How is the shoulder issue explained realistically:  Releasing a controlled, soft moan , she overrode the urge , finding equilibrium on the consuming edge of euphoria and agony. “This-is-so-in—uhh…mm-in-tense” , she breathed, collapsing against Liam’s arm , unable to speak as she panted out small moans. “I know , Lara, but you’ve got this. You’ve come so far and you’ve done such amazing work. I love you , and you can do this” he said, continuing his movements as she focused intently on his touch. She concentrated on each jolt of raw pleasure his touch created inside of her, as her baby moved down , and the familiar urge rolled over her once again. She panted hard, letting herself finally give an engulfing push at the very peak of her contraction. Controlling its length , she restrained the effort , instead breathing out the remaining desire as it dissipated in her gasps. Lara focused the nurses hands at he opening, and her low voice. “The head is crowning Lara, now this will be intense and if you feel any burning , I’m right here to help keep you lubricated . You keep up the amazing pushing, and if you’re perennial area becomes too thin we will deal with that very carefully. It’s all looking good Lara. The big moment is here” she encouraged , and Liam grasped his hand tightly. “I want to catch her when she-“the nurse , focusing on Lara slow progress , gestures toward the baby’s emerging head. “You’d better get down here then Dad, shes on her way.” Liam ran his hand across Lara’s abdomen as he moved to position himself between her thighs. The nurse guided his hand to cradle the emerging head of his daughter , and he lifted his gaze to lock eyes with his wife, as bore down, channeling the urge that stole her breathe and her voice. She couldn’t even manage a grunt as she breathlessly pushed the head out into Liam’s waiting hand. The room remained silent she fell back, gasping, and the nurse informed her “you did it Lara , but I’m really going to need you to focus hard, and pant for me , while I clear her umbilical cord. Don’t push Lara . “ she took over from Liam’s cradling of his daughter as he repositioned himself at Lara’s side , as she gripped his shirt and drained her knuckles white. “Li-uhhh-“ . Liam tightened his grip on hers as he urged .” Just vocus on my voice Lara , no one else is here alright. Pant through it. “ Lara’s desperate pants punctured the air as she rested her head against Liam’s , his deep stare the only place she found the strength to ride each breath u til the urge faded. “great job Lara , the cord is clear , really amazing work, now the first shoulder is coming, nice deep breaths for me …” Liam held Lara’s head in his palms , planting a kiss on her forehead as she leaned against his forehead , still panting. Lara fell away into a deep push , her abdomen shaking as Liam kept his hand on her pelvis, applying counter pressure. The nurse continued supporting the baby as Lara gasped against Liam’s arm. “It’s -“. Liam’s eyes flashed with concern as Lara dug her nails into his forearm, tearing his skin as she muffled a scream . “The shoulders are on a bit of an angle , Lara this is a perfectly normal, but challenging thing. We can try and move your baby through smoother, but this could take a few extra pushes-. “ Lara shook violently , tears streaming from her eyes . “Lara , listen to me. “ the nurse instructed, as the room buzzed with activity that seared through Lara’s concentration. “Its so loud——I want to stop“ she whimpered, collapsing against Liams chest as the nurse intervened. “I’m holding her head , Lara, and her shoulders are coming. I’ll have to guide them through but we can’t stop now. “ Lara shook her head, her teeth clenching in distress . “I need -to- stop” The nurse began to manipulate the first shoulder as it edged on Lara’s opening and her hips jerked forward as she ground her teeth in resistance. Another nurse was at Lara’s side , briefly encouraging “just take a minute , she doesn’t have to come right now, but it IS time to meet your baby Lara, what have you worked so hard for?” Liam squeezed his fingers against Lara’s abdomen, creating a firm line of comforting sensation between her hips. “she’s coming Lara, we’re all here , she’s so close, baby.soo close.” Lara gasped out “she’s —ugghh -—-I “ . As Liam removed his now bleeding arm from her grasp, he redirected her trembling hand to his jeans , encouraging her to take hold . “I wasn’t joking when I said she was strong …” he muttered, as her hands ground into his thigh, and she panted desperately, and small grunts fell from her lips. “She’s just taking her time-she one resilient little girl, just like her mom huh? “ The nurse said, turning the shoulder as Lara’s cervix continued pushing and she surrendered helplessly , as the room remained a blur of noise and activity , and Liam was suddenly gone from her side. The nurse announced as the lip remained caught around her baby’s shoulder, and her push ended with a tortured scream. “she’s in a better position now , Lara , take a few minutes to catch your breath , it’ll be a good few minutes before she gets past the lip however. maybe a little longer. “. The room blurred as Lara gripped the railing of the bed, her arms shaking as she pled “I can’t-“ . The searing pain tore through her skin as she felt the nurse silently pushing her cervix aside, and the sea of pain consumed her. Her hands clamped the railing with all she had as she resisted the irresistible urge to push, fearful her opening would explode into a thousand pieces . “I need to stop-uhhhh-“ He hand searched frantically for Liam as he braced himself on the sterile wall , a pained look in his eyes . “I can’t -I just need a moment, I—“ he explained to a distracted nurse passing by. His admission fell into the hall and he stared in exhausted disbelief as she screamed into the air . As he rubbed a hand over his drawn features , her pained cries the only sound in the bustling room that hurt his head , Liam turned to another nurse , grabbing the sleeve of her scrubs . “Please , give her anything-she’s in too much pain and -I cant do a damned thing .”, he broke out in frustration and concern. “Sir, we need to respect her choices, but we have the situation under control, we will manage the shoulders , she’s doing amazingly well considering the duration of her labour and the choice not to have an epidural-you should be very proud.” He looked at the stark linoleum floor , as her grunts punctured the air. “Sorry I-oh God I just, I haven’t slept , or eaten but I can’t stand to watch her anymore . I didn’t mean to-“ . The nurse glanced at her pager with an urgent tone “it’s alright, take a moment if you need , also you can go back inside when you’re ready. Maybe take a walk and clear your head. This stage may take some time-it isn’t easy“ and then she was gone in the crowd of medical staff, leaving Liam alone. As he stepped out into hall , steeling himself, there wasn’t any solace in the quiet, only guilt and fear. “Well you’re useless out here -can’t sleep or eat when she’s -and you know the damn window for an epidural is gone. “ The As another nurse passed he called out, his frustration and concern lacing his voice, the frantic environment drowning him “My wife has been in labour for over twenty hours and they expect her not to push out this shoulder that is ripping her half -apart. What if something goes horribly-“ The nurse placed a hand on his shoulder, only passing briefly as she assured ,”that’s what we’re here for. You should go and be with her when you’re ready.” And then she too was gone. Liam approached a vending machine , scanning the soda but only seeing his worn reflection staring back as he slammed a fist over a random button. he drained the can and crushed it in his fist , it’s metal absorbing his anguish. As another half hour slid by, he trudged back over to the bed where Lara was deep in the throes of a contraction, the nurse gone . “Baby , they left you? What’s happening? “ a nurse returned and stripped the curtain back as she deftly checked Lara’s progress . “You’re doing well Lara , the lip will mean that her shoulder will move foward , but slide back, but we’re getting there “ Liam’s complexion paled as he dropped to Lara’s side and she wrenched his shirt, without looking up from her trembling thighs. “Uhh-Li—uhhhh” she moaned in a desperate plea , as she fought to push through a punishing barrier , all of her strength gone , enduring each contraction with all she had left . “So , how many pushes could this take?” Liam asked , and the nurse replied , as she swiped Lara’s brow with a damp cloth “Maybe a few more, it depends on when the lip of her cervix gives way. This isn’t entirely common but- while it takes time it’s not a risk to the baby’s health. She has a good strong heartbeat, she’s proving her resilience-“ Liam grasped Lara’s hand protectively, as he muttered. “I’m getting damn tired of hearing bout resilience , an hour ago it was “a few pushes and-“ . Sliding , defeated, onto a chair at Lara’s side his strained voice reached her, “I’m here, I’m sorry I-“ Liam said , and dropped his head into his free hand as she tightened her grip in his . Lara panted , her womb clenching down with a ferocity that was visible on her sweat drenched abdomen. As the contraction finally released her, the blissful reprieve afforded her a few deep breaths . Then the familiar stalling hovered in the air . Lara gazed at her expensed husband , and smiled through gritted teeth. “He’s always been-like-this” she gasped and fell back against the headboard. “But it’s too-late -for-“she gasped out. Liam readjusted his