Twin delivery question

[JodiAriel]

We are having a hospital delivery because there is not 1 midwife (that has MD backup) in the state of CT that will do a multiples homebirth, nor will the only 1 birth center in the state allow multiple deliveries.  I am seeing a practice that is all midwives but it is hospital policy that in the case of multiple births, third stage of labor/pushing must happen in an OR because they want to be prepared for an emergency c section.  I am not happy about any of this but I am working on accepting it. That being said, these are the options that have been offered to me:

I have been told I can have an epidural placed and not turned on to be used in the event of an emergency c section or I can do nothing and risk having to be put under general anesthesia if I need an emergency c.  I don't react well to anesthesia and it takes me a long time to wake up and I feel lousy for hours-days afterward so I am really scared of the general option but I also am afraid of the epidural needle side effects (nerve damage, HA's etc).  Plus if I have it placed already I think I would be more likely to just have it turned on which I really don't want to do. 

As of now we have decided to have the epi placed and not turned on but I am still struggling with that choice.  Any thoughts?

[Gena 22]

Hmm, I would have thought CN would have more options. 

Here's my $0.02:

The OR is a pretty standard requirement.  Not that I'd like it either (it was just one of the many factors that kept me home with a MW for my twins) but it's probably not worth fighting about.

But if you're inclined to go med-free, I would strongly urge you to skip the epi catheter.  Why place it in if you may not need it?  As a first time mom, chances are you'll have plenty of warning if you need one.  Plenty of time to change your mind and go with it if you find that's what you want.  And general is an option in the dire emergencies, but unlikely to be needed.

Walking around and choosing my position was really important, and a catheter in the back doesn't sound like fun.  Labor for FTMs is hard enough.

I'd suggest you skip the catheter if you can.  And stay home as long as possible!

[mamalovex3]

The OR policy is the same here.  There is a possibility of having the first twin in a regular delivery room and then transferring to an OR for the second, but I'm not sure what our plan will be yet.  Also, none of the midwives in my city will do a homebirth for twins either...boo.

We faced the same decision regarding the epidural and did a lot of thinking and research on it.  The hospital where I gave birth had a 96% epidural rate (it was a high risk clinic) and I knew that they were going to be pushy about the epidural.  I really, really didn't want one.  So we decided to risk it and go without, knowing that if things went wrong, I would have to be put under general anesthesia.  I had a beautiful natural vaginal birth.  I think it depends on your level of comfort and your situation when you go into labour (are both babies vertex?  how dilated are you?  how are you handling the pain?  etc.)  For us, the high liklihood of having the natural birth I wanted made it worth the risk of possibly having to be put under if anything unlikely happened.

[~Adorkable~]

my hospital had the same OR policy for twins and i decided to pick that as one of my battles.

i felt strongly that being in that harsher place would be a lousy thing for me and i was already bummed enough for being in the hospital in the first place.  i was pretty impressed that i got a doc, after talking to me for a while, to agree that as long as i was vertex vertex i could stay in a normal L&D room since i pointed out that the L&D OR was about 47 feet down the hall and they could get me there faster than they could done their gloves i bet. basically i argued that my being in the next room over what not the thing that was going to slow  down the time between deciding that i needed a c section and me getting one. the rest of the prep took just as long.  they agreed, i was impressed, this was a strict old fashion military hospital.

they also did not push for a epi, i originally chose not to get one. after 20 hours on Mag Sul. for pre E level BP and then needing a light dose of pit to counter act the relaxing nature of Mag. (it is also what they give to stop PTL), i decided to get the tiniest dose of one to let me dealt with the pit and decided to take a nap (it was actually my request for a tiny dose that pissed the guy off, he said i was wasting his time not to get the full thing! i reminded him that i was the one birthing and that he could get as much of one as he wanted when it was his turn to birth a kid).

after a 2 hour nap i had them turn it off and wait for it to wear off before i started pushing. it was a bit of a pain to have in (we left it in because why not at that point) but i was not able to get up and walk anyhow because they were scared that Mag makes women pass out. so it was an easier choice since that freedom was the big one i had already lost.

in the end i pushed both babies out blissfully (pain)unmedicated and in 16 minutes for both. after a great first 7 hours of labor at home and a kinda shitty boring  20+ in the hospital, the last few hours were rocking great again. i was so happy how i not only did not get caught in too much of a cascade of intervention, but actually managed to back out of the whirlwind and continue to make healthy choices after accepting a few very needed interventions at the beginning. (1. being in the hospital in the first place, a last minute choice with the blood pressure sky rocketing and 2. getting put on Magnesium sulfate to help stave off BP related seizures) 

anyway I'm rambling, but the gist was, you might poke around and see what you can get them to agree to with the OR, and in any case remember that negotiation will get you a lot if you do it properly with a good doula or avocate by your side and with respect for all sides.

[rinap]

I had my epi placed at the very last minute, no drugs other than the test thing that makes your toes tingle. As in, they placed it in the OR after I'd been pushing in the L&D room for half an hour. This was a bit late, but the risk they were worried about was vaginal delivery for A, then C section for B, so the timing was fine. It was hard to sit still for, but I'm glad I was able to walk during the early parts of labor (which required negotiations...eventually we returned for monitoring every 20 minutes, then walked between. (or hung out in the shower between)

Talk to your doctor  *a lot* beforehand. Get a doula if you can. If you don't want the standard, as people before me have said, you can often negotiate. It helps to know exactly what they're worried about and whether there are other ways around it.

[tipper]

I admire your ability to stand up for yourself! I sure wish I had that courage when I had my first (in a hospital).