives were great. Everytime I would go in for a prenatal visit, they would say how great my belly looked and encourage me to eat and eat and eat. They made me feel really good about myself. I lost sight of what a normal, full term belly was supposed to look like. I remember this woman who gave birth a few weeks before me to an 8 lb. baby. At full term, I thought her belly looked small.

Towards the end of the pregnancy, it really was tough. It got to be a marathon, because I had swelling in my ankles and feet. I have always jogged or walked or done some form of exercise. I had said to myself, "I'm going to walk through this whole pregnancy." A couple of months before I had babies, I just couldn't really walk anymore. First, I couldn't run, and then I would get out of breath if I walked more than a short distance. My blood pressure did start to creep up. I was spilling protein, so I started eating. I didn't want to get pre eclampsia, and I didn't want to go to the hospital. That was my battle. I tried to stay healthy and fit, but things kept coming up. Here would be another opportunity to have to go to the hospital. But I was really determined about the whole situation.

I had a lot of support from my woman friends. We would get together. Several had had home births, and one had had a home birth of twins about 10 years earlier. She was a good role model for me, and had a wonderful story and a great outcome. In that respect I was lucky.

When we got to 38 weeks, we thought we had made it. I was so big and had had a good weight gain. I felt that everything would be okay.

Just before Christmas, I told my husband, "We've got to go and get a Christmas tree and do all these things. The babies might come any minute." I began to run around quite a bit. I was still feeling great and went to prenatal. The midwives were kind of freaked out and said that my blood pressure was way too high and that I had to go home to bed. I was really surprised, because I felt great. People couldn't believe me when they saw me on the street, but I felt healthy. Everybody thought it would probably just be a few days. (My belly measured 62 or 63 cm a few days before I had the babies).

Fortunately my husband was working out of our house and had an office in the home. That was very nice for us, less stressful than if he had had an 8 to 5 job. If I needed him, he was there for me. A few weeks before I gave birth, I called a very good friend to come and stay with me and help take care of me and my son. This also was a big lifesaver. If she hadn't been there, we would have just gone down the tubes in those last 2 weeks. She helped feed me every few hours. I didn't even see the Christmas tree I had decorated, since I was only allowed up to go to the bathroom. The midwives really were serious about me staying in bed.

Part of the staying in bed was great, and part of it was miserable. I read about six books before the babies came, including a trilogy, which I thought was appropriate later. I had to deal with my mind because I couldn't busy myself. The midwives told me not to read my birth books anymore. They told me I had read them at least twice anyway, and they wanted me to try to keep light and not worry. I was grateful that they suggested this, so I read a lot of fiction. I knew this was the last time I might have time to do this.

My friend was supportive and loving, and she kept my husband and me on an even keel. She's a big part of why everybody came out so healthy and happy.

A week went by and no babies, and Christmas rolled by and still no babies. They did a urine sample, which came out OK. But it began to get pretty scary. We had wanted the babies to stay in, that was our big thing. Towards the end, the midwives started feeling like they needed to come out. They were worried about the stress of the pregnancy on me.

I really didn't worry about the fact that it was a VBAC. That was the least of my worries. I didn't believe that the uterine scar was going to rupture. A friend of mine told me that she went into the hospital with her third, was given pitocin, and her uterus ruptured. I thought, "That isn't going to be it for me. I have other things to worry about."

What came up for me was the herpes at the end. It was like, "Oh no, here I am due again, and I have the chance to have the herpes again. Sure enough, I did get a sore right before my due date. My midwife didn't make a big deal about this.

I had read some really interesting letters in Mothering magazine from women who had had herpes lesions and decided to go ahead and have a vaginal births. I made up my mind that if I had one small lesion, as I had with my first baby, I was going to go ahead and have my vaginal delivery. I just thought it would be okay. I really did. I just kept going along as each new thing came up (blood pressure, twins, herpes), and said I was going to have to handle it. The babies didn't come, which gave the herpes lesion a chance to heal up. I didn't worry about it. The lesion was gone on a Sunday, and the babies were born on a Monday.

I drank a lot of black cohosh tea toward the end, and they had me do nipple stimulation. The babies were due January 1, and January 7, I went into labor. I didn't know if it was really labor, not Braxton-Hicks, so I told myself that I wanted to have another contraction in 4 minutes, that I was ready. I used a lot of visualization toward the end of my pregnancy.

I cannot say that I was in pain, I just felt uncomfortable. When the midwife got here, I had been in labor an hour and a half [and I] was already 7 cm dilated.

It was a fantastic labor and delivery. It was just wonderful, just how I imagined a birth should be--loving and gentle. We had a roomful of people, but in the end, we didn't really have a surplus of people, because so many babies came out.

