Running out of delivery options for breech twins - HELP

[twins-help]

Twins - 37 Week 4 days -

Baby A - Frank Breech

Baby B - Transverse

Perfectly healthy with no medical history. Second birth. No complications so far. Two ECVs performed (one by primary doctor and one by a 2nd opinion because primary doctor originally declined to perform the ECV citing poor results and difficulty to turn twins). We feel we are lucky and thankful to have two doctors performing ECVs on us.

We have been seeing a primary OB/GYN doctor that have been providing excellent care and is typically pro natural vaginal over c-section. However, primary doctor has adamantly refused to deliver twins vaginally if Baby A continues to be breech. He is willing to work with baby B if baby A is head down which is much more then a lot of doctors around here are willing to do. We questioned the necessity of medical intervention for a major surgery and he's stating it is too high of a risk of injury to the baby. He's citing a 1 out of 10 chance. Wife is not afraid of C-Section but strongly believes the risk shift and the many negative social ramifications for the baby far outweighs the "danger". Wife knows her body well and she's a terrible healer and part of the major reason why we think a c-section is more devastating to the wife for her life than the miniscule risk to attempt a vaginal twin breech delivery provided no complications at onset of labor. We have no issue to shift mid-gear to surgery if there are issues. We have had 2 formal opinions with one agreeing to do the ECV. The ECV was partially successfully but it turned back. We called many hospitals and spoken to nurses/physicians to ask about their delivery protocols if we show up unexpectedly, while they cannot give a firm answer with what would happen, they stated that likely it is going to be a c-section. We don't want to be shooting darts and want a clear birth plan. At this point, we are running out of options. Most physicians will not see us due to being this late in pregnancy and I'm sure insurance is not going to cover for a 3rd, 4th, 5th opinion either.

All doctors around the area seem to share the same medical protocols of NOT performing a frank breech twins vaginal birth. The real kicker today for us is our wonderful primary doctor pulled if you do not go along with the c-section, he will lawyer up with a psychiastrist and declare us as unfit parents simply because we want to exercise our patients right. He made it clear if we show up at the hospital where he is, its c-section if baby is breech regardless of medical condition. He suggest if we want our way is to deliver at home. We would if we could but finding a midwife has been tough and we have called numerous places for the last few weeks.

I'm not sure if we are giving the impression off that we are selfish parents and care only for the mother but he stated his responsibility is to protect the fetus at all cost. We have done our research reading medical journals and publications by government agencies. All of them seem to indicate it is perfectly acceptable to proceed with a vaginal birth on certain type of breech (frank) twins.

http://www.ncbi.nlm.nih.gov/pubmed/9180784
" CONCLUSION: Vaginal delivery of breech-breech and breech-transverse twin gestations appears a reasonable option provided criteria for vaginal breech delivery are adhered to."

The criteria they speak of is pelvis size, high blood pressuer, baby weights/size.

http://www.acog.org/publications/patient_education/bp079.cfm

"Most breech babies are born healthy. If your baby is still in the breech position as your due date draws near, talk with your doctor." They do NOT make a specific recommendation to go either way.

Our hospital St Charles cited in their Labor and Delivery guides given to all expectant mothers checking in -- "Non-vertex Presenting Twins - Cesarean delivery is generally recommended". It does NOT state its not recommended. The guide has a NOT RECOMMENDED section which includes when second baby is considerably larger, pelvis is judged too small, or baby is very small (less than 4 lbs).

Anyone have any last minute suggestions? We just WANT A PEACEFUL birth but the medical system is making it very difficult and we feel our patient's rights does not exist. We are sorely disappointed with the medical system have a all or nothing view on breech delivery.

[L'lee]

It seems to me that the doctor is saying that he doesn't feel that he has enough experience with this kind of a birth to feel that he could do it safely. I would definitely not feel comfortable having him do a procedure that he isn't experienced doing, no matter what the policy says, it would be better to find someone who has experience with breech twins and that is hard to find because basically no OBs are willing do that (and the date is so late, especially for twins!). I think it's actually a good thing that he's talked to you honestly about this before you're in the hospital, because many people get pressured into a C-section during labor, and that says a lot about the urgency that he feels about this. The doctor you are working with probably genuinely feels that it is absolutely *not* safe to go through with this and he doesn't want to be responsible for the consequences if you do, and that is why he wants you to work with someone else if that is what you feel that you *need* to do. To him, it is CLEAR that the best (and only, if he is going to be there) option is a C-section. Given the current trends, it would be a very unique OB that would be willing to knowingly supervise a breech twin birth.

