Please help...about to deliver twins and I'm terrified....

[Ahappymel]

Hi all,

Thanks in advance for reading and any/all input.

I am week 36, day 4 pregnant with twin boys.  My presenting boy is head down. My 2nd baby boy is breech and is actually in a bit of a transverse lie, facing OUTWARD (posterior) like he's "lying on a beach blanket" according to the ultrasound tech. I am the beach blanket, evidently.

This will be my third delivery. My first was hospital born vaginally, my 2nd was homeborn and I've been on the fence in "wait and see" mode this whole pregnancy for the twins.

I have been receiving concurrent care from Kaiser and my midwives. They've been very sweet and supportive and told my family that they are willing to take small payments forever if I want to deliver at home. The contract rate they worked out for me is not much more than what I'd have to pay a single midwife.

I've done so much research this whole pregnancy. I interviewed a LOT of midwives, asked a lot of questions of the Kaiser doctors and combed the internet. I realize that homebirth of twins is uncommon and carries more risks with it.

At my Kaiser appt yesterday, the doctor scheduled a c-section for 12/28/11 (which puts me at week 38 1/2) based on the position of my 2nd twin. After he left the exam room, the nurse told me it was the right thing to do based on that twin's position, that he wasn't going to turn. I responded, "You mean no one here at Kaiser will try to turn him" (I've been told repeatedly that Kaiser will not do external versions, internal version or breech births. That it is extremely RARE for such births to happen there). The nurse said, "It's dangerous!  Do you want to end up with a dead baby?"

I left in tears and in a lot of fear. We've been hoping for homebirth...trying to have faith that it's the first twins position that really matters...and he is head down. We want to have faith he will pave the way for his brother and that the 2nd baby will turn head down or breech once his brother is out to be born. My midwives have been reassuring me that this is the normal process and although things could go wrong, in likelihood, the 2nd twin will know what to do once his brother is out. And if he needs help, they can try and turn him.

So yesterday, I communicated with both midwives again and both told me they've never actually done versions in labor. One of them has done external version many times prior to onset of labor.

Oh dear lord, I am so scared and confused and want to make the best choice for my babies, myself and my whole family.

I am just praying, hoping for clarity/peace to come and it hasn't in this pregnancy. I'm almost at delivery here and just don't know what to do......

Mel.

[ThankfulMama]

No advice, just wanted to offer and best wishes.

[Ellie'sMom]

Oh Mama. I only have a minute, but I had to reply. I had my twin boys at home. My baby A was head down forever, but baby B was flip flopping almost until the end. Even many OBs will let you deliver vaginally if the first baby is head down. I have no idea how that nurse would know what your baby is going to do in labor! Can you speak to some other providers at Kaiser to see if there is anyone who would give you a trial of labor as long as the first baby is head down? I saw both a family practice doc and a perinatalogist for shadow care and they were both willing to do this, though the stipulation was that I had to be in the OR with an epidural in place. The thinking is that the epidural would make either a version or, if necessary, a c-section, less traumatic. It's not ideal. but it might be preferable to an elective section. 

As far as a homebirth goes, how many sets of twins have your midwives attended? That would be important to me. Also, do they have breech experience should the baby turn from transverse to frank or footling breech? My midwife was comfortable delivering the second baby butt or feet first if necessary. How close are you to a hospital? If you had to transfer to birth the second baby would it take you a long time to get there? 

I think external versions during pregnancy are pretty rare with twins. I can't imagine how hard it would be! Have you tried other things to help him turn? Once the first baby is out, my backup OB made it sound like encouraging the second baby to spin was a definite possibility. 

I wish I had more words of wisdom, but I really wish you the best! Remember that you do not have to go to the scheduled c section at 38.5. My boys were born at 40+2. 

Big hugs!!

