Help! They are trying to take away my natural twin birth!

[SashaBreeze]

I have been wanting to post for advice all day but I was so upset after my appointment this morning all I could do was cry and think of worst case scenarios. I have calmed down a lot now and a lot of my panic is starting to be replaced by anger but I have no idea what to do.

I went for my appointment with my CNM today. Both of my babies and I are the picture of health. Weight gain for me and the babies are fantastic. Vital statistics are wonderful. I have not had so much as a BH and am 23 1/2 weeks along. Sounds great huh? But wait....

So I get back into the office after the ultrasound and such and I am informed that they will be wanting to induce labor at 36 weeks! I ask why and basically get a story about how they dont like for twins to be carried much more than that because of the chance of the placenta breaking down. I am stunned at this point. Seeing my discomfort she says we can try to wait until 38 weeks! But not to worry because I will probably go before that. Keep in mind that I have a history of going either at due date or over unless induced, so I found very little comfort in the idea that I will go before that. True I may, but the dead line hanging over my head is seriously making me twitch.

I then ask how my labor will be different with this one. I will will have to have constant fetal monitoring. I asked how that will work because I HAVE to stand while in labor (I have hip/thigh labor and if I cant move around I feel like I am dying) and have learned from the past that if you are up and moving, at least on my body, they do not get a constant heartbeat with those monitors. So then I find out that I will have to lay down if need be to get the heartbeats! I can NOT do that. If they tell me I have to lay down then they might as well just strap the epi in me right then and there because I will NOT be able to handle that.

I am so frustrated. This is also the most natural child birth friendly practice within a 2 hour radius from were I live, trust me I have searched and searched. The hospital I go to has horrible stats (with my last baby the labor nurse told me they have a 80% induction rate) but I have always been ok with birthing there because my CNM had my back. Now I get the impression that her hands are tied, she practices under/with a OB/GYN and is having to cave into the doctors and hospitals policies.

Also baby B is still breech but baby A is heads down. My CNM is completely fine with me doing a vaginal birth but apparently the idea of the second baby being breech is crazy scary for the doctors and hospital and I am super scared that when every thing is said and done they are going to try and force a c-section on me.

Dh says well lets just do a UC. I am not feeling comfortable with this, and think that would be a horrible idea. If it was a singleton that was heads down then I could totally see us doing that but twins, with one breech???? No I think my panic alone would make that for a bad mix.

What, if anything, can I do???

[rparker]

You have the right to refuse an induction. You have the right to elect for an induction at a later date (i.e. 40, 41, 42+ weeks). You have the right to show up at the hospital in labor and only accept the level of care that you are comfortable with. Your midwife and her supervising physician(s) are obligated to provide you with medical care even if you don't accept all of their recommendations.

You could also try switching providers, but my guess is that will be hard this late in the game with twins?

It totally sucks that they're being so awful about these things, but no HCP can force you to have an induction or strap on continuous EFMs or consent to a c-section just because you're pregnant with twins.

[calihannah]

This won't be eloquent, but here goes...

First of all, HUGS to you. That sucks that you feel betrayed I would, too.

Second, they can't actually force you to do anything. In labor with my first daughter (at the hospital, after induction) they told me that I had to have continuous fetal monitoring. I told them that I preferred to move around and that it was *their* choice to have the monitoring in place, so if they wanted monitoring, they needed to ensure that it picked up what it needed to pick up. So I ended up with a nurse chasing me around holding the monitoring discs in place. It was probably hysterical to watch. I did my best to ignore her, since the alternative was laying down, which was NOT going to happen (posterior baby, anyone?).

Practice your questioning skills/techniques:
* Why do you recommend doing this?
* What could happen if we wait?
* How long could we wait?
* What might change your recommendation?
* I prefer to wait until tomorrow/next week/whatever.
* etc etc etc -- the point is to practice the answers and questions so you don't get flustered by people who are supposed to be looking out for you but are really mostly looking out for themselves.

Thinking of you...

