Mono-di natural twin birthing stories. Please, please, please share!!

[Gindugirl]

Hi, I'm 28 weeks preg with mono-di twin boys.  I've been feeling very anxious lately with all the talk from my peri of having to induce, needing an IV, possible C-section, delivering in the OR, yada yada yada.  He supports my want for a natural birth and has even said he's done them before and will deliver baby B breech if need be.  But he also feels the need to constantly remind me what he recommends, which is often different than what I want.  He ends the conversation with, "it's your choice," so I really appreciate that.  But I've still been getting quite anxious as I'm moving into the third trimester.

I'm in some serious need of positive vaginal birth stories of mono- di twins. And are there any ladies out there who were induced, but were still able to labor without an epidural?  And what form of induction did you use?  This is a big concern of mine.  I want to know that if I had to be induced, do the contractions become unbearable?  I had a totally natural birth with my DD, but I had no intervention whatsoever and while the contractions (birthing waves as we call them in hypno birthing :) were manageable, I wonder if they were stronger b/c of an induction, could I do it again??  Thanks so much!

[~Adorkable~]

first of a big double congrats and a welcome to Mothering.Com!!

i think a lot of your issues will be affected by placentas and positioning and the like, forgive me with not knowing all the combos of mono, Di, do your two share  placenta? it was my assumption that they dont, but there may variations. i assume they share a chorion sac but each have their own amnion sac, correct?

i think in general you sound like you have heard the same things that are told to most twin pregnancies, even DI/Di ones like mine.

so i can tell you what i found about each one in my case and some good questions to ask.

induction:

  first of all you should ask why and at what point would he want to induce and if he blames hospital policy i would ask to see where that is written down.  just going full term or even a bit over is not in itself a medical issue, there are some issues that can come up but decisions should be based on those, not the date on the calendar.  if he regularly induces at 37 or 38 weeks, i feel he is a bit nuts and i would just ask for regular NST to calm him and let you go longer. if it is that the policy is not to let you go over 40 or 42 weeks you can be pretty assured that you won't likely get to that but also talk about the what and they why in that case too.

now if they push to induce you because of something they found in a scan or NST there are ways to make that go way smoother, think you can do at home and ways for them to do things slow, so i would look into that just so you know.  most of it involved making sure your cervix is ripe and soft so that the inception is not fighting agaist it and causing it stress and swelling.  

you can also choose your own timeframe, and often women who are near term only need the tiniest of nudges to start their own labor, so something could be used to kickstart, but not be used continuously and there for not affect your contraction thru out.

i started as a natural labor (35w6d) but because of extremely high BP that popped up at the last minute (7 hours into a blissful labor) i was put on Magnesium to safeguard from seizures, sadly that drug also stops labors a lot, so 20 hours later i was given a small about of Pit to balance its effect out.  i can tell you that the natural cnx and the pit cnx where like night and day, the former feeling pretty healthily and functional and the later feeling really aggressive, but that was me, your experience key be very different.  i had been trhu hypnobabies and my dual was my instructor, so it was nice to have someone trained in that plus experienced in the ways of hospitals to help me balance out the two.

 so after 30 hours i got the lightest epidural i could get, used it to take a nap and let the pit get things rolling then turned off everything and waited till i was no longer numb and then worked on my own to get to pushing and 2 hours later i blissful had my twins within 14 mines of each other!   my placentas were completely fused and caused no issues what so ever, but they were two different placentas.

[Gindugirl]

Adorkable- Thanks for that story! So question?  Had you been having problems with BP before, or did it just spring up while you were in labor?  Were you eating/drinking during labor or on IV?  And did they make you deliver in an OR?  

I am mono-di with one placenta, same chorion sac and very thin membrane between them.  The one placenta is the main issue.  Most Peri's are now recommending induction by 36 weeks! Yes, 36 weeks.  I did my research and apparently this comes from a study that says after 36 weeks (in only mono-di, one placenta twins) the rate of still birth increases.  But I read the study and I didn't find it so super compelling that all MFM doctors should jump on the 36 weeks band wagon.  With the absence of an emergency, my doc is willing to push it longer, but like I said, he loves to remind me that this wouldn't be his recommendation.  There are still a lot of docs out there who aren't even willing to vaginally deliver mono-di twins...at all! 

[rinap]

With my mono-di twins, I went off bed rest at 35 and a half weeks, and we did a lot of walking and acupuncture and talking to encourage them to come. After having read the study referenced elsewhere, we had decided that it was best for them to be born by 37 weeks.