Honestly, despite being a *huge* fan of natural births and patient rights, given the timing and situation, I think I would just try to accept that your wife is going to have a C-section and to try to make THAT and her recovery as peaceful as possible. Sometimes we get so used to fighting that we forget to realize that things like C-sections can actually be a life saver in some situations. You or your wife could talk to the doctor about making sure the incision is done in a way that your wife could have a vbac if you might want more children. Neither of you need more stress at this point, and you want to be ready to joyfully welcome your babies into the world! Maybe you can focus your energy on finding people to help out in those difficult first weeks when your wife is recovering and you are both dealing with two additional family members.

Good luck, and I hope everything goes as smoothly and peacefully as possible!

[cameragirl]

Have you heard of gentle c-sections? While I would prefer a VBAC this time, I may have to have a c-section because of a health condition. Even if you can get the doctor to incorporate some of the gentle c-section practices, it would make for a better experience. Things include "walking the baby out slowly" to allow for fluid to be squeezed from baby's lungs, mirrors or dropped curtains to allow you to view the birth, delayed cord clamping at about 2 minutes, and placing the baby directly on mom's chest.

[RachaelsMommy]

I'm sorry that you are in this situation and that your doctor is threatening to take away your child. Your best bet is to keep trying to turn that baby. Has your wife seen a chiropractor? They have techniques that can help turn the baby. Also check out www.spinningbabies.com if you haven't already.

I hate that pregnant women's options are so limited. I was prosecuted for choosing homebirth, and I know of another couple who was prosecuted for having a breech homebirth instead of a c/s. Honestly, I think I'd switch doctors even if you can't find one to accommodate your wishes. I would not be able to trust somebody who has threatened me like that. 

I agree that frank breech is safe, but I would assume these studies were done with doctors who have that experience. It sounds like your doctor is not experienced with breech, so you need to take that into consideration. We don't know what the stats are for frank breech birth with an inexperienced doctor, who is likely to want to interfere with the process. It could be higher than the risk of c/s. So that's just another thing to consider.

I'm going to be saying lots of baby-turning prayers for you!

[cameragirl]

I can't believe they would prosecute over things like that. Isn't it YOUR body and YOUR baby? Grr...

OP - this link may help as well. It is worth a shot, at least. http://www.homebirth.org.uk/ofp.htm

[RachaelsMommy]

Originally Posted by cameragirl 

I can't believe they would prosecute over things like that. Isn't it YOUR body and YOUR baby? Grr...

OP - this link may help as well. It is worth a shot, at least. http://www.homebirth.org.uk/ofp.htm

No, it's only your body if you want an abortion. If you choose to keep the baby, then it seems like it's everybody's body BUT yours. Legally in my state, the baby isn't even considered a person before birth, so they shouldn't been able to charge me with child endangering, but they did. A court had determined that a woman can't be charged with child endangering for using cocaine under this statute. Also in my state, a husband can't be legally responsible for his wife's actions, so they shouldn't have been able to charge my husband, but they did. And for the record, my son was born perfect, and we even took him to the hospital to be checked out and monitored, yet they still charged us. The statute even says that it's not unlawful to not seek medical treatment for our child, but on the charges they took out the word "not". And these charges held up.

Sorry to hijack!

[twins-help]

We have done everything we can to help the baby turn -- spinning babies procedures, chiropractor, flashlights shining, music at the pelvic area, moxi chinese herb burning at accupuncture points, ecvs, multiple consultations, calling doctors blindly asking for policies and hospitals.  We are certain that the c-section is going to be riskier overall.  Homebirth is out of the question as we do want to be in a hospital environment for twins.  We understand c-section where it is necessary is great but current situation does not merit it.  If that changes during labor, we are all pro for it.  However, we are not given that choice at all.  We agree as well going with an untrained doctor for breech delivery increases the risk also.  Feeling very lost.  We are going to try for one more midwife service (Gaia midwifery) tomorrow recommended by someone tonight that seem promising.

[cameragirl]

That is frustrating that you have tried everything and haven't been able to get them to turn. They must be in the best position for them already. I tried everything I could to turn a large, posterior baby (DD), but she just seemed to like being where she was.

I may have missed this, but do any of the nearby hospitals have midwives on staff? Midwives are generally more prepared to deal with breech deliveries, as doctors aren't routinely taught to manage breech deliveries anymore.

[XanaduMama]

If Baby B stays transverse, then (as I understand it) there's no alternative to a c/s. Right? It's one thing if s/he turns frank breech, but after everything you've tried, and at this late stage in the (twin) pregnancy), chances are s/he's going to stay put. I'm a zealous believer in homebirth and natural childbirth (seriously zealous), but in these circumstances--untrained doctors, twins AND breech, your wife's health issues--and especially if you've got a transverse lie, then I think c/s is the sensible thing to do.

