Written by Josnella Caulker
The Caesarean Birth of Our Twins.
My name is Josnella, Caulker.
I'm originally from Sierra Leone but came to the UK as a child and live in Reading. I'm married to my childhood sweetheart of 15 years and we have 3 boys (a 3 year old and 6 months old twins). We've been married for 5 years.
I have a younger brother and we were both brought up in a Christian home. My dad passed a while ago.
As Christians and we go to church on Sundays.
Our family is not too big. My father in law is also deceased. My husband has two
younger sisters who are like the sisters I never had. We are a close knit family and we have a really good relationship with each other and we support each other.
When I was pregnant with my first and I had severe preeclampsia my husband's family would stay up all night on the phone praying with us and supporting us.
Children are a great source of joy and love and a big blessing considering how many people are going through infertility. I'm so grateful my family has been blessed with the privilege.
In African culture most women are required and expected to bear and care for children particularly when married. It seems like that is their only purpose.
You're expected to gracefully go through pregnancy, childbirth/care without complains because you were made to do this and your mothers/grandmothers have all done it without any complaints.
My mum is my rock, I don't know what I'd do without her.
She's made so many sacrifices for her children and now she's making sacrifices for her grandchildren. They are her life and she would do anything for them.
I'm grateful for "my village" and the love and support I get from them. I fully understood what people mean by it takes a village to raise a child when I had the twins.
I've had two pregnancies and my experience with the first was sort of mixed. The pregnancy phase was fairly easy and pleasant but the birth was very traumatic.
I went in for my 36-38 weeks antenatal when I was 37+ weeks and found out that I had severe pre eclampsia and HELLP syndrome.
It had been missed due to the infrequent antenatal appointments during Covid 19. I was told I wasn't going home without a baby and it was so severe that there was also a small chance one of us wouldn't survive it, It was very scary.
I was given medication to reduce the blood pressure and induced a few days later. I was in labour for 3 days without progressing and had to have an emergency c-section because the baby's heart rate dropped to a critical level. Recovery was slow and painful and I was dealing with a bad case of baby blues. Thankfully I got through that and started enjoying motherhood.
I'm now so in love with my first born.
My experience with my second pregnancy was so different. The pregnancy was filled with excitement and anxiety given my history with pre eclampsia and HELLP and because I was pregnant with monochorionic twins.
We were worried about TTTS and the small chance of stillbirth etc.
My family was really excited about me having twins.
My son was slow to grasp the concept but loved touching and kissing my baby bump
My husband and I were really shocked because it's our parent's siblings that are twins so we assumed their children would have twins.
We waited a little while to announce but it was a bit difficult because I started showing earlier this time around (10-12 weeks).
The pregnancy was a bit more difficult than my first as expected especially because I had another child who required my care and attention whilst my body was working hard on making 2 humans.
I suffered with extreme fatigue and morning sickness, nose bleeds, side pains and PGP but still had to drag myself out of bed to get my toddler ready for nursery and do the nursery runs.
During my first pregnancy I craved prawns quite a bit we didn't find out the gender then but guessed we are having a boy I thought I was having girls as per old wives tales because I craved sweets. This second time round we decided to find out the gender.
I must confess that I had a bit of gender disappointment but only for a short while. I was elated to have boys. I believe they are more loving to their mums.
My consultant obstetrician was un empathetic and detached.
She made a decision about my birth very early on and was unprepared to shift her position. She didn't listen to my wishes instead she was always quick to point out that she is the professional which I found condescending.
She seemed agitated at the fact that I kept bringing up the idea of a VBAC. She insisted that I had a previous c-section the risk of uterine rupture is high especially with multiple pregnancy. She also thought that the second/possible weaker twin may not tolerate labour particularly if I had to be induced.
I felt like a task she needed to complete and she wanted to do so quickly and be done with me, wanting to take the easiest option so she could be finished with me even if it goes against my wishes/preferences.
