Twins -- C-Section/Vagina

[L.A.Mamma]

This is my first pregnancy, so labor seems quite daunting. I'm seeing a traditional OBGYN and an MFM. I'm a high risk pregnancy b/c of twins, 3 previous miscarriages, had to get knocked up through IVF and maybe my asthma.

I'll admit it, labor and delivery sound hella scary!! My doc has basically told me he'll only do a Vaginal if both are head down.

I'll tell you my thoughts:

Vaginal -- natural always seems better. I'm a pretty green type of girl. Recovery time is less. Though the idea of tearing down to my bummy is scary. I also worry something will go wrong so to speak.

C-Section -- This is selfish, but I like my vagina the way it is, lol. But on a more serioius note, I'm just afraid something will go wrong with a Vaginal. I got pregnant through IVF; fertility/pregnancy, have not been my friend thus far. It's been a struggle and I just don't want anything happening to my babies. I guess I'm afraid to press my luck, since this pregnancy is such a miracle.

I feel like if both babies are head down and there are no medical obstacles, I should go and do a Vaginal. My husband thinks I'm crazy. What do you all think?

If one is in breach, I'm really just darn scared and may opt for a C-section.

UGH, I just don't know!!!!!!!!!!!!!

POINT OF CLARIFICATION AFTER READING COMMENTS:
Ladies, point of clarification. The tearing is a fear -- it's not a deal breaker here. It would be immature imo to not have a vag birth simply b/c of the fear of tearing. Obviously our bodies change after child birth=)

[crazycandigirl]

Hard decisions for you to have to make. I can't offer much advice as I have only had one baby at a time, but I hope you find the decision that is right for you and your little ones.

If it was me I would try for the vaginal birth. I have had 2 vaginal births and the thought of a c-sec really does personally scare me a bit. I guess I would have to weigh the options and find out how to have the best possible chance at a safe and easy vaginal birth, but prepare myself for a possible c-sec.

Oh and to let you know (cause you made me smile with your comment) vaginal birth does not necessarily mean a big tear, and I have found absolutely no difference in how my vulva and all its wonderful bits preform from before and after. I was really worried about that before my first, but a woman's body is an amazing thing, and everything goes right back to how it is suppose to be. DH notices nothing different during sex either.

Happy birthing vibes to you no matter what decision you make!

[Spring Sun]

I am photographing newborn twins in a few days and their mother did it naturally. I am so amazed by her.

I did not tear and I dont thing my vagina is any different now. Plus, remember your babies will be a bit smaller than normal so I doubt they will make a huge impact down there, you know?

It is sooooo much better for the babies to be born vaginally too. I would do a little research before you totally decide.

[thorn]

I personally didn't like recovering from major surgery with a single newborn, I definitely wouldn't want to while trying to keep up with two of them!

[Degas]

Not in your DDC, but I personally would be more worried about complications and things going wrong from a c-section than a vaginal birth. A c-section is major surgery. There is a greater risk of infection with a c-section as well. Take every chance you can to birth vaginally.

[BeagleMommy]

There are a lot of things that can go wrong with a C-section. Since most don't have major complications, I think we have the impression that they are safe. Well, it is major surgery. And even if it appears that everything went well, a huge percentage of women have ongoing pain from the surgery. Not to mention the added difficulty of breastfeeding initiation. And any future pregnancies are going to be more challenging to find someone who will "let" you have the next one vaginally. My SIL had a perfectly healthy, full term baby by elective C-section and she didn't even see the baby until she was almost 4 hours old! And that was at a regional "women's hospital" with a good reputation.
I'm not saying there are no good reasons for a C-Section, but it really is a big deal whereas having a baby or two vaginally is what we were designed for. That's a much longer track record!
You have time to do some research- take advantage of it!

And, yes, many women successfully fully breastfeed twins!
Congratulations on your two little blessings!

[Gena 22]

I stumbled on your post, the title caught my eye although not in this DDC. If you're still pondering this issue, consider joining us at the Parenting Multiples board.