[mamagranola28]

SashaBreeze
I'm so sorry you are going through this. It must be very disappointing to have already done the research to find a provider to work with that you thought would support your birth choices and then to find out part way through that your choices won't be respected. Unfortunately vaginal, intervention free hospital birth for twins (especially when one twin is breech) has become increasingly rare in the US. If you feel a hospital birth is the best choice for this birth then hire a great doula and DO NOT consent to anything unless that is what you think is best. Is finding an experienced home birth midwife an option for you? I have a friend you had a beautiful twin home birth last fall. Her babies were born at 40 wks. Baby A was head down and baby B was breech. Having a home birth for her was the safest choice. She felt like birthing in the hospital would have been more risky (probable induction, possible c-sec for baby B). Good Luck!

[HeatherB]

I'm so sorry you're in such a tough spot. I can't really add to what everyone said already except for a . Don't do anything you don't want to do. Consider homebirth if there's an option anywhere near you. Get a really good doula and stick to your guns.

You CAN do this the way you want to. They may or may not like it, but you can!

[Beanjeepin]

Hugs, Mama! I had twins (vaginally, naturally, twin B breech) last September and I recognize the fears well. I didn't have the birth I envisioned going into it all, but it was a pretty close to perfect birth for us.

You CAN refuse anything - including induction and a section. Twins take 40 weeks (+?) to gestate, just like any other baby. Unfortunately some do come earlier but some go to term. I went to 38 weeks 3 days (I didn't even go to 40 weeks with my singletons, so this was normal for me). I like Hannah's line of questioning for anything they want to do to you. EMTALA is the law that says they cannot refuse to care for a woman in active labor, no matter what that woman refuses that they want to do. It helped me to know that law was on my side when I went in ready to fight for my rights (be aware, though, that some nurses/doctors will retaliate with children's protective services threats).

I labor quickly so didn't have to fight much/at all when I got to the hospital (twin A came after 4 contractions there). I was lucky enough to find a supportive doctor last-second with mine, keep looking, there may be a hidden gem.

I am happy to share more of my experiences/issues/birth story if you'd like. Hang in there, Mama, I know all too well the fears, uncertainty and craziness surrounding the twin pregnancy and birth!

[MegBoz]

That stinks.

Originally Posted by calihannah

I told them that I preferred to move around and that it was *their* choice to have the monitoring in place, so if they wanted monitoring, they needed to ensure that it picked up what it needed to pick up. So I ended up with a nurse chasing me around holding the monitoring discs in place. It was probably hysterical to watch.

Love this! & that's actually what I was going to say too. You can tell them the nurse will have to literally stand there & hold a doppler. Cuz you're just absolutely not going to lie down. Period, end of story. Just stand firm that it's "absolutely not an option."

For induction, you could always try the "passive aggressive" approach - just keep rescheduling & delaying. "Oh, wait, let me go check with DH, so I'll call back later this afternoon to schedule."
Then, "Oh, let's push to next week, DH has a big work conflict, OK, we'll push it 4 days out, it's just 4 more days."
etc. etc.
That way you don't get too much on their radar as a 'difficult patient.'

Originally Posted by Beanjeepin

EMTALA is the law that says they cannot refuse to care for a woman in active labor, no matter what that woman refuses that they want to do. It helped me to know that law was on my side

While that is technically true, it seems most docs & nurses don't realize this to be fact. We've all heard the horror stories.. So I'd chose a seriously TOUGH doula & have you, DH & doula all ready to fight if need be, even dropping terms like "lawsuit" & "criminal medical battery" (touching you without consent) if need be. Hopefully it won't come to that & when you say "no, no no" they'll just shrug, be a little annoyed, but leave you alone. But I'd say it's probably best to be prepared since it already sounds like they're getting pushy & trying to tell you what you "must" do.

Finally, the biggest thing I'd worry about is if twin B stays breech & you don't want a CS. I don't know tons about vaginal breech birth, but I've read a few places that "hands off the breech" is the best policy. Just don't touch the baby as he emerges, not even to wipe off any poop! Considering in-hospital vaginal breech is practically nonexistent in America today, it's safe to say that's most hospital-practicing HCPs have no experience with it. So they may panic and yank at the baby, causing problems.

Not sure how to handle that one, that's really tough. But I've seen a degree of consensus here on MDC that if your HCP is vehemently opposed to vaginal breech (& therefore has no experience) this may be one case where it's best NOT to fight & not to force the HCP to attend the vaginal breech birth.

Here in Baltimore, we have a couple good hospitals for NCB, but home birth is still your best bet for twins here too.

