Homebirth and Triplets

[mamabear3]

Anyone ever heard of triplets born at home (in the 21st century)? Also, how about NCB in the hospital? Thanks for any imput!

[nikirj]

Here's one I found:

AUTHORS: Alamia V Jr; Royek AB; Jaekle RK; Meyer BA

AUTHOR AFFILIATION: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, State University of New York at Stony Brook, New York, USA.
SOURCE: Am J Obstet Gynecol 1998 Nov;179(5):1133-5

CITATION IDS: PMID: 9822488 UI: 99039941

ABSTRACT: OBJECTIVE: The objective of the study was to evaluate a protocol for vaginal delivery of triplet gestations.
STUDY DESIGN: All women with triplet gestations managed between January 1, 1995, and December 31, 1997, by University Medical Center's perinatal practice were offered enrollment in our vaginal delivery protocol. Our protocol offered attempt of vaginal delivery if triplet A was in vertex presentation, fetal monitoring was possible, and there were no other obstetric contraindications. Twenty-three triplet gestations were identified; 8 achieved vaginal delivery. Outcome parameters investigated included neonatal mortality, Apgar scores, neonatal intracranial hemorrhage, arterial cord pH, neonatal weight, and length of postpartum hospital stays of mother and neonates. All parameters were analyzed with analysis of variance and the Student t test as appropriate with the JMP 3.1 statistics program (Cary, NC).

RESULTS: Twenty-three sets of triplets were enrolled. Eight sets were delivered vaginally. Eight of 9 patients (88.9%) who attempted trial of labor were delivered vaginally, 1 of which was a vaginal birth after cesarean section. The remaining triplet gestation failed to progress at 4-cm dilation. Twelve sets of triplets had a nonvertex-presenting triplet and were delivered by the cesarean route. The remaining 2 triplet gestations were delivered by the cesarean route because of inadequate fetal monitoring. Neonatal survivals were 100% for both groups. No significant differences in neonatal mortality, Apgar scores, intracranial hemorrhage, arterial cord blood pH, hospital or neonatal intensive care unit stay of neonate, neonatal weight, and change in maternal or neonatal blood cell count were noted. There were no cases of grade III or IV intraventricular hemorrhage in either group. A significant reduction in postpartum hospital stay of mother was noted in the vaginal delivery group (2.8 vs 4.5 days, P <.001). The mean gestational age at delivery was significantly lower for the vaginal delivery group (31.3 vs 34.0 weeks, P <.02). The mean neonatal weight for the vaginal delivery group was significantly lower (1758 +/- 473 vs 2022 +/- 407 g, P <.02). There were no significant differences in outcome parameters for the first, second, and third triplets within each group when compared with each other or with the other study group. One patient who underwent vaginal delivery had retained products of conception and required curettage. A single fetal death occurred at 22 weeks' gestation from twin-twin transfusion, with the remaining triplets being delivered vaginally at 35 weeks' gestation. Cesarean hysterectomy was required in 1 case for uncontrollable bleeding at the time of cesarean delivery. Perinatal complications occurred in a large number of patients, with the incidence of premature labor 47. 8% (n = 11), that of preterm premature rupture of membranes 26.1% (n = 6), and that of preeclampsia 34.8% (n = 8).

CONCLUSION: In selected cases vaginal delivery of triplet gestations can be accomplished without increased maternal or neonatal morbidity and mortality and may significantly decrease maternal hospital stay and postoperative morbidity.

[Belle]

There's a story in Having Twins and More by Elizabeth Noble about a triplet home birth. It was a VBAC.

The mom knew she was having at least twins but refused an U/S to confirm it. If she had had an US her MWs wouldn't have been able to attend her birth. Her FP was also present for the birth.

Her babies were born at 41 weeks. The first two were vertex and the third was breech. They weighed 6lb 8oz, 6lb 14oz, and 7lbs respectively. The mom had a small tear with no episiotomy

[CryPixie83]

triplets, 41 weeks and 6+lbs? That is awesome! Go mama!

[The Lucky One]

Triplets at 41 weeks gestation???

That would be very rare, and dangerous, imo. That woman gave birth to 20+ lbs of baby.

[JesseMomme]

Rare yes, but I don't understand why it would be so dangerous? I admit I know less about twins and triplets vs a singleton birth.

[CryPixie83]

I agree about rare, but I also fail to see the dangerous in it. Yes, it was 20+lbs of babies but the babes themselves weren't of abnormal size and obviously her body could carry the load or she wouldn't have carried to 41 weeks.

Maybe you're seeing something we aren't?

[Shenjall]

wasnt there an article in mothering a couple months back about a woman giving birth to triplets at home? The main story was about her nursing with only one breast. Am I remembering it wrong?

edited to add: I was wrong, it was twins.