Having twins is different than a singleton, all the way along, even through pregnancy. You'll hear all sorts of medical concerns, some of which do need to be taken seriously. I'd strongly suggest reading on the subject. Dr. Barbara Luke has a book most MOMs swear by. It's great for guiding you through the nutrition you'll need, although I disagree with her estimate of when twins should be born and how inactive you need to be.

Anyway: to the birth aspects of twins. Like you, I went to OBs and an MFM specialist through my pregnancy. And like you, my OBs said they'd go let me go for a vaginal birth if both twins were head down. They were. But, I talked through delivery with the different OBs in the practice, thought about my mother's history (going late - long labor), and chatted with L&D nurses at the hospital. Mine had an 80% twin c/s rate. The twins were my first, so I had "an unproven pelvis."

So that left me with a decision. If I had delivered with my OB at the hospital I would have needed to be at peace with the idea of a c/s. I probably would have waited as long as I could, and ideally let at least some early labor start. Maybe I could have tried for a hospital vaginal birth, but I think it would have been best to agree to at least a semi-scheduled c/s with my OBs. I'd have wanted calm, planned agreement with my doctors.

Instead, I wasn't at all at peace with the idea of a c/s forced on me. And I didn't want to fight all through labor over every little thing. Now I liked my OBs, but we had some major philosophical and factual disagreements. I don't think twins are best born preterm. I don't think induction is safe. Etc. So I found a midwife and birthed my twins at home.

Originally Posted by Spring Sun

I did not tear and I dont thing my vagina is any different now. Plus, remember your babies will be a bit smaller than normal so I doubt they will make a huge impact down there, you know?

It is sooooo much better for the babies to be born vaginally too. I would do a little research before you totally decide.

:

Labor was a little rough, and I caved to home induction with castor oil. But my birth went very smoothly. My twins had great heartbeats all throughout. They were born with a quick pushing phase. Birth was better for them at home by far. Then recovery was much easier on me.

Mull it over and do some research. Come to peace with what you choose. I can definitely respect women who make an informed decision to birth their twins surgically. But birthing vaginally at home can be a wonderful and healthy decision too. It's the middle ground that's tough - vaginally in a hospital. There are lots of challenges, and you'll need great fortitude, luck and help.

Feel free to PM me. Hope to see you on the Multiples Board!

[Pernillep]

Personally I would say go vaginal if at all possible. Even if one shows breech. From what I understand once one is out the second often turn. There just isn't a whole lot of room to move around and before birth they take any spot they can find.
My mom did a twin vaginal (me) and one of my best friends did too. Both said it really was not a whole lot different from giving birth to just 1. Their labor was similar, the only difference was once you had a baby you still had to push.

It is a lot easier to recover from even a twin vaginal than a c-section. A c-section is major surgery and you can see complications after delivery which you rarely see in vaginal births.

Birth and labor can be scary if you have never done it before. I was a little freaked out before having DS because i just didn't know what to expect but my fear of a huge needle in my spine was much larger than that of giving birth. Your body is meant to have a baby and while for some people it is not a sunday walk in the park with pink clouds, roses and cotton candy it is doable. So much so that 5 min after DS popped out I asked when can I do this again.

About your down there bits. I asked DH about it and he says he can't tell the difference. I am not spending my days looking at it so honestly I don't really care.

Going vaginal doesn mean you will tear. I for one didn't at all and DS was suctioned out because of cord issues.

Lastly, the difficulty you had getting pregnant doesn't necessarily mean giving birth will be any harder or more complicated than if you had gotten pregnant on your first try. I do understand the fear and doubt though. You went through a medical procedure to get pregnant so it can be very difficult to trust your body and nature to take its course with the birth. You still have plenty of time before you have to make your decision. Spend some time reflecting on what type of birth you want and where your fears may be interfering with what you want and who you are as a a person (since you say you are pretty crunchy ) Then once you have made your decision you can be comfortable in knowing you did your research and made the decision that was right for you whether it being a c-section or vaginally.


