Twin Mom Carrie talks to student midwife and twin mom Maria Mayzel about all things pregnancy.
Maria, my dear, thank you for taking the time to talk with us! I remember when we first met—my twins were just a few months old, and you shared with me your passion for and love of becoming a midwife. Then, just over a year later, you were pregnant with twins of your own! It is such a magical journey, isn't it?
Yes, it has been quite a journey to say the least. Similar to deciding to become a midwife, being a mother of multiples is somewhat of a calling—in other words, a journey that has chosen us.
First and foremost, could you take a moment to explain what a midwife is and why midwives are still very relevant to modern medicine?
Midwives are the guardians of normal pregnancy and birth. Prior to obstetricians, midwives delivered all babies. In many parts of the world, midwives still serve as a woman's primary birth attendant.
In the United States, we have many different types of midwives—from lay midwives who receive their training by apprenticing with a more experienced midwife to Certified Professional Midwives, like the famous Ina May Gaskin, who also do an apprenticeship as well as study a core curriculum and take a national certification exam.
I am studying to be a Certified Nurse Midwife, which is a registered nurse who has a master's degree in Nurse-Midwifery.
What made you decide to become a midwife, and why do you find it so rewarding?
After living overseas for a few years, I came back to the United States with a passion to work in women's reproductive health. I saw many problems both in the U.S. and abroad that could be solved if women had access to family planning and could make decisions about their reproductive healthcare.
After working in program management for a few international public health organizations, I realized that my true mission was to help women through the journey of pregnancy and birth. The reward comes from seeing the love and satisfaction on a family's face after the birth of a healthy baby. It also means being with women during sad moments, such as the loss of a pregnancy.
How can a midwife help and guide a twin pregnancy, and what is a midwife's role when dealing with a more high-risk pregnancy?
A twin pregnancy is simply a variation of a normal pregnancy, and many midwives manage twin pregnancies and attend births; however, depending on the type of twins you are carrying (dizygotic vs. monozygotic), the risks can be different. Not all midwives have the experience and training to manage twin pregnancies past a certain gestational age.
In general, midwives are trained to handle normal pregnancy. In the event that a pregnancy becomes complicated, they should refer clients to a collaborating physician—an obstetrician (OB) or maternal fetal medicine (MFM) doctor. For example, twin moms are more at risk for preterm labor and preeclampsia, two conditions that should be managed by an OB or MFM. Still, even if your care has been transferred to an OB for delivery, you can always resume care with a midwife after your babies are born.
Can an obstetrician and a midwife work together?
Absolutely. My twin pregnancy was managed by a group of midwives and an obstetrician. Again, the key is collaboration. Many women still receive the benefits of midwifery care even if their obstetrician delivers (or "catches," as midwives say) the babies. My midwives provided assistance both prenatally and during the post-partum period. I even had two midwife friends serve as doulas during the birth of my twins. A doula is a trained support person who assists a mother and her family through labor.
How can midwives assist new mothers post-partum?
Midwives are invested in building relationships with their clients and can be excellent resources during the post-partum period. From assisting a new mother with breast-feeding to helping her through the baby blues to helping her choose a method of birth control for preventing future pregnancies, midwives provide comprehensive care to their clients.
The long-term relationship built throughout the course of a pregnancy may continue through several years and even after menopause. There are some midwives who have "caught" siblings and even the grandbabies of their clients. Midwives, by nature, provide women support throughout her reproductive life—from puberty through menopause.
How did your role as a labor and delivery nurse and aspiring midwife help prepare you for your twin pregnancy?
Being a labor and delivery nurse and student midwife definitely informed the choices I made during my pregnancy. The two most important things a woman can choose are her provider and place of birth. I chose to receive prenatal care and deliver at the hospital where I work—partially due to convenience but mostly due to the fantastic care I have seen my patients receive.
It was important to me that my team of providers respect my desire to deliver my twins vaginally, and I was able to work with an MFM who was comfortable delivering a breech baby in order to realize my goal.
Of course, delivering in the hospital meant giving up some of the things I had wanted for my labor, such as a completely natural birth. I was induced with medication at 40 weeks and three days pregnant, and it was understood that I would get an epidural in the event of an emergency.
However, I was able to have a wonderful birth experience. I walked around, showered, used the birth ball, and received massages during labor. My co-workers came in to chat, and one even performed Reiki on me during labor. I rocked in a rocking chair for a good while. I made the decision to get an epidural at 8 centimeters as planned; this proved to be a good decision.
I believe women should carefully select a provider they trust and know the policies of the facility where they plan to deliver. For example, if you want a vaginal birth but your hospital's policy is that all twin moms get a C-section unless both babies are vertex (head down), then maybe you should plan to deliver your baby at another hospital.
I am also a firm believer in childbirth education for both partners. Although I am trained and work with pregnant women every day, the same is not true for my husband. Going to a childbirth education class was an important part of the pregnancy experience and truly helped us bond during a nerve-wracking time. An added benefit was that after those 15 hours of childbirth education, my husband turned out to be a pretty good doula himself.
As I mentioned, I also see the value in having a doula, or labor support person, at your birth. Doulas are trained to provide physical and emotional comfort to women, and they can take some pressure off the woman's partner when it comes to providing continuous labor support. Labor can be long and exhausting, and doulas get paid to be there for most of that time.
Lastly, a "Woman on the Street" question: If a woman approached you on the street and asked for advice about being a first-time mother of twins, what would you say?
Get all the sleep you can before they get here!
I can't thank you enough for sharing your expertise with our community! We also greatly appreciate that you took the time to share your own personal birthing story on delivering twins naturally. Your unique journey provides a perspective that many mothers can appreciate.
Maria Mayzel, RN, BSN, MPIA, SNM, is a labor and delivery nurse and student midwife located in Baltimore, Maryland. She teaches childbirth education classes at the hospital where she works, is a trained and certified doula through DONA International, and has experience in the field of international maternal-child public health. You can reach her at