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OR Delivery

post #1 of 31
Thread Starter 
Our OB will only concede (thus far) to delivery in the OR, even for a vaginal, non-medicated birth. His reasoning is the need for a sterile environment and staff on standby in the event of an emergency.

I do no want to deliver in the OR! I already stated that I would agree to a heplock and the insertion of a catheter in my spinal area to deliver anesthetic in the event of an emergency. He did not agree to this.

He stated that in the event of emergency, I would need to be put under General Anesthetic and therefore the things I mentioned wouldn't be helpful.

Does anyone have any experience with policy dictating an OR delivery and can you tell me how you got around it or how you made it work for your birth. I am scared to go into the debate without some facts to back me up, and I haven't found many in my searching.

Thanks!
post #2 of 31
In my case, it was the hospital's policy that multiple births happen in the OR.

Frankly, I think part of it was b/c there wouldn't be enough room for all of the staff in a regular labor and delivery room! (There was a team of ped's people for EACH baby, so that alone was like 4 or 6 people, plus nurses, doctors, etc.) The rest of the reason is all CYA, IMO.

I ended up having to have a scheduled c-section, so it was all moot, but I was very bummed when I was still planning a natural birth.

I suppose it's not too late to consider a second opinion from another OB, or explore the hospital's policy yourself? Hope you find a good comprimise.
post #3 of 31
This is pretty standard with OBs and one of the main reasons I made sure to find a homebirth midwife who was comfortable with twins. I didn't end up with twins, but with family history it was a major consideration. If I do get pregnant with twins, I will have them at home. (fwiw my midwife had twins herself at home unassisted, so she knows that it can be done!)

-Angela
post #4 of 31
I hope you can find something that is a good compromise. Can they have you in a delivery room close to OR?

There's a local mom who had an OR delivery of twins. She was just happy that she found anyone willing to delivery twins vaginally, which in our state is rare.
post #5 of 31
I had the same problem and here it is hospital policy and one of the only things my ob would not budge on. He said that I had to have the babies in the or and that was it. I talked to the head of the maternity ward and she just made me feel worse about it all. I called hospitals within an hour or so of where we live and that is the way it was at all of them. SO, I had my babies at home After a lot of crying and talking to lots or docs & hospitals I decided I could not do what they wanted me to. I still saw my doc the whole time I was pregnant because if there was a problem or I had the babies early I wanted him. In the end I was so glad I had made the decision I did. My 1st baby was born 1 hour 20 min after I woke up in labor and that would have been a horrible car ride and he might have been born in the car by the time we got things together and our ds dropped off. I did also have my 1st son at home so I was very comfortable with home birth and I knew it was the right thing to do for me. Sorry I don't have any advice for you for dealing with this, I had no luck getting what I wanted from my doc in this area. One thing I highly suggest if you have not already is to go to your hospital and do a tour and see the or so that you are not caught off guard.
post #6 of 31
When I delivered it was up to the DR. I had two backup doctors and one insisted on the OR and the other was agreeable to the ldr room.
The doctors almost always get final say, but they use "hospital policy" to lay the blame somewhere else.
I went to 40 weeks and got induced and that put the day I delivered in my control and I wouldnt have been induced if the knife happy misogynist was on call (my term of endearment for the doc I feared). I even tried to do the castor oil on a weekend the good doc was in charge (it didn't work)
Basically I would have done anything to keep out of the OR, if that meant delivering in my minivan in the hospital parking lot. (this was the scenario I often presented to my DH! LOL close enough to get help but out of the hospital's clutches if I didnt need it!)
Good luck, you have the right to refuse treatment you do not agree with.
Joline
post #7 of 31
I delivered in the OR. It was the hospital's and my OB's policy to do so. It was ok with me though. I labored in my regular L&D room and even did some of the early pushing there. They just wheeled us around the corner to the OR when it was time for my OB to catch Sam, (baby A). It really wasn't bad. Plus, whoever said a standard L&D room isn't big enough is right. In the OR at my delivery was: my OB, the med. student working with him, an anesthesiologist (just in case), my L&D nurse, the student nurse working with her, the U/S tech, the neonatalogist and a team of neonatal nurses for each baby. I *think* that was everyone. Oh, yeah and DH!!

At any rate, all those people wouldn't have fit in a regular room.

ETA: I delivered at 34 weeks.
post #8 of 31
My mother had a VBAC in '85, and she still delivered in a regular room. Tell your OB that if he's really worried he can have the OR set up down the hall (they did for my mom), but you think it's dangerous to risk not having an OR open for someone who really needs it just because he's afraid of normal birth. (Um... maybe find a nicer way to phrase that.)
post #9 of 31
Speaking quickly as an L&D nurse, then I will bow out.