We had done a lot of talking and negotiating with our doctor ahead of time for the most natural possible birth.

A few days before the birth, we drove out to the coast and spent some time on the beach. I went into labor on the way back, settled down for some sleep planning to head to the hospital later that night, and labor stopped.

At 36 weeks 1 day, we checked into the hospital to induce. They induced with cervadril at 11PM. By 4AM, I was in serious labor. We got them to do periodic external monitoring, and between monitoring sessions we walked and walked. For the most part, the nurse hung out while I spent time with my husband and my doula. We used a birthing ball and lots and lots of walking and some hanging out in the shower. (there wasn't a tub in the hospital). It was intense, but with the help of my husband and our doula, and the warm water, manageable. At 10 centimeters, after a bit of pushing, we transferred to the OR, and I got an epidural placed (just in case of issues). Then, after some pushing, our first daughter was born just after two in the afternoon. Nine minutes later, her sister joined her and we snuggled for a few minutes before they went with their father to be checked out in the NICU while I got some stitches.

We all rejoined back in the room for some nursing and the four of us were able to bond.

At 36 weeks, the girls had some latch issues, but were mature enough to come home with us two days later, and they got only my milk until we started solids at nearly seven months. (by three months it was exclusively by breastfeeding)

[mamalovex3]

My first set of twins were mono-di.  I started with a midwife but ended up with the high-risk clinic at the hospital due to a short cervix at 24 weeks.  From 24 weeks on, I celebrated every week I carried those babies, and imagine my surprise when we hit 37 weeks and my doctor wanted to hand them an eviction notice?  I can't believe that we work so hard to get full term big health babies only to force them out on these arbitrary timelines!  They scheduled an induction at 38 weeks and as it approached I knew I wasn't ready and I didn't feel that it was necessary.  I talked with my midwife and with the doctor and really found no good reason to induce.  Their "reason" was that the placenta "could" start to deteriorate. We went in for an ultrasound instead and found that both babies were still growing, and healthy and they agreed to push it back another week.  

I did not want to be induced, as I feel that one intervention opens the door for more interventions...so my midwife offered to check me and I was already 4 cm.  She did a stretch and sweep and I started using Evening Primrose Oil.  I started walking and had lots of sex (!!) to get the babies going!  I ended up going into labour on my own at 38w2d.  I woke with what I thought might be contractions at 6am, arrived at the hospital at 8:45am, fully dilated, and had my first daughter at 9:36am, vaginally with no drugs.  Her sister was born 20 minutes later.  We were in an OR, and they had started to place an IV that I did not agree to but it wasn't attached to anything until after the girls were born.  

Bottom line: they can't MAKE you do anything but you do have to be willing (to some degree) to work with them if you want to deliver in the hospital.  I think 36 weeks is ridiculous to induce if there is no medical reason to.    I've met many other twin mamas who carried their babies to at least 38 weeks, and it has made all the difference in their health, ability to breastfeed, etc.  In the end, it's really up to you, even your doctor said - it's your choice.  As long as it's an informed choice (and you certainly sound like you are informing yourself and doing your research) then have confidence in what you decide.  This is your body and your babies after all. 

[~Adorkable~]

Originally Posted by Gindugirl 

Adorkable- Thanks for that story! So question?  Had you been having problems with BP before, or did it just spring up while you were in labor?  Were you eating/drinking during labor or on IV?  And did they make you deliver in an OR?  

I am mono-di with one placenta, same chorion sac and very thin membrane between them.  The one placenta is the main issue.  Most Peri's are now recommending induction by 36 weeks! Yes, 36 weeks.  I did my research and apparently this comes from a study that says after 36 weeks (in only mono-di, one placenta twins) the rate of still birth increases.  But I read the study and I didn't find it so super compelling that all MFM doctors should jump on the 36 weeks band wagon.  With the absence of an emergency, my doc is willing to push it longer, but like I said, he loves to remind me that this wouldn't be his recommendation.  There are still a lot of docs out there who aren't even willing to vaginally deliver mono-di twins...at all! 

so i did have two placentas, though they were fused i understand that you are in a different pregnancy than i was.

