Is an epidural a necessary evil to give birth vaginally?

[landgyrl]

(Also posted in I'm Pregnant- not sure how to move it over?)

A close friend of mine is due with twins at the beginning of May. (She would be posting here because I bought her a subscription, but nobody at Mothering will answer my calls/ emails about it.)  For insurance reasons and legalities, she is giving birth in a hospital. Her obgyn has told her that she "must" have an epidural to deliver vaginally. Does anybody have the experience delivering twins and forgoing an epidural? My SIL had twins and her obgyn told her the same and she trusted him and went with it. Also, she will be 36 weeks next week and her obgyn wants to induce. She's been on 'bedrest' for a few weeks because her cervix has shortened...but otherwise it is a healthy pregnancy. What would you do?

Thanks all!

[mylilmonkeys]

I had my twins at home, including a very involved manual extraction of Baby B.  It was rough, but definitely doable without epidural.  However, had I been in the hospital, it is quite likely I would have ended up with a cesarean under general.  If an epidural is in place and a c becomes necessary, you shouldn't require general anesthesia.

If all else is fine, I wouldn't agree to induction at 36 weeks.  That's just borrowing trouble!  It was hard enough establishing breastfeeding with 38 week twins, even being a very experienced, long-time nursing mom.

[Spring Lily]

Maybe it has do do with the OB's comfort level and amount of experience?

I had a planned hospital birth with an OB, and she agreed that I could have a natural birth if I let them place the epidural. That way if anything went wrong, they could start the epidural for an emergency c-section without wasting time. But during labor, I'd still be free to move around. She also said that I could deliver vaginally even if B was transverse or breech, which some OBs refuse to do. She's delivered many twins, though, and many OBs haven't.

If your friend's OB is saying that, she should find out if it is the hospital's policy or if that is the OB's policy, and find out if placing the epidural but not actually starting it is an option. Having been through the NICU with twins myself, I certainly wouldn't deliver them a day earlier than necessary. Is there a reason for induction? Is there any reason that she can't wait and go into labor naturally? An induction is also going to mean a likely epidural. If the babies are both doing well and not in the same sac, induction may not be necessary yet. Has she had a 2nd opinion from a perinatologist or MFM?
Edited by Spring Lily - 4/7/11 at 7:20pm

[Smurfette2]

I don't think I had time for an epidural because I arrived at the hospital in full active labor and Baby A's sac had ruptured. The pain was horrific but not as bad as I thought. I had to deliver in the OR though and I was on a saline drip which my husband mistakenly thought was a morphine drip so it was a placebo for me. After Baby A was delivered, I was done. I didn't even have the energy to hold her. The worst pain was when she was in the birth canal. That seemed to last for hours. Baby B was delivered easily but I put up very little effort. Like I said, I was done. Sometimes I can't believe they're already here after waiting for so long. I keep expecting to wake up from my sleep-deprived dream and still be pregnant! :)

You're a good friend.

[burleson]

I'm delivering in the hospital with my twins and my OB is not requiring an epi.  He recommends it, but it's not required.  I would never consent to an induction at 36 weeks.  My OB is not a fan of going past 40 with twins, but that's a far cry from 36.  

Good luck to her!

[ShanaV]

Many moms on MDC have delivered twins without the "just-in-case" epi. I chose to get it because I'm not that much of a risk taker. But it's totally do-able. 

And 36 weeks should NOT be time for an induction. 36 weeks is, like, a goal to get that far. By no means a max amount of time to be pregnant with twins.

[Imprint]

My o.b.'s practice generally induces twins at 38 weeks, but I am hoping to argue them out of it, if the twins are thriving - or go into labor naturally close to 38 weeks.  I definitely would not consent to a 36-week induction, unless there's a serious reason in that particular pregnancy.

My twins still have a while before I can attest to personal experience, but (though there may be one) I haven't read any reason aside from the chance of emergency c-section as a reason for 'requiring' an epidural in twin deliveries.  They're usually used at the hospital I'm delivering in, but it sounds like I will be successful in refusing to have one, even 'in case', if my first twin is head-down and we are allowed to go ahead with a vaginal birth.  But this hospital sees a lot of twins, and may be slightly more at ease with them than most.  

[vachi73]

Didn't carefully read PP so forgive if repetitive :)

I think my OB would've wanted to deliver me no later than 37 weeks with my twins. (sadly, I only made it to 32.5, and had an emergency c-section due to HELLP syndrome; luckily both babies were totally healthy and did not require resp support after birth!)

In my case, the presenting twin was breech at 32 weeks. Baby might've turned by 37 ... we'll never know ... but my OB said I could try for vaginal birth if presenting twin was head down. I have two prior successful vaginal births, so I think there was no reason to believe I would be unable to deliver smallish babies vaginally.