I lay on my side a lot toward the end of my pregnancy. My belly was so huge, it had a life of its own. It took quite a bit of concentration to move from side to side or to get out of bed. During the labor I was lying on this one side for hours, and it got to be painful. My hip felt crushed.

The first baby came out head down. I kind of felt like this first baby would be a boy. He sort of swam out and paved the way for the others. About ten minutes later, Anna sort of flew out. My midwife didn't break any water bags, a precaution we had learned about that might be good because of the herpes. The surprise about Anna was that she was head down, because I knew there was a breech baby in there. I felt a breech baby the whole time, a head underneath my heart.

My midwife thought the breech baby must have turned around. My neighbor, who [was] holding my leg, smiled and looked at me and said, "Well, it's all over." I remember thinking, That wasn't so bad. Then my other friend said, "But her belly's too big. I feel a head up here." I thought, Oh my God, am I still going to have to go to the hospital after all this? I didn't understand what that meant, that there was another baby in there. Was it an emergency or what? Then my midwife told me that the baby was face up and that she was going to have to go up with both hands and turn the baby around, because breeches have to come out face down. I kind of freaked out, closed my eyes and felt my body tense up. The other midwife who had come along said, "Come back. Look into my eyes." This kept me in the present and helped me relax.

My midwife went up, turned the baby, and brought her out. It wasn't even painful. The baby was a little blue, but in 30 seconds, she was all right. I tore a little bit when she put both hands up and brought the third baby out, but it wasn't big enough to need stitches. Meanwhile my friend was supporting my hemorrhoids with gauze. After the births I didn't have any problems with my hemorrhoids. My bottom wasn't very sore at all. I didn't come out of this battered and abused. I was overwhelmed about the whole situation, with three babies out and healthy. My midwife said this was the first delivery she had attended where there were enough babies for everybody to hold.

I know that a lot of people might think that we were crazy to do it this way, but for me, it was the best possible birth I could have had. We were lucky, but we did take care of ourselves. I feel that we can take some responsibility for that positive outcome. When I was in bed for that last two weeks, the midwives came every other day and checked on my urine, my blood pressure, and they talked to me. If I had been in a hospital, I don't think I would have got such good care. In fact, I did talk with a woman who had had triplets in the town where we had been living. They put her in the hospital at 28 weeks, and she lost weight and [had] her babies early. I don't feel that she had the care that I got from my midwives. It was a group effort to bring out these individuals into the world. My midwives and I had done a lot of reading about triplets. We knew that they are usually born at about 28 weeks.

I ate a lot of turkey, tuna, green peppers and carrots. Lots of Vitamin C. I think that helped keep the babies in. I would eat a big plate of food when I would get up to go to the bathroom at night. I didn't understand why I kept spilling protein, because I was getting at least 150-200 grams of protein a day towards the end. It was very hard to keep up with all those growing babies. It was an unbelievable amount of protein for a human being to consume in one day.

In the end, I'm really glad that I didn't go and have an ultrasound and that we didn't know there were three babies, because I can't say I would have done it at home. I'm sure the midwives wouldn't have done it. It would have been the straw that broke the camel's back.

I think a few days before the babies were born, I began to have a suspicion there were three, because the midwives always had trouble hearing the heartbeat of the baby who was head down. Then during the last few days, all of a sudden, there was all this movement, and off to my right side, I felt a part of a baby sticking out. I knew that the head down baby had not moved, and I kept wondering, Who is that? Who could have imagined there were three babies in there?

Another thing that I found out is that a relative on my father's side had had triplets. Two had died at birth. They would have been my age. I knew there were twins on both sides of the family, but I never dreamed to ask if there were triplets.

I could hardly walk after I had the babies. I drank a lot of fluid afterwards. I few hours later, when I stood up to go to the bathroom, I almost fainted. I went back to bed. It was uncomfortable for me to pee until I had passed a really large blood clot. I needed help walking to the bathroom for the few days after I no longer needed the bed rest. I noticed that my gait was different for awhile after the birth. After all, I delivered 21 pounds of babies, plus the three placentas.

I decided to breastfeed all three babies. That went really well, mainly because I had good people around me who were supportive of my decision. There was never any question that we would do it another way. Nobody treated me like I was crazy for trying to breastfeed all of them. My friend, my father, and my mother came and walked babies while I breastfed one of them. My 70 year old aunt came up, and my sister came up. I had somebody with me most of the first three months. It was hectic. Usually it was me and another adult, which was minimal, with three babies.

But I got so much strength from doing that birth the way I wanted that it carried me through the hard times of that first six or seven months. We'd be so exhausted by evening, and we'd have to take a deep breath, knowing that we would have to get up in the middle of the night with them. But we did it.

Now that they're older (11 months), it's so much fun--they're such characters. I was so grateful that they were healthy.

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