(ok this got a lot longer than i expected, Sorry)

[August09baby]

Hi L.A.Mamma: I am in your DDC - having twins in August. I am not sure if it helps to get other people's perspective on their own choices but here is why I am doing everything in my power to have these babies vaginally - because I genuinely and sincerely believe that having these babies vaginally is the very best thing I can do for my children:

There are very strong, valid medical reasons that babies should be born through a vagina. As a L&D and postpartum nurse for several years I can tell you from my own experience (and the medical evidence backs this up) that c-sectioned babies are more likely to need to go to a NICU, they can have more trouble latching on for breastfeeding. Without the vagina to help expel the fluid in the babies lungs, their lungs are "junkier" and they usually, if not sent to the NICU, will be kept in the well baby nursery for longer periods of time. We used to play a game in the well baby nursery for new nurses. We would have them come assess a newborn and not tell them if it was a vag or cs delivery. We would put the babies hat on so you could not see if there was head molding or not (a vaginal delivery give away!). Sure enough, after one or two assessments, even a novice nurse could tell the difference between a c-sectioned babies lungs and a vaginal birth babies lungs. That alone is a huge motivating factor for me.

Also, the recovery period for a c-section is much longer and much harder. The thought of caring for two babies after major abdominal surgery is daunting, at best. An I never forget that a c/section is major abdominal surgery. Using serious, heavy duty drugs that do also affect recovery and the babies.

I hear what you are saying about being afraid of something going wrong with a vaginal birth. Those are valid feelings. But I would maybe consider thinking about the fact that things can go wrong with a cs as well. One of the hardest things for me with the birth of my DS was getting over the fear of what could be and trusting that my own body could do the job of labor. It took a lot of work on my part - but it was worth every second of my beautiful labor and delivery for DS. And my vagina does not seem all that different after the birth of my son - 8lbs 6oz !!!

I have a doctor who is very comfortable with a breech delivery so if baby b is breech we will deliver it vaginally. I searched for weeks to find a doctor committed to the fact that vaginal birth is how babies should arrive into the world (barring a true medical emergency).

Anyway - those are just my thoughts on the matter. In the end every woman is different and you have to make the decision that works best for you. I wish you peace as you make your decision and a wonderful birth experience with two healthy babies at the end of it all

[snowmom5]

Barging from July. I delivered my IVF twins vaginally (vbac, actually). Baby A was head down, baby B was transverse (really he was all over the place lol). After baby A was delivered, the OB and resident turned baby B to vertex and he was out in two pushes, five minutes after baby A. They were born at 33w due to p-prom. The pregnancy was complicated by PTL/early cervical changes, bedrest, lovenox for clotting issues, tachycardia, etc.

Let me tell you, it was a heck of a lot easier waddling around the nicu following the vaginal delivery than it would have been following a section. I *hated* the recovery from my prior scheduled section, which had been for a breech singleton. Not that recovery from the vaginal delivery didn't have its moments (like three days later in the bathroom when I thought for sure I'd bust my stitches LOL). But by comparison to the section, it was a piece of cake. (I have since had two more vbacs, which were even easier to recover from, and am hoping for one more this summer. No, not all ivf, but that's a story for another day...)

So, if you can manage it, I totally vote for going vaginal. There are plenty of complications that you can't control, but if baby A is head down I'd go for it. Of course, if your provider isn't willing (or experienced) to turn baby B then you're in a pickle, unless you switch to someone who is. If both are head down, it's a no-brainer to me. Seriously.

(As for effects on the vagina, section vs. vaginal, I think my pelvic floor muscles were shot long before I ever attempted a vag delivery anyway, and honestly three vag deliveries later I think I like it better. I think it's a weak argument when it comes to choice of delivery.)

There's another factor: your future deliveries. I know it's hard to imagine now, after all you've been through, but it's a whole lot easier to have more babies vaginally if you don't have to worry about vbac issues (e.g. you can ask your doc now - do they do vbacs at your hospital?).

Many congrats on your hard-won pregnancy! I hope all goes well no matter what sort of delivery you end up with!

[tankgirl136]

I think so many people have given you some great advice!!!

I am only having one as have most of my friends, but honestly seeing the difference in recovery between my friends who went vaginally and C-section, there is a huge difference. My C-section friend had so many more issues and pain and found caring for her son to be so hard afterwards. She had a teenage daughter to help thank goodness. My other friend had three other young children and she seemed up and ready to go so much faster.