1. It has nothing to do with room size, it really and truly is about the medical equipment available. What's available in the OR isn't available in the LDR rooms.

2. Lots of younger docs are afraid to deliver twins outside of the OR, they have been taught that twins are "double set-up" deliveries, meaning you are ready for a crash c-section at all times. They honestly don't know any better.

3. It is indeed your right to refuse treatment/procedures of any kind you do not want.

Delivering in the OR is not as horrible as it sounds. It really really isn't. Inconvenient? You betcha. Annoying? Yep. Believe me, the nurses hate moving you to the OR to deliver as much as you hate being moved there.

If your doc is really stuck on this and won't budge, and neither will you, I honestly suggest you try to find an alternate care provider. Someone who has enough experience delivering twins that they don't view it as "abnormal." Which is how lots of OB's I know think of twin deliveries. It doesn't make it right, but as the song says, that's just the way it is. Most midwives will deliver twins....well....like you expect a midwife to deliver. They usually don't do the move to the OR crap unless they have a really control-freak spaz OB on call as their backup.

Bowing out now. I hope you have a wonderful birth.

ETA: I think the idea the poster above me came up with, the having the OR set up "just in case" is a good compromise. The OB should be willing to do that. That's very reasonable.
post #10 of 31
I just had my twins September 28th. I had my first twin (DD) in the labor room, not OR, with no medication or intervention of any kind. This was not what I wanted by the way. I wanted an epidural but had precipitous labor and barely made it to the hospital.

But there was no policy of the hospital or my OB that I had to give birth to my twins in the OR. My second twin (DS) was an emergency C-section and I was literally thrown on a gurney and into the OR for a C-section in a matter of minutes due to a prolapsed cord. This was a deadly serious, potentially fatal complication for my DS. For my multiple delivery, there is no way I would have an unassisted delivery or delivery anywhere but in a hospital. My son would have died without the C-section taking place as fast as possible. As it was he spent 12 days in the NICU. As I understand it, a prolapsed cord is when the cord emerges from the birth canal before the baby and is more common in multiple deliveries.

I think as long as you are close to the OR and you and your doctor understand the potential risks, you are fine in a regular L&D room. Even with my serious complication, we were only steps away from the OR. Maybe it depends on whether or not the OR is on the same floor as L&D in your particular hospital? Maybe the nurses and/or doctors here would know this?
post #11 of 31
I wanted to really echo what the PP said about a midwife.
I had a midwife attend my twin birth, she was the same who had attended my previous out of hospital birth. Her backup doc had to be on the premises but he did not have to be in the room. In fact he made an appearance once only and that was between babies A and B to make sure baby B didnt change position.
The majority of the team in my LDR room were my people (not the hospital staff) I had my dh, dd, Doula, doula's daughter, MIL, Mom. And the two midwives and two baby nurses.
It was the best possible hospital birth and everybody was incredibly respectful.
Joline
post #12 of 31
Can you find another doc?

Ultimately, the birth you have is the birth you have. You can plan and want and wish for an 'experience', but your end goal is to have healthy babies, no?

That said, I had complete faith and trust in my OB. he was comfortable delivering a breech baby vaginally (which we needed to do) but prepared me for the possibility that I might need a c-section. He would avoid it if he could, but if DD showed ANY distress, he wouldn't hesitate to do one. I labored until the very very very end in a LDR room (was moved to the OR 5 minutes before DS was born) with my doc the whole time (the nurse was there, but not nearly as long or as consistenty as the doc). When we got to the or, there were about 87,000 people there but you know what? I didn't care. I was completely focused on my body and my babies. It wasn't the experience I WANTED, but it was the experience I HAD.

Does that help?
post #13 of 31
You have plenty of time to find the doctor or midwife who can give you what you want.

Good luck. My grandmother was the first of a fraternal twin set of girls born at home. Both lived to a ripe old age.

My Aunt, her DD, had fraternal twin boys in an OR in a huge medical center and teaching hospital; and one twin boy was stillborn and the other boy, my cousin now 30, lived.

No one can guarantee you anything, no matter how much technology is around. It is the hospital policy and the doctor's malpractice insurance dictate the OR policy.

Good luck with your decision.
post #14 of 31
I had to have my deliveries in the OR because it was connected to the NICU. I did delivery early (35 weeks), but would have delivered there at any time. Also, my first was an unmedicated vag birth and the second was a c-sec under general anathesia.
post #15 of 31
Thread Starter 
My previous birthing center does not do VBACS, and the second that is semi-close won't deliver VBAC Multiples. I'm not comfortable being 2+ hours away from where we would deliver, or I would consider The Farm in a heartbeat.

