routine epidurals for twin births

[Brambleberry]

I finally got to discuss things with my FPD since finding out that we're having twins, and I was unpleasantly surprised to learn that she strongly recommends an epidural just in case we need to do a c-section quickly.  I REALLY want to avoid an emergency c/s with general anesthesia, but mostly I want to avoid a medicated birth, and feel like I'll be more likely to end up with a c/s if we start in with interventions like that.  She had never heard of just putting in an epidural catheter without the medication, but said she'd ask the anesthesiologist about it.  I'm not sure I'm willing to go that route anyways, assuming I don't have complications, since it would feel like a very disruptive intervention in what should be a natural process.  She answered positively to my other concerns, saying I could labor in the jacuzzi with only intermittent monitoring, deliver in the LDR room as long as both twins are vertex (She'd want me in the operating room if the second was breech, and won't deliver the first breech at all).  She was supportive with the natural birth of my first baby, and I don't think she'll INSIST on the epidural if I flat out refuse, but I'm really disappointed.

Does anyone have statistics on how often an attempted vaginal birth of twins ends in emergency c/s?  I've seen plenty of distressing stats on how many twins are delivered by c/s, but nothing about how likely an emergency one is.  Also, is it unreasonable for me to expect to be able to tolerate the manual manipulation of a breech baby B without an epidural?  I have a pretty high pain tolerance. 

My other option is a naturally minded OB an hour north of us who is the backup for all the (illegally operating) midwives in the area.  I hate to count on delivering an hour away from home in February, but he's a visiting specialist at our local hospital and I wouldn't have to travel for the prenatals at least, since he comes down here once a week for that sort of thing.

[Adaline'sMama]

Originally Posted by Brambleberry 
 Also, is it unreasonable for me to expect to be able to tolerate the manual manipulation of a breech baby B without an epidural?  I have a pretty high pain tolerance. 

My other option is a naturally minded OB an hour north of us who is the backup for all the (illegally operating) midwives in the area.  I hate to count on delivering an hour away from home in February, but he's a visiting specialist at our local hospital and I wouldn't have to travel for the prenatals at least, since he comes down here once a week for that sort of thing.

I'm really interested to hear from ladies who have had the manual manipulation done as well. My OB says I can handle it, so Im going with that for now but I do wonder....

Does the place an hour north of you have a NICU? Or one close by? 

[Brambleberry]

Originally Posted by Adaline'sMama 

Does the place an hour north of you have a NICU? Or one close by? 

No.  It's Bloomington, which is a big university town - so definitely a higher level hospital than ours, but no NICU.  The closest to there would be Indianapolis, which is two hours from us, so we'd have to make a special request to get the babies flown to Louisville if an emergency came up.  So unfortunately it wouldn't work for me to deliver there if I go into PTL.

[ziursrm]

Well the c/s rate with twins, emergency or otherwise, is going to vary a lot from doc to doc, hospital to hospital etc. It honestly sounds like you would be happier with the other doc, despite the drive. Intervening in advance to make a theoretical emergency easier raises red flags in my book about her philosophy of care.

On a second note. When you are talking about manipulation of a breech one are you talking about doing a version while in labor after the first is born? If that's the case I have to say I'm just not a fan of the process. It's really uneccesay as the first baby paves the way and would discuss on length with doc about the pros and cons of a breech birth. My oldest singleton was breech and at 7lb 6oz he was much larger than most twins. Breech should not be demonized and is more normal than manually manipulating a baby that is not showing distress or lack of progress. Food for thought.

Good job seeking out the best options for your twin birth in your area and advocating for yourself.

[SusannahR]

