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OR Delivery - Page 2

post #21 of 31
We also had to have our twins in the OR due to hospital policy. While this wasn't what I wanted, it wasn't that big of a deal to me. We had a dr who totally believed that twin pregnancies were normal unless proven otherwise, who was completely on board for a spontaneous drug-free birth, who was pleased that I had a doula and that I would be breastfeeding and who didn't work on rotation so we knew that he would actually be the one at our birth baring a personal emergancy...the location just didn't matter that much to me.

Our hospital's reasoning was the same as some have mentioned that twin deliveries are double set ups and they want to be ready to do an emergency c-section. During my delivery, there was me, dh, our doula, my dr and two nurses in the room. There was quite the contingent on standby outside the room (anesethologist, pediatrician, more nurses, etc) but my delivery was lovely and very personal despite the slightly sterile environment - not that the l& d rooms were much better!

Something that made it less of an issue for me, too was that when I arrived at the hospital I was 8cm so we moved to the OR rather quickly, rather than me having been there for hours and comfortably spread out in an l&d room. They did move me on a gurney, though, which was quite entertaining as I wouldn't lie down and went on my hands and knees
post #22 of 31
Hello, I just had my twins on Thanksgiving. It was also policy at the hospital where I delivered to deliver twins in the OR. I was scared to death of the cold, sterile OR, but it actually worked out well. By the time I was ready to push, I didn't really care if I was in the L&D room or the OR.
It was more important to me that my babies were delivered vaginally and they were.
Ask if the doctor will place an epidural catheter w/out medication. In this case, he/she will be able to administer meds quickly if an emergency arises and not have to give you general anestesia. General anestesia is often used as a very last resort, so it is important to discuss with your Dr. all the steps he will take before resorting to that.
My doctor and I agreed on having the catheter placed without meds. It worked out great! My baby A got a little stuck and was started to get distressed, so the doc used forceps. The doc had enough time to give me little bit of an epidural so that I didn't feel it too much when he used the forceps or pulled baby B out by his feet.
I guess what I'm getting at is that he should be able to place the catheter w/out meds if he's super worried about have quick access in case of an emergency. Also, I was able to get the experience I wanted (laboring in the L&D room, unmedicated labor, vaginal birth) despite the birth took place in the OR. Hope this helps and good luck.
post #23 of 31
Quote:
Originally Posted by Karen Gromada
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!)
Is it likely he turned after baby A was born? My two were vertex, but there was concern that after A was born, B would turn breech, so I am guessing it could work the other way. At least there would be a lot of room after A was born!

OK, now back to the OP. I have been hesitating to post just because it is going to be long and maybe not really even directly answering any of your questions. But here goes. I hope something in here my help you, even if only as a way for you to prevent having to fight some of the same battles.

I had a hospital birth. In my case I would have been comfortable with a midwife attended homebirth, but couldn't find someone who would do it in this area. I was not comfortable with an unassisted birth though, so ended up planning a hospital birth when I found out about the twins at 34 weeks. Up to that point I was planning a homebirth with a midwife.

Anyway, my OB is very natural birth friendly, but the hospital really isn't. So the difficulty was in my OB having to basically walk a thin line to keep the birth natural but also to not cause problems at the hospital. If the birth had a negative outcome, and he was considered by the very conservative hospital to have not intervened enough, then he probably would lose his ability to practice there.

So, when I talked with my OB initially he told me that I would not have to be in the OR. Then at a later appt. he said we would have to move to a bigger room for stage 2. Later after that, I realized he probably meant the OR, but just honestly didn't have the energy to contest it any more.

There were a few "battles" at the hospital.

The nurse doing my check in claimed that baby B was showing stress, based on heartrate, and she thought I must be dehydrated. She wanted to start IV fluids. I showed her my water bottle, and said I would drink more water, and I would be okay with a heplock but not actually starting an IV. When I thought she was setting up a heplock, she actually started IV fluids. I did not want that but didn't know I could unhook it. When the nurse left, my husband unhooked it for me. Later they did put a helplock on instead, but I did not have an IV connected throughout.