fingers between Lara’s, his eyes glassed over. “I know baby, and I know you really are stronger than me. “I just don’t like that you’re working so hard and -“ then the nurses voice cut through the intimate moment of reprieve , her fingers against Lara’s opening “seems that lip has cleared Lara, now , work with your body and have your baby. Let’s do this Lara. When your contractions start up again, give me a hard push and don’t breath away the urge. ” . As Lara accepted a rough kiss on her temple from Liam as he displayed both urgency and hesitation to begin the way, not not close enough , Lara gasped out “ok -I’m -re-“ as she cradled her abdomen, her muscles clenching and pushing as she held her breath, savouring the intensity she could no longer exert by herself. As she went with the push, her fingers found the curves that needed her touch , and she trembled against them . As the nurses hand guided the shoulder out , she motioned to Liam with her head. “Get ready , Liam, the time is now “ Liam ran the back of his hand over his eyes, the lights of the room barring his vision with harsh lights . As he let the nurse position his arm in place , all he could hear was static and the noise of the room. “Ok Lara , the first shoulder is out, once more” Her breath stopped in her throat as her scream tore through the air . The left shoulder , grinding to a halt , left her panting in agony as the nurse manoeuvred it . “Ok Lara, deep breaths she really is a fighter, keep pushing” . Liam felt the bed rail shake with her hands as she collapsed against the side. “No-“ . She was soon crying as the nurse kept her hand firmly in place . “This time she’s coming Lara, there’s no turning back, deep breaths -“ it seemed as if she were yelling besides Liam’s ear as the exhaustion gave the room an echo “She said no- “ his voice broke with confusion and an anger he’d never felt on his own tongue. Another nurse grabbed his shoulder “get ready Liam, it’s now “. He watched as his own hands shook with fatigue and the baby’s shoulder , along with her body, emerged and was suddenly on his forearm , along with more blood than he’d seen . “Oh God -“ he muttered, as his daughter was swept away from him . “Clean her airways …” a distant voice blared as Lara’s pants punctured the room and she fell back, her hands sliding from the bedrails as she lay crying through a smile. Then there was a silence , not as disturbing as a calm before a storm . “Alright Lara. Rest a bit, catch your breath , you’re doing amazing “. Lara felt her cervix stretching with a familiar fullness, and she cried out “Li-help-m-“ “the second one has a clearer path, here we go” Lara clutched at the open air , as her uterus pushed with a force she was too exhausted to resist , moaning weakly as he arm went limp. Liam watched , his eyes glossing over as he muttered. “But I-she-we-already went through this part. “ the nurse barely managed a smile as she she kept her focus on second babys head as in slid into a full crown. “Keep pushing Lara , your first daughter is healthy , now keep going. “No-I Uhhhh- “

Releasing a controlled, soft moan , she overrode the urge , finding equilibrium on the consuming edge of euphoria and agony. “This-is-so-in—uhh…mm-in-tense” , she breathed, collapsing against Liam’s arm , unable to speak as she panted out small moans. “I know , Lara, but you’ve got this. You’ve come so far and you’ve done such amazing work. I love you , and you can do this” he said, continuing his movements as she focused intently on his touch. She concentrated on each jolt of raw pleasure his touch created inside of her, as her baby moved down , and the familiar urge rolled over her once again. She panted hard, letting herself finally give an engulfing push at the very peak of her contraction. Controlling its length , she restrained the effort , instead breathing out the remaining desire as it dissipated in her gasps. Lara focused the nurses hands at he opening, and her low voice. “The head is crowning Lara, now this will be intense and if you feel any burning , I’m right here to help keep you lubricated . You keep up the amazing pushing, and if you’re perennial area becomes too thin we will deal with that very carefully. It’s all looking good Lara. The big moment is here” she encouraged , and Liam grasped his hand tightly. “I want to catch her when she-“the nurse , focusing on Lara slow progress , gestures toward the baby’s emerging head. “You’d better get down here then Dad, shes on her way.” Liam ran his hand across Lara’s abdomen as he moved to position himself between her thighs. The nurse guided his hand to cradle the emerging head of his daughter , and he lifted his gaze to lock eyes with his wife, as bore down, channeling the urge that stole her breathe and her voice. She couldn’t even manage a grunt as