the question that i would ask in your position is if the worse outcomes where due to some identifiable issue that was popping up for these Mo/di mothers, and if whiteout that particular issue if the still birth rate is still higher. (example, if they take out cases of TTTS and growth restriction and drastically different sizes for instance, does that then make the numbers just the same as for di/di twins?) they may not even know this because they may have not crunched the number like that. but i think it would be the most important thing to look at.  also i like to see actually number and not talk in terms if "doubled, or "significant rise"  but cause it may actually mean that normality it happens to 1 pregnancy in 1000 and doubled it is 2 in 1000. not if that 1 or 2 is you then it is 100% horrible, but if we applied that standard to everything we would be neurotic piles if fear and couldn't even stand pregnancy.

for instance if you look at twin pregnancies as a whole you see that they have a higher rate of plenty of complications hand bad outcomes. but if you take out the ones that had uncontrolled GD and pre E you drop the numbers to way way better! so if you dont have either of those things there is no point in using numbers that include them to make descisions.

so i liked to base things on what actual issues i had (very little) rather than what i could possible have by just having twins.

as for your question about my birth,

i had no BP issues before labor at all, my BP was 125-130 over 70-80 the whole time, actually went down a tad from my BP at conception and stayed low till like i mentioned many hours into labor.  i felt fine, but did have some strange sense that something was up and that is what caused me to go to the hospital. it was 185/150 or something similar and my urine test showed massive dumping of kidney and liver stuff. i had clearly gotten a rapid onset of pre E or the like, they never actually called it that. (i had a moderate case of cholestasis the last few weeks which was actually my only "significant" health issue, and could have been causing the urine issues)

i was told not to eat and did not listen to them at all, i had protein drink and juice whenever my hubby would bring them to me and didn't care. if i truly needed up in a emergency c section i would probably be intubated anyway so aspiration is really not that bad of a concern as they make it out to be, my DH is a medic and has worked in ERs a lot and reminded me that millions of emergency surgeries happen every day when folks have full stomachs, and millions of ladies come in and have unplanned c sections within hours of eating and are fine.  there was no way i was going 33 hours without food, it is the stupidest thing i have ever heard.  i went into labor basically during christmas dinner and yes i picked it up and 4 in the morning, who cares. i never puked again, despite the snacks.

i was on a iv because i was on a drip of Magnesium Sulfate to protect against sessions and occasional doses of something to attempt to lower my BP (that did not go down till 4 days PP)  i will say that was the most annoying thing, it was not the IV itself, though i didn't like it, but that most ladies feel unstable on MAg so thy dont let you stand up at all, and i felt totally fine and they didn't care, so i had to pee bedside (they want to cath me to told them off.) and i could not pace around.

i didn to labor or deliver in the OR it was the line i nthe sand i drew and stuck to, i have written about it in other threads, i gave them the burden of proof to explain why it was so much better and i held the position that they could get me down the hall way faster than they could get the ten in the OR to cut me open, so i was not the slowest fact being in a normal L&D room.  they agreed to my points and left me be.

i did a lot of negotiating and held strong to the belief that getting one thing done did not been automatically letting the next thing happen, it was a great proactive in halting a cascade and making each choice separately and without default acceptance.

i hate terms like "make you" and let you" they get used all the time, we and our babies are the clients, not animals to be pushed around, remember that you and your birth have rights and deserve respect. this does not mean you have to fight them, but it does mean you get to be heard and feel free to pick you battles and put the burden on proof on them. default is a natural birth, they rest they need to prove is actually better, not the other way around. emergencies happen and medical care is there for a reason, but its not one size fits all, no matter what your babies are like.

[rinap]

Originally Posted by ~Adorkable~ 

i did a lot of negotiating and held strong to the belief that getting one thing done did not been automatically letting the next thing happen, it was a great proactive in halting a cascade and making each choice separately and without default acceptance.

This is very important to remember. And to talk to your husband about. And to remind your care providers of if necessary.

[Gindugirl]

Wow!  Rinap, Mamalove, Adorkable....You ladies are really amazing!  I can't tell you how much I appreciate well informed, conscious mamas, who are so proactive in the decisions affecting their labor.  Thank you for your stories! They are very inspiring to me and truly mean a lot.  As I've scanned the internet, blogs, studies, etc, I've been getting so discouraged.  It's easy to forget that we're the clients and are hiring THEM (the doctors and hospital) and therefore have power in the decisions being made.  