During stage one labor, the staff was trying to maintain continuous monitoring with external fetal monitors. It didn't work very well, because whenever I moved, one of the monitors would lose a heartbeat. At any rate, someone on the staff suggested baby A was experiencing delayed accelerations, meaning the heartbeat was accelerating after the contraction was over. There are a lot of reasons I question whether that was a problem (I don't completely believe the contraction monitor to be accurate in the first place), but that person was using that to pressure my OB to use an internal fetal monitor. He basically gave in, and even my midwife said it might be a good idea. I was completely against it and so negotiated to start pushing early instead. The OB checked how things looked and thought that would be okay. So the internal monitor was never used.

One other note about stage one. I had brought food to eat, but did not eat anything. I also do not remember drinking water. I think at home I might have done these things. It just was that in the hospital I felt like I had to spend all of my energy keeping the staff from escalating things. I don't remember really having a moment where I could just kind of retreat for a bit an take a drink of water. Either the anesthesiologist was giving me a long talk (through transitional contractions) about what he would do in the case of an emergency, or they were fussing with the monitors pushing them hard to try to pick up baby A, or etc.

So then we moved to the OR. I am not sure if it would be possible to just refuse to move into the OR at that point. It sure didn't seem like it at that time. My husband then had to do a lot of negotiating to get my midwife and doula to be allowed to come into the OR with us.

In the OR, I had to lay on my back while pushing. It hurt alot. I don't know whether this was because I was pushing a little too soon, or because I was on my back, or because I just truly did not want to be there, or because it would have just hurt regardless. At some point I did insist on trying to stand/squat on the OR table. My husband supported me. But it really was not a good enough arrangement, in that I really could find a position to relax between contractions and soon my legs were tired and I was on my back again.

At this point monitoring was with an ultrasound. They were pushing hard on my belly to see the babies. That hurt a lot too. So between pushing I didn't really get a rest from pain...just more pain of a different sort. Also, some people were kind yelling/coaching "push" which really irritated me and made be feel like I was being attacked.

I also felt a lot of stress that if I took to long with pushing they would pressure a c-section. So I feel the whole pushing stage was really poorly managed.

Baby A was born three hours after I checked into the hospital. I think it was only an hour of pushing, but am not sure. (I had second degree tearing from her birth, but again don't know if it was because the pushing stage was rushed or because her hand was up by her face, or because it just would have happened anyway.) Then I think my OB used an amniohook and baby B was born three minutes later. Both were vertex.

It was the first natural birth of twins witnessed by everyone in the room except my midwife and my OB.

My midwife and doula helped get both babies nursing before we even left the OR.

The way to the recovery room passed by the nursery. Even though from the start we made it known that we did not want our babies in the nursery, I guess the head nurse did not know in advance. She tried very hard to get the babies and was very upset when she didn't. I think if I did not have my midwife, my doula, my babies' pediatrician and my husband surrounding me and the babies, she might have got them. Later my husband talk with her to smooth things out.

After being in the recovery room for a bit, some nurses came in and said I should try to pee. I heard them talking about smelling salts but didn't really make the connection. I made it to the bathroom and then started to pass out and the smelling salts appeared. Turns out they were insisting I pee because they assumed I had an epidural. Because I felt so weak after that I decided to stay overnight. Otherwise I had really wanted to go home. My husband was not allowed to stay overnight in the room with me.

The next day we let them do hearing tests on the babies in the room. In retrospect, I think I should have skipped it. It took a lot of time with one baby, who basically cried the whole time.

Then we checked out and went home.

The big picture is that I did manage to have a natural birth in an OR. My OB supports natural birth, the hospital does not. If I had time to search for another OB, I would have tried to find one at a hospital that was more supportive of natural childbirth. I felt very violated after the whole experience, but I am pretty sensitive, and I think another person would really have not had any problem with any of it. I think it also would have helped if I could have somehow come to better terms with the fact I was going to give birth in the hospital beforehand. With only four weeks to prepare, I just never really accepted it, so the reality hit kind of hard.