I also hate to say this but another friend had one of the scary things that can happen from a badly stiched up prior C-section, make sure if you have to have a c-section that they do a double stitch closure not a single!!! Her son was fine but things became very scary for her for a bit there.

I have to say I am scared too and I am only in for one! I think that a huge incision on my belly is way scarier then anything that can happen to my vagina in this case, since that is where babies are supposed to come from. That and the thought of a big needle in my spine is SCARY!!!!!!! We all have to be educated and do what is best for us and our lil ones. All the best to you!

[NaturalMindedMomma]

Originally Posted by L.A.Mamma

This is my first pregnancy, so labor seems quite daunting. I'm seeing a traditional OBGYN and an MFM. I'm a high risk pregnancy b/c of twins, 3 previous miscarriages, had to get knocked up through IVF and maybe my asthma.

I'll admit it, labor and delivery sound hella scary!! My doc has basically told me he'll only do a Vaginal if both are head down.

I'll tell you my thoughts:

Vaginal -- natural always seems better. I'm a pretty green type of girl. Recovery time is less. Though the idea of tearing down to my bummy is scary. I also worry something will go wrong so to speak.

C-Section -- This is selfish, but I like my vagina the way it is, lol. But on a more serioius note, I'm just afraid something will go wrong with a Vaginal. I got pregnant through IVF; fertility/pregnancy, have not been my friend thus far. It's been a struggle and I just don't want anything happening to my babies. I guess I'm afraid to press my luck, since this pregnancy is such a miracle.

I feel like if both babies are head down and there are no medical obstacles, I should go and do a Vaginal. My husband thinks I'm crazy. What do you all think?

If one is in breach, I'm really just darn scared and may opt for a C-section.

UGH, I just don't know!!!!!!!!!!!!!

It's hard when you go through fertility treatments.

First off, your vagina will be fine after the vaginal birth. Its a muscle and it recovers. LOL I promise

Men think any type of vaginal birth is crazy (most anyway), their bodies are not made to do and their brains are not programmed to accept it, they dont NEED to biologically, we do for the survival of our race. Until the techno medical model of care became so prevalent in this country, midwives attended births at home and babies were born all sorts of ways. He will think its crazy after a c section when he sees the healing/help you will need to recover. Either way, they are in AWE of us and the whole experience! I would talk to him and tell him you really need his support for a vaginal birth. Show him research of why vaginal birth is better.

labor was tough. Delivery was not (for me). I think your HCP makes all the difference in that. I pushed in a great gravity using position and no one counted or yelled. it was gentle. Albor was so worth it in the end and mine was 41 hours, lol. I'm doing it again, I promise it's not THAT bad. No one would do it twice! HAHAA

Twins alone, does not qualify you as high risk. The miscarriages may, it depends on the circumstances. Try (I know this is hard) to not consider yourself high risk until something truly goes wrong. Birth is psychological. Therefore as a woman who has obviously been traumatized by infertility, miscarriages, and is deemed high risk, will naturally doubt her bodies ability to birth as well, its part of anatomy (I went through this and so is my best friend and countless other women I know). By thinking this way, you actually can inhibit birth and pregnancy to work for you. Get a pregnancy affirmations CD (hypnobabies has an awesome one). PLEASE get the idea of elected C section out of your head. I hate to see a woman who is completely capable of delivery throw away her chances because she doubts herself. Most likely, both babies will not be head down. A lot of HCP will not deliver breech singletons nevermind twins, this is due to medical malpractice insurance and hospital policy rather than actual statistics or true factual information. Breech birth can happen with singletons and can happen with twins.

Read as much as you can, as many positive birth stories, especially about twins and surround yourself with knowledge. Don't rely on your Dr for that.

Please remember, C sections are not guarantees either. Birth comes with no guarantees, it is risky no matter how we look at it.

Good luck sweetie, it is a hard decision to make and you will not be wrong either way. I wish you a healthy, easy, pregnancy and birth.

[L.A.Mamma]

Thanks ladies! Lots of invaluable information.