I don't know about statistics, but this is my story.  It might help.  My OB greatly encouraged me to have an epidural for the same reasons you stated.  I really did not want to be knocked out in case of a emergency c-section, so I decided to have one.  For some reason the medication did not effect the left side of my body, so one half of me was still in a lot of pain.  So they increased the amount until it worked on my left side as well.  Unfortunately this made my right leg so numb it might as well have been cut off.  I hated it, and would have much rather dealt with the pain.  I think being so numb effected my ability to push, as I pushed for an hour and 30 mn. before my son, baby "A" was born.  After he was born, they could not find my daughter, baby "B", heartbeat.  When they finally did find it, it was very low and sinking rapidly.  They used suction to help pull her down, and told me to push with everything I had.  I kept asking for them to turn off the epidural, because I felt like I would be able to push better if I could just feel.  The Dr. looked like it was the first time she had ever had any one ask that!  After dd moved down into the birth canal, her HB picked up and she was fine; just a little blue.  After she was out, my OB said the reason she didn't do an emergency section, was because by the time they got me prepped for surgery, it was quicker to get her out the way they did.  And I was already in the OR.  If I had to do it over again, I would have taken the risk of having to be under general anesthesia in case of an emergency c-section, and not have an epidural.  Once they hook you up, whether or not you get the meds right away, you are tied down.  You can not get up and walk because you have a giant needle in your back.  You also get pumped with so much fluid, you swell like a balloon.  There is no way to know how you or your babies will react to the medication.   Every one else I know says they loved having an epidural, but I hated it, and will never ever have one again. 

[mamacolleen]

Hi there. I'm 35 weeks with twins and have been told the same thing about the epidural, right from the beginning, with the same reasons: to avoid general anesthesia in case of emergency c/s and in case there needs to be some manual manipulation of baby B. I really waffled a lot on how much I want to fight against the epidural. I have shared care with a midwife and an OB and I know my midwife will be a huge advocate for my informed choice of interventions, no matter what the hospital/OB policy is.

I have recently decided that I will likely have the epidural. I had an unplanned (not true emergency) c/s with my DD after 52 hours of labour and so this will be a VBAC (thankfully baby A is vertex!) and honestly, the only way that c/s could have been worse is if I had been under general and DH wasn't with me and neither of us got to see DD until it was all done. Seriously the thought gives me nightmares. I anticipate that a true emergency c/s is unlikely to happen with these two but for me even the slight risk isn't worth it. Emotional recovery from my previous c/s took a very long time and definitely interfered with my early bonding with DD and I think it would be worse if I was under general. Having said that, I am going to fight against having an epidural placed as soon as I walk in the door, which is what some of the nurses/residents have advised during my prenatal appts with the OB. I plan to wait until I get well into active labour and at least 6 cm so that I can be up walking as much as possible in the beginning to help baby A get in the right position. Luckily my midwife supports this plan.

I don't know how helpful that answer is to your thought process of working out the epidural question. I know it's totally possible to deliver twins naturally without medication and lots of women have. If I didn't have the c/s history, I think I would be less likely want an epidural "just in case".
 

[~Adorkable~]

remember that i think they are just talking about having it in place, but it does not have to be turned on, the numbing happens super quick, its placing it that takes a while. so although i personally would not want one "just in case" because of how it restricts your movement and how placing it can cause pain and stress, i would have it in and not turned on if i had to take that step. (or possibly they need to pump one dose thru to make sure it works and then you can let it wear off, it takes about 30 min.)

in my twin birth, i ended up getting an super light epi because after 30 hours of which the last 20 was stalled from Mag (given to avoid high BP related seizures) we decided for some Pit to counteract the stalling of the Mag (yeah how about that for a cascade effect?!)  anyway i got it put in, then shocked the doc by kicking everyone out of my room and took a 2 hour nap, at 8 cm!

then had it turned off and about 40 min later when i could feel everything again i pushed both babies out in 16 min and it rocked.

did it suck to still have wires running into my back, yes, but it was not the worse thing, frankly the IV bothered me more becasue it was in a bad spot and the bruised me badly on the first attempt to place it. (hit a valve!), as did the restrictions the MAG placed on me (they apparently have some ladies get really dizzy on it, so they dont like you being where you can fall, i had no side effects, so it was just silly and annoying.  ]

so in the end i had Mag and Pit in me, finally canceling each other out and labored pretty much normally from there and was in full control and amazing sensation for th birth itself.  could have been a lot better, could have been a huge shit ton worse. (fyi i was in a normal L&D room for all of it)

[Adaline'sMama]

If somebody's gonna stick something like that in my back, they damn well better turn the drugs on :)

I'm pretty anti-epidural, mainly for the reason that it limits movement, meaning that it will be difficult to control the pain on your own, making the request for drugs so, so much easier. I am serious, if someone is going to poke a huge hole in my back, I want them to at least make my pain better. 

