All of the pregnancy books I read mentioned that I should create a birth plan. While I don’t necessarily disagree with that notion, one thing I wished they emphasized more is that you need to be flexible with that plan. Especially with multiples. In fact, my advice would be not to worry so much about a specific plan but rather make sure you understand what your options are and the pros and cons of each. Then, decide if you have anything that you absolutely will not compromise on. After that, just go with the flow and do what makes sense to you at the time.

One major decision they suggest you make is what you want to do for pain relief during labor. This was actually one of the hardest things for me to try and decide. After all, I had never given birth before. I had no idea how bad the pain would actually be. I got a lot of well-meaning advice (including my sister’s-who has no kids but has delivered many babies-succinct “Don’t be a hero”) as well as the horror stories people feel they must tell pregnant women about the level of pain they endured.  In the end, my optimism won out. My pain tolerance has always been high (thus how I let my appendix rupture a few years ago before going to the hospital), so I thought I would be okay without pain relief. After all, it could not be worse than an appendix rupturing, right? (Side note: it wasn’t, at least not the contractions I experienced before receiving pain relief—but it did last much, much longer.)

That particular plan did not last much past my admission to the hospital. The doctor who would be delivering asked what my plans were for pain management, and I mentioned that I wanted to try to deliver without it. He paused for a moment and finally told me that though I could do what I wanted, they highly recommended epidurals for mothers delivering twins vaginally. Apparently, the second baby often does not cooperate once his or her sibling is delivered. I can’t say that I blame her—after all, she suddenly has more space than she has had in months. It seems only natural that she would want to enjoy her newfound freedom. Practically, however, this means the delivering doctor will often have to do what the OB called “manual manipulation.” And yes, it is just as pleasant as it sounds. In my particular case, once the first baby came out, the second one fortunately stayed head down but retreated back into my uterus. That meant that the resident had to. . . well, I’m sure you get the picture.

I thought about it for awhile and did finally agree to the epidural. However, I asked to have it closer to time, knowing that once they put it in, I would not have even the limited freedom I enjoyed during early labor (it numbs you from the waist down, so you cannot get up and walk around with an epidural). With that plan in place, they increased my Pitocin drip, and the waiting game began. 

The contractions felt more like mild menstrual cramps for the first few hours. I will admit, I got somewhat complacent. I finished up a lot of work that I hadn’t done that day, cleared my calendar for the unexpected outage, and generally continued as if nothing special was occurring. A few hours after they started, the contractions did start to get more painful. I tried my usual methods for pain control—deep breathing and trying to adjust to a more comfortable position. Unfortunately, I was hooked up to three monitors (one for each baby and one for contractions), and any movement seemed to jar at least one of them and bring a nurse into my room to readjust. Eventually, I decided to just stay in one position and try to sleep.

Needless to say, sleep did not come. Instead, I spent awhile staring at the wall trying to ignore the pain before finally admitting to myself that I wasn’t going to sleep and grabbing my phone to distract myself. The nurses checked on me frequently, offering pain relief each time, but I refused each time, figuring that I could at least hold out until labor was more advanced and get the epidural.

Around 4AM, however, I had an epiphany. I was dead tired, and I had only lost one night of sleep. There were going to be many, many more sleepless nights in my future, and it seemed silly to go into that period of my life already sleep deprived for no good reason. And so the next time the nurse offered pain relief, I took her up on it. I then slept for four hours straight which is the longest contiguous stretch of sleep I have had since. I applaud everyone who does make it through labor without medication, but for me, taking the medication offered was definitely the right decision. That sleep was key to surviving the following day and, in all honesty, probably the next few weeks.

By the time I woke up, the meds had worn off, and I was definitely feeling the pain. Labor had also progressed considerably, so I agreed to the nurse’s suggestion that it was time to start the epidural. One of the nice things about having a sister in residency is that you learn a lot of the ins and outs of how healthcare works. In this particular instance, I knew that

1. There was a point at which they would not put in an epidural because my labor was too far progressed (a point I had decided I definitely did not want to reach without an epidural)
2. Just because I said I wanted an epidural did not mean I would get one right away. Anesthesiologists must insert epidurals, and there is not always an anesthesiologist available immediately.

I got lucky with the epidural. They dosed it just right such that I could still feel the contractions enough to know when to push but they were not painful. This made labor smoother than it might otherwise have been if someone always had to tell me when to push. I also still had some control over my legs—I was able to move around somewhat in the hospital bed and help them transfer me to the OR bed when we got there (I did not end up having a C-section, but twins are nearly always delivered in the OR just in case). But for anyone else out there considering an epidural, note that these are both risks you take with it. In the end, it was worth it for me, even if I had not been quite so lucky with the dosing. It also taught me that sometimes, the best birth plan is to listen to the advice of the medical professionals. In my experience, they do have your best interests at heart.