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Pregnant with Twins (or more!): Spring/Summer 2013 - Page 14

post #261 of 335

Hello all,  wanted to check in as I haven't been able to get online much lately with work being extremely busy!

 

I have some news regarding my Dr. situation, that I wanted to share my frustration and possibly get a little advice about, not I am not sure how much control I have over it...

 

When I first became pregnant, I found a midwife across the river in another state, as midwives are illegal in my state.  There are only 2 practices, each with their own hospital) that have midwives as an option.  I chose one and have been going there.  At my only ultrasound I was planning on having, we found out it was twins.  Identical twins, with most likely 1 placenta from what they could tell by it being so far along.  So I got switched to an OB in that practice.  I was very nervous with using an OB because of a very bad experience with DD's birth.  We went to the first appointment with the OB and went over all of my questions and it seemed like it was going to be okay.  We planned on having the midwife go over our birth plan with the OB and in on the delivery.  Then my OB calls out of the blue and says that I am not going to be able to delivery at that hospital or with their practice because the twins have one placenta.  I felt completely blindsided because at our appointment, the OB said the ultrasound looked fine and didn't mention anything about having to see another doctor, and she knew that they were mono/di.  So now I am back over the river in pretty much the worst state for inductions and csections for singletons, less on twins.

 

I know a lot of you gals have had csections, but I would really to like to avoid it, especially if everything is going 100% okay.  I feel like this is going to be such a battle and will have fight to be heard.  DSp isn't going to be much either because he thinks anything a doctor says is 100% the best thing to do and doesn't want to "chance" anything with the boys and thinks that I believe I know better than doctors who have gone to medical school and all of that....  But I just don't take a doctor's word as gold, just because they are a doctor.  I am worried about the number of ultrasounds, but I also know that TTTS is no joke.  What is the right thing to do?  What would be considered chancing things?  I am also worried about monitoring during labor, but then there is placental abruption.  How do balance naturally minded pregnancy/birthing with the safety of twins (mono/di)?  I am just so afraid of what I am going to be pushed into "for the health and safety of the babies."

post #262 of 335

It sounds like you're in the Louisville area?  I'm in Indiana, an hour Northwest of Louisville, and Adaline'sMama is also in the Louisville area.  I saw an MFM in Louisville for my 20 week anatomy scan - his name was Dr. Tabb - and he seemed open to some more natural options, such as delivering the second twin breech.  But he's part of a practice with 4 or 5 other doctors, and he said they wouldn't all necessarily be comfortable with that, and you have no way of knowing who's going to be on call when you deliver.  I only saw him once, since I had an uncomplicated di/di pregnancy, but I would have delivered with his practice at Norton's if I had gone into labor before 32 weeks.  My doctor is a Family Practice Doctor at our small town level 1 hospital, and she's really flexible and open to natural birth options.  We really love her.  I don't know if she'd be comfortable delivering mono/di twins at a level 1 hospital or not... Plus we're at least an hour from you which would be inconvenient.  

 

I would do some more searching in New Albany if I were you - call different practices and see if anyone's comfortable with mono/di vaginal deliveries.  I toured Norton's and wasn't crazy about it, especially the fact that they don't have tubs to labor in.  Apparently none of the hospitals in Kentucky have tubs any more.  But if you have any complications and end up having to have babies in the NICU, you'll really appreciate not having to transfer or be separated from them if you're at Norton's.  Good luck with your search!

post #263 of 335
How far along are you? I am almost 30 weeks with mono/di identical boys...so exactly same situation!!! Did a ton of research so happy to help...will post more later. For now...your priority is to eat a lot of protein (at lest 100+ grams a day)....this is especially important to prevent / reverse ttts! Let me know how far you are and I will share more thoughts. As a side note...I will be having a natural (no meds) birth with MD in NJ (assuming all goes well)...so totally possible. You just need to find someone supportive!
post #264 of 335
Esenbee2, I so hear you! It's so hard to know what is actually safer when the natural birth movement questions the mainstream on every count. When are ultrasounds, c sections etc really a good idea? I'm struggling with this same issue.
I am just about 37 weeks and my presenting baby is breech, has been despite doing everything I can to flip him... So we are struggling w vaginal breech vs c section. Which is safer/better? I feel torn. Luckily I have an awesome midwife team who brought in an OB when we found out we were having twins and everyone on the team is really open to natural birth... But it's not black and white.
What makes me feel better is that the midwives will be there even if I end up a c section to make the experience as good as possible. Maybe a doula would help in your case?
post #265 of 335
Here are some more thoughts. As you probably found out yourself, identical twin boys are the highest risk of all twin types...which made me a bit nervous at fist but not so much anymore!