Adorkable-  your story is fascinating.  When I delivered my DD, the hospital also tried to keep me from eating and drinking.  I ignored them as well.  Other than that, they really left me alone and respected my birth preferences totally.  But that was in Los Angeles, which I discovered is more open to alternative birthing methods in general, than I've found here in NYC.  Everyone seems to be more skeptical here. That and the fact that the minute I was "diagnosed" with mono-di twins, they acted as though I will surely die, along with my babies, if I don't follow everything they say.  Did you deliver in the States?  I'm impressed you got your doctor to allow you to deliver in L&D.  I'm going to see what my hospital's actual policy is about that and see if I can do the same thing.  How did your doctor react to you in general?  When you asked for these things, was he respectful and impressed?  Or did you feel you were waging a "battle" so to speak?  Sorry so many questions, but I am very interested.  

[~Adorkable~]

its going to take a day or two for me to write more, traveling tomorrow, i will write though

[Yourobgyn]

You should have an honest discussion with your OB about risks vs benefits of your plan. Twins can be delivered naturally but most MDs do not want to take an unnecessary chance. Trust me, your doc is documenting all over your chart that you're assuming risks based on your birth plan. At the end of the day, you want 2 healthy, beautiful babies. As a board certified OB and a published author, I felt compelled to tell share this info with you. Best of luck with your pregnancy.

[mylilmonkeys]

Originally Posted by Yourobgyn 

You should have an honest discussion with your OB about risks vs benefits of your plan. Twins can be delivered naturally but most MDs do not want to take an unnecessary chance. Trust me, your doc is documenting all over your chart that you're assuming risks based on your birth plan. At the end of the day, you want 2 healthy, beautiful babies. As a board certified OB and a published author, I felt compelled to tell share this info with you. Best of luck with your pregnancy.

On the other hand, premature delivery offers no risks at all.  </sarcasm>   

[~Adorkable~]

yourobgyn, i want to welcome you to mothering.com   

you may want to do some reading around here to get the general tone before posting too much more, I'm guessing ladies here would read a bit into your post that you may or may not have meant. I was a bit bothered by it personally, and while it is certainly not your job to only post things that make me happy, you will be more helpful is your thoughts are received clearly.

Originally Posted by Yourobgyn 
You should have an honest discussion with your OB about risks vs benefits of your plan. Twins can be delivered naturally but most MDs do not want to take an unnecessary chance.

i think that one of the first breakdowns a lot of ladies seem to have is not feeling like our OBs are having a honest discussion with us, instead they tend to give you the info that gets you to make the choice they feel is best. what we simply want is all the info so that we can understand what the best discussion is for us personally, in our unique pregnancy.

and since every medical choice comes with pros and cons they are often trading con for another. 

Originally Posted by Yourobgyn 
Trust me, your doc is documenting all over your chart that you're assuming risks based on your birth plan.

this sounds a lot like a threat and fear mongering to get a women to "fall into line" and "do as she is told" i take total office to the idea that this is ok or that it should affect the medical choices i make with my body and my babies, period.

Originally Posted by Yourobgyn 
At the end of the day, you want 2 healthy, beautiful babies.

 

At the end of the day we want the medical people that have agreed to care for us to actually care for us and respect that we have a right and belong in the decision making process.  When we get that we will me most likely to get a healthy outcome to our births and those beautiful babies we have nurtured into this world.

Originally Posted by Yourobgyn 
As a board certified OB and a published author, I felt compelled to tell share this info with you. Best of luck with your pregnancy.

thank you for sharing your side of things

[Gindugirl]

Yourobgyn- I'm actually glad you posted b/c it really highlights the exact debate that takes place at every one of my doctor's appointments.  You and all of our OB's obviously mean well.  They/you are trained to identify problems before they happen and do everything in your power to prevent these problems from having horrible consequences.  Western medicine tends to focus on treating and avoiding catastrophic events.  So most doctors are trained to always think in terms of 'how can I fix this and make sure there are no problems.'  The issue I have with this, is it automatically places a very natural, age old occurrence (pregnancy), and makes it like a disease that needs to be "treated."  And because we're dealing with babies, any negative consequence in one clinical trial, or for one doctor, sounds the alarms to such an extent, what was once natural and normal, gets turned into something that should be feared.  Case in point- breech deliveries.  30 years ago babies who were presenting breech were considered another form of normal (in terms of position).  All doctors were trained in delivering babies breech.  It wasn't an issue, or even thought about.  Even my grandfather, who was a GP, not an OB, delivered over a dozen babies breech. But of course, life is precarious and there will always be risks to any procedure.  C-sections seemed to mitigate that risk, all while shortening the time an OB had to stay with a patient, and ultimately giving a lot more money to hospitals, doctors and insurance companies.  It seemed like the quick fix savior and don't get me wrong, I know it has saved countless lives.  I don't chastise Western medicine; for when it's necessary, I certainly would want to be in the hands of an OB who is a skilled surgeon. I just take issue with doctors treating all mothers under one model, where they start making decisions based only on their need to avoid lawsuits, adhere to hospital policy, or just fall in line.  And back to the point of breech, it really sucked having to search for weeks and weeks, in NYC, to find a doctor willing to perform a breech delivery.  That was shocking and disheartening.  Most doctors now are not ever trained to deliver breech.  So soon it will be a totally lost art and skill; and that is sad.  Is this really what's best for women and their babies??

