hospital twin birth - epi or no epi? internal version pain?

[DWife03]

If you had a hospital birth, do you recommend having an epidural or not? If you had an internal version, did you have an epidural or go med-free? How did you handle the internal version and what was it like?

Background: I had a home waterbirth with my 2yr old DD and LOVED it! Now that I am pregnant with twins, I spoke with several of the midwives in my state, and they are saying it would be best if I chose an OB. They are trying to lay low and not take on "higher" risk births basically because the laws in my state are difficult to deal with. If anything goes wrong, it could lead to their arrest and midwifery being made completely illegal. Only 2 of the midwives were willing to take me on, but one of them is very anti-doctor (I am not) and sort of scares me with her philosophies a little. The other was very expensive and we just cannot afford it since my insurance will cover all but $1600 of the hospital birth.

I have decided to go with an OB whom several MoM's recommended to me, as well as one of the midwives. Last year he delivered 7 sets of twins and only 1 set had a c-section. He also delivered a set of VBAC triplets! In talking with him, he mentioned that if one of the twins is transverse or breech, he would do an internal version and pull the baby out by the ankles. I then said, "if you do that, I'll want an epidural. Normal labor/delivery is hard enough but do-able, but the thought of you sticking your hand up inside my uterus sounds more than I could handle!" His reply was, "It will last about 30 seconds and then will be over. You don't have to have an epidural if you do not want one. You will already be open from the first baby anyway."

When I was in labor last time, I wanted everyone to leave me alone, not tell me what to do unless stated slowly and clearly using few words. And I did not want anyone touching me, let alone touching my vaginal area. I'm not a private person, I just wanted to focus on relaxing and staying on top of the contractions. I am trying hard to create a positive outlook for myself on the atmosphere I know will be at the hospital. I want peace and quiet when I'm pushing, and no one to tell me what to do, but I know I NEED to look at the nurses as cheerleaders cheering me on. I'm just trying to make the best out of a situation that I wouldn't have chosen but cannot help.

Please share your experiences/thoughts. Thanks!

Joy

[eatingfor3]

 I spent 16 minutes with my doctor's arm in my uterus. The external version for baby B worked, but then she put her arms above her head and flipped, so he did an internal version. She then put her arms above her head again and the cord threatened to prolaspe. He kept his hand up there to both hold her in place and to keep the cord for prolapsing. My doc was amazing and kept the ultrasound wand on my belly the entire time to keep an eye on her-- he KNEW how much I didn't want a c-section so he wanted to give her a chance to put her arms down so I could deliver her vaginally. Long story short, her heart rate plummeted after about 14 minutes, he called for a crash c-section because she wasn't recovering and about 30 seconds before they put me under, she moved her arms, he yelled at me to push and I pushed once and she was out.

I did all of this without meds-- no IV meds, no epidural. I don't remember any pain, but I am very very good at coping and breathing and going to my "happy" place. About 3 minutes into the internal version/ arm in my uterus, I went outside my body. I saw everything from above. I could describe people who were in the room that had never walked in front of me so I could see them when I was on the table and I knew exactly what was going on, but not from *me* laying on the table. looking back, it kind of freaks me out but that is how I coped. My husband said I looked like I was in pain, but I honestly don't remember the pain at all. I don't remember it hurting and I wasn't sore after the babies were born, even though I probably should have been. However, I was on a ridiculous birth high for about 3 days. I think I got a quadruple dose of endorphins. Once the high wore off I wasn't sore, either. 

I was very much like you, didn't want to be touched, didn't want to be talked to, I just wanted to be left alone during labor and delivery and they totally respected that. But when it came time for baby B and all of her antics, I really didn't care what was going on, I was just focused on NOT having that c-section. I always said that I would rather endure a few minutes of intense pain that to have to deal with the side effects of an epidural so I know I made the right choice, FOR ME. It certainly isn't the choice for everyone. I trusted my body and knew myself and that I could handle an internal version w/out meds so I went for it. Also, I know my doctor wouldn't have done it if he didn't think I could handle it. He would have gone straight for the c-section had I not been coping like I was, and that was straight from him. There's no way he would have waited as long as he did if I was in obvious pain or not handling what he was doing like I was. 