Hopefully that was not more than you wanted to read. I am very glad to read about people who had a better experience. I guess I just wanted to post my experience so maybe at least if you run into any of these things while you are in the hospital it might help.
post #24 of 31
Ugh...Kristi, that is exactly what I am afraid of with my twins! I am having to go to a doc and hospital who are used to twins being delivered by csection unless both are vertex, and then they are still USUALLY born by csection...I think all the ppl around here just like the idea of scheduled csections, ya know? Anyway, I am waiting to hear from a midwife who will let me know if she's willing to take me as her patient for a homebirth! I am praying so hard! I SO do not wanna deliver at that hospital or even with my doc. I have had 3 babies all natural, but since we've moved, there are no docs around here that I can find who are natural-childbirth-friendly. OK...gtg...kids calling :-)
post #25 of 31
i love this username: 3+2=5:-)

we were 3 + 2 as well.

as for the op, i saw a midwife/ob-gyn team during pregnancy. one water broke at 34 weeks and even though i fully dilated i was not comfortable with an attempt at vaginal delivery. both babies were in an oblique transverse presentation with one twin's feet around the other's neck (this part being what would have presented).

the dr was willing to attempt a version and vaginal birth in the or since i was fully dilated and neither baby was showing signs of distress. but yes, we had to be in the or.

i, however, am a soggy weakling and decided i would rather just have the c-section.
post #26 of 31
LOL!!!! soggy weakling! I don't know what I'd do in such a unique situation!! I am praying mine will be both vertex!!!! Or at least regular old breech, lol. :-)
post #27 of 31
I think there are risks you take no matter where you birth.It is what you are comfortable with and who you can get to help you birth in that situation.A dear friend of mine just birthed her twin sons a few weeks ago.She wanted a home birth,she felt very confident about it and got a midwife who supported her.During the birth there was a prolapsed cord and she was rushed to the hospital but one of her twins died if she would have been at the hospital this would not have been the case.But again there is a risk no matter what.I birthed 4 kids at home and my last was a shoulder dystocia.We made it through that just fine.But then my friend homebirthed a son one month after me and he had shoulder dystocia and he died.I think if you feel confident enough then keep looking and you will find someone who can assist you to have the birth you want.Happy birthing!
post #28 of 31
I was not happy to hear that I wasn't able to have the homebirth I wanted with my twins. Then I was told I had to deliver in an oR I was MAD. I was also given the line into my spine just incase. My delivery was not my dream at all I was so mad at my OB I couldn't even look at him. In the middle of delivering my first born my second born Elizabeth's heart stopped. I was given the spinal in seconds and in less then one minute Emma was delivered and my Ob reached up into my uterus and pulled Eliza out feet first. She was dead a total of two minutes before they got her heart going again, she is a perfect little girl today. I am glad my Ob didn't listen to me. I don't think my little girl would be here today if they had followed my orders. I thank god for the OR the Spinal and the fetal monitors.
post #29 of 31
Quote:
Originally Posted by Ravenmoon
I think there are risks you take no matter where you birth.It is what you are comfortable with and who you can get to help you birth in that situation.A dear friend of mine just birthed her twin sons a few weeks ago.She wanted a home birth,she felt very confident about it and got a midwife who supported her.During the birth there was a prolapsed cord and she was rushed to the hospital but one of her twins died if she would have been at the hospital this would not have been the case.But again there is a risk no matter what.I birthed 4 kids at home and my last was a shoulder dystocia.We made it through that just fine.But then my friend homebirthed a son one month after me and he had shoulder dystocia and he died.I think if you feel confident enough then keep looking and you will find someone who can assist you to have the birth you want.Happy birthing!

