Mono Di Twin Homebirth

[FiveandTwo]

Hi there!  I am new here and have been searching all over the internet for any home birth stories of Mono di twins.  I am expecting our 4th & 5th babies.  My last birth was an unassisted HBA2C!  The first two were breech and my midwife would not deliver them, nor would every other doctor in my state. :-(

Anyway, after a very successful HBA2C, I demand to have these two at home!  Learning of their uniqueness sharing a placenta and chorion, though, I do want to be wise about it as well.  My hospital here will not allow me to birth these babies vaginally, so I am forced to birth them at home (which is great!).  I have already found a willing team to do it, but would love some positive feedback on any other Mono di success stories....

Anyone out there?
 

I am 20 weeks. 

Nice to meet you all!

Jodi

[~Adorkable~]

congrats x2 on the pregnancy and welcome to MDC!

i would just really make sure that your team is experienced with twin issues and fully understanding of what Mono/Di brings to the table in terms of risk and things to plan around. I would also make sure that you do have a smooth back up plan is that is possible.  Can i ask what area of the country you are in?  Can you possibly find a different hospital as a back up so that you have a better plan B? huge congrats for your VBAC and a home UC one to boot! wow. 

learn what the risks really are and how often they happen and how they can or need to be dealt with, accurate information is your best friend

twin pregnancies can be very different, i would focus right now on being as super healthy as you can and keeping those babies in for as long as you can, that is going to keep the most options open to you and your birth team.

Protein.

[TheGirls]

Congrats on your twins!

I would definitely make sure your homebirth team is very experienced in these issues - both the VBAC and the mono/di twin issues.  I was also wondering if you have any other hospital options in case you need to transfer.  I'd definitely make sure that you have a really good backup plan in case you need to transfer either for you or for the babies.  Our twins were di/di and nearly 36 weeks, but still needed NICU time and had some early breathing issues.  Also be sure to think through how you would handle a transfer in between babies.  My partner (who birthed our twins) birthed baby A vaginally but had to have a c-section for baby B (transverse, couldn't be turned).  We were in the hospital, but a transfer with one newborn and a still-laboring mother is going to be more complicated.   I'd also discuss with your team and decide for yourself how early you'd be willing to birth at home, and decide which hospital you'd want to go to if you go early (perhaps one with a good NICU if you know you're going to have preemies).  That may be different than the hospital you'd choose for a full-term birth. 

[SympatheticDad]

OK, I'll be the bad guy here.  But please realize I am saying this out of respect and good-will.

As the mother-to-be of multiples, you are at greatly elevated risk of complications.  You need to acquaint yourself with the statistics and make an informed decision.  Speaking from brutal experience, mono-di twins have their own set of complexities (the most dire of which is twin-to-twin transfusion, but it doesn't stand alone - whenever two twins share a single placenta, then the risks of both placenta previa and placental abruption are elevated).  I certainly hope that your pregnancy and birth goes swimmingly and with no problems whatsoever, but in the event there are complications, particularly if the birth comes earlier than you expect, the availability of a level 3 NICU is critical, and a difference of minutes spent in transport can be important.  If I had had to take 20 minutes to transport my twins to the hospital, they would be dead now.  Period.

Good luck with whatever you decide to do.  I simply urge you to make sure your decision is based on the best available evidence.

[newsolarmomma2]

I wouldn't take a chance with mono di twins, the risk of placental abruption is just too high.
Heres a story, but let me warn you, it doesn't end well. I did see one more that did end well, but couldn't find it.

http://www.anniebourgault.com/2011/08/twin-birth-grieving-my-son.html

wikipedia also has some good info on the extra risks of these type of twins.
No matter what you choose, I hope it goes well.

[Gena 22]

I had a great twin homebirth, for the same reason you are - my hospital has an indefensible 80% twin c/s rate.  To protect my twins from a surgical birth before their time, and protect myself from unnecessary surgery I stayed home.  Got lots of back-up plans in place and great, experienced attendants.  It went wonderfully. 