she breathlessly pushed the head out into Liam’s waiting hand. The room remained silent she fell back, gasping, and the nurse informed her “you did it Lara , but I’m really going to need you to focus hard, and pant for me , while I clear her umbilical cord. Don’t push Lara . “ she took over from Liam’s cradling of his daughter as he repositioned himself at Lara’s side , as she gripped his shirt and drained her knuckles white. “Li-uhhh-“ . Liam tightened his grip on hers as he urged .” Just vocus on my voice Lara , no one else is here alright. Pant through it. “ Lara’s desperate pants punctured the air as she rested her head against Liam’s , his deep stare the only place she found the strength to ride each breath u til the urge faded. “great job Lara , the cord is clear , really amazing work, now the first shoulder is coming, nice deep breaths for me …” Liam held Lara’s head in his palms , planting a kiss on her forehead as she leaned against his forehead , still panting. Lara fell away into a deep push , her abdomen shaking as Liam kept his hand on her pelvis, applying counter pressure. The nurse continued supporting the baby as Lara gasped against Liam’s arm. “It’s -“. Liam’s eyes flashed with concern as Lara dug her nails into his forearm, tearing his skin as she muffled a scream . “The shoulders are on a bit of an angle , Lara this is a perfectly normal, but challenging thing. We can try and move your baby through smoother, but this could take a few extra pushes-. “ Lara shook violently , tears streaming from her eyes . “Lara , listen to me. “ the nurse instructed, as the room buzzed with activity that seared through Lara’s concentration. “Its so loud——I want to stop“ she whimpered, collapsing against Liams chest as the nurse intervened. “I’m holding her head , Lara, and her shoulders are coming. I’ll have to guide them through but we can’t stop now. “ Lara shook her head, her teeth clenching in distress . “I need -to- stop” The nurse began to manipulate the first shoulder as it edged on Lara’s opening and her hips jerked forward as she ground her teeth in resistance. Another nurse was at Lara’s side , briefly encouraging “just take a minute , she doesn’t have to come right now, but it IS time to meet your baby Lara, what have you worked so hard for?” Liam squeezed his fingers against Lara’s abdomen, creating a firm line of comforting sensation between her hips. “she’s coming Lara, we’re all here , she’s so close, baby.soo close.” Lara gasped out “she’s —ugghh -—-I “ . As Liam removed his now bleeding arm from her grasp, he redirected her trembling hand to his jeans , encouraging her to take hold . “I wasn’t joking when I said she was strong …” he muttered, as her hands ground into his thigh, and she panted desperately, and small grunts fell from her lips. “She’s just taking her time-she one resilient little girl, just like her mom huh? “ The nurse said, turning the shoulder as Lara’s cervix continued pushing and she surrendered helplessly , as the room remained a blur of noise and activity , and Liam was suddenly gone from her side. The nurse announced as the lip remained caught around her baby’s shoulder, and her push ended with a tortured scream. “she’s in a better position now , Lara , take a few minutes to catch your breath , it’ll be a good few minutes before she gets past the lip however. maybe a little longer. “. The room blurred as Lara gripped the railing of the bed, her arms shaking as she pled “I can’t-“ . The searing pain tore through her skin as she felt the nurse silently pushing her cervix aside, and the sea of pain consumed her. Her hands clamped the railing with all she had as she resisted the irresistible urge to push, fearful her opening would explode into a thousand pieces . “I need to stop-uhhhh-“ He hand searched frantically for Liam as he braced himself on the sterile wall , a pained look in his eyes . “I can’t -I just need a moment, I—“ he explained to a distracted nurse passing by. His admission fell into the hall and he stared in exhausted disbelief as she screamed into the air . As he rubbed a hand over his drawn features , her pained cries the only sound in the bustling room that hurt his head , Liam turned to another nurse , grabbing the sleeve of her scrubs . “Please , give her anything-she’s in too much pain and -I cant do a damned thing .”, he broke out in frustration and concern. “Sir, we need to respect her choices, but we have the situation under control, we will manage the shoulders , she’s doing amazingly well considering the duration of her labour and the choice not to have an epidural-you should be very proud.” He looked at the stark linoleum floor , as her grunts punctured the air. “Sorry I-oh God I just, I haven’t slept , or eaten but I can’t stand to watch her anymore . I didn’t mean to-. We discussed all