My instinct is that vaginal is better. But the first issue I have is that my OBGYN will not do a vaginal delivery if one baby is in breech (for reasons discussed above, i.e. malpractice). So the question is do I continue with this OBGYN? My gut is saying yes. Also, I only want to deliver at a specific hospital at LA, my thoughts are that it will be very difficult finding a OBGYN that would deliver a breeched baby. The idea of changing up my OBGYN/MFM team is daunting. I'll have to reflect on this.

Now I agree with everyone, 2 babies head down, w/o any other medical complications seems like a no brainer. I'm not denying being scared sh*tless, but my decision can't ever be motivated by fear. I agree, what's difficult at this point is trusting my body. After infertility, it's been tough having faith in my body. But I'm joining a women's circle here in LA and I think it will help.

I've got to do tons of research. My brother-in-law is a brilliant doctor and he really is advising for a C-section as well. It's hard to not put a lot of weight on his advice b/c I trust him. Still, it's my decision to make. I know my husband is on board with whatever I choose.

I'll do my research. And be prepared for whatever happens in this pregnancy.

[jeliphish]

Not in your DDC but I wanted to comment that the vagina is a muscle and it recovers extremely fast and well. I think mine is in better condition after having a baby - my orgasms are certainly much better

[Talula Fairie]

If it were me, I'd do everything in my power to get those babies out of my vaj, even going so far as traveling to a midwife who will do it naturally. I'd also avoid an epidural at all costs in this situation. Previous miscarriages and IVF do not hinder a possible vaginal delivery or make you totally "high risk" (although I am not 100% sure on that, I don't think they do). Twins do carry a higher risk for many things, but there are midwives out there who will attend to you.

I hate to say it, but your body is not going to be the same after having children. That's just part of having babies, yakno? Your vagina will likely be about the same, and won't feel any different, and even if it would be...would you really be willing to add a threefold risk to your chance of death, and the chance of losing your babies...for that? Probably not, but I just thought I'd give a different perspective. I often say "ok this is a sacrifice I'm making for my kids" and I think it's important for every woman to have a reverence, respect and acceptance about the way their body changes after birth. I know our society tells us a lot of these changes are ugly, but in a way, they are beautiful too.

To help with the fear, I recommend not watching ANY of those scary baby shows on TV. They only reinforce the negative birth culture in our country. Try watching some movies that talk about how wonderful birth can be, and how normal it really is, like The Business of Being Born. You may also want to read Ina May Gaskin's books (either of them, and in both there is talk of delivering twins naturally, even if both are not head down). Her books really helped me with a lot of my fear. And hire a doula or birth coach! They will be invaluable to you for keeping you calm. I was kicking myself for not hiring one when I was in labor with #1.

Oh, and btw: I birthed two full term, POSTERIOR, average-to-large size babies (7 lbs, 11 ounces and 8 lbs, 10 ounces) out my vaj. I did tear both times, but I healed quickly and honestly, sex is even better now. So if there was a change in my vagina...which I can't really feel with my hands and neither can my husband, it was positive if anything. The vagina is an incredible organ, and most of the time, it totally recovers from birth. Remember, this is something our bodies were designed to do.

[Flower of Bliss]

Well, I'm not having twins, and I haven't done the research on vaginal twin births and which circumstances truly warrant a c-section...

However, I wanted to chime in on the tearing concerns. I had a 4th degree ("tearing down to my bummy" as you put it). DD was a compound presentation (hand at head) and a very fast birth, and her little elbow ripped right through me. DD was a tiny 5lbs 14oz. It was the presentation and speed of the birth, not her size that was an issue.

My recovery was honestly fine. I was able to walk up and down the stairs easily when I went home the next day. I was going on walks around the neighborhood with DD in her first few days. I traveled to a wedding in my home town about a 5 hour drive away 3.5 weeks postpartum, and again for my BIL's wedding 12 hours away at 6.5 weeks postpartum.

We had some issues with pain during intercourse in the first 4 months postpartum. These were complicated by limited time and energy caring for a newborn and by the typical dryness of a breastfeeding mother. Finding a lube I liked made a huge difference. By 6 months sex was wonderful. I'd say it's been better in the last 2 years than it ever was before DD was born. DH has absolutely no complaints.