FWIW - My twins were probably di-di, but I have some doubt.  They are MZ and one placenta came out.  The peri's techs say I was di-di, but it looked more like one all along than a fused placenta.  But I'm not a professional, and the professionals say I was di-di.

There is a mom who doesn't write here much anymore (purpleheather) who has seen it both ways.  She had a great mono-di HBAC.  Then she had a second set of mono-di twins (truly, 1 in 70,000).  Something came up with the second set of twins - acute TTTS in labor, so she transported.  I think she ended up with a surgical birth, but the twins did well and are now beautiful, rambunctious toddlers.  In my mind, her story is a great one of things going right.  Not that she got two homebirths, but that she was responsive and did her best for each set.

Look her up, and if you PM be understanding - she's got a lot of things going on as you might imagine!

[FiveandTwo]

Thank you all so much for the feedback.  I am more than willing to transport and am also watching this pregnancy for any signs of additional risk.  My heart really wants what's best for me and the babies, which in most circumstances would be a vaginal delivery, but I also have to be wise about what I am dealing with.  Gena 22, thanks for the info...very encouraging.  I am going to take this one step at a time with several plans in place.

Thanks!

Jodi

[~Adorkable~]

if you look back over this multiples area, you will find a handful of threads i started when i was working on figuring out where and how to birth my twins last winter (di/di) i was really working hard on getting a handle on what the risk numbers really were, since so few folks have their twins with out some sort of intervention, it is hard to understand what things were really necessary how much of the time and what was done " just to be on the safe side"

 i found it really frustrating.

 in the end i did set up for a home birth with a lady that was very experienced with twins (caught Genna 22's twins) but in labor developed extremely high BP and did end up doing a very relaxed transfer at 7 cm to the very close hospital that i had been getting shadow care at and thankfully ended in a wonderful vaginal delivery.  it was all so much to think about and i had a less problematic set up than you (though in the end had a fused placenta that no one knew about before hand.

 flexibility and knowing that one thing did not always have to lead to another were my best friends those last two days.

[mylilmonkeys]

I'm sorry that you have such limited options.  With the hindsight of our twin home birth, I would find it difficult to say that home birth for twins is a good idea.  Things can happen not found in any textbook.  For example, you would never knowingly deliver a placenta previa at home.  Somehow, between the birth of my A and B, both placentas came down on top of my cervix.  When I began to bleed and we lost B's heartbeat, my midwives went in to rupture B's sac and bring her out, all they encountered was placenta.  Not abrupted placenta, but still attached placenta.  By the grace of God, they were able to maneuver between the placentas and after some harrowing and endless minutes of work, pulled B out.  Breech extraction didn't work.  The midwife finally was able to reach all the way behind her bum and guide/force her out.  She had a 1 minute apgar of 2, but responded to resus well and we  were able to send the paramedics away.  We were within spitting distance of the hospital.  We chose to birth at our midwife's home because she was in the backyard of two hospitals.  But in that moment it didn't matter one whit.  I am a huge home birth advocate.  I run a website showcasing home birth for one of the top midwifery schools.  But home birthing twins carries unanticipated risk factors which make it difficult to equate with single births.  I'd home birth a singleton in a heartbeat, but never again for multiples.

[baltimoremomtobe]

Thanks for your feedback, lilmonkey's.  I am currently 29 weeks pregnant with didi twins and also a primip.  I have been agonizing hospital vs. home birth for the delivery.  There are some options in my area, but not many.  It's frustrating and the level of intervention I've already received (transvaginal ultrasounds every week for the past month for a short cervix scare) are just the beginning.  I'm unsatisfied with my current care - everyone's been nice and highly professional - but I suspect I am still mourning the loss of my homebirth and those in-home visits with my midwife as opposed to the sterility of an office visit. 