Ttts is a serious complication and shouldn't be taken lightly....but...the risks of ttts developing fall sharply after 24 weeks. If you are past this stage and babies have been measuring about the same...you are likely in the clear. I question the safety of ultrasounds and limit them to a min...our first was at 20 weeks (and would have been only if not twins), then 23 (to rule out ttts, confirm growth), then 28. I am plannih the next one for 33 or 34 weeks. With respect to hospital monitoring...I am not a fan and will try to avoid. My hospital required 20 minutes upon checking and then it's doctor's call. My plan is to have intermittent monitoring with continuous every hour or so for 10-20 minutes as a compromise. The challenge with doing this however is that you need a midwife / doctor / nurse that is experienced in intermittent monitoring and knows what to look for and how often.

Ttts and other complications can arise at birth. With twins I think it's a lot "safer" to be at a level 2 or 3 NICU hospital if possible...if for no other reason than to ensure that you are not separated from one or more baby after birth If one or more needs to be transferred to a higher level hospital.

I had a wonderful hospital water birth with my first baby (completely natural) and LOVE my midwives! Unfortunately I did not feel the same way about their supporting doctor (and he needs to be in the room / takes charge during twin birth). I am now looking for a different doctor that I feel comfortable with and am pretty sure I found the perfect one (meeting tomorrow). She has done many twin births naturally. In spite of that I hope one of the midwives can be at the birth acting as a "doula" or I will hire one for extra support! You should consider doing the same.

A few things will maximize chances for a natural birth...your health (diet is key to this and almost completly in your control), avoiding pain meds during labor, laboring and birthing in a natural position (squating is best or all fours...works with gravity, shortens birth canal, etc ...being on your back is the worst), coming to the hospital far into labor (411 is the Bradley meathod rule for one baby...contractions 4 minutes apart lasting a minute or more for an hour or longer...but twins come faster so some adjustment to this is needed), staying well rested, hydrated and fed during early labor, etc. My number 1 priority to ensure vaginally birth is no meds...number 2 is not being on my back! The biggest factor to natural birth and twins is babies' position...which we have some but little control over. Check out the spinning babies website for some exercises that can help to get babies into the best position. Also...try to tailor sit as often as possible (on floor, legs crossed, shoulders back....if this is uncomfortable...pay attention to how your belly leans forward a bit in this position and try to replicate that when siting in a chair or on a couch. This encourages babies into head down position. The worst is sitting on a couch leaning back. Some doctors will allow natural delivery if baby a is breach, no one will allow if a is transverse. The second baby's position less important (although head down is best) because there is a ton of room after a is born and b can flip/shift. You want to find a doctor that is comfortable with and ecperienced in at least breach delivery of baby b!

There are a number of precautions you can take while still trying for a natural birth. For example, you can refuse IV fluids, but get an IV tap placed so its ready to go in case of emergency. Same with epidoral...they can insert the needle but not administer drugs unless c-section is necessary (or some other emergency need arises. Most hospitals / doctors insist on labor taking place in the operating room...if this is your case...negotiate to have a normal laboring bed in the room. I am pushing for delivery in a normal room right next to or across from operating room.

If you haven't read any books yet..."when you're expecting twins, triplets or quads" by Dr. Barbara Luke is a good starting point (especially for diet...although she misses some key points like avoiding GMOs, etc). But I would also strongly suggest reading some "natural" birthing books. While they are single baby oriented...many of the ideas raised still apply. My favorite is "The thinking woman's guide to childbirth" and if you can convince your husband to read a book "the business of being born" seems to resonate with men.