[wombjuice]

I agree with the poster who said that no matter what method of birth your wife has, you might want to consider changing OB's if your current one is already threatening you.

And I would get a lawyer with some obstetrical knowledge and experience just in case your current OB continues to act the way he is acting and decides that he knows more about your wife's body than she does.

You guys are in a really, really crappy situation.  I'm so sorry you are going through this.  I will keep your family in my thoughts, and I truly hope everything works out the best way it can.  Good luck.

[L'lee]

Originally Posted by twins-help
 

The real kicker today for us is our wonderful primary doctor pulled if you do not go along with the c-section, he will lawyer up with a psychiastrist and declare us as unfit parents simply because we want to exercise our patients right. He made it clear if we show up at the hospital where he is, its c-section if baby is breech regardless of medical condition. He suggest if we want our way is to deliver at home. We would if we could but finding a midwife has been tough and we have called numerous places for the last few weeks.

I think some of OPs are interpreting this differently than I am... I don't think the Doctor is purposely threatening twins-help and his wife to be a jerk or as a stand-alone threat, I think that he is genuinely concerned and unwilling to be pushed into something he is extremely uncomfortable with - I think he is saying "I am not comfortable delivering your babies vaginally under these circumstances, and if you force me to do so (by coming into the hospital where I work in labor expecting a vaginal birth) against my will and judgment, I will talk to a lawyer and consider taking action. If you choose to deliver at home with a midwife then that is your choice, and you are removing me from a position of responsibility, so I will not take this action." He is very concerned that one or both of your babies might not survive a vaginal birth and does not want to be held responsible if you force the issue when he is in a position to be held responsible. Additionally, since your twins will NOT be preemies, they may be larger than twins typically are at birth, making the process harder, longer, and riskier.

If, as you say, this wonderful doctor has been providing excellent care until this point, then I don't think that there is any reason to switch to a doctor that is a complete unknown and would still end up giving your wife a C-section in the end.

Originally Posted by twins-help
 

We are certain that the c-section is going to be riskier overall.

Is this something you can be certain of? Look, I'm sorry that you have to go through this, but there is definitely significant risk either way and to deny that fact could potentially be very dangerous.

Looking at the links that you posted, the first is based on a very small prospective observational study of 68 women in rural South Africa, where obviously there is a preference, possibly based on financial "realities" (and therefore doctors with experience) that breech twins be delivered vaginally, and the results could be very different in an area that does not typically perform breech twin births.

The second link does not specifically say that a (single) breech baby cannot be born vaginally, but it certainly does not recommend it either, in fact it recommends consulting with your doctor regarding the matter. I would be *shocked* if ACOG would support your position. Referencing this without referencing their opinion on twins is a bit deceptive.

In fact, if you look up ACOGs recommendations on twins, you get the following page: http://www.acog.org/publications/patient_education/bp092.cfm - which clearly states that cesareans are performed when when the first twin is breech (see the last sentence of the following quote, italicized by me).

Delivery

In some cases, twins can be delivered by vaginal birth. In others, a cesarean birth, in which the baby is delivered through a cut made in your abdomen and uterus, may be needed. How your babies are born depends on certain factors, including:

• Position of each baby
• Weight of each baby
• Your health
• Health of the babies

Labor, especially the pushing stage, may take longer with twins. Babies usually are born several minutes apart in a vaginal delivery, but it can take longer.

Twins usually can be born vaginally if they both are in the head-down position. A vaginal birth also may be possible when the lower twin is in the head-down position but the higher twin is not. Once the first twin is born, the other twin can sometimes be turned or delivered with feet or buttocks first. When this can't be done, the second twin is delivered by cesarean birth. When the lower twin is not in the head-down position, both twins are delivered by cesarean birth.

In any case, neither of your links would support you if you were trying to make a legal case.

IF you had more time to find and get to know a practitioner that was experienced with and comfortable with attending a twin breech birth, then perhaps that would significantly decrease the risk of trying that, but in this case you (probably) have very little time and you do not have an experienced practitioner available.

I hope that you understand that I am trying to support you by providing my honest opinion. At this point, I think that stubbornly fighting a cesarean is dangerous, and you really need to consider that maybe the best choice for your family would be to take your, in your words, "wonderful ... primary OB/GYN doctor that (has) been providing excellent care and is typically pro natural vaginal over c-section" Doctor's advice.

[TiffanyToo]

Have you reached out to ICAN-Online.org asking for help with the threat of lawsuit and seeking another care provider?