[Beanjeepin]

[QUOTE=MegBoz;15656360]

Finally, the biggest thing I'd worry about is if twin B stays breech & you don't want a CS. I don't know tons about vaginal breech birth, but I've read a few places that "hands off the breech" is the best policy. Just don't touch the baby as he emerges, not even to wipe off any poop! Considering in-hospital vaginal breech is practically nonexistent in America today, it's safe to say that's most hospital-practicing HCPs have no experience with it. So they may panic and yank at the baby, causing problems.

Not sure how to handle that one, that's really tough. But I've seen a degree of consensus here on MDC that if your HCP is vehemently opposed to vaginal breech (& therefore has no experience) this may be one case where it's best NOT to fight & not to force the HCP to attend the vaginal breech birth. [QUOTE]

I agree, it's best to have an EXPERIENCED/comfortable breech birth attendent - or a c/s may be the best choice.

As far as hands-off breech - this is true, it's so much better to be done that way. However with a twin B this is sometimes not possible. My double footling posterior breech twin B flipped vertex after his brother's birth (yay!) and then I turned back to hands-and-knees - which is when he went transverse (boo). So, intervention was totally necessary - doc went in, broke waters, grabbed feet and did a double footling breech extraction. At that point he'd already put his hands on so it was safer TO touch, in my research, and help the baby out.

And it is never, ever too late to switch care providers. I found my OB less than 12 hours prior to birth - met him when I was not yet in labor and I was NOT induced!!

[St. Margaret]

I agree that you and DH and a strong doula can educate yourselves about the laws and what langauge to use with the hospital staff. It's true that they can get pushy-- I have a midwife friend who's seen a woman cut as she yelled she did not consent, but you can arm yourself. Then just don't show up! They can't abandon you at that point, so just don't show up for any induction. Show up later when you're well into labor. 38 weeks is good, even if you tend to go long, twins really do tend to move the schedule up. You shouldn't have to stall for long.

I hope they chill out about the breech issue It's true it's so hard to find competent help for breech. But at least they can leave you alone until the time comes.

The one other thing may be a midwife or other care provider who's passionate about natural birth, who'd be willing to step in, even for free or similar, to help in this situation, with your options suddenly closing in... you never know.

Good luck!!!!

[SashaBreeze]

Thank you all.

I am much calmer today. I think one of the frustrating things about the whole situation is that for my last 2 appointments I have been blind sided by information and have found myself unable to think clearly until well after the fact. For the visit before this last one we found out we were having twins which came as a MAJOR shock and then this last one I got the induction at 36 weeks speech out of the blue and I just did not handle myself well at all. Looking back at it I wish I would have said something like "What?! You want to take my babies a full month early for NO REASON?!" and just laughed at the whole thing as so ridiculous as to have to be a joke. I mean seriously why in the world would they have such a policy in place? If you happen to go into labor at 36 weeks then so be it, but to force that for all twin pregnancies???? Crazy.

Calihannah, that was a great list I am going to work at memorizing it to use at my next appointment. I think I may have my dh or someone role play with me with it and try to get a little confidence with asking the questions without it sounding like a recording.

Dh has been telling me the same thing about them not being able to force me into anything and if I dont want to do a UC then to just tell them no at the hospital. But that kind of scares me. You read those horror stories of CPS being called in and your baby (babies) being taken for medical negligence or some other false claim by the hospital or about women being strapped down and forced into the OR and although in your mind you know that is so not the normal reaction that those are just the stories that get printed up and you read about your heart still beats a thousand miles a minute with you thinking but what if? What if that DOES happen to me???

I have been looking around on line for a Doula but so far I haven't found one I could send a letter to. Either they all live to far north, or south of us or their sites say they are only taking repeats or no new people at the moment. So I am going to post over on the finding your tribe forum for in my area and see if I can find anyone that can make it to the hospital when I go into labor and help me build up my confidence in bucking the system in the mean time.

Needing someone that is trained in vaginal breech is one of the main reasons I really dont want to push to hard against what my CNM feels we have to do. For one I know and trust her, this will make my fourth pregnancy with her, and this really is the first obstacle we have ever ran into with each other. Plus she is totally willing and trained in vaginal breech and I am just really afraid that if I push to hard the next thing I know I am going to be shuffled off to one of the OB's in the practice and get scheduled for a c-section because the other ones wont do a vaginal breech.

