Advice/Support for Twin Breech Homebirth

[Sanalana]

Dear wonderful mommies and mommies to be,

I am writing to you to share my story and to get any wisdom and support that you can offer me. I am 37 weeks pregnant (naturally) with twins boy and girl. We feel like we won the lottery! I am a huge proponent of natural, vaginal and home births. My partner and I have persevered, against many odds it seemed, to find a knowledgeable and experienced midwife excited to help us deliver at home and a doctor who was willing to be a backup at the nearest hospital in Long Beach. We’ve been doing tandem prenatal care with the doctor and the midwife because the midwife lives 2 hours away from us. Last week, the doctor insisted on an ultrasound and discovered that baby A was at that time a footling breech and Baby B was vertex. She told us that she no longer feels comfortable with a homebirth and that she would like to do a scheduled cesarean at 38 or, at the latest, at 39 weeks. This was a huge shock and immediately felt wrong to me.
After the most intensive week of researching, speaking with midwives and doctors who value midwifery, assessing all the risks, collaborating with our midwife, prayer, meditation and contemplation, we are very clear that we still want to have a homebirth with our midwife. (By the way, I've been collecting all the research I could find so if anyone is in the same situation, I'd be happy to share it.) I am planning to pre-register at the nearest hospital just in case. Meanwhile, I’ve also been focusing on doing what I can to work with either turning Baby A vertex or at least tuck his little leg in so that he is just breech. I have not yet spoken with my doctor about my plans and am trying to find the right way to let her know how I feel and release her from any liability. I am a bit nervous about speaking with her because I do not want to feel any pressure from her. I am comfortable not having a backup doctor since if we need help during labor, we'll be heading right to the emergency room anyway and whoever is on call will take us.

In my heart, I feel very clearly that I am doing what is best for our babies by allowing a beautiful, sacred birth experience to unfold in our home. I feel that Spirit is guiding me on this journey and is certainly teaching me how to trust myself more and feel more empowered as a woman. I am practicing letting go of any fears and trusting that everything is unfolding perfectly.

I would love to hear from anyone who has been in my situation or who is knowledgeable about the topic. I appreciate your support!

[Jenne]

Have you contacted The Farm? Depending on how far from there you are, you might consider going there to birth. They have experience in breech and twin breech births. I would imagine they would be willing to speak with you and your midwife and might even take you on if you'd want that.

You have done the research and it sounds like you have a reasonable back up plan. I wish you the best in speaking with your doctor. I also wish you easy labor and either a turned or well tucked Baby A!

Jenne

[pregnant@40]

It would be very dangerous for you to do a home birth at this point. Please do not risk the health/lives of your babies, or yourself. Home births should be reserved for uncomplicated cases. It would be unethical for this midwife to agree to a home birth w/ one footling breech twin. If an emergency happens & only SECONDS are crucial for emergency life saving measures, what is your plan?? An ambulance can't get you to a hospital fast enough. Twins are already at higher risk for cerebral palsy and other adverse events, but a vaginal birth w/ a footling breech could result in a prolapsed cord leading to complications such as permanent brain damage or paralysis (or even worse).

[MamaMonica]

Moved from I'm Pregnant to Homebirth

[medicinemansgirl]

I believe in the power of a woman to birth twins naturally. I got all kinds of awful negative feedback on our choice to naturally deliver our 1st set of twins with one of them being breech. I finally quit letting everyone know what our plans were and just went with it. I knew what was right for us. And I had a very successful uncomplicated delivery with a breech twin. My only hesitation would be that A is breech while B is vertex and they may possibly go into chin lock upon delivery. In that case you do need an experienced midwife that can unlock them during birth or keep them from getting into that position as A descends. I think Spiritual Midwifery by Ina May goes into this position a little and also gives very detailed instructions on how to successfully deliver it. I would definitely check into The Farm if you are close enough. It would be well worth it. It is entirely possible to deliver them. Just look for someone experienced with this position. It pays to be educated and do your research, which you have. I loved knowing what exactly was taking place and being able to challenge the medical profession when they threw their scare tactics out there mandating I have a c/s due to a breech baby with our 1st set. Be educated, well informed and pursue it from there...which you have and you are. If you're too far away from the Farm to deliver there you can at least call and talk with one of their very experienced midwives and get some encouragement and wisdom about your delivery. I trust them and all of their experience! I went into our twin delivery knowing that I would definitely consent to a c/s if it was truly neccessary and any of us were in danger...but I at least wanted the opportunity to TRY a natural delivery...and no one would give me that. I think most all twin moms are in the same boat. They just want the chance to at least try and a care provider that trusts the woman's body to do it. I have 2 close friends that are twin moms that both had a double breech delivery at home. An experienced midwife makes all the difference.