Seems like your priority is finding a doctor you can trust / rely on to get the birth you want (assuming all goes well). Try google searches for doctors that support VBACs....these doctors are the most likely to "support" a natural twin birth. Also...reach out to doulas in your area and ask them for doctor recommendations for your situations!

Best of luck. Happy to help in any way I can. Will let you know if I learn anything new from my new doctor tomorrow!
post #266 of 335
how is everyone doing?
post #267 of 335
Brambleberry, yes, I'm in Louisville, so not many options. I am 24 weeks. Everything looked fine in the 19 week anatomy scan, both babies were measuring right around the same and right around average for singletons. I am still trying to get my midwife/OB's practice to transfer my care to another MFM doctor so I can get in to an appointment soon! The woman doctor I chose, without much research other than one of the only woman MFM doctors I found, is in the same practice as Dr. Tabb, I think. I am hoping that I will be able to do split care between the MFM doctor and the Clark Memorial practice with 3 midwives and be able to split care there with a midwife and one of their OBs..... but since I haven't gotten in for an appointment, I don't know. I would love to be able to labor in a tub. My *dream* is to be able to deliver in the tub..... apparently they don't do that in a hospital anywhere close greensad.gif

Thanks for all of info/ suggestions Yelena. It's pretty much what I've been reading too. I just won't know anything until I see a MFM doctor. My old practice doesn't want me back and the other practice that has a midwife and is more natural minded in my area (there are only 2 practices to choose from that are), want me to see the MFM doctor first before transferring. ..
post #268 of 335
The Dr Luke book has been great. Inspiring me to track what I whatt and make sure I get enough protein.
post #269 of 335

The only new thing i learned from doctors appointment this morning is that for mono/di the national standards are to strongly recommend not waiting past 37 week.  However, I told the doc that I wouldn't be comfortable inducing before 38 and that seems to be ok.

post #270 of 335

My goal is 38 weeks, but I know the babies can come on their own earlier!  In my first OB appointment, she said she would be comfortable with me going to 40.2 weeks, but nothing over.  I was so relieved.  With whatever doctor/midwife combination I end up with, I am nervous about what they would say and push me into doing.  The MFM called with my appointment for next friday, at 26 weeks, so we'll see!  I have an ultrasound scheduled for that appointment :/  But I guess it will be okay, 7 weeks from the last one.  Total of 3 is what I am comfortable with, right now.  Should I be okay with doing more?  I saw a study on 1 ultrasound vs 5 and there was a direct correlation with low birth weight and IUGR, things of concern with twins.  Could it be just because twins do tend to have loads more ultrasounds, other factors too?  Do the risks of not checking in on them outweigh the affects of ultrasound???  I haven't been able to come up with any recommendation or opinion so far...

post #271 of 335

esenbee, i don't think there is one right answer when you are dealing with complicated decisions like the "best" care for a high-risk pregnancy. as far as number of ultrasounds, "safe" labor (i.e. in a birth tub? in a delivery room? in an OR?), cesarean rates and so on, there are too many variables to determine one right pathway that will bring a mom to her ideal birth. could an ultrasound show that something has gone horribly awry with one of your twins? certainly. would it affect how the pregnancy is treated? in some cases yes, in others, no. you have to ask questions each step of the way - e.g. if my babies are not growing enough, or are not growing at the same rate, what are my options? IUGR is a real concern with twins, and i have yet to see any correlation between ultrasounds and IUGR. in fact, from what i can tell, there is very little concrete information about what causes IUGR and how to help it, beyond delivering the pregnancy if it becomes life-threatening. i have heard of women in the position of deciding whether to deliver 26-week twins or let one of them pass away -- growth ultrasounds, in that scenario, would be indispensable to me. 

 

in many cases, as much as we might prefer natural-minded pregnancy care, many things are out of our control. this is true in every pregnancy, but more so with multiples. you know that you can eat the perfect diet, exercise properly, get acupuncture and chiropractic care, visualize your babies in the right position, do prenatal yoga and spinning babies exercises, and still end up with breech or transverse twins, iugr, or placenta problems. i think most of the moms on the MDC board would prefer not to have a cesarean, all things being equal and healthy, but it just doesn't work out for everyone. i think the most important thing is really connecting with the care provider you can trust and talk to -- someone who is not only supportive of natural practices, but realistic about the risks and willing to discuss them frankly with you (and your spouse). sometimes the professional can say something to your spouse that will totally help them "see the light" - so it's good if the care provider is on your side. 

