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How did you decide where to birth/who to have as a CP?

post #1 of 5
Thread Starter 
Hi mamas. I'm looking for some BTDT advice...

For background, DS was a hospital birth w/ CNM. Bad experience. DD was a homebirth w/ CNM. Fantastic experience. Was planning a homebirth with same CNM for this pg, but now that I'm a twin-mama-to-be, I have to change my CP. In my state, CNMs cannot deliver twins outside of the hospital. I love her and I'm sad about it and not really sure where to go from here...

My goals are (obviously) healthy pregnancy/healthy term babies, but I would very much like a vaginal, unmedicated birth. My twins are di/di

My options are general OB, HR OB, or unlicensed midwife.

There are only a handful of unlicensed MWs in my state, and the one is is considered the "twin guru" would certainly take me as a client, but I just didn't connect with her at all.

But then, I met with a gen OB who is considered "natural birth" friendly and she started talking about how she's natural birth friendly bc she only places an epidural catheter and doesn't make you run meds in it. eek.

I'm also considering shadow care, bc I know so much of the birth stuff, in the end, will come down to gestational age and position, but I'm not sure we can afford to pay two CPs.

Anyway. I'd love to hear what went into your birth decision-making process and, for BTDT mamas, when you reflect on it- would you have chosen differently?



ETA: Does anyone have any good articles or sources on the safety of twin homebirth? My CNM that I have to transfer away from was pretty anti-home twin birth, but I'm not sure if that was fact or opinion based. When I look, all I've been able to find is really political and not necessarily factual.
post #2 of 5
Not a twin mama, so hope you don't mind me crashing! I'd probably reflect on my issues with the twin guru midwife. Are the issues you have with her fixable? If it's just a matter of not meshing with her personality, does she have an assistant that could perhaps help remedy that?

Several mamas here have had twin home births, and the stories are beautiful! If I found out I was expecting twins rather than a singleton, I'd go ahead with my planned home birth (provided I carried to term and there were no issues). I'd rather have a midwife I didn't LOVE, and just do my own thing at home, than try and fight the hospital.
post #3 of 5
I was in your exact position last year at this time. My twins were born in March of this year.

Figuring out all that stuff was the most stressful part for me. It can be so challenging to try and decide what is best when you have so much to consider. I had had two great homebirths before my twins and I knew in my heart that I wanted another one. But I also knew that it may not work out and I would have to deliver at a hospital.

For that reason I had a midwife and an OB. The midwife I had was the only one who would consider a twin birth since every other one in NC was too far or could not do it for insurance purposes. But still, she was about two hours away. My OB was considered to be the most home birth friendly in the state, but he had his downfalls, too. Whenever I brought up twin homebirth with him he brought out all the scare tactics. He said, "If you are comfortable with one of your babies dying, then you could have a twin homebirth."

So I saw my midwife for all of my prenatal exams and I saw him when I needed an ultrasound to see how the babies were positioned and to see how my placenta was doing. When I got to be about 38 weeks pregnant he started talking about induction and I knew that would be the last time I saw him, and I never went back. I went all the way to one day shy of 41 weeks. By then my midwife was talking induction and that kind of made me angry, but that's a whole other ball of wax.

I ended up having a labor of about 45 minutes or so at home and both girls were healthy and wonderful. Eight pounds, six ounces and seven pounds, six ounces. My midwife was not here but my sister in law, who has attended tons of births, was and she really took the lead. So it was sort of an unassisted twin homebirth, I guess. I had no bleeding afterward, and I was terrified about that.

I kind of feel like I didn't get to choose any provider with my twins, that I had to use what I was stuck with. My midwife ended up being kind of flaky. (She never called me after the birth to see how things were going, and my babies were losing weight due to tongue tie. It took a long time to figure out what was wrong and I really could have used her help. She did email me six weeks later, but by then I was really disgusted with her lack of concern)

Good luck, mama! I know what a big decision all of this is and I really wish you the best.
post #4 of 5
I have had two hospital births. One with epidural and one drug/intervention free. My 2nd birth was a planned homebirth but when we had some pTL complications we changed providers nad just never really went back.

This time I knew I wanted a homebirth when I found out I was pregnant. I went back to my origional midwife I had with DS. Then we found out it was twins. Oye... that changes things. I then switched OB's. I went with an OB who didn't think twins was an automatic CS. Little did I realize him and a couple of his colleges are semi-pro homebirth. They aren't for it, but not really against it. They just want to make sure their clients have all the knowledge.

So we kept seeing midwife and just recently at 23 weeks switched for personality reasons. I am seeing two non-licensed midwives, as well as my OB. My OB is aware of homebirth plans and thankfully hasn't really said much. He did explain some additional risks with twins, but wasn't all scare tacticy. Just quite honest.

He said "Twins have a higher risk of PPH". Which makes sense. Your uterus is larger and may have more troubles shrinking down immediately after. Also esp with di/di twins. You have two placentas, so essentially two wounds on your uterus. Protocol still calls a PPH over 500ml of blood loss, however with two wounds theorhetically twice the blood loss seems appropriate.

He also went over some "additional risk to twin B". Explaining that twin B isn't very low or engaged in the pelvis. So as twin A exits, twin B can get themselves in all sorts of funky positions, or cord prolapse (IF their membrane is ruptured) Makes sense to me. I asked how he would handle a hospital situation like that, he stated that generally birthing upright helps them get into a better position, as well if there is cord prolapse depending on how severe a lot of times baby is still kinda way up in there, (Your all stretched out from baby A coming out) they can either gently manipulate cord out of the way of baby and just monitor closely, emergency section, or reach on up in there and pull twin B out

Realistically those all minus emergency CS... are things my midwife can handle.

I think having a good back up plan and a good transfer plan in place is very important, so we are still working on that with our midwives.

I wouldn't expect necessarily as hands off of a birth, there is twice as many babies to keep an eye on. But its definately do- able.

For me knowing what my risks are helps me adn thankfully I was able to find an OB to openly discuss things with him. he's not thrilled I want to homebirth but he isn't negative about it either.

Good luck choosing
post #5 of 5
When I heard that the hospital I'd chosen had an 80% twin c/s rate I went running to a CPM. I did lots of research too, but didn't find many hard facts.

As a BTDT mom, I can say that even the natural birth friendly OBs may have less experience with unmedicated vaginal twin birth than a skilled MW. It's AMAZING how few "natural" twin births happen in the hospital. Nearly none. And to be successful you need experience. Or at least I did. As a first time mom, I had some positioning issues that my MW could resolve. But I suspect a less experienced MW would have had trouble and I would have eventually transferred. Or had an unnecessary c/s in a hospital. Nothing dangerous, just needed a little fiddling to get the positions right.

If you're inclined, especially as an experienced mom, I HIGHLY recommend a homebirth. Sorry you and the twin guru don't get along. Are you anywhere close to the Farm? Who would the twin guru's back-up be?

Hope you can make it work, twin homebirth is definitely worth it. Good luck!
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