Mono-Di twins and TTTS

[AleshiaP]

I'm about 16 wks pregnant with mono-di twins and my Dr just told me that even though everything is fine right now (the babies are exactly the same size and everything) and even though I am "the perfect person to be carrying twins" (because I have carried 3 large babies, don't go into early labor (all 3 were overdue) and have overly large healthy placentas right to the end) that I HAVE TO have a C-Section because of the risk of TTTS coming on during labor even if everything is fine up until then... they say it is hospital policy. I can't find anything that says the actual statistics of TTTS coming on during labor/delivery other than most people saying it is rare, they don't seem to have any info on HOW rare or HOW serious it is if it does happen... and I can't seem to find an easy way to find a new Dr. who will at least let me try to have them vaginally.... it would also be a VBAC situation because my last baby was breech (at 10 lb 2 oz) anyway, if anyone has info on statistics or info on a good Dr. in the greater Seattle area.... please help!

[Tigerchild]

I call bogusness.

You need a second opinion.  My twins were diagnosed with TTTS, and it was not considered an automatic cesarean!  The only reason why I did not attempt VBAC was because both of them were transverse and while my doc did do a version for my firstborn (singleton) she would not do it with twins (not sure that is possible anyway, and given the circumstances I feel it was reasonable for her to feel that way).

Granted, this was 8 years ago, so god only knows how "protocol" and insurance has changed.

Anyway, the Seattle area has a world class TTTS specialist.  (Dr. Martin Walker, practices on the Eastside at both Overlake and Evergreen if I'm not mistaken, and because of that their office sees a lot more TTTS than most practices do.  http://www.eastsidemfm.com/index.htm)  I don't know how greater seattle you mean, but even if you don't see him as your doc I would highly HIGHLY recommend getting a 2nd opinion at least.

For better information than the majority of OBs (or other pregnancy/birth professionals, to be quite honest) have about TTTS, please contact the TTTS Foundation (www.tttsfoundation.org). 

Of course, your doc admits that there *are no problems* and s/he's trying to bully you into this?  Not a good sign.  Maybe they're doing it out of ignorance or fear.  Chances are your twins don't have TTTS and will never develop it.  Frankly, I would arm myself with good, fact-based and REAL TTTS info (even though you probably won't need it).  I would also call up the hospital to see if that is for real that ALL mo-di twins have to be elective section because of the miniscule risk of TTTS.  I really hope that's not overlake or evergreen, that makes me feel sick to think about.  It's bullcrap.

[nwatt]

Even though my twins had unequal placenta sharing and were 1 1/2 pounds different in size none of my doctors had a problem with a vaginal delivery.  Even when I developed pre-e and I was induced and got my vaginal delivery.

I would definitely find a different doc and hospital if necessary that have more experience with twins. 

[j.e.n]

I would concur with the previous responses! There is a difference between TTTS during pregnancy and acute TTTS that can occur during labor. Neither should be disregarded because they can both be serious, but there's always a *chance* for anything during any pregnancy/delivery. I personally had mono-mono twins, which comes with it's own set of risks and complications, so I can't speak directly on behalf of moms that have had mono-di.

Are there any groups or individuals you could reach out to that would have an idea of providers in your area that are more open to a different plan of care? I know in my situation, I had a friend that put word out for me, and I was able to find a doctor that was more supportive of deviating from the "norm". I would really think there should be a decent amount of providers that would be pro-vaginal delivery, especially if your babies aren't showing any signs of TTTS or other distress. I was also given the suggested policies and procedures for my babies, however, they cannot force you to do anything you do not want to do. Though I will admit, it can get intimidating fighting for what you want when everyone is pushing for you to choose something else. I'm a big believer in going with your gut and trusting your mama instincts. 

I know it can be overwhelming (especially finding research - believe me, I did the same!!). Sending you happy, successful vibes in your quest to find a provider to bring your sweet babies into the world the way you desire! Good luck!

[teamla]

I call bull on that one too.

We have mono-di twins vaginally here all the time.  As far as I know, acute TTTS during delivery is extremely rare.  My doctors were not completely opposed to a vaginal birth for my mono-di twins (one with selective IUGR, so therefore there were TTTS-like placental issues) and no one ever breathed a word about the acute type being a risk during birth.  I wish I were able to refer you to someone else!

[AleshiaP]

Thanks for all the support. :) It is Evergreen hospital that has that policy, I don't know what Overlake's policy is because they aren't on my insurance so I didn't even bother checking it out. I found a place where they don't have any specific policy about delivery of Mono-Di twins in Seattle, the Dr. is Luba Foltz, a friend suggested her because she is pro VBAC. I have an appointment in a couple of weeks to meet with her and go over my records and ultrasound results thus far... (crossing fingers!!) I also need to find out for sure that the hospital itself doesn't have a specific policy in place (its Swedish First Hill) A little farther away, but should be worth the distance if everything works out!

thanks again!

[Tigerchild]

How incredibly disgusting.  Evergreen has really gone downhill.  Forcing all Mono-Di twin moms into a cesarean based on a very remote possibility of a) developing TTTS during delivery and then b) that it would be so acute as to be a problem is barbaric and money grubbing.  :/  I had my REAL TTTS twins at evergreen and there was no such policy then.  Absolutely appalling.

[ChaoticMum]

I had mono/di twins (finally believing they actually were! LOL) and I would have been allowed to deliver vaginally if not for a transverse Baby A.....

[purpleheather79]

Acute TTTS is supposed to be very rare and there is very, very little info out there about it.  (Both of my sets had it-one set born at home, one set by emergency c/s under general anesthesia.)  There's no way to predict it and although some people do favor an early c/s to prevent it, there's not really any evidence that it decreases the rate of acute TTTS, AFAIK.