I am not personally 100% comfortable with a homebirth. We have considered finding a homebirth midwife and laboring at home as long as possible, and then going to the hospital (it's less than 2 minutes away). I wasn't sure how protocol of care would work in that situation. I imagine we would simply keep our OB appointments and hire the midwife. That starts getting really pricey though - especially since having twins alone is almost double the cost.

Thanks for all of the information! I think my best bet is to request the OR be set-up and be very agreeable to moving at any sign of distress, but otherwise staying in my room. Have an appointment in a few minutes...
post #16 of 31
I totally understand why you are not comfortable with having twins at home. There are more variables and everything and if you are not comfortable with it of course you should not do it. When we were g to figure out what to do we talked about staying at home with our midwife as long as possible also and even parking my moms trailer in the parking lot at the hospital and going in right at the end I hope you can find a solution or doc that will work for you and that you are comfortable with. Good Luck!
post #17 of 31
My doctor also gave me the reasoning that there is more room in the OR and they need more staff on hand. But then again this is in a NYC hospital and the labor rooms are very small!
post #18 of 31

me, too!

I don't have any answers for you, but I can sympathize! I am feeling so frustrated! I have changed docs once, but this one is not much better. They won't consider vaginal delivery unless both are head down...and they don't sound very happy about THAT. Just about all the twins around here are delivered by caesarean, and that just makes me mad, b/c I do not need to have a caesarean recovery when I have 5 children under age five to take care of!!! I SO miss my midwives where I used to live. There are none around here! Anyway, my kids are calling! gtg for now...I'm gonna keep reading these posts and keep trying to find a better doc! :-)
post #19 of 31
Quote:
Originally Posted by 3+2=5:-)
I don't have any answers for you, but I can sympathize! I am feeling so frustrated! I have changed docs once, but this one is not much better. They won't consider vaginal delivery unless both are head down...and they don't sound very happy about THAT. Just about all the twins around here are delivered by caesarean, and that just makes me mad, b/c I do not need to have a caesarean recovery when I have 5 children under age five to take care of!!! I SO miss my midwives where I used to live. There are none around here! Anyway, my kids are calling! gtg for now...I'm gonna keep reading these posts and keep trying to find a better doc! :-)


The research literature indicates that in otherwise uncomplicated twin pregnancies, the outcomes for babies' conditions are about the same for vag vs. surgical delivery IF baby A is vertex/head down. In other words, unless some issue/complication arises during labor or delivery, it doesn't seem to matter if baby B is vertex, breech, transverse lie, etc. (Some Euro studies are even questioning "auto" c-section if baby A is non-vertex, esp. for a mother who has had a previous pregnancy and birthed vaginally.) Sure, issues can come up after the birth of baby A -- issues more likely with twins than singles -- and one can end up with surgical birth for the 2nd. I'm just sharing what's in the research lit -- unless there's some new lit out there, which is certainly possible.

Another concern is "pushing" docs who are apparently uncomfortable into something they may not be good at. I'm not sure I'd want to depend on an unpracticed person in charge if my baby was footling breech, transverse lie, etc. I'd want someone who'd done a bunch and was comfortable (but not overconfident) skill-wise. Personally, I'd be interviewing to locate that doc.

BTW, if of interest, I have a "fill in the blanks" birth plan for twin and some triplet pregnancies under "articles" at my web site: www.karengromada.com/

One thing you might do for now is ask your current docs to support their position about surgical delivery if any twin is non-vertex with research re: outcome studies. May be interesting.

Good luck.

Karen (who had an unmedicated birth with her vertex A and surprise vertex B -- surprise as he'd been obviously breech up to within hours of birth and we have no clue as to when or how he turned; can't believe he found room!)
post #20 of 31
[QUOTE=Karen Gromada]
Another concern is "pushing" docs who are apparently uncomfortable into something they may not be good at. I'm not sure I'd want to depend on an unpracticed person in charge if my baby was footling breech, transverse lie, etc. I'd want someone who'd done a bunch and was comfortable (but not overconfident) skill-wise. Personally, I'd be interviewing to locate that doc.
QUOTE]

Absolutely. you do not want any practitioner, OB or midwife, doing something they are not comfortable with. You don't want someone cocky, but not unsure either. I would interview some other OB's and ask around.

I had a solo practitioner OB who also said he was do a vaginal birth if both babies were vertex, and probably if just Baby A was vertex. I had a failed induction, though, and ended up with an urgent C-section. The hospital's policy was to deliver in the OR and I was OK with that, the goal like the PP said is healthy babies, not an "experience." You will still labor in the labor room, and by the time you are pushing you will be focused on your body and your babies, not the room you are in.
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