[lesliesara63]

I totally understand where you are coming from. I stressed about it throughout my entire triplet pregnancy! Eventually all 3 turned head down. It is standard to have a csection with triplets, but I just wanted the chance to at least have a trial of labour & deliver baby A vaginally. I was more than willing to have a section for the other 2. Baby B had turned breech just a few days before they were born. I posted my birth story in this forum, but the doc who delivered was willing to do breech extraction and everything was fine. However I did encounter negativity from some medical staff & my mother who thought that I endangered my babies. Think, pray and go with your gut. Can your midwives deliver in hospital? If I had been carrying twins that what would have happened.

[chaimom]

Originally Posted by Ahappymel 
We've been hoping for homebirth...trying to have faith that it's the first twins position that really matters...and he is head down. We want to have faith he will pave the way for his brother and that the 2nd baby will turn head down or breech once his brother is out to be born. My midwives have been reassuring me that this is the normal process and although things could go wrong, in likelihood, the 2nd twin will know what to do once his brother is out. And if he needs help, they can try and turn him.

So yesterday, I communicated with both midwives again and both told me they've never actually done versions in labor.  

I have twin boys.  Baby A was head down and Baby B was breech, and I was under the care of a Kaiser perinatologist for my pg, so your post really strikes a chord with me.

If it were me, I would ask myself what's the safest thing for the babies and myself, not what kind of birth do I want.  When I was facing delivery, all I cared about were healthy baby boys.  

Sorry you're so scared.  I felt that way for each of my deliveries, too.  I think that's natural.  And with twins, it's just all the more scary.  I hope you make a decision that will give you peace. 

[~bookcase~]

such a tough decision mama, when you're kind of damned if you do, damned if you don't iykwim ( there are critics both sides on everything with multiples!!!!)

i know that i would personally go with the possibility of birthing my twins naturally every time, unless there was a definite IMMEDIATE danger to one of their health by vaginal birth.

but we all make different risk assessments, and sometimes the fear is there for a good reason.

can you not negotiate in hospital, that twin A's birth be vaginal, as that is best for you both, and see what happens with twin B's position on the day?

breech is not a problem. please don't panic about little butts

mine were both breech in the end. i didn't feel fear about it - more anxiety about them being not breech!! one was actually oblique breech in labour to start out with and i told drs i wanted to give the labour time to move baby into a better position before i consented to a surgical birth.

i don't think any mother should have to decide 100% before labour

[BroodyWoodsgal]

Forum crashing here...but mama, what that nurse said to you was WRONG. You don't ever say "You don't want to end up with a dead baby, do you!?" to a pregnant woman, forget about one so close to her birthing time! - yeah, like that's exactly what you want, a dead baby. That's really what you're going for here. SHEESH!

Her opinion about your situation and birthing choices are not the gospel...there is more than enough scientific and anecdotal evidence to back your wish to try as hard as you can to have a home/hopsital/surgical birth. Any way you slice it, any opinion you look at, is going to have research you can point to, stories you can point to, etc that will support that opinion.

You have to form your OWN opinion, based on the research you've done, your past experience with birth and the advice of medical professionals you TRUST....not the callous and flippant remarks of a mean nurse. That was just mean. You DON'T say things like that to a mama who is a month away from a birth that feels more tricky to her.

For what it's worth, MY opinion, is that things sound like they could really go off without a hitch at home. You're a "proven" birther, with competent MWs who are willing to assist you at home. Baby A is head down. That's not necessary for success...but it sure paints a rosier picture. Baby B, I'd be willing to bet the farm....will turn. I've known multiple women who have delivered twins at home....and I think more of these babies came out feet or butt first than did head first.

My personal feelings and the research that I've done, leaves me not one tiny, little, insy weensy bit scared of breech birth. Like, not even a little scared. I'd deliver a breech baby at any time, any where and wouldn't feel like I was in a dangerous situation. I am of the "breech is a variation of normal" camp, though, so that is why my comfort level and ability to remain relaxed is where it is.