[mylilmonkeys]

I can speak to the manual manipulation without an epidural.  I had both an external version and then a full "fetal" extraction with twin B at home, where I delivered B's entire body along with the midwife's arm behind her butt.  The worst part about the version was lying on my back.  I never do this in labor (after my first) because it is excruciating for me.  But others do not have the same reaction.  However, the baby ended up jack-knifed with both head and feet at the cervix, plus both placentas had come down over the cervix as my uterus shrunk after A was born.  By the grace of God everyone ended up healthy after rescue breaths.  Mamas are built to do what needs to be done.  Obviously the fear and worry were far more memorable than the pain of the extraction.  I was so focused on getting her out that the pain hardly even registered.  Had this happened in a hospital, very little would have been different.  There was no time for placing an epi, or prepping for C.  Our backup OB delivers vaginal twins all the time, and would have made the same breech management choices as our midwife that led up to the problem, but I wonder what her impulse would have been with recourse to surgery right there.  In fact, had they made the choice for surgery, likely our sweet girl wouldn't have made it.  She was born with a 2 apgar.  It was worse after the fact, as I felt like I had been beaten up from the inside.  It took a few weeks for that to heal.

[Adaline'sMama]

Speaking to the manual manipulation, it hurt like a b*tch. But, it was fast. While it was happening, I wished for drugs. Afterwards, I was glad I didnt get them, but oh it really hurt. A lot. 

[13pumpkins]

Originally Posted by SusannahR 

I don't know about statistics, but this is my story.  It might help.  ....   Every one else I know says they loved having an epidural, but I hated it, and will never ever have one again. 

I second this.  I have had three types of birth and hands down, I would rather do the emergency c-section again than the epidural.  And that is saying a lot.  I hated the c-section and it caused SO much angst the entire pregnancy for me.  And then the morning came that I went into labor.  Between waking up and the OR I had about 8-10 contractions.  The babies were coming so fast, I showed up to the hospital very progressed, my water broke, and Baby A started coming down the birth canal (I remember the nurse begging me to not push).  Everything was going so wild, unplanned, and fast that the choice to put me under was made right in the OR.  There just was not enough time otherwise.

I've gone over it again and again and I don't think I'd ever be okay with epidural/c-section.  And yet, as much as I dislike c-sections, I accept my emergency one.  Being there, it was what was needed to be done with the absence of all the information on babies' wellbeing (there was not enough time to even monitor them)...and it turned out two babies had flipped breech when the previous week all three were head down.  I felt that without the spinal, I also was up and around much faster post c-section.  I think if I was given the option, I would still prefer to forgo the epidural even if it meant that if a labor would end up as a c-section it would be an emergency one under general anesthesia.  Perhaps also because I kinda feel strongly that is what a c-section should be for, an emergency.

Also, I guess I ought to point out that I had triplets.  If it was twins and one was engaged in the birth canal, that would be one thing.  However, with triplets (as our OB discussed with us and as we researched) there has to be a certain arrangement for them to safely consider vaginal birth.  I struggled with this up until the day I had them because the idea of a c-section was upsetting.  But when they were coming so quickly and we had no idea how they were lined up, it was terrifying.  If only Baby B had flipped breech, she could have gotten her chin locked with Baby C...just so much unknown and such a fast labor there was not time to make any other choice.

[Katie063008]

Okay so I just wanted to toss out there that I didn't hate the epidural. The first time I had one with my DD1 it sucked.  They put it in really early and it interfered with pushing. With the twins the doctors in my hospital really didn't want to deliver twins vaginally.  The on call OB that day had never delivered twins vaginally. They only agreed to go with the midwives and me delivering without surgery and not in the OR if I agreed to an epidural. Frankly, I was so happy that they didn't insist on surgery that I said to go right ahead with the epidural. It hurt, but it was low dose and I was already 9.5 cm when they put it in.  So the twins were born just after it was in.  The insertion is no fun and you do have to lie down after but my twins were born so soon after I didn't notice  It was even kind of nice because there was not so much pain. Just to put it in context though: my water broke at 5 am, drove to hospital and got put in observation with mild contractions and 4cm. The nurse checked me a few times and then the contractions started like crazy. The next time she checked me I was 9cm so they quickly took me down to L&D room discussed how to proceed with OB and then insisted on Epidural.  The twins were born at 9:00am and 9:15