 

having the right providers has been enormously helpful. i would encourage you to find some kind of birth worker(s) in your area who could give you honest, third-party advice on which doctors do or don't REALLY support the safest and most natural practices. (my previous OB practice said "sure, if everything is going well, we want you to have a vaginal birth." I had to talk to a lot of people to find out that was not really true.) ask doulas, midwives, homebirth mamas, acupuncturists, natural childbirth class teachers, etc. the practice that works for you might be an OB or an MFM. you might get a male or a female doctor. you might be able to split care between midwives and an OB back-up. you might find some random, unimpressive OB who doesn't connect with you personally, but has a reputation for getting out lots of babies without c-sections. you might find a doctor who is not "naturally minded" but is willing to discuss and negotiate with you, as an educated, informed consumer. call everyone in town if you have to. then call everyone in the next town over! other twin moms on this board goaded me into asking these questions and meeting with more doctors, and i can't express how grateful i am that i did. 

 

i had been planning my midwife & doula-attended birth center birth for years before conception. when i found out i was pregnant with twins, that midwife practice would no longer see me. i had to really grieve that birth experience. i was angry for weeks. i had a physically difficult first trimester and i was really resentful about the whole thing - even though i had spent an eternity and a fortune trying to GET pregnant, i was so mad that i was ACTUALLY pregnant. i started seeing "the" OB practice that seemed to deliver "all the twins" in my small town. i hated them. every appointment made me angry. i saw an MFM. i hated her even more! i said things like "maybe i should just have the babies in the backyard by myself." all the time.

 

with the help of my acupuncturist, i found a really experienced, well-connected doula. i wanted her to make me feel better about this experience that was so shitty at every turn. and actually, she did. and i really needed that, as we were kind of working without a net up to that point. she told me, in no uncertain terms, that the hospital and OB practice i chose provided virtually 0% chance of not having a cesarean birth. (i thought it would be a struggle but i did not realize that every possible thing was stacked against me) she gave me some names of other providers and another hospital to check out, and really encouraged me to not give up completely. after researching these things, i switched my care provider at 20 weeks. i have a doctor, doula and midwife team that is as committed to my healthy pregnancy and vaginal twin birth as i am.

 

i know i am extremely lucky that my twins are di/di and that impacts what i can ask for and how hard i can advocate.  i found out that i can deliver in a regular L&D room (assuming the twins cooperate and everyone is healthy). i am going to a hospital who will let me labor (but not deliver) in the water. i have a provider who will sign off on my birth plan, let me move around and eat, and is willing to deliver a breech second twin or do an internal version. my doula thinks it is reasonable for me to ask them to delay cord clamping for both twins & ask for immediate skin-to-skin contact, but she is also realistic that we need to have a plan for who stays with me and who goes with the babies if we are separated and someone ends up in the NICU. i get to see midwives for my prenatal care! a midwife might even deliver the twins! i really feel like i would have none of these options if i hadn't connected with this doula. i feel actually excited and empowered about this birth - a complete 180 from how i felt 6 weeks ago, when i hoped to just get through it and focus on having my boys on the outside. 

 

there are still con's - they are "more conservative" (their words) with twins. i'm driving further for appointments and i will have to travel when i go into labor. they won't let me go past 38 weeks - they say that the risk of stillbirth is analogous to 42 weeks with a singleton at that point. but the national average for twins is 35 weeks! so i am focusing more on keeping them in than worrying about induction. the OB in the practice strongly encourages epidurals in the event that she has to do an internal version. i have ultrasounds every three weeks, going up to every 2 weeks during the 3rd tri. i do feel like i can question things - what are we looking for? what would we do if we found a problem? and i can discuss with my wife how we would handle those decisions. in most cases, though, i feel like they are already a few steps ahead of me and i feel confident in the care. i have really adjusted my standards for my "natural birth" but at the end of this, i want to take home two healthy babies and feel like i didn't get run over by the medical industry, epidural or not.

