Why isn't breech/breech twins acceptable for a vaginal delivery?

[turnquia]

I'm just curious. I keep finding most people deliver breech/breech twins by CS because their OB's say can't do vaginal. Why?

If its not safe why isn't it safer? I mean if one is breech what's teh big deal about another breech? (Provided the breech position is a safe one not footling)

I'm looking for links or articles.

I"m hoping to homebirth or at least do a vaginal hospital birth and aviod a CS if possible so i'm trying to start all the reading now while I can.

[newmommy7-08]

The way I understand it is that when baby A comes out head first it already widens things making it easier to deliver B Breech. Usually it involves the doc or midwife pulling the baby out by their feet while mom pushes. I could be wrong though...

[klocke]

According to 2 different OBs that I have talked to and a local midwife studies show that either singleton or first born multiples that come out breech have a higher rate of learning disorders and developmental problems. The same is no true for second (baby B) babies that are born breech. The thought behind this is that Baby A does widen the birth canal so there is less chance that baby b's head will get stuck coming out. This only holds true though if Baby A is bigger than Baby B. If baby B is bigger then they have the same rate of developmental problems.That is why some Obs / midwives will only allow a vaginal delivery if both are head down.

[mambera]

Not my field but at least one large study has found that c/s doesn't fix that.

http://www.faqs.org/abstracts/Health...-delivery.html

[mlec]

Thanks for that post, mamabera. Interesting link.

[Intertwined]

I had my twins breech/breech at home. I was a multip and had already given birth easily to larger babies with no issues. We felt very comfortable (all midwives involved and myself) that I was not at unusual risk for head entrapment. It was more difficult to push Claire out and she was only 6 pounds 6 ounces. But once I got her head out of my cervix she just dropped right out. Her brother flipped posterior vertex as she was born and was a whole pound bigger at 7 pounds 6 ounces. That sucked way worse, to be honest.

Anyway, it's that way because obsetrics doesn't like breech birth. IMNSHO.

[Gena 22]

On another twin site I read, a mom recently had a breech / breech birth in a hospital with an awesome OB. Worked perfectly. Not science but a nice story. Let me know if you want the link!

[turnquia]

Originally Posted by Gena 22

On another twin site I read, a mom recently had a breech / breech birth in a hospital with an awesome OB. Worked perfectly. Not science but a nice story. Let me know if you want the link!

I would LOVE a link. I found a study that said pretty much data proves the outcomes are exactly the same as vertex/vertex deliveries with a skilled provider however their current recommendations are still for a CS with a presenting twin. So that made NO sense. I read a risk of interlocked twins is their concern for not doing breech deliveries for baby A.

I am sure we will end up doing our homebirth for our twins provided we don't have twin A as a footling or transverse

Baby B i don't care AS much about position because I know they can do all sorts of flipping etc.

TY so much for all the links/stories.

[skybluepink02]

My doctor said it was because there is a risk of baby B turning during the pushing and the babies becoming "locked" together. Their chin of one baby could get caught under the chin of the other and both would not be able to be born.

[Gena 22]

http://twinningboys.blogspot.com/200...er-joseph.html

The mama's a pretty cool lady. Much like our Intertwined. Breech - breech vaginal deliveries are amazing!

[womenswisdom]

Originally Posted by skybluepink02

My doctor said it was because there is a risk of baby B turning during the pushing and the babies becoming "locked" together. Their chin of one baby could get caught under the chin of the other and both would not be able to be born.

I have heard that too. How is that even possible, really? I mean, have you ever felt how slippery a newborn is?!

[Intertwined]

Interlocked twins do happen. It's rare. It can be a problem, but from what I understand it's not always an EMERGENT problem and sometimes babies can be manipulated to move. Especially if both membranes are still intact. At one point I had a breech a and a vertex b and I was WAY more concerned than when they were breech/breech.

And gena, I love you.

[alegna]

Fwiw- way back in "the day" my dh is a twin and they were born vaginally- he was twin A and breech, his brother was vertex. No problem at all- no thought of a section in that day.