The ladies up thread had really good suggestions. Find out how many twin births these women have attended...that would be paramount to me in deciding if I could feel comfortable with them. Find out how many breech births they've attended. Those kind of questions will help you to make these decisions. Tell that nurse to go XYZNGYTHYN if she ever shares an opinion with you like that again.

"It's dangerous!  Do you want to end up with a dead baby?"

^mama, that is CRAAAAAZYYYY talk....can you see how crazy that was to say to you! This woman is NUTS for saying that to you. What was that, but emotional sniping and callous disregard for your feelings and situation?? She ought to be ashamed for saying that to you. I'm sorry that was said to you, you are doing the best you can and whatever way you move forward, it will be with SO much thought and care....you are capable of making this decision. You are not going to end up with anything less than perfect, healthy, happy babies and a birth story that you will feel happy to tell, because no matter what it ends up being, it will be what it needed to be, to ensure the well being, happiness and safety of all three of you.

[cristeen]

Forum crashing here - Kaiser has a complaint process in place.  Please utilize it.  That nurse was completely out of line, it was neither her place to comment on a your medical choices, nor her place to offer medical advice. 

Contact the business office for your local campus and ask for the patient advocate or about the process for making a complaint.  You don't have to have the nurse's name to do this.  Just the date and time of your appt and if you have a general physical description of her, that will be plenty.  They have records of who attended what patient, and who was on shift at that time. 

I have long regretted not filing a complaint for inappropriate things said to me by Kaiser personnel during my first pregnancy.  I got it from the NP, and the doctors both at that point though.  And almost 5 years later I'm still kicking myself for not standing up for all the pregnant women in the practice, not just myself. 

[~Adorkable~]

i want to add that last year during my twin birth (that was in a hospital mostly due to high blood pressure) went great and i was able to talk them out of doing in the OR since i just asked them really, what could happen that could not wait for me to be rolled 45 ft down the hall? they just count tell me why it was safer to be in a room where i felt uncoftable, so i stayed right were i was.

also and this is the point of me posting is that i had both babies in good position and they wanted to have their hands all over me the second the first baby slid out to make sure it stayed that way. they all talked about how much room baby B was suddenly going to have to flip all over the place. so they were very firm in keeping his path to move down as small as possible so he didn't "get lost and turn left" one nurse amusingly put it. i could literally feel him drop from top to bottom, i bet he could have flipped 4 times if he was left to his own devices

anyway being thru what i felt i would say that the second baby could always move tons, specially in the right hands. my ob mentioned that based on a deception about the weight and head circumference difference between baby a and b he decided if it is smoother to let a b deliver butt first breach or just reach in and grab both feet and help him slip out that way, but either way he was totally confident that b could be turned at least halfway around in nearly every case.

so anyone that says babies dont move during labor and birth are just plain wrong and fear mongering, to say that of twins is even more idiotic!

[aja-belly]

baby b could always turn one way or the other regardless of how they start out. that would not concern me much. it would concern me if my care providers were planning to attempt a breech extraction or internal version of baby b when they had no experience with it. it's a pretty difficult procedure.

[TiredX2]

First,   I can tell you are reallly stressed out about this (with good reason).    I was confused about something:

 

Originally Posted by Ahappymel 

At my Kaiser appt yesterday, the doctor scheduled a c-section for 12/28/11 (which puts me at week 38 1/2) based on the position of my 2nd twin.

What does this mean?  Did he schedule a c-section based on the positioning of your second twin OR did he insist on it at that time because of the positioning of the 2nd twin.  What happens if you just don't show up at 38.5 weeks.  What is the arguement against a trial of labor in the hospital?  What is the arguement for inducing at 38.5 weeks assuming that both babies are still doing good--- that would give you more time.

Good luck with your decision.

[Kelly1101]

This.  Totally ridiculous to for the nurse to be so harsh with you, and a twin can totally be turned or delivered breech.  But terrifying that a midwife with no experience doing so would want to make you her test case.