While it's not too late to make a decision to hb, I also don't know if it's the best option for a primip pregnant with multiples.  I appreciate the honesty in your post and it gives me hope that by choosing a hospital birth I am safeguarding against those potential problems one would have w/ a multiple birth.  

FWIW FiveandTwo, I respect your bravery to HBA2C unassisted, but I know UC is not for me at all.  I want to be taken care of during labor and as a student midwife, I don't want to put on my thinking cap during a time of intense emotion and possible pain.  I really admire those who can take on the challenge, but it's not for me.  I would probably never hb w/ mono-di twins since the risks are much, much higher than didi twins.  I'd say go for it if you had didi twins (I likely would if I weren't a primip and knew what birth was like) and I've seen some nice hb videos of didi twins.  Mono-di is much riskier and as lilmonkey's pointed out..even being "spitting distance" from a hospital can be too far in some instances.  I hate playing the fear card, but I do it for myself.  I know my boy (Twin B) is larger and if he's breech there is going to be a higher risk of head entrapment. While head entrapment is rare...it does happen...and you just have to pray you are on the good side of the outcome.  Same with placental abruption/cord prolapse, etc....it's rare, but god forbid it happens to you at home.  Good luck with your decision-making.  I do know how hard it is.

[cjc-to]

I have 17 month old mono-di twins and originally wanted a home birth as well.  However, after reading a lot about the risks of TTTS, and acute TTTS during birth there was no way I wanted to risk the health of my babies.  After a super stressful pregnancy because they were mono-di and the possibility of TTTS, i just couldn't bear the thought of carrying them to term and then losing them during delivery.  Granted, I had an AMAZING team of doctors who supported any decision i made, but at the end of the day, for me, it just wasn't worth the risk.  Good luck in whatever decision you make.

[ladydodson]

lilmonkeys, i had no idea your birth was so harrowing!

i had di/di twins at home, both breech...but they were my 4th and 5th (3rd and 4th hbac)...i had an OB present as well as a midwife and a student midwife. i am also a student of midwifery, and it took me all the way up until their birth to feel confident in my decision to HB...lol. i knew i had to try, but had back up in line and did concurrent care w/ a hospital just in case i went into labor before 36wks.

[mylilmonkeys]

Originally Posted by ladydodson 

lilmonkeys, i had no idea your birth was so harrowing!

i had di/di twins at home, both breech...but they were my 4th and 5th (3rd and 4th hbac)...i had an OB present as well as a midwife and a student midwife. i am also a student of midwifery, and it took me all the way up until their birth to feel confident in my decision to HB...lol. i knew i had to try, but had back up in line and did concurrent care w/ a hospital just in case i went into labor before 36wks.

I couldn't even talk about it for a long while after the birth.  We literally were so close to losing our little girl!  And I just couldn't wrap my head around how it all happened.  Now that it makes a little more sense, I can discuss it, but I really don't like to go there.  

I'm glad your experience was so positive!  I loved all my singleton home births.  It is an incredible, amazing experience!

[Novella]

Originally Posted by newsolarmomma2 

I wouldn't take a chance with mono di twins, the risk of placental abruption is just too high.
Heres a story, but let me warn you, it doesn't end well. I did see one more that did end well, but couldn't find it.

http://www.anniebourgault.com/2011/08/twin-birth-grieving-my-son.html

wikipedia also has some good info on the extra risks of these type of twins.
No matter what you choose, I hope it goes well.

I'm surprised that this story was cited as a reason to NOT choose a twin home birth. The placental abruption was sudden. Even hospital crash c-sections take some time. A tragic story, but certainly not evidence that the birth was less safe due to the home location.

I did not have a home birth (can't in my particular part of the province due to the sell-out deal our midwifery college made when achieving public funding). Was not ready for a twin UC, but had an almost completely non-interventionist hospital birth of mono-di vertex followed by double footling breech. Arguing with doc during labour to advocate for self and babes worse than the birthing! No TTTS for me, chronic nor acute.