I can't remember what the "rule" was on epidurals, but knowing that this particular OB/hospital is epidural-happy (one of my very good friends was going to her for a VBAC but switched to a midwife practice after being repeatedly, constantly barraged about not having an epidural ... it just got too discouraging!) I probably would've been required to have epidural in place and deliver in the OR if I had gotten that far.

I think that it is totally possible to deliver twins vaginally (esp if not first delivery, and not a vbac trial; though I had a close friend who had identicals as her 3 and 4 and intended to VBAC with the twins in a hospital, w/ epidural in place; unfortunately her water broke but no labor, so she ended up with a second section for her twins). However, your friend just needs to look at the ultimate tradeoff -- best case is vaginal/no drugs; worst is c-section/general anesthesia (b/c epidural not in place, so in a crash setting, it's all the way under for mom -- which has risks to her and to the babies).

Last, I saw one PP message referring to how hard it is to nurse twins, especially preemies, even when an experienced nurser ... I wanted to second that BIG TIME! I had 2 prior kids, nursed them both exclusively for 12+ months, no issues at all. With the twins, we brought them home @ 36 weeks gest. age, weighing under 5 lbs each (what was the NICU thinking?! LOL) One twin took to nursing pretty well/effectively/quickly; the other, it was all the way until due date that he started to get the hang of it. It was a brutal 4 weeks ... lots of tears (on my part), second-guessing myself, LCs in the house, weigh-ins, etc. But in the end, WE PREVAILED! And the twins were EBF until about 14.5 months. So it all ended well ... but it was HARD. I agree with PP that I would not agree to an induction at 36 *if* everything looks OK for the babies. I would agree to 2x a week U/S or monitoring to be sure they're OK ... stuff can go downhill really, really quickly at the end of a twin pregnancy, so you do need to be reasonable/cautious, but if things look good, then no reason not to go until labor starts itself, but NOT PAST 40 WEEKS, period! (IMHO ... I am not a doctor!!)

If she really wants a no-drugs vaginal birth for twins, and both twins are head-down, and everything looks totally normal on monitors and u/s, she could wait for water to break/labor to start, and then stall a little on going to the hospital ... not too long, but a little delay ... to increase the odds that she will be given the "mandatory" epidural ??? Remember, I'm not a doctor ... but my thinking is this -- if she gets to the hospital at 7 cm, she has a better chance of avoiding pitocin/epidural than if she gets there at 0-1 cm (or is induced from a zero). But again, this would TOTALLY be dependent on everything being totally perfect at every prior exam/ultrasound/monitoring, etc. And it would not be without risk. It's all a balancing act between her perception of risks and benefits of all the options.

So, just something to ponder. Undoubtedly someone will get on my case for suggesting a small delay, but that's how it goes!

Sorry I went on so long :)

[mamalovex3]

I delivered my twins naturally without an epidural at a hospital with a 96% epidural rate.  It is definitely doable, but your friend needs to be ready to face some opposition from some potentially pushy doctors.  The risk, of course, is that if something goes wrong and a c-cestion is needed, they will go to general anesthesia.  I think for an otherwise uncomplicated pregnancy, it's worth taking the chance.

I was put on "bedrest" at 25 weeks due to a shortened cervix and when I hit 37 weeks and my doctor started pushing induction, I became very emotional.  I felt that induction would increase my chances of needing interventions, provide the hospital staff with more opportunities to pressure me into an epidural and posible lead to a c-section that might otherwise be unnecessary.  They scheudled an induction date for 38 weeks, I pushed it back to 39 weeks and went into labour on my own at 38 weeks 2 days (wit an amazing natural birth that I am so glad I stuck to my guns to get!)

[Imprint]

Originally Posted by mamalovex3 

I delivered my twins naturally without an epidural at a hospital with a 96% epidural rate.  It is definitely doable, but your friend needs to be ready to face some opposition from some potentially pushy doctors.  The risk, of course, is that if something goes wrong and a c-cestion is needed, they will go to general anesthesia.  I think for an otherwise uncomplicated pregnancy, it's worth taking the chance.

I was put on "bedrest" at 25 weeks due to a shortened cervix and when I hit 37 weeks and my doctor started pushing induction, I became very emotional.  I felt that induction would increase my chances of needing interventions, provide the hospital staff with more opportunities to pressure me into an epidural and posible lead to a c-section that might otherwise be unnecessary.  They scheudled an induction date for 38 weeks, I pushed it back to 39 weeks and went into labour on my own at 38 weeks 2 days (wit an amazing natural birth that I am so glad I stuck to my guns to get!)

- All of which I find very encouraging.  :-)
 

[Neuromancer]

I know two women who gave birth recently (one in December, one about 2 months ago) to twins vaginally without epidurals -- both in hospitals.  One at 39 weeks and one at 35 1/2 (not an induction).  They were both second pregnancies for the women in question. 

