Twin Delivery: Waiting to go into labor spontaneously?

[OneSmallAxe]

I am 38 weeks 2 days pregnant with twins. Baby A (presenting baby) is footling breech. My doctor wants me to have a scheduled c-section on Wednesday, Jan 19th (I will be 38.5 weeks). I want to wait (if safe for all) until spontaneous labor happens, due to the benefits to the babies and myself. And in addition, I understand that babies have been known to turn vertex in the rigors of natural labor. If this happens I get the natural, vaginal childbirth I wanted from the beginning. My doctor is pushing hard for the scheduled section because one, going beyond 38.5 weeks is "like splitting hairs" regarding benefit to detriment. And two, that she can advocate the minimal intervention I have requested and the skin to skin c-section I want if I must go that route. I can't help listening to my gut and my desire for the babies to be ready...not the doctors to be ready.

Does anyone have an opinion or experience with this kind of decision? 

[cileag]

It's a tough call in your situation I think.  It sounds like your chance of having a cesarean is pretty high and in that case, I'm totally supportive of controlling the MD on performs the surgery (if she wouldn't come in for you) and the circumstances as you can.  Instead of Wed. could you advocate for Friday or next Monday to give yourself a little more time if you still feel it's a little early? 

[OneSmallAxe]

My main focus in waiting for spontaneous labor to set in, regardless of how they are delivered, is to make sure the babies are ready to be born and to deliver all the benefits of natural labor. 

This article is compelling to me and the information therein is a big reason I can't ignore my feelings to wait.

http://pregnancy.about.com/cs/laborbirth/a/aa042300a.htm

[jecombs]

 Great article!  I can see why you're torn about what to do.  I think I would be, too.  One the one hand, you want the babies to get the benefits of labor starting naturally.  On the other hand, you want your doc to be there when the babies are born so that your wishes are respected as far as interventions and skin-to-skin contact goes.

It's a tough call and you have to decide what you can live with.  Would you be more unhappy if the babies were born somewhat prematurely and ended up in the NICU for a few days or if you went into spontaneous labor and got a doc that was less than respectful of what you want during birth?

Personally, I am a big believer in going with my gut. It has never steered me wrong.  I also have a lot of faith that God will work everything out exactly the way is it supposed to be.  I hope you can find peace with whatever decision you make!

[HariB]

While you're thinking about it, here is another link (now under discussion on this forum)

http://californiawatch.org/health-and-welfare/early-elective-births-increase-so-do-health-risks-mother-child-7689

Not only is labor good for babies, but being born too early is bad for babies, in short--according to the above article. 

If your babies are doing well and so are you, then if it was me I would not schedule a csec this early (probably I wouldn't schedule at all...but that's just me).  Even if you ultimately are faced with a decision to go ahead with surgery--if babies don't turn, for instance--then waiting for labor is still a good idea.  You will know that your babies are truly ready to be born, and you will also give them the benefits of labor.

[MegBoz]

Originally Posted by OneSmallAxe 

My doctor is pushing hard for the scheduled section because one, going beyond 38.5 weeks is "like splitting hairs" regarding benefit to detriment.

I'm scratching my head at that one. OK, maybe it's true that going beyond 38.5W doesn't make much difference for the babies ... but CS vs. vaginal birth has a huge MASSIVE difference in terms of "benefit to detriment" - especially for you! So that strikes me as an odd statement. & maybe you'll end up with a CS anyway - but at least if you wait there is a chance for baby A to get vertex. Even if it's only a small chance, it's still a chance - and again, that is all aside from the added benefits of 1. babies choosing their own birthday (to make sure they're ready) and 2. the benefits to both you & baby of laboring (even if it's a CS in the end.)

So again, I hardly see this as a 'toss up.'

& finally, as I recently read in "Gentle Birth", modern obstetrical research tends to focus so much on perinatal mortality & ignore so many other things. For example, breastfeeding might not be "all the same" at a scheduled CS at 38.5W vs. babies choosing their own birthdate.

As for the skin-to-skin post CS, I believe the nurses have a lot to do with it & I believe the anesthiologist has a lot of control over what goes on in the OR, such as if you can have 2 support people. On the whole, I'd be less inclined to alter my birth plans in order to make sure I had the doc I wanted if I knew it was going to be, or likely to be, CS anyway as opposed to working to get my preferred HCP for vaginal birth.

[lexapurple]

I am no expert on benefits vs risks in waiting for labor to start and than have a CS, so I look at you situation from the persective that you might end up having a CS even if you wait for spontaneous labor and baby does not turn. If it was me, I would look at scenarios of CS with you OB who says she can better advocate for you wishes vs CS with random OB if she is not on call when you go into labor. What would be difference between whose two? Is your OB super crunchy and does everything different from others? will she be able to advocate for you better simly because she is you OB? Do benefits of waiting outweigh you OB support for you CS birth plan? How much of a difference can she really make? How much value do things that she can actually advocate for/make sure are done certain way have for you? How bad would it be if things are done differently? What did you do?

[BabyBearsMummy]

Labour is much like Breastfeeding some is better then none. The squeezing of the infants body during labour helps to then to pass mucous from their systems. The labour contractions will also help to begin the process of returning your uterus to  a non-pregnant size. The benefits of going beyond 38.5 weeks is not "splitting hairs". Medical staff cannot tell you when your babies are ready to be born. Only your body and the babies can decide that. To say anything else is claiming to have knowledge that the OB just doesnt possess. Your OB actually sounds like a wolf in sheeps clothing to me. Claiming to be supportive but in practice not really.

I notice your OB wanted you to have a scheduled c-section today regardless of the decision you made I hope everything goes wonderfully for you and your little ones.

[LittleOsMom]

not sure if you're still pregnant or not, but I'm in a similar situation and also torn.  The part that would worry me most about your situation is that it's a footling breech, so the risk of cord prolapse is higher if your water breaks when you go into labor.  Mine are both breech, though frank breech, so I'm less worried about the cord issue because Baby A's butt should act as a cork.

I'm going for the crunchiest c-section I can, though, and that's more likely to happen with a planned surgery. (See more on what I want in my blog here.  It's easier to link than to retype :)  My midwives and the OB are behind it, but they're trying to organize an anesthesiologist and nursery team who will be ok with it too.

I also worry about the faster rate of placental degradation with multiples and consider the fact that their lungs tend to mature a smidge faster with a womb mate.  I'm not sure if any of that affects sucking reflex, though.  My 1st son was born at 38w5d and had some nursing issues, but who knows if that's from being a tad early or not.

That's what's leaning me towards scheduling it.  I think the benefits of the immediate skin to skin contact, getting to cuddle them right away, etc outweigh the benefits of waiting for me...I think. 

I've got a few more weeks than you to keep thinking on it.  I'm curious to see what you decide, though.

I've heard very few stories of breech twins turning this late in the game due to being packed pretty tight in there and having to negotiate with the other twins' position, but I keep trying all the tricks.

I've also been contracting as frequently as every 3 minutes since 28w so am not sure I'll be aware of labor quickly enough to make it a non-emergency c-section unless my water breaks.