of this of course , but she’s past the point where this much pain was expected . She’s past the damn window  and I just -. The nurse glanced at her pager with an urgent tone “it’s alright, take a moment if you need , also you can go back inside when you’re ready. Maybe take a walk and clear your head. This stage may take some time-it isn’t easy“ and then she was gone in the crowd of medical staff, leaving Liam alone. As he stepped out into hall , steeling himself, there wasn’t any solace in the quiet, only guilt and fear. “Well you’re useless out here -. “ he sighed , the realisation of being useless everywhere sinking in. Then as another nurse passed he called out, his frustration and concern lacing his voice, the frantic environment of the hallway drowning him.  “My wife has been in labour for over twenty hours and they expect her not to push out this shoulder that is ripping her half -apart. What if something goes horribly wrong, what if she-“ The nurse placed a hand on his shoulder, only pausing briefly as she assured ,”that’s what we’re here for. You should go and be with her when you’re ready, I would suggest taking some time to regroup your nerves , it’s normal to feel inadequate when the reality is we have manoeuvres that will prevent injury..” He offered a grateful state and then rested against the wall as she walked away . Liam approached a vending machine , scanning the soda but only seeing his worn reflection staring back as he slammed a fist over a random button. he drained the can and crushed it in his fist , it’s metal absorbing his anguish. As another half hour slid by, he trudged back over to the bed where Lara was deep in the throes of a contraction, the nurse momentarily gone . “Baby , they left you? What’s happening? “ a nurse returned and stripped the curtain back as she deftly checked Lara’s progress . “You’re doing well Lara , the lip will mean that her shoulder will move forward , but slide back, but we’re getting there, just take each breath as it comes , and each push as it happens. “ Liam’s complexion paled as he dropped to Lara’s side and she wrenched his shirt, without looking up from her trembling thighs. “Uhh-Li—uhhhh” she moaned in a desperate plea , as she fought to push through a punishing barrier , all of her strength gone , enduring each contraction with all she had left . “So , how many pushes could this take?” Liam asked , and the nurse replied , as she swiped Lara’s brow with a damp cloth “Maybe a few more, it depends on when the lip of her cervix gives way. This isn’t entirely common but- while it takes time it’s not a risk to the baby’s health, we are working to optimise her position , and to guide her through safely.. She has a good strong heartbeat, she’s proving her resilience-“ Liam grasped Lara’s hand protectively, as he muttered. “I’m getting damn tired of hearing bout resilience , an hour ago it was “a few pushes and-“ . Sliding , defeated, onto a chair at Lara’s side his strained voice reached her, “I’m here, I’m sorry I -“ Liam said , and dropped his head into his free hand as she tightened her grip in his . Lara panted , her womb clenching down with a ferocity that was visible on her sweat drenched abdomen. As the contraction finally released her, the blissful reprieve afforded her a few deep breaths . Then the familiar stalling hovered in the air . Lara gazed at her expensed husband , and smiled through gritted teeth. “He’s always been-like-this” she gasped and fell back against the headboard. “But its why I lov-“she gasped out. Liam readjusted his fingers between Lara’s, his eyes glassed over. “I know baby, and I know you really are stronger than me. “I just don’t like that you’re going through this -“ then the nurses voice cut through the intimate moment of reprieve , her fingers against Lara’s opening “seems that lip has cleared Lara, now , work with your body and have your baby. Let’s do this Lara. When your contractions start up again, give me a hard push and don’t breath away the urge. ” . As Lara accepted a rough kiss on her temple from Liam as he displayed both urgency and hesitation to be the way, nor not close enough , Lara gasped out “ok -I’m -ready-“ as she cradled her abdomen, her muscles clenching and pushing as she held her breath, savouring the intensity she could no longer exert by herself. As she went with the push, her fingers found the curves that needed her touch , and she trembled against them . As the nurses hand guided the shoulder out , she motioned to Liam with her head. “Get ready , Liam, the time is now “ Liam ran the back of his hand over his eyes, the lights of the room barring his vision with harsh lights . As he let the nurse position his arm in place , all he could hear was static hum of the room. “Ok Lara , the first shoulder is out, once more” Her breath stopped