Originally Posted by aja-belly 

baby b could always turn one way or the other regardless of how they start out. that would not concern me much. it would concern me if my care providers were planning to attempt a breech extraction or internal version of baby b when they had no experience with it. it's a pretty difficult procedure.

[Ahappymel]

The doc scheduled me for c-section based on the fact that my twin B is not head down.

I could just refuse to schedule a c-section and say I want a trial of labor and see how it goes....but it's been made clear that they won't attempt versions or deliver any breech babies regardless. I too am totally comfortable with twin B delivering breech. My midwives have delivered

I live literally 2 blocks from the hospital...could be at L&D in 2 minutes flat if necessary.

As for choosing the kind of birth I want, I believe in natural birth for a variety of reasons. I think it's best for mamas, best for babies. I love the Hormal Blueprint of Birth article here on Mothering and strongly agree with many theories of Michel Odent about why natural birth brings with it so many important hormones that play out into other aspects of development and life. I do realize that c-sections are there for a reason and under those circumstances, I would have one. But I'm not going to defer to a c-section just out of fear or misinformation or lack of research or because it's easier. This isn't just about "me" and wanting a vaginal birth. I want what's best for my twins too. 

As for that nurse with all of her nasty comments, I could go on and on with the things she's said (could make a new thread). Here are a few:

1) "That baby (B) has a snowball's chance in hell of coming out of your vagina."

2)"I'll bet you $100 bucks you wind up with a c-section."

3) "You can try to nurse them and Kaiser will encourage you...but just remember, the Nipple Nazis aren't going home with you."

4) The dead baby comment already referenced (which, by the way, was said in the presence of my almost 5 yr old).

I'm sure there are a few more I"m not thinking of right now....

And I do intend to report her comments....after I've delivered : )

I do appreciate all of the feedback here! 

Mel.

[TiredX2]

Wow, that nurse is really inappropriate.  I wonder what bug crawled up her ass and died.

That said:

Are there any statistics available on the chances of twin b turning after the delivery of twin a?  I would not be comfortable with planning on being the midwifes trial run of external version during labor and delivery of twins!

Is there any inducement for you to actually show up to the appointment for the c-section?  Will you be given a horrible doctor if you wait? Some other outcome?  Have you asked to schedule the c-section later at least (giving your body a better chance of going into labor naturally)?  I was under the impression that ACOG's most recent recommendations said *no* inducement/planned c-sections before 39 weeks.

[~Adorkable~]

Yeah I had forgot to add that the timmig of the scheduled c section seems totally out f line as well. If your pregnancy is going even mostly well there seems to reason to rush those babies out, I'm so sick of this. I got it with me too they wanted to induce for absolutely no reason and were shocked I would not play a long. 

Even If in the end a section is warranted, why not vaginaly birth baby a and give both you and one baby the benefits of that? And even if birthing both both babies by section is decided, then I would still wait till I went into labor and then do it. Seems like every day inside is a benifit and the labor hormones help you a lot in milk and uterus ways.

Can you go to another hospital that also takes your insurance? 

[AMothers Love]

I live in Canada so things are a bit different here but I am a mother of twins plus a singleton. My twins were born preemies at 30 weeks and were delivered by emergency c-section but I do have some friends that delivered twins vaginally. Usually the second twin had to be delivered breech and you need to watch out for hemmoraging, MUCH more common in multiple pregnancy. That all being said, if I would have made it to term and my first twin was head down for sure I would have attempted to have a vaginal birth. But honestly, as much as you may want a home birth I think you should push to do a vaginal birth IN a hospital, just to be on the safe side. Use your midwives but just be there as things can go wrong quickly for the second twin. I wouldn't allow a planned c-section at your gestation age and it's not your first pregnancy. Go with your gut. It's no fun recovering from a c-section ever, especially when you have two babies to care for. Good luck!!! (And always wake the second twin to feed. Trust me! Otherwise your whole day is screwed up and you'll never get any rest! You can stop doing that when the most demanding twin to feed starts sleeping thru the night. And invest in a sound thereapy/white noise machine and the twins shouldn't wake each other up!!)