[Rani]

Nope. My doctor didn't like that I didn't want one but I held my ground and said no.  I agreed for them to place a heplock finally BUT then..darn..I didn't get there till heavy contractions and almost completely effaced...it was too late for either :)

[mauri456]

I had my twins by VBAC epidural free in the hospital.  My doctor did not require an epidural.  I also did not have to deliver in the OR.   However, my OB is very comfortable with twins and has lots of experience.  He did need to turn baby b who was vertex but went transverse after A was born.   It really wasn't that bad though (the turning) I had them the day before their due date.   There is no way I would have agreed to an induction at 36 weeks unless there was a true medical indication.  Since having my twins I have met 4 twin moms all who carried til at least 38 weeks.    They went into labor on their own.  My OB explained the twin gestation thing as twins being two weeks ahead.... so 40 weeks w/ twins was like 42 weeks with a singleton.  I can kinda buy that one but for your friend it would be like inducing at 38 weeks... the babies will know the right time to come.

[mamamolly1]

My hospital is one where they require twin births to be in the OR and require an epi to be placed, but not the drugs to be pushed, in case of an emergency.  One thing about this is it makes it a lot harder to have a non-medicated birth because all of this (along with all of the monitors, etc.) really preclude a lot of walking around, time in water, etc.  I did use an epidural after a really painful pitocin induction after my water broke. (despite being nearly fully effaced for over 5 weeks, my cervix wasn't dilating almost at all)

I can't understand inducing at 36 weeks unless there are other problems (blood pressure, ttts, etc.)  I was on bedrest from 29 weeks due to a shortened cervix and my doctor said I could go off the bedrest if I wanted at 36 weeks (and take my chances).  I wasn't sure what I was going to do, as I wanted to get to 38 weeks.  But my water broke at 35.3 weeks so that was moot :)  But considering that I went into pre-term labor at 29 weeks, I was pretty happy to get to 35 weeks.

[MamaChicken]

I did it without epi. The only "risks" that I got out of the OB were pain from breach extraction and having to use general anesthesia in case of emergency. The anesthesiologist admitted that even if I had the epi in, and a true emergency came up, they would have to put me under general anyway.

I opted out.

[RSG]

I had my twins at 39 weeks in the hospital with no epi.  MD was pushy; but my midwife and doula were supportive and I was clear about not wanting one and understanding the risks.  I'd resist the induction if possible... I did have to deliver in the OR; but moving rooms wasn't a bad experience for me.  Yes, it was painful - but I didn't expect differently :)

[Coco99]

Our doc recommended it because of the chnce that the 2nd twin will shift and need to be turned internally by the doctor... which did happen to us. The doc needed to put all her arm inside my DP... so yeah, huray for the epi in our case.

[SashaBreeze]

That would be the famous "just in case" epidural.  My OB (a specialist because my twins had ttts) explained that he highly suggests them so that way if there is an emergency, and the emergency usually happens with baby B, then they can go ahead and do surgery with less side effects for the mom and baby.  The other option was that if you would rather then no epidural but with the knowledge that if emergency surgery needed to be performed you would need to receive general anesthesia and be put under, which was not a scenario he wanted or preferred.  I agreed with him. But I could have chose to wait it out if I had wanted.  Maybe an option like that would be available to her?

My CNM and her back up OB also wanted to induce at 36 weeks, it is pretty common, but then when I was transferred to a high risk specialty OB he wanted me to keep my little guys in for as long as possible.  We went to great lengths to keep them in where they needed to be.  I because he saw on a regular basis some of the scariest situations out there my pregnancy was easy peasy in comparison so he panicked less.  I think a regular OB is more likely to induce and also do c-sections when ever something out of the "norm" happens because it is out of their comfort zone and they get afraid.  Sometimes a high risk OB is better in these situations.
 

[feral007]

I had 32 week twins and they pushed for an epidural block because of the risks of the 2nd twin going sideways or breech.  I knew the risks mentally and the hospital midwife discussed the fact that they would push me for one - we looked at the problem and decided on a trial epidural - so having it placed in and a test dose given to prove it would work if needed later and then I laboured naturally until pushing when I asked for a top-up.  Pushed out both babies.  I've had a client who trialled the same thing at a large hospital and the epidural didnt work and they let her labour normally without interference.  So it's mainly up to the hospitla policies I think. Ali

[JenChaffee]

My OB insisted that c/s was the way of delivering twins.  Therefore, I did much research before switching practices.  The most natural friendly that I found required that I have a "just-in-case" epidural.  And I had to labor in the OR and give birth on a table!  Hence my decision for HB.  Baby B flipped to breech.  I was thankful to have a midwife who would deliver breech, so I didn't have to go through any sort of version attempt.  She was quite easy to deliver.  If I had stayed with the hospital route, I fear that I would have had Baby A vaginally and Baby B via c/s ... and I would have never known that a breech Baby B is not necessarily a problem!