I debated whether to respond. My heart goes out to your friend who second twin died because of a prolapsed cord -- a scenario that is more of a risk with the secondborn of twins, since the second cannot descend into the birth canal until the first twin is born, as I hope her midwife informed her prior to the homebirth. Because you are correct, and it is quite likely that had she given birth in a hospital her secondborn twin would probably be alive and healthy because a crash/emergency c-section would have been done immediately. A prolapsed cord is one of those situations with only minutes for intervention if a safe outcome is to occur.

I apologize but I don't understand the logic about maternal comfort or confiidence for birth situations that pose more risk for the infants involved. I believe the infants have rights about outcome as well. When discussing full-term, unmedicated, vertex birth following an uncomplicated pregnancy and facilitated by an experienced and well-skilled midwife or physician, risks for home vs. hospital are comparable or better. The same cannot be said for twins. Less than 15% of twins are full-term; less than 45% are vertex-vertex. Not to mention that the risk for postpartum hemorrhage is significantly higher with twin births.

Just because "there are risks no matter...," it does not follow that all risk is equal and that place of birth of is of no consequence in some situations. There are levels of risk. And it is important to be aware of relative risk and level of risk when making decisions about place of birth for infants who cannot make this decision for themselves.

I'm not against home birth when risks favor or are comparable; my fifth child, a singleton, was born at home. However, the level of risk is higher for any twin birth -- even when full term, even if both are vertex. I understand that each couple must decide the level of risk they are willing to accept, and what consequences they are willing to live with. But for babies' sakes/health as well as a woman's own, I hope any expectant couple obtains the information they should have to make well-informed decisions.

Karen
post #30 of 31
Thread Starter 
:

We actually found out that I am carrying Monoamniotic twins, so unless we find a membrane there won't even be a discussion about where I will push... I simply won't be pushing. In my opinion, the risk of cord compression is too great to leave it to fate that the girls would make it through a vaginal birth both healthly and alive.

The whole roller coaster actually put a lot in perspective for me. Would I love a VBAC? You bet! However, there does come a point where you simply have to weigh the risks against the rewards. At this point, I am willing to do most anything to have two, healthy girls.
post #31 of 31
Quote:
Originally Posted by Karen Gromada
I debated whether to respond. My heart goes out to your friend who second twin died because of a prolapsed cord -- a scenario that is more of a risk with the secondborn of twins, since the second cannot descend into the birth canal until the first twin is born, as I hope her midwife informed her prior to the homebirth. Because you are correct, and it is quite likely that had she given birth in a hospital her secondborn twin would probably be alive and healthy because a crash/emergency c-section would have been done immediately. A prolapsed cord is one of those situations with only minutes for intervention if a safe outcome is to occur.

I apologize but I don't understand the logic about maternal comfort or confiidence for birth situations that pose more risk for the infants involved. I believe the infants have rights about outcome as well. When discussing full-term, unmedicated, vertex birth following an uncomplicated pregnancy and facilitated by an experienced and well-skilled midwife or physician, risks for home vs. hospital are comparable or better. The same cannot be said for twins. Less than 15% of twins are full-term; less than 45% are vertex-vertex. Not to mention that the risk for postpartum hemorrhage is significantly higher with twin births.

Just because "there are risks no matter...," it does not follow that all risk is equal and that place of birth of is of no consequence in some situations. There are levels of risk. And it is important to be aware of relative risk and level of risk when making decisions about place of birth for infants who cannot make this decision for themselves.

I'm not against home birth when risks favor or are comparable; my fifth child, a singleton, was born at home. However, the level of risk is higher for any twin birth -- even when full term, even if both are vertex. I understand that each couple must decide the level of risk they are willing to accept, and what consequences they are willing to live with. But for babies' sakes/health as well as a woman's own, I hope any expectant couple obtains the information they should have to make well-informed decisions.

Karen
I agree with this completely. My son would have died of a prolapsed cord had I not had an emergency C-section. I would never put my desire for a birth experience over the safety of my children. He's alive today because of that.
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