[BroodyWoodsgal]

Originally Posted by AMothers Love 

I live in Canada so things are a bit different here but I am a mother of twins plus a singleton. My twins were born preemies at 30 weeks and were delivered by emergency c-section but I do have some friends that delivered twins vaginally. Usually the second twin had to be delivered breech and you need to watch out for hemmoraging, MUCH more common in multiple pregnancy. That all being said, if I would have made it to term and my first twin was head down for sure I would have attempted to have a vaginal birth. But honestly, as much as you may want a home birth I think you should push to do a vaginal birth IN a hospital, just to be on the safe side. Use your midwives but just be there as things can go wrong quickly for the second twin. I wouldn't allow a planned c-section at your gestation age and it's not your first pregnancy. Go with your gut. It's no fun recovering from a c-section ever, especially when you have two babies to care for. Good luck!!! (And always wake the second twin to feed. Trust me! Otherwise your whole day is screwed up and you'll never get any rest! You can stop doing that when the most demanding twin to feed starts sleeping thru the night. And invest in a sound thereapy/white noise machine and the twins shouldn't wake each other up!!)

The hospital will not allow her to do this. I think this would pretty much be the plan for her, if her providers weren't kind of buttheads about twins....they won't do vaginal for twins (or is it just because they aren't both head down?) and they won't do an external version.

[Spring Lily]

Originally Posted by Ahappymel 

At my Kaiser appt yesterday, the doctor scheduled a c-section for 12/28/11 (which puts me at week 38 1/2) based on the position of my 2nd twin. After he left the exam room, the nurse told me it was the right thing to do based on that twin's position, that he wasn't going to turn. I responded, "You mean no one here at Kaiser will try to turn him" (I've been told repeatedly that Kaiser will not do external versions, internal version or breech births. That it is extremely RARE for such births to happen there).

I'm so sorry you're going through such a difficult decision so close to the births.

Not all Kaisers have that same policy/problem with breech births. My Kaiser OB & perinatologist were supportive of me trying a natural, med-free birth as long as baby A was head-down. My baby B was flipping between transverse and breech, and it wasn't an issue. I know you're looking at this as two choices, that hospital or home, but I wanted to throw out there the possibility of speaking to some other Kaiser hospitals, if there are any near you. Maybe another hospital will have a more educated policy. At the very least, I'd call each of the OBs for your hospital to find out if any would be willing to help you deliver vaginally. Maybe it's not the hospital's policy, it's just that one doctor? Gathering all the info is really going to help you understand what your real choices are and how comfortable you are with each of them.

With them both being boys, do you know if they share a placenta and/or sac? Sharing a sac would be a major reason to go the hospital route, but if they have 2 placentas and sacs the risks are way lower. You didn't mention any risk factors, but that factors in to the decision.

Scheduling an early c-section seems unnecessary, too. If you do decide to go that route, I'd ask to have it moved back a week and a half. Even though sometimes twins do mature a little more quickly than singletons (for unknown reasons), that isn't something to bank on. Yours might need a little time. Coming early can make breastfeeding difficult which puts a lot more stress on a twinmom.

[AMothers Love]

Ok, I see. It's too bad, seems ridiculous to force someone to have major surgery when it is clearly not required.

Yes, I know they don't try to turn multiples externally as it is too risky.

[ladydodson]

mel,

i sent you a pm, but i'll quickly add here that i also live in so-cal, used kaiser concurrent care and went on to deliver both my twin girls at home, both breech...please contact me privately if you'd like to talk a bit more...im curious as to whether or not we're neighbors...my birth story can be found here...it talks a LOT about the fear i had around birthing...and how once i overcame that, it was smooth sailing all the way. xo.

http://breathbox.livejournal.com/336974.html