Yes, mono-di deliveries have higher rates of complication. But that doesn't equal near-certain disaster and there seem to be several comments in this thread (especially from newer members) that suggest pretty strongly that twin HB isn't "worth the risk" - implying that the hospital route is less risky. Mmmm. . . Iatrogenic complications come up frequently enough in singleton hospital births. With a multiples pregnancy, your risks of iatrogenic complications go WAY up because it's so overwhelmingly difficult to refuse the medical model standard of care for twin births - even if many of those protocols aren't evidence-based.

[prothyraia]

Originally Posted by Novella 

Yes, mono-di deliveries have higher rates of complication. But that doesn't equal near-certain disaster and there seem to be several comments in this thread (especially from newer members) that suggest pretty strongly that twin HB isn't "worth the risk" - implying that the hospital route is less risky. Mmmm. . . Iatrogenic complications come up frequently enough in singleton hospital births. With a multiples pregnancy, your risks of iatrogenic complications go WAY up because it's so overwhelmingly difficult to refuse the medical model standard of care for twin births - even if many of those protocols aren't evidence-based.

I've had two homebirths (singletons) and I'm not exactly a new member, but I have to say- with mono-di twins I would choose to be in a hospital.  The potential for iatrogenic complications does go up, yes, but those complications are less likely to involve a catastrophic outcome than a homebirth in this situation.   Twins, shared placenta, two previous c-sections; there is just too much potential for Really Bad Things to happen.  I'm not certain I would trust a birth team that was happy to assist with a birth like that at home.

That said- it sucks that the hospital is unwilling to look at having a vaginal birth.  Homebirth should be for low-risk pregnancies, but the sort of higher risk situations where I think I would prefer to be in a hospital often come with an automatic c-section that I don't agree is warranted.  So, what do you do?  Potentially unnecessary (and certainly unwanted) surgery?  Inappropriately risky homebirth?  It's not a fun place to be.

At any rate, I don't have any birth stories to share, so I'll stop derailing the thread now.  FiveandTwo- could your birth team have some of their clients who have experienced a pregnancy and birth like yours share their experience with you?  Maybe ask them to pass along your contact information to the moms who've birthed with them and had mono-di twins?  Seems like that could be exactly what you're looking for!

[baltimoremomtobe]

FWIW, Novella, I think the length of time someone is on Mothering.com says little to nothing about their education level or expertise/interest in birth-related issues.  I joined when I got pregnant a year ago (a pregnancy lost to miscarriage), but I have been a birth worker for years and my experience and interest base is wide.

I do think there are risks in the hospital, but I also think it is questionable to assume that just because there are one or two people out there who WILL deliver you at home (regardless of your history and/or potential complications) that this is the best reason to deliver at home.  As a CNM student, I really wrestled with the idea of homebirth (as a primip who is almost 38 weeks pregnant with didi breech/transverse twins, I still do), but birth is unpredictable and risky in any setting.  If this were just about me, I'd choose a homebirth, avoid c/s at any cost, etc. but I've realized this whole thing is not just about me anymore.  It's about my two babies and my husband as well.  We have to stick with our inner gut feeling, which tells us which path to choose.  For some, that comfort will come from being at home, but for others a hospital birth is what makes the situation feel safe to them.  It's not that complications don't happen in either setting, rather it's about informed consent of consumers and the ability and willingness to make a decision that's right for you/your family.  

[~Adorkable~]

Great thoughtful post, Baltimoremom!

[lesmom]

I know this is an old thread, but hopefully it is still being watched.  I am also planning a homebirth with mono-di twins.  I am about 10 weeks pregnant and just found a midwife (or rather a midwife team) that is willing to attend my homebirth.  I haven't had a C-section, but my previous two children were both attended by midwives and the second was born at home in the water. 

I would love to talk about the experience of planning a homebirth with twins.