It isn't the right choice for everyone-- only you know your body and what you can handle. But FOR ME, it really was worth it not to have the epidural. And really, the chances of you having an internal version are really quite low. And the chances of you having an arm in your uterus for a long time is really low so try not to stress too much over the possibility :)

Good luck!

[mauri456]

My twins birth was an unmedicated hospital VBAC.    I went into it wanting the least intervention but knowing that there was  alot of unknown.   I had a  HB midwife as my labor support and an OB is the one who caught the babies.  He sounds alot like the OB you are considering... very skilled, does breech births, low c/s rate, etc.   I knew that by going to him if he said I needed whatever intervention, I trusted him.  He knew that I wanted as little as possible and is one of those docs that totally gets it and believes in a woman's ability to birth.   

My labor involved me needing to push past cervix, getting into all sorts of positions that a 39+ week pregnant with twins lady shoudlnt have to do..hahha!   Both babies at the time were vertex.  Once baby a came, I had a lot of bleeding.  Enough that he was worried about a rupture.   He did manually feel my scar from the inside.  Honestly, it hurt, but pushing past cervix was WAY worse for me.....I think you have protective hormones going on to be truthful.    B did turn to transverse.    He was able to turn her to head down externally but had to push her arm out of the way internally.    Then B pretty much fell out. 

I am a wimp.   Truthfully I am.  I get anxious about pap smears and have to breath through them.   I know I didnt have a total internal version, but probably the same amount of manipulation... I was so much in labor land/bliss over one of the babies being here, that wasnt bad.  

My MW did talk alot about the fact that he may need to do some manipulation after A.   I was just hoping it wouldnt come to it.   It was relatively easy for me to focus on the beautiful baby on my chest and just ignore all that was going on down there.  

As far as the epidural - I really didnt want one, but sometimes it is a tool.  I pretty much told my MW to let me know if it was best for me to get one when we were in the labor... ie) I wasn't relaxing enough, getting to tired, etc.  Sometimes they can be a tool and I think until you are in the thick of it, you won't know what the best thing is.   After the birth she told me that there is no way I would have gotten A out with an epi (she was OT)  and was so glad I hadnt needed one.

Moral of the story --- there is so much unknown until that day... sucks but just have faith in yourself and your babies.   I just did alot of positive affirmations that the RIGHT situation would happen -- whatever that may be.    

[mauri456]

I totally agree with you on this!! I felt the same way during all of the manipulation I had... and def agree about the endorphins.  It was alot like an out of body experience or being on  some crazy drugs.... (even though I wasnt)  And yes, the endorphins after were out of this world.  I think I was "high" from them for WEEKS.

Originally Posted by eatingfor3 

 I spent 16 minutes with my doctor's arm in my uterus. The external version for baby B worked, but then she put her arms above her head and flipped, so he did an internal version. She then put her arms above her head again and the cord threatened to prolaspe. He kept his hand up there to both hold her in place and to keep the cord for prolapsing. My doc was amazing and kept the ultrasound wand on my belly the entire time to keep an eye on her-- he KNEW how much I didn't want a c-section so he wanted to give her a chance to put her arms down so I could deliver her vaginally. Long story short, her heart rate plummeted after about 14 minutes, he called for a crash c-section because she wasn't recovering and about 30 seconds before they put me under, she moved her arms, he yelled at me to push and I pushed once and she was out.

I did all of this without meds-- no IV meds, no epidural. I don't remember any pain, but I am very very good at coping and breathing and going to my "happy" place. About 3 minutes into the internal version/ arm in my uterus, I went outside my body. I saw everything from above. I could describe people who were in the room that had never walked in front of me so I could see them when I was on the table and I knew exactly what was going on, but not from *me* laying on the table. looking back, it kind of freaks me out but that is how I coped. My husband said I looked like I was in pain, but I honestly don't remember the pain at all. I don't remember it hurting and I wasn't sore after the babies were born, even though I probably should have been. However, I was on a ridiculous birth high for about 3 days. I think I got a quadruple dose of endorphins. Once the high wore off I wasn't sore, either. 