I never had a face to face appointment she would always call me and rush off the phone after 10mins. The usual was "your scan is fine, babies are growing well, your BP is fine nothing concerning. Speak to you in 2 weeks after your next scan".
She booked my c-section and when I asked if we could cancel or move the date she said "it's up to you I could cancel and book an induction if you don't go into labour naturally but you have to bear in mind that you may not get a suitable date and you may end up with one instead of two babies if you go past the recommended 36 weeks of delivery for monochorionic twins and the weaker twin isn't able to cope with labour."
I was flabbergasted, I couldn't believe a medical practitioner could be so cold especially when dealing with something so delicate as childbirth. I didn't really make a birth plan for my second pregnancy as my first didn't go as planned. I didn't want to get my hopes up so I went with the flow.
The second pregnancy was tough on me mentally. I didn't feel like I was listened to much by my clinician or my family. My clinician because she was detached and my family because they lack the knowledge/ understanding of the mental strain a pregnancy puts on you and because of cultural beliefs that women should be strong and just get through their pregnancy without complaints.
I found out about Sarah and contacted her 2 weeks before my scheduled section and although due to pressures from family I didn't end up taking her on as my doula, her advice and support in that short space of time was invaluable.
She was always available to listen to me and offered advice for no charge. She was kind and supportive and had my best interest in mind.
The birth was somewhat pleasant and calm with background music until my second twin was born and couldn't breathe and had to be given oxygen to breathe.
It was the longest 20 minutes of my life waiting for him to be handed to me. When I first saw my babies I was so happy I started crying. My heart was filled with so much love and joy. I held twin 1 and said hello my sweet baby boy. Twin 2 needed help with breathing and wasn't handed to me when he was taken out. He was given oxygen to help him breathe.
I felt powerless as I laid there watching them trying to resuscitate him. Even though I was numb from the waist down, I still attempted to get up and help him. I wanted to touch him maybe that would make a difference. I felt scared and sad. I started praying for him to be okay.
He was well in the end and didn't need any time in SUBU/NICU. We all left the hospital happy and healthy a week later.
The first month home was tough physically and mentally with 3 children under age 3. I was stuck in the couch feeding the twins or sleeping whenever I can even got 30 minutes which was all I got some days.
I also had to give my love and attention to my toddler so he doesn't feel sad and deprived. I was very upset about not being able to care for him as much. My family and I love taking walks but I couldn't get out of the house or have a long bath or eat my food at my own pace. Breastfeeding twins was so different and took a toll on my body. I was surprised at how something I've done before felt completely new.
Looking back, I would have liked to try for a VBAC but I've made my peace with my pregnancy and birth experience. My babies were born the way God intended it to happen and the most important thing is that they are all alive and healthy.
6 months in and although I sometimes feel overwhelmed and exhausted I tell myself it's a phase that will pass. My babies will only be so little and needy for a while. They'll eventually grow up and need me in a different way. If we decide to have another child in future, I'd be more insistent on my wishes and I'd go with my gut and make sure I'm listened to and taken seriously by clinicians and family members. I'd have the pregnancy and childbirth that I want as long as long as it's safe for me and my baby (ies)!
As for our son, he loves his siblings so much especially now that they don't sleep all day. He plays with them quite a bit and doesn't just ignore them which fills my heart with so much joy.
Sarah's comment: Meeting Josnella and supporting her in a way that would fit well with her family and culture meant I had to not apply my own and hold space for Josnella to guide me in supporting her. "I wish more doulas would do this and stop placing their own bias and world view into something that is not about them."
It is not uncommon for women to wish they had gone for (insert any number of other things) our default setting as women is regret guilt and not feeling good enough. The way some Birth Workers impose their thoughts and beliefs on a woman when not necessarily unsafe might play into feelings of not doing "good enough"
To Josnella, I say you did amazing you smashed it and I am so impressed by you and your story which I really enjoyed.
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