[turnquia]

I have to say I am quite disappointed in some of the comments on this thread.

As a twin mom who is due in december. I personally wouldn't feel comfortable with a footling breech baby A. For me there are too many added risks with a footling breech vs a standard breech for me to feel comfortable.

My midwives and OB are also not comfortable with Breech/Breech presentation... I'm on the fence here but would probably opt for a C-section. But I feel safer about this presentation than some others.

Breech/Vertex is again not one I'd feel comfortable doing at all at home. The chin locking issue is a real concern with those too.

We are currently planning a homebirth for our twins. But last we knew Baby A has been head down and semi-engaged for 10 weeks now. With her brother sitting on her lol so she cannot flip around (althought I think she did something odd last night).

I think you need to figure out what it is you feel comfortable with, given the added risks. As well as considering what your birth team feel comfortable with. (who you have in place because you trust their medical advice) I think waiting until as long as you you can for the c-section. I recently had a friend who had twin A stubbornly breech until she went into labor on her own... baby flipped and she was able to have a drug free VBAC of twins

Good luck, I hope you can come to a decision with something EVERYONE is comfortable with. And that baby A flips back to head down

[Gena 22]

Originally Posted by turnquia

I have to say I am quite disappointed in some of the comments on this thread.

Wow! Yeah that.

OK, I'm not sure I'd be comfortable with delivering a footling breech twin A at home either. I just don't know. There are women on the Parenting Multiples board here who have, but I'm not sure if I'd make the same choice. Ultimately that's your call.

What I do feel strongly about is not scheduling a c/s at 38 or 39 weeks. What! That's your doctor's suggestion - goes right from supporting a HB to what I consider a pre-term c/s? That's quite a swing.

Is there a problem with going into labor with a footling breech? What's the down side to waiting for labor? Is there one?

More importantly, it is entirely possible that your vertex Baby B comes out first. It would be a pity to have a surgical delivery a few weeks early when it wasn't necessary.

Show this to your doctor if you want:

http://www.uptodate.com/home/content...=labordel/5122

A peer-reviewed study suggesting it's best to let twin moms go into labor spontaneously at least up until 40 weeks.

FWIW, in your shoes I'd wait until labor and either trust my MW's palpitations or get an u/s at the very last minute. If I had decided on a c/s for a presenting footling twin, go and get one then and not before. That has two benefits - your twins get every minute in utero that they want and need, and there's a chance to have a natural, vaginal homebirth. Having had one, and having researched hospital births in my area carefully, I can say it's worth trying for the homebirth. It was wonderful.

Make informed decisions that are right for your circumstances and your family. Best wishes, whatever you choose. Lots of good vibes coming your way.

[turnquia]

Originally Posted by Gena 22

Is there a problem with going into labor with a footling breech? What's the down side to waiting for labor? Is there one?
.

From what I've read and discussed with several midwives and OB's. Is the risk of waiting for labor with a known footling breech (especially if feet are low and semi engaged). Is IF the water breaks there is an increased risk of cord prolapse because nothing is plugging the hole so to speak. And because one never knows how labor will start....

Personally if it was me... I would hold off scheduling a C/S until 40 weeks. I'd be seeing chiro, accupunture hanging from the ceiling by my ankles.. anything to encourage babies to change positions. I'd also discuss with OB why you want to wait that you know positions CAN change in labor or even before labor. If your baby was able to change positions at 37 weeks... they will be able to change at 38 weeks

Good luck to you and keep us updated. I hope to hear about your awesome homebirth and if not an uneventful wonderful C-section if it comes to that. One of the lovely pleasures of being a twin mom is they will always keep us guessing.

[Mrs.Music]

I have ZERO advice, but I'd recommend reading some birth stories. One of my all time favorite episodes of a show is the double footling breech twin birth on Twins By Surprise. It's inspiring.

http://www.youtube.com/watch?v=fjLELdaPtiI

It's edited weird... And you kinda miss the birth of the first baby, but here it is. It starts at around 3 minutes in.

[Sanalana]

Thank you so much everyone for your support! My midwife has over 25 years of experience and she's delivered double breeches, breech/vertex combinations and footling breeches so I have no doubt that if I end up doing a homebirth, I am with the right support. I am in CA so the Farm is too far, but as far as I am concerned my midwife is just as knowledgeable as many of the midwives at the Farm. And my partner is just about the most intuitive supportive man I have ever come across so I know he will be of great help as well.