I was very much like you, didn't want to be touched, didn't want to be talked to, I just wanted to be left alone during labor and delivery and they totally respected that. But when it came time for baby B and all of her antics, I really didn't care what was going on, I was just focused on NOT having that c-section. I always said that I would rather endure a few minutes of intense pain that to have to deal with the side effects of an epidural so I know I made the right choice, FOR ME. It certainly isn't the choice for everyone. I trusted my body and knew myself and that I could handle an internal version w/out meds so I went for it. Also, I know my doctor wouldn't have done it if he didn't think I could handle it. He would have gone straight for the c-section had I not been coping like I was, and that was straight from him. There's no way he would have waited as long as he did if I was in obvious pain or not handling what he was doing like I was. 

It isn't the right choice for everyone-- only you know your body and what you can handle. But FOR ME, it really was worth it not to have the epidural. And really, the chances of you having an internal version are really quite low. And the chances of you having an arm in your uterus for a long time is really low so try not to stress too much over the possibility :)

Good luck!

[kjoy2]

My labor was HB transfer (non-emergent) to hospital (with supportive OB as back up)  My baby B was also an unmedicated breech extraction - she was transverse & not turning well w/external version.  Time  between A & B was 6 minutes, so it certainly didn't last long, and it wasn't painful in my mind.  I breathed through it.  And after such a long labor and ridiculously drawn-out pushing stage, I was very ready to have baby B o.u.t.   For me, having a few stitches post birth was the most painful!  And as for the birth high, my god, I didn't sleep for 2-3 days after the birth.  Yikes! 

[SunshineH]

There are so many amazing birth stories here. Many strong mamas who know they can do it! Just quickly from me - I've had all vaginal hospital births. 2 medicated, family doctor attended singletons, 2 midwife attended, drug free singletons, and then the twins. My 4th singleton was 9 lb. 6 oz, and it wasn't easy, although it was fast. I remembered how I felt I had no control with that birth, even though my midwife was wonderful. I think I still had some of those nervous feelings going into to have the twins. With the twins, I was induced at 38 weeks (which is something I still wonder about after reading so much more but that's not what you asked...). I was dialated to 7 and they just broke baby A's water. I chose to have an epi, and it took some fears I had away. Baby A was born about 3 hours after his water was broken and it was easy pushing for him, and baby B was born a 1/2 hour after that. Baby B was transverse at first, but went head down. She was posterior too, and the ob tried to turn her but she kept flipping back - her chin kept getting stuck while I was pushing. I don't know how I would've handled that without the epi. It ended up being one of my easiest labors. It was the right choice for me, but as other posters have said, you need to know yourself. There are always so many more risks with each medical intervention. Just thought I'd share that it was OK for me.

[aja-belly]

i had baby a breech on the way into the OR and baby b was an emergency breech extraction. it was a two handed job with no epidural. it hurt worse than anything i've ever felt but it was over with very quickly. i would do it without an epi again.

[cdlover]

count me as another no epi....though i did not have a breech extraction as both babies were head down.   i did have some pit however (i was having major contractions for a week and walked around at 5 cm for a week before i decided that babies really needed out---labor was not deemed induced.)  what i wanted to add though was that after the first baby came out sunnyside up---hence then trouble triggering active labor to stick) i really did not feel pregnant at all anymore.  it was very surreal.  babies were 26 minutes apart and i was extrememly relaxed.  dr.'s were getting antsy as they often do and lost a heartbeat (big duh from me.....babe was moving into position away from fhm.)  i stopped nursing baby a when i felt one contraction and dr. reached in and did SOMETHING extrememly painful but short lived down there...i have no idea what.  out came baby b with 1 push i did not feel. it was so fast.   i am very happy we did not have an epi.   

also....all of the dr.'s and nurses in a very medicalized hospital were pushing for no epi for us.  they knew how important it was to me.  :)

[ShanaV]

I went thru 24 hrs of labor without, then right before it was time to push I weighed the risks and decided to get one. An hour later both babies were born. Turns out I totally could have gone without it bc Baby B didn't flip, decelerate or anything. He slid right out 5 mins after baby A. Oh well. Knowing my luck it would have all gone south if I had not gotten it.