I agree with ADORKABLE, honest discussions are definitely not happening in our appointments, because as a patient, you always feel like you're battling an entire institution.  The doctor often is condescending and looks at you like, YOU'RE (a mother who has no training in the medical field) gonna tell ME (doctor who went through medical school, residency, etc) that I may not be doing the right thing?!  They do NOT like to be questioned.  Even the nicest doctors, who are incredibly open (which I consider mine to be) raise eyebrows at me when I start siting studies, and research I've done.  I come from a family of doctors, so I really see both sides.  Not all women want to be this proactive in their births.  I have talked to many women who prefer for a doctor to just tell them what to do and they do it; and they're fine with that.  That's great, but there is a growing group (as you see on this website) of women who want to be more involved with the decisions affecting their bodies and their babies.  It is imperative for us to be looked at as equals in this decision making.  We want our voice to be heard and respected.  The debate is great and should always be there, so thank you for posting your opinion because that's how we have honest dialogue.  I wish more OB's posted on this site, I think that would create great and much needed conversations all around.

[DiannaK]

Originally Posted by Gindugirl 

Hi, I'm 28 weeks preg with mono-di twin boys.  I've been feeling very anxious lately with all the talk from my peri of having to induce, needing an IV, possible C-section, delivering in the OR, yada yada yada.  He supports my want for a natural birth and has even said he's done them before and will deliver baby B breech if need be.  But he also feels the need to constantly remind me what he recommends, which is often different than what I want.  He ends the conversation with, "it's your choice," so I really appreciate that.  But I've still been getting quite anxious as I'm moving into the third trimester.

I'm in some serious need of positive vaginal birth stories of mono- di twins. And are there any ladies out there who were induced, but were still able to labor without an epidural?  And what form of induction did you use?  This is a big concern of mine.  I want to know that if I had to be induced, do the contractions become unbearable?  I had a totally natural birth with my DD, but I had no intervention whatsoever and while the contractions (birthing waves as we call them in hypno birthing :) were manageable, I wonder if they were stronger b/c of an induction, could I do it again??  Thanks so much!

Congratulations! My twin boys are 4 (WOW!) and these ladies here saved my sanity so many times during my pregnancy. 

I delivered my boys naturally, with Baby B being a breech extraction -- I'll link you up to my blog. 

[Gindugirl]

Ah, DiannaK, I read your blog!  Thank you so much!  What an awesome birth story!  I am truly hoping I have a similar outcome.  But I'm also trying to make sure they allow my husband to hold baby A skin to skin while I push baby B.  And I want them on me right away, not cleaned up.  I hope the nurses let that happen.  Oh boy, it's getting close and people like you give me hope!  Thank you!

oh and how many weeks were you when you went into labor?

[anonymous5]

I live in the triangle area of NC. Where can I give birth to my mono-di twins vaginally? Everywhere I call, they seem to be telling me that I'm going to have to have a cesarean! I really don't want to have a cesarean. I want to have more babies after this. This is my first pregnancy.

[bethunc04]

Anonymous5- it's been a while since you posted this, so hopefully you have gotten some good results. The two places I would check are UNC and Duke. I am in your same situation & will be talking to my peri next week to see what they say about delivering mono-di twins vaginally (I'm 31.5 weeks). Thing is, my regular OB is the one delivering me at Rex, not the peri, so I'm a little concerned that even if the peri was on board with the idea, the OBs at my office & the hospital won't necessarily have the knowledge/ability/willingness to do it. 

& everyone else, thanks for all the info!