The idea of major abdominal surgery scares me. The idea of another 4th degree tear sounds unattractive, but it really doesn't scare me. My biggest concern about a 3rd or 4th degree tear this go round is that my home birth midwife only stitches 1st and second degree tears, so I'd have to transfer for the stitching (she's only had this happen once, and I'm highly doubting that I'll deal with it again).

I hope that this helps settle some of your fears about tears. Of course, you might not tear at all, but I wanted to tell you about my experience with a really bad tear.

[L.A.Mamma]

Ladies, point of clarification. The tearing is a fear -- it's not a deal breaker here. It would be immature imo to not have a vag birth simply b/c of the fear of tearing. (I'll be adding this to the top of my post since this seems to be a hot issue).

I need to do my own research. And honor my body in a way that I think is best. All the insight is helpful, especially if you've delivered twins.

[L.A.Mamma]

Talula: "If it were me, I'd do everything in my power to get those babies out of my vaj, even going so far as traveling to a midwife who will do it naturally." I respect that. Unfortunately, I don't feel comfortable with having a midwife delivery vs. an OBGYN. I have too many doctors in the family that have shaped my way of thinking. Not to disrespect midwives -- it's a wonderful service they provide, unfortunately not for me.

[Gena 22]

Sounds like you're a strong lady, LA Momma. Vaginal twin births, even unmedicated ones, can be had in the hospital. Maybe you can use some of your medico family members to your benefit. Get educated, and make sure your OB is on the same page you are. I hated the idea of changing providers too, but it might be a good idea. Ask around and see what the L&D nurses think of your OB, and how many vaginal twin births she / he's done. FYI - I'd hope that your OB would be on board for a vaginal birth so long as Baby A is head down. Baby B can be turned afterwords. The instance of a first baby vaginally and a second by c/s is really rare.

If you do switch OBs, one piece of advice I've heard is to look for one that specializes in multiples. To a doctor who does, twins are no big deal! Otherwise be really savvy about a doctor's history. Ask around, that will tell you more than an interview will. Also, understand that the risks in twin births and pregnancies vary. If, like mine, yours are fraternal, each with sac of their own, the risks are much less. In the words of Ina Mae, twins are just a variation of normal. My Baby B was swimming happily in her "apartment" right up until minutes before birth! She floated right through the birth of her sister.

Here's a birth story that might be right for you:
http://www.mothering.com/discussions...d.php?t=613772

And here's mine, although I know you're not into the midwife route, there are parts you might be interested in:
http://www.mothering.com/discussions...d.php?t=925854

PS - Hire a doula and labor at home as long as possible. Those two things will do a lot to help you with a smooth and comfortable birth!

[ChichosMama]

Originally Posted by L.A.Mamma

Talula: "If it were me, I'd do everything in my power to get those babies out of my vaj, even going so far as traveling to a midwife who will do it naturally." I respect that. Unfortunately, I don't feel comfortable with having a midwife delivery vs. an OBGYN. I have too many doctors in the family that have shaped my way of thinking. Not to disrespect midwives -- it's a wonderful service they provide, unfortunately not for me.

That is a serious statement right there. Not to offend you, nor your family(I have drs in my family too), but they are not god and certainly DO NOT know everything, ESPECIALLY when it comes to having a baby. In fact, this is midwife territory that MDs stomped on, making it wayyyyy more complicated than it needs to be. Midwives are the ORIGINAL providers! The medical world has been screwing with nature for years. Research the way birth has been treated over the decades; in 20 years people are going to look back and say omg can't blv we did THAT in a hospital.
You should change your obgyn; she wants to cut you open bc of the possibility of a malpractice case? I mean Im sure there are other reasons, but if an ob said something like that to me, I'd peace out.
Is the hospital you are talking about Cedars? I've never been, but I know the nurses mucked up with a dosage and almost killed twins. Im pretty sure they have a crazy high c/s rate; Drs make more money doing c/s, but im sure you know that.
Check out Huntington Hospital in Pasadena. I had my son there; the staff was amazing. However, they also have a high c/s rate. That being said I would never have a baby in a hospital again. Its totally unnecessary, it saddens me that you think otherwise.
It seems to me you have not truly researched the possibilities. You need to read up. Mothering has great past articles where they actually cite sources. You need to research both sides without bias. This is so important.