HELP - do she need a c-section?

[Nu_Mommy_2003]

My healthy under 25 sister is 35 weeks preggo with twins...everything about the pregnancy was perfect until today they told her that after monitoring the babies and an ultrasound that her blood pressure is a little high, both babies heart rate is over 95 but under 120 steadily, Baby A is head down but baby B has moved from head down to laying across the belly facing her back, she is dilated at 1.5 , she was told that they will induce her today (reasons are because the heart rate, the babies moving less, and baby b's new position). Her doctor is a doctor that she randomly found by calling female doctors in order in the insurance book and asking if they delivery twins, the first to say yes, she chose.

She wants and has prayed for a natural birth is it still possible?

[alfabetsoup]

This sounds like a tricky situation. I wouldn't take the advice of strangers on the internet as to whether or not your sister can deliver naturally. It's possible the babies don't have room to move and their positioning doesn't sound great.

If she does have a csection, she can always go for a VBAC next time, many women do here (UK).

[Nu_Mommy_2003]

There is plenty of fluid around the babies and the doctor came in and stated that if she promises to get an epidural (which she forcefully refused prior) that she would start pitocin and vaginal delivery both babies.

[RedOakMomma]

You could call around and ask other doctors if they will deliver a breech baby B.

I carried twins to 40 weeks, did non-stress tests the last three weeks (twice a week) to get a good idea of their heart rates, and Baby B was breech. Baby A was head-down. I did end up having a natural labor and birth. I pushed Baby A out, and then they did a "breech extraction" of baby B...basically the dr. reaches up into the uterus, finds the feet of baby B, and helps guide the baby out. Not many doctors will do this, but some will.

If she is going to be induced today and wants a natural birth, I would urge her to do whatever she can to stay mobile (ask for mobile IV pumps, mobile monitoring, etc.), stay vertical, and wait (!!!) to get an epidural until she's many centimeters dilated (at least 5, more would be better). Getting early epidurals and saying in bed is one of the worst things you can do if you want to avoid a c-section.

Also, ask her to request a labor nurse who is familiar and supportive with natural labors. This can be very important in a hospital setting.

[SeekingJoy]

Can she ask for a second opinion?

[Storm Bride]

Originally Posted by alfabetsoup

If she does have a csection, she can always go for a VBAC next time, many women do here (UK).

That's frequently all but impossible in the US.


OP: I think your sister should find another doctor by the same method, and get a second opinion. Normally, I automatically say "no c-section", but this one is a little tricky. The blood pressure and the heart rates may be an indicator (a real one) for induction...but it sounds like Baby B is transverse(?), which would make an induction a bad idea. I really don't know how low the heartrates are, or how high her bp is, though. Without those factors, I'd just hang in there for a couple more weeks and see if Baby B moves again.

[AustinMom]

It's my understanding about twins that the baby B is usually not head down, but turns after baby A is out, as more room is made, especially if there is a lot of or plenty of fluid.

The blood pressure thing, I think should be more clear. How high is it? Has she tried other ways to bring it down? Does she have other symptoms that indicate a more serious problem like pre-e?

I would avoid epidural and pit, that's just because I think the risks don't seem that good. UNLESS NEEDED. Epidurals can slow labor, and pit is usually needed to speed it back up, and you have two babies to worry about with pit in this case, and the effects of pit usually have risks to baby, like crazy heart rates and such.

Have her Hire a DOULA!!! This way she can help out in your sister being her own advocate during the birth. It make it a lot easier to deal with pressures of staff, and they have great support to lower cs rate, induction, and need for epidurals and other pain meds.

[AustinMom]

Originally Posted by alfabetsoup

This sounds like a tricky situation. I wouldn't take the advice of strangers on the internet as to whether or not your sister can deliver naturally. It's possible the babies don't have room to move and their positioning doesn't sound great.

If she does have a csection, she can always go for a VBAC next time, many women do here (UK).

Just to let you know, this is one of the worst things to say to a woman facing this decision. And in the US, no, it's not like the UK, ACOG and BJOC are completely different in VBAC guidelines.

[prancie]

I think she should get a second and third opinion. I would not induce and the blood pressure rise may be normal for late pregnancy. In fact blood pressure often rises a little at the end and can signal that labor is possibly imminent. The fact is, this doc is trying to make her feel powerless when she has all of the power. They can't drop her from their care without siginificant notice and she doesn't have to consent to any procedure that she does not want. Not an induction or pitocin or an epidural or a c-sec. I would not consent to any intervention unless there was imminent real danger to the babies. Any other course will most likely lead to a c-section.

[Gena 22]

I'm a twin momma who had a natural delivery. It is possible. Twins are a little tricky, not as tricky as many OBs believe, but you do want an experienced attendant (Dr. or MW). Like a PP said, we're just strangers out here on the internet, so it's hard to judge things. But nothing you wrote in sounds like a good reason for an induction. Induction is one of the fast routes to a c/s.

PLEASE, for the sake of giving your twin nieces / nephews all the gestation time they need, convince your sister to get a second opinion. 35 weeks is not too late to switch providers, and it doesn't sound like an emergency.

Get a recommendation on an OB if you can. Search the internet and find in your sister's area has a local twin club. These are sometimes called Moms of Multiples clubs, sometimes Parents of Multiples. For instance, I live near Fairfax, VA and am a member of the Fairfax County Moms of Multiples (FCMOM) group and the Northern Virginia Parents of Multiples (NVPOM). There is a national organization which might be able to help you find your local one. Once found, send them an email asking for good, experienced and natural minded OBs. It can make a HUGE difference!

Then follow the above suggestions - doula, ask for a naturally minded nurse.

Good luck to your family!

[sanguine_speed]

I'm confused. You said the doctor will induce. They don't generally induce if they are 100% planning a c-section.

[SeekingJoy]

OP, what ended up happening?

[dmpmercury]

Any updates? The babies heart rate does sound really low and with less movement I actually think in her case it may not be best to wait. I hope she is/was able to get a good delivery. It sounds like they are letting her try for a vaginal if she being induced.