At any-rate I know in my heart this is just the beginning stages of a very long uphill climb and although I am up for it now that I am on the trail I just wish I had known before hand so I could have packed my hiking boots and canteen.

[Gena 22]

Yup, yup, yup. No time to write all I feel on this subject. My twins are 2 1/2 and I'm only just now over the ANGER that I felt as my sweet OBs took all my choices away from me. I know of one OB in the area I'd trust. Maybe. OBs just don't see vaginal twin birth much. And when they do, it's usually because the twins came fast and early. Full term vaginal birth? Unmedicated vaginal twin birth? Nearly unheard of.

There are some good birth stories here. Read up on what made some women successful. Don't let them bully you because of the twins. The science isn't good! Routine induction at 36 weeks is so wrong, wrong, wrong. That's choosing prematurity.

Love your husband's UC comment.

Consider a HB if you can. If not, don't consent to ANYTHING until you research it. You'll be told all sorts of things. Get a solid doula, or better get a MW and stay home until you're near to pushing.

Here are some good links:
http://www.uptodate.com/home/content...=labordel/5122
http://www.lookydaddy.com/weblog/200..._that_mos.html
http://www.naturallyparentingtwins.com/drupal/node/139

You can do this! Good luck!

[Lit Chick]

www.ican-online.org may be helpful to you.

Regarding the doula - contact any of them anyway, even those that say they are not taking new people. You have a special situation and some doulas may be very passionate and want to help you protect your right to birth. It's worth a shot at the very least.

HB is not awlays possible for twins. I believe that in my state, it is illegal for my MW to attend a twin birth... not quite sure.

[smeep]

Originally Posted by Lit Chick

Regarding the doula - contact any of them anyway, even those that say they are not taking new people. You have a special situation and some doulas may be very passionate and want to help you protect your right to birth. It's worth a shot at the very least.

This goes for another care provider if you decide to look for another one. Always talk to them directly and explain your situation. Doulas, in particular, may be more than happy to attend your birth even though they're not accepting new clients. Many doulas would jump at the chance to attend a twin birth and fight for you and your babies. Your circumstances are very special and you need the help of a doula more than most women. There are also often doulas in training that would gladly take on a twin birth, though I would try to find a doula with the most experience in situations like yours (unsupportive/reluctant hcp, having to fight for a safe and minimal/non-intervention birth).

[Beanjeepin]

Originally Posted by Lit Chick

www.ican-online.org may be helpful to you.

Regarding the doula - contact any of them anyway, even those that say they are not taking new people. You have a special situation and some doulas may be very passionate and want to help you protect your right to birth. It's worth a shot at the very least.

This. Play the "twin card". You'd be surprised at how out of the way people may go for it. And I had someone from ICAN helping me out as well - they know the good, compassionate, believing-in-birth docs. She was also my on-call person in case I did end up sectioned.

I found out about my twins at 20 weeks, so I know the head-spinning feeling. It will get better.

[SashaBreeze]

Thank you all.

I have been making a list of people to call and will be doing that this afternoon. I would call now but our house phone plan does not allow anything but local calling so I have to wait for dh to get home from work with the cell phone.

I keep shifting back and forth between feeling very confident to be terrified all over again. I need to find my center, and fast. Dh keeps telling me not to worry too much about me going back and forth so much because he knows from experience with me that if I know about something before hand I will sit and fret about it but in the "heat of the action" I become solid as a rock. I hope and pray he is right this time around.

I had a couple of thoughts:

1. Do you think it is possible that the reason my CNM wanted to induce me was actually because of the whole risk of me getting in the hands of someone that doesn't know how to do a vaginal breech delivery? I started thinking about it and she knows that I labor and deliver very fast, my last birth was a little over an hour from start to finish, so if I go naturally into labor there really wouldn't be much time to do a c-section. So do you think it is possible that the idea is that if she schedules an induction then she can schedule it for a day she will be on call at the hospital instead of one of the OB's???

2. Do you think that the idea that I mostly need a doula to help me fight for my rights and to remind me that I do have those rights but dont need a lot of help with the actual labor and birthing process will throw off and be distasteful to a lot of doula's?