 

anyway, i just want to encourage you to keep looking and asking questions. hopefully you can find care providers who will be on the same page as you. you can find ways to evaluate what is more or less important to you and balance that with the real risks of mono/di pregnancy. there is never one right solution, and what worked for someone else may not be right for you at all. 

post #272 of 335

Perfectly said mrsandmrs.  There is nothing more important that having a providor that makes you comfortable and being in a hospital that will allow things to unfold naturally (to the extent possible).  Even if you have to travel a long distance...its worth it!  I am so happy that i switched away from the OB that supports my midwives...it would have been an uphill battle with him on many fronts, despite having two midwives in the room!!!  My new doctor did not push for an epidoral (which the first did to make it "easier" to manipulate the second baby if needed)...and she also would deliver first baby breach (only combination that she will not do is first breach second head down - because of chin locking concerns and first baby transverse).  When i asked not to deliver in OR....she had a rationale explanation...that the hospital set up is such that if an emergency does arise there would be a delay in getting me to OR and that hospital has pretty strict policy.  If i push, i could probably be in a regular room, but i don't feel the need any more (especially after she offered turning up the heat, turning down the lights and putting on some music without any suggestion from me).

 

Regarding ultrasounds....eseenbe2 i had the same concerns as you...and with my first baby we only did one at 20 weeks and i am very much so against them.  However, i have come to terms with ultrasounds serving a purpose in twin pregnancies.  That being said...i strech them out!  I had first two close together (20 and 23 weeks to confirm no ttts).  The next one at 28 weeks i wish i waited a week or two more because i feel that once you hit the 30 week plus mark they become more important to monitor growth restrictions. I am now debating whether my next one will be at 33 or 34 weeks and if I do one again at 36 or 37 weeks.  All TBD.  My rationale for doing ultrasounds is the same for why i do one at 20 weeks....they can catch problems that can be addressed / fixed while you are still pregnant. 

post #273 of 335
Thanks mrs amd yelena. We'll see how this appointment with the MFM goes. Your post mrs, reminded me that I needed to get on sending out my email to the doula I had planned. Hope she is still available and would like to do twins!
post #274 of 335

definitely! i hope the doula is available. i found out that most of the "over-booked" really popular, exclusive doulas in town were a LOT more interested in me when they knew i was having twins. they don't get a lot of opportunities to help with twin births, so they all jumped at the chance. i felt like we had our pick. the doula we ended up hiring takes ONE client per month at this point in her career! she said that a lot of people, when they learn they are having twins, give up on natural aspirations and don't hire a doula - whether b/c they are overwhelmed or it's just a huge financial burden on top of twins. for me, i feel like i need a doula even more with twins than a singleton - we have two babies to hold/breastfeed/care for, too many decisions and options to consider, too many opportunities to avoid or side-step intervention, potential of a NICU stay, and so on. I just feel so relieved to have another person on our side. I really hope you find a doula who can be that for you! And I'm so excited we're having twin boys so close together! 


Edited by mrsandmrs - 6/5/13 at 11:11pm
post #275 of 335
Our twin boys Sam and Max born Tuesday morning at 38 weeks! They weighed 7-8 and 6-14 and are doing so well.
We had hopes of a natural breech birth of both boys with a fantastic midwife team and doctor but after 14 hours baby A wasn't descending enough to dilate me passed 7 cm. We did an ultrasound and saw baby b had flipped vertex during labor which jostled baby A into footling position. My dr was a lot more nervous about that so we decided on the c section.
My midwife talked me through it and the recovery has been good. Nursing is going super well. We're bring them home in a couple hours!
post #276 of 335

Congratulations….they look adorable.  Glad everything turned out well in the end!!!  Sometimes we don’t get what we want but knowing that you did everything possible should make you feel amazing about yourself and the whole experience!!!

post #277 of 335

Sam & Max are adorable!! Congratulations! C-section may not have been your plan A, but it sounds like you had a great support team and quality medical care along the way. It's wonderful that nursing is going well too. 

post #278 of 335
Amazing story! Glad your boys have arrived safely and that nursing is going well.
post #279 of 335

Wonderful babies, aprilv!  So glad they are doing good!

post #280 of 335
Congrats!!!! They are beautiful!
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