in her throat as her scream tore through the air . The left shoulder , grinding to a halt , left her panting in agony as the nurse manoeuvred it . “Ok Lara, deep breaths she really is a fighter, keep pushing” . Liam felt the bed rail shake with her hands as she collapsed against the side. “No-“ . She was soon crying as the nurse kept her hand firmly in place . “This time she’s coming Lara, there’s no turning back, deep breaths -you’re almost done-“ it seemed as if she were yelling besides Liam’s ear as the exhaustion gave the room an echo “She said no- “ his voice broke with confusion and an anger he’d never felt on his own tongue. Another nurse grabbed his shoulder “get ready Liam, it’s now,  keep your hand under our arms  “. He watched as his own hands shook with fatigue and the baby’s shoulder , along with her body, emerged and was suddenly being held just above his forearm , along with more blood than he’d seen . “Oh God -“ he muttered, as his daughter was swept away from him . “Clean her airways …” a distant voice blared as Lara’s pants punctured the room and she fell back, her hands sliding from the bedrails as she lay crying through a smile. Then there was a silence , not as disturbing as a calm before a storm . “Alright Lara. Rest a bit, catch your breath , you’re doing amazing “. Lara felt her cervix stretching with a familiar fullness, and she cried out “Li-help-m-“ A voice cut through her plea with calm reassurance. “the second baby has a clearer path and is optimal position, now  here we go” the nurse instructed briskly, and the movement of the baby’s head stretching and burning Lara’s opening was undeniable as it claimed her entire being. Lara clutched at the open air , as her uterus pushed with a force she was too exhausted to resist , moaning weakly as her arm went limp. Liam watched , his eyes glossing over as he muttered. “But I-she-we-already went through this part“ the nurse barely managed a smile as she she kept her focus on the second baby’s head as in slid into a full crown. “Keep pushing Lara , your first daughter is healthy , now keep going. “No-I Uhhhh- “ She released a moan that was filled with instinct , as her control was relinquished to the overwhelming pressure of the pull of her next push, its essence involuntary. It was happening faster than her breaths could match, as her gasps grew lighter and faster , and she was panting without trying. “Great job Lara , the head is out “ the nurse said as she held Liam’s hand in place and his arm trembled against hers. “And here come the shoulders , breathe Lara, let it happen , breathe-“ Her moans spilled through the room as the first shoulder eased out , followed by the second, and their second daughter’s body was above Liams’ arm, secure in the nurses hands as he rolled back onto his heels. She was swept away just as quickly, as Lara’s legs fell closed , her body shaking with relief. “Up off the floor Dad, I know it’s a lot but-Congratulations you have two of them -“ He rose, dazed and smiling through tears as Lara was handed her two newborn daughters . “Let’s just name them both after you, I always knew you had two middle names for a reason-“ . She shook her head, enamoured with them both at once. “ I’ll name this one Lila Rose . “ Liam gazed down awestruck yet uncertain. “Do you really trust me with this -“ Lara laughed through her tears. “I know it’ll be perfect” . His fatigue slowed him down as he mused …”Lily..Grace. That’s the word I have . It’s fits. “ Liam let his eyes close as he micro slept, weathered by the ordeal.  As Lara recovered , a nurse explained as Liam asked” why did she go through such an ordeal with Lila, but Lily just -kept coming ?” “With twin births, the baby can get stuck with the pressure of the second twin making her way down right after. It can cause trauma for both infants… so you have two incredibly strong girls. Liam leaned in to sling an arm around Lara “Nah, make that three”As Lara moaned softly , feeling a few weak contractions taking hold , a nurse took Lila from her , holding her hand good job Mom, the placenta means there’s certainly no third one in there “ in a few moments it was removed from her opening and Lila was returned to her arm, as she sank back smiling , and falling asleep. Liam told the nurse “we already wanted to use these names , and our first argument might have been that . But well , I just want to sleep now that she’s not in any pain . It’s just a relief to see her smiling. I’ll have two of them screaming soon enough. I need all the sleep I can….” He trailed off into a deep yawn. “It’s fine Mr Weston , we’ll take them off your hands and let Lara recover properly, we have sleeping arrangements if you’d like a proper bed a proper meal. “Can I just sleep here for a bit “ he mumbled at no one in particular as the room faded out.