[Twinklefae]

re: doulas No, I don't think it will bother the majority of doula's. My doula said to me that her job was to support a mother in whatever way she needed support. If that meant facilitating her epidural and keeping her company while they watched TV, then that was her role. If the client wants her to be hands off, but wrangle the medical staff, then that it her role.

[EmTheWife]

Originally Posted by SashaBreeze

...
I had a couple of thoughts:

1. Do you think it is possible that the reason my CNM wanted to induce me was actually because of the whole risk of me getting in the hands of someone that doesn't know how to do a vaginal breech delivery? I started thinking about it and she knows that I labor and deliver very fast, my last birth was a little over an hour from start to finish, so if I go naturally into labor there really wouldn't be much time to do a c-section. So do you think it is possible that the idea is that if she schedules an induction then she can schedule it for a day she will be on call at the hospital instead of one of the OB's???

As a L&D RN, I've known practitioners to do this for certain clients.
on the other hand, if it comes to "induce or else" (without medical indication, of course), you can schedule, but just not show up!

[butterflies]

I know it's so overwhelming. Within minutes of finding out about the twins, I realized how different things were going to be this time. I've been trying to deal with just one thing at a time... first, I found a perinatology practice with lots of vaginal twin birth experience (including breech). I've also heard "unofficially" from the CNM there that they do sometimes deliver vaginally even if baby A is also breech. That was a big step because every other practice in the area seems hit-or-miss when it comes to vaginal twins-- it depends who's on call when you happen to go into labor but you could easily end up with a practitioner who goes straight to a c/s. You're so right that there just aren't many OB's trained to do a vaginal breech delivery safely.

I've also been told that they would like me to give birth by 38 weeks-- but of course, everyone else keeps telling me I won't make it that long anyway. I'm just not going to worry about that until the time comes. I think you could easily delay from 36 weeks to 38 weeks (they can always check the condition of the baby and placenta with an u/s and NST in the meantime) and then just take it day by day from there, if you have to. My 2nd child was born at 41.5 w (no induction) but my intuition says I don't have to worry about being overdue with these guys.

I think I'm still going to have to deal with strong "encouragement" to have an epidural and monitoring, probably a hep-lock etc but I feel like at least I'm in a good starting place for the vaginal birth I want. I'm terrified of the idea of an epidural so I'll definitely put my foot down there.

With ds, I arrived at the hospital already at 8 cm and there was no time for talking about any interventions-- I hope I can repeat that! Also, dh is great about speaking up for me with hospital staff (he's much more firm than I would be!) But a doula sounds like a great option too. With past births, dh and i discussed many different scenarios and he knew what questions to ask of the hospital staff and what questions to ask me. He actually made himself a flow-chart... it was so cute (in a nerdy kind of way). And we brought a folder of information printed out from medical associations like ACOG, etc that supported our choices. We didn't actually use any of it-- but it gave us extra confidence.

Good luck with all your decisions!

[lovebeingamomma]

if there's a childbirth educator in your area you could check to see if they would be your doula, some don't practice as doula's because they teach classes but if asked they may have experience in that role and be willing to help out in your situation.

I would also be very open & honest with your midwife, tell her how you feel about induction. I think it's best to get things out in the open rather then just not show up for a scheduled induction and them wondering why.

[RedOakMomma]

Can you have a heart-to-heart with your CNW and ask her about her motivations for such an early induction?

I had vertex/breech twins in a natural vaginal birth, and they arrived at 40wks1day.

I agree with others that say a breech-experienced/comfortable CP is very important. In our case, the OB did a breech extraction (gently pulling the baby out by his feet) and our son got STUCK. He had a huge, huge head. The OB was experienced, though, and didn't lose his focus for a second. He had me do some adjustments, worked quickly, and baby was born fine.

I would not opt for a UC. I know it can be done safely, but if baby B is breech then I wouldn't attempt it. Like I said...breech deliveries require some special skills, knowledge, and comfort-levels.

Stick to your guns. I know it's hard. I had a lot of doctors urging me, pressuring me, to "use the zipper" and c-section my babies. My OB, who--bless him--was supportive of a natural childbirth, even got a little nervous as I approached 40 wks. Stick to what you want. Insist upon what you want. Vertex/breech twins are born all the time, and you can do this.