-Angela

[turnquia]

I was told Baby A being breech and B being vertex is more dangerous than breech/breech presentation. However it seems like if they were going to get locked up... their chins is such a small part in which to do so. It would seem like breech/breech the head of one would get caught on the feet of the other. However our twins are di/di so its not like they are floating around in there together.

[queenofchaos]

I think it boils down to malpractice insurance issues. I have an OB that is very experienced with twin births and says that breech/breech births seem to be much rougher on everyone. And that's why he won't do them. He's ok with baby A vertex and the other breech, tho.
In general though, there are less and less OBs that have any experience delivering breech babies. So many OBs won't deliver breech at all because they don't know how.

[3 little birds]

I just read this story on the ICAN site a couple of days ago. HBAC, baby A breech, baby B vertex. http://ericainohio.livejournal.com/180733.html

[Freeman]

Originally Posted by queenofchaos

I think it boils down to malpractice insurance issues. I have an OB that is very experienced with twin births and says that breech/breech births seem to be much rougher on everyone. And that's why he won't do them. He's ok with baby A vertex and the other breech, tho.
In general though, there are less and less OBs that have any experience delivering breech babies. So many OBs won't deliver breech at all because they don't know how.

This is what an OB practicing for 30+ years told me -- that it's really not taught much in medical school these days and is somewhat of a dying art-- they're taught to do c-sections. More than one OB has told me that malpractice issues are a large part of it. Even if one OB knows what he/she is doing, if she does something that is not deemed medically reasonable in today's birth culture (i.e., deliver vaginally when the majority would have recommended c-section in a particular scenario) and a problem occurs, then she is going to be judged by that standard. Frankly, I think it's just not worth it for many of them to risk getting sued--which is a large part of why the c-section rate is so high. From the OB perspective, a c-section offers a very controlled birth, esp. when delivering multiples. Of course, I think you can always sign a release acknowledging that OB gave you advice on delivery and that you refused a c-section, etc.

[aja-belly]

the first ob i had in labor tried to explain the chins locking up issue to me and it just sounds like bullshit. she didn't even seem to believe it when she was saying it.

i had both twins breech in the hospital with an awesome ob.

here is my birth story. http://www.mothering.com/discussions....php?t=1051143

[Gena 22]

FWIW - I did have a problem with interlocking chins - in my vertex, vertex babes. My babies were facing, like they were hugging upside down. The chin of Baby B was blocking the shoulder of Baby A, so Baby A couldn't descend. At least that was the case at my 37 week u/s, and verified by a late, long, unproductive labor. The problem was solved at home by having an assistant hold Baby B up while I pushed Baby A out in an upright position.

My super-awesome amazing midwife, who has lots of experience with the Amish and has seen lots of homebirth twins, said she has the most positioning problems with vertex, vertex sets.

I take her word for it, because she's seen a lot, more vaginal twins than most OBs.

[homewithtwinsmama]

Originally Posted by Gena 22

FWIW - I did have a problem with interlocking chins - in my vertex, vertex babes. My babies were facing, like they were hugging upside down. The chin of Baby B was blocking the shoulder of Baby A, so Baby A couldn't descend. At least that was the case at my 37 week u/s, and verified by a late, long, unproductive labor. The problem was solved at home by having an assistant hold Baby B up while I pushed Baby A out in an upright position.

My super-awesome amazing midwife, who has lots of experience with the Amish and has seen lots of homebirth twins, said she has the most positioning problems with vertex, vertex sets.

I take her word for it, because she's seen a lot, more vaginal twins than most OBs.

Said midwife just did footling breech A, vertex B this past week. LOL! She also had an interlocking where she just basically shoved the one kid up out of the way and first baby came right out, followed by next one. She is absolutely, to my mind, the most breech experienced midwife around. I do know that Tchabo did a breech breech for a client of mine. Nearly sectioned her, long story, but in the end did it vaginal. Basically I have three people I recommend for breech. One area midwife, the PA midwife G refers to and Tchabo. That is it, cause everyone else is just to skeered!