After taking in all the advice, I will ask my chiropractor to help turn Baby A and am now looking for a knowledgeable acupuncturist in my area to stimulate turning. A wonderful doctor who I reached out to for advice told me that he has seen twins turn at this stage many times and that I just need to keep monitoring. I told my doctor that I want to wait to go into labor so even if I end up with a c-section, the babies have had plenty of time to grow and get strong. More than anything, this experience has been teaching me to trust that I know what is in the best interest of my children and that although there are many opinions, ultimately, only I (and my partner) know what is the best option for us. Can't wait to share with you my success story in a few weeks!!!

[Sanalana]

And Mrs. Music, that you for the video - amazing!

[Sanalana]

Originally Posted by medicinemansgirl

..but I at least wanted the opportunity to TRY a natural delivery...and no one would give me that. I think most all twin moms are in the same boat. They just want the chance to at least try and a care provider that trusts the woman's body to do it. I have 2 close friends that are twin moms that both had a double breech delivery at home. An experienced midwife makes all the difference.

That's all I want, you're right! Thank you for your inspiring story!!!

[Jenne]

You may already have an acupuncturist in mind...but here is a link to the community acupuncture clinics in the US...I wish you the best!

http://www.communityacupuncturenetwork.org/clinics

Jenne

[MsBlack]

Originally Posted by pregnant@40

It would be very dangerous for you to do a home birth at this point. Please do not risk the health/lives of your babies, or yourself. Home births should be reserved for uncomplicated cases. It would be unethical for this midwife to agree to a home birth w/ one footling breech twin. If an emergency happens & only SECONDS are crucial for emergency life saving measures, what is your plan?? An ambulance can't get you to a hospital fast enough. Twins are already at higher risk for cerebral palsy and other adverse events, but a vaginal birth w/ a footling breech could result in a prolapsed cord leading to complications such as permanent brain damage or paralysis (or even worse).

If I were in the OP's position, I would not find this particularly helpful.

Sanalana, it sounds like you have a good team and a very healthy perspective for you and your babies! Listen most of all to yourself, your own internal guidance system. You will make good choices for all of you, I'm sure.

[Twinklefae]

Originally Posted by MsBlack

If I were in the OP's position, I would not find this particularly helpful.

Sanalana, it sounds like you have a good team and a very healthy perspective for you and your babies! Listen most of all to yourself, your own internal guidance system. You will make good choices for all of you, I'm sure.

Really? I would. Knowing the risks is part of informed consent. There are risks to a footling breech at all, and more so as part of a twin birth. It's well outside my comfort zone as well.

I agree that Sanalana will make good choices, but she's asked us for information, and we do her no good by only telling her the good news.

[turnquia]

Originally Posted by Twinklefae

Really? I would. Knowing the risks is part of informed consent. There are risks to a footling breech at all, and more so as part of a twin birth. It's well outside my comfort zone as well.

I agree that Sanalana will make good choices, but she's asked us for information, and we do her no good by only telling her the good news.

I think the point of Mrs. Black was how confrontational your post was vs informative.

There are added risks to a footling breech. Yes. (Maybe if you care to explain those risks vs a standard breech you would help me make more informed consent vs just telling her she's nuts for thinking about it. )
There are added risks to a twin birth over a singleton yup, she is already well aware of it.

[medicinemansgirl]

[QUOTE=Sanalana;15826924]Thank you so much everyone for your support! My midwife has over 25 years of experience and she's delivered double breeches, breech/vertex combinations and footling breeches so I have no doubt that if I end up doing a homebirth, I am with the right support. I am in CA so the Farm is too far, but as far as I am concerned my midwife is just as knowledgeable as many of the midwives at the Farm. And my partner is just about the most intuitive supportive man I have ever come across so I know he will be of great help as well.

That is all you can ever ask and hope for!!! A midwife with lots of experience is what makes the difference along with supportive people around you that believe in you. I finally had to get off of all boards and websites when I made the decision to go not induce and go through with a natural delivery of my breech Baby B. The criticism endured wasn't worth it and only proved to stress the situation further. I had 1 fellow twin mom that continued to encourage me throughout it all and we became very close. THis time around my midwife and the 2 others attending Baby A and Baby B have no twin experience whatsoever...as in, never even attended a twin birth. So my main midwife has called in a midwife with TONS of experience in every area of twin births and we are all confident and very at peace with this arrangement. It really is a matter of what you are comfortable with and just trusting your own body and instincts. But if you have an experienced midwife there is no need to even check into the Farm even if you could due to the fact you have someone in place that is confident, encouraging of your choices and you both are at peace with the coming births of your babies. And having a supportive spouse is an amazing thing. It can make or break the birth, in my opinion. When you have both confident and experienced care providers that support your decision of a homebirth and a partner that is completely and 100% supportive it proves to be an amazing thing with amazing outcomes. This is an amazing unassisted twin birth story that involves a footling breech. There are also some twin birth stories involving a transverse/footling breech on the hypnobabies website.