[bamamom]

I read the article you are thinking of...I think it was twins. I dont; remember anything about triplets in the article!

[kerikadi]

Originally Posted by Shenjall

wasnt there an article in mothering a couple months back about a woman giving birth to triplets at home? The main story was about her nursing with only one breast. Am I remembering it wrong?

edited to add: I was wrong, it was twins.

She had a set of twins and already had a toddler so she was nursing 3 babies with the one breast - that's probably why you were thinking triplets.

Keri

[Kathryn]

Originally Posted by The Lucky One

Triplets at 41 weeks gestation???

That would be very rare, and dangerous, imo. That woman gave birth to 20+ lbs of baby.

What's so dangerous about it? She let her body grow the babies to the size they needed to grow. Sounds very wise and healthy to me.

[mama_at_home]

I remember reading that triplet story in Having Twins. It was both encouraging and scary at the same time because I kept thinking "what if I really have 3 in there?" I asked my midwife if she would do a triplet homebirth and she said no. I don't expect it to ever happen but if I were ever pregnant with triplets I would defenitely want a NCB and I would travel anywhere I needed to, to find a skilled and experienced midwife or dr. willing to do it. But....I don't think I would attempt a homebirth.

I also agree that I don't see the danger in carrying triplets to 41 weeks. The fact that she was able to do it, and that the babies were so big shows that mama's body was capable of nourishing them. Also, if I remember correctly her triplets were concievd naturally and were not a result of fertility treatments. Multiples concieved with infertility treatments have greater risks but those conceived naturally tend to have less complications.

[Belle]

Originally Posted by nancymom

I don't expect it to ever happen but if I were ever pregnant with triplets I would defenitely want a NCB and I would travel anywhere I needed to, to find a skilled and experienced midwife or dr. willing to do it. But....I don't think I would attempt a homebirth.

The mom didn't know she was having triplets. She felt it was impossible for her to have the vaginal birth she wanted if she were "Plugged into the medical establishment" so she refused the U/S to confirm twins.

I'm paraphrasing here.
Her dh worked in the home so that he could help her out while she was pg. She ate 200 grams of Protien a day and gained 70lbs. Two mws took turns visiting her every other day to check her BP and Protien. The first two babes were born vertex and 9 minutes apart. After the second baby was born the FP checked her belly and said he felt a head. The mw reached in and turned the baby to face her back because she was breech posterior. Baby C was born 10 minutes later.

[mimid]

I think the most dangerous thing would be not having the pregnancy monitored in some way. I was doing wonderfully until 33w5d when I went in for a regular appointment knowing I was feeling a little under the weather and ended up in the hospital trying to stop pre-e, get the girls some steroids for their lungs and get rehydrated. My platelets dropped in 2 hours so they ended up delivering at 11:30 that night.

Personally, I think that a lot of the thinking on it is "better safe than sorry" and that is why you will have such a hard time finding anyone to attempt a natural delivery. All of mine were breech so it wasn't really an option, but I'm praying for a home VBAC if I happen to get pg again.

[kerikadi]

Originally Posted by mimid

I think the most dangerous thing would be not having the pregnancy monitored in some way.

But here pregnancy was monitored as are most homebirths.

Keri

[CryPixie83]

Originally Posted by mimid

I think the most dangerous thing would be not having the pregnancy monitored in some way.

And there are also those of us who believe that the most dangerous thing you can do to a normal, healthy woman is monitor her pregnancy [the way an OB would].

[kerikadi]

Originally Posted by CryPixie83

And there are also those of us who believe that the most dangerous thing you can do to a normal, healthy woman is monitor her pregnancy [the way an OB would].

: That's what I meant

Keri

[mama_at_home]

The mom didn't know she was having triplets. She felt it was impossible for her to have the vaginal birth she wanted if she were "Plugged into the medical establishment" so she refused the U/S to confirm twins.

I know she didn't know they were triplets, I read that story over and over while I was pregnant. I was just thinking outloud what I would do if I knew ahead of time they were triplets.

[MCatLvrMom2A&X]

Wow I had no idea that triplets could even be born vaginally. That is great. I was always afraid of getting pg with twins because of the very high likelyhood have having a section with triplets it never occured to me that it was even possible to have a vag birth. Makes me happy to know that the possibilty is out there.

Should rephrase that first sentence. I figured they could come out vaginally but never thought it was "allowed" by the medical establishment.

[maxmama]

Originally Posted by CryPixie83

And there are also those of us who believe that the most dangerous thing you can do to a normal, healthy woman is monitor her pregnancy [the way an OB would].

But by definition a pregnancy with higher-order multiples is not a normal pregnancy, regardless of how healthy the woman is, and I'm in favor of OB-MW comanagement for high-risk pregnancy (which multiple births are).