[amnesiac]

I think you need to choose whatever is best for you so I wouldn't go so far as to say what I would recommend for anyone else. I did have an epi and I would do it again if I had it to do over though.

[DWife03]

Thanks for all your honest answers! I'm still doing some thinking about it, and will probably decide at the last minute depending on circumstances.

[annettemarie]

I had an epi and am so glad I did because I ended up in an emergency situation. My husband actually had to stop me from Facebooking about how wrong I was and how wonderful I felt. That said, it;s definitely a decision you have to weigh for yourself.

[maritraveler]

Mine were both head down and the doctor told me I should get an epi, in case the top one turned, and she could pull her out breech.  She wouldn't pull a breech baby out without an epi.  I got one very late in the game, around 8 cms, since I really didn't want one.  In the end I got a fever from the epi and had to have the 2nd one as a c-section after 4.5 hours of non-progressive labor with the 2nd.  The first came after pushing for only 20 min.  I don't know what to tell you.  I was scared the 2nd one would turn breech, and I REALLY wanted a vaginal birth.  Then I basically ended up with the c-section with the 2nd from having the epi fever, and they were scared it was an infection.  In the end, I think I would have not gotten the epi if I could have done it again and trusted my own body, not doctors.

[KellyTTC#1]

I had a breech birth for baby B and an epi was highly recommended by the OB.  I have no comparison as this was pregnancy but I am glad that I did because there was a lot of manipulation and it was still very painful with the epi.

[Fuschia]

I had twin 1 very swiftly with nopain relief at all, except some time in the pool. Then paused to meet and feed him... labour had stopped. After 2h I was checked, twin 2 was coming feet over her head. They suggested turning her manually, I had gas and air for that. It wasn't as painful as the drip I thne had ti keep her down. they broke my waters and she ws born pretty quickly.

My most recent baby I had my waters broken at 40+4 due to high BP... it was a very difficult procedure for the, baby was coming brow first and the bag was very tight.. it took 20 mins.. TBH it was worst than the manual turning (I had gas and air for the AROM as well)

[aja-belly]

was it the pain of labor after AROM that hurt or the actual procedure? i don't remember having my membranes ruptured hurting at all (well, not any more than an exam - which were pretty uncomfortable at that point).

 

Originally Posted by Fuschia 

My most recent baby I had my waters broken at 40+4 due to high BP... it was a very difficult procedure for the, baby was coming brow first and the bag was very tight.. it took 20 mins.. TBH it was worst than the manual turning (I had gas and air for the AROM as well)

[Fuschia]

Originally Posted by aja-belly 

was it the pain of labor after AROM that hurt or the actual procedure?  

 

 With my recent labour, it was the AROM. I didn't go into labour for another 10 hours, and even then only with a synto drip. The AROM was very difficult as my cervix was still posterior and not fully effaced (despite 24h of gel and 24h  of pessary) and the waters were very tight around baby's head, he was coming brow first. Bishops score was 6

In my twin birth AROM was straightforward, Bishops score was 10 and after the AROM I went into labour swiftly and T1 was born 3h later, I didn't need any pain relief for the AROM or T1

[mom_of_steele]

See now I feel like I shouldn't have been afraid dangit! I went into labor on my own and was having a relatively wonderful labor (especially in comparison to my first horrible pitocin birth) and once I got to a 9 I was so afraid of the second one flipping that I ended up getting an epidural at that point. Which I always thought I was so grateful for when baby b decided to flip transverse and had a prolapsed cord and my OB was rummaging around in my uterus for about 7 minutes! And I WAS quite sore afterwards, but now reading some of the others, it kinda makes me feel like I could have done it. :(

[DWife03]

mom_of_steele  - aw sweetie, don't be hard on yourself. No guilt here! You made the best decision you knew to make at the time. And who knows, if you hadn't gotten the epi, you may have wished you had since they had to have a hand in your uterus for so long. (7 min is a long time to me!)

For me, as long as labor is "normal" (no one's hand is up inside my uterus), I would never consider an epidural. And if I knew the internal version and extraction would be quick (60seconds), I think I would still choose to skip the epidural. BUT if it's more than "normal" I start thinking about pain control. I want to deal with going through such traumatic pain (above normal) if I don't have to.