Homebirth and Triplets - Page 5

[lexbeach]

Very interesting thread!

I, too, love the story in Noble's book about the surprise triplets. I read that one a lot while I was pregnant with my twins. I wish I had had such a supportive midwife. I'm sure I could have birthed my twins vaginally, but since the presenting twin was breech, I couldn't find *anyone* who would assit me, and at the time I did not feel comfortable with a UC.

Another fascinating birth was that of the Dionne quintuplets. . . identical sisters born at home (in Canada) in 1934, 2 months premature. Of course, they had no idea they were expecting more than one baby. All 5 babies survived and were healthy, although their story then became really quite depressing. But it still shows just what our bodies can be capable of.

If I suspected I was having twins (or more!), I would definitely choose to have an u/s to determine what the situation was with placentas and amniotic sacs. I would want to rule out ttts (I'm guessing that was probably the cause of death of the 26-week twins, not premature birth at home. It sounded to me like they died in-utero), and make sure that the babies were not sharing a sac. Monoamniotic twins are at a huge risk, and it really would be dangerous to attempt a vaginal delivery. Once I knew that there was no ttts, and that the twins did not share a sac, I would feel very comfortable delivering them at home. While I can understand why some women choose not to have u/s monitoring to check for twin issues, for me that would be to big of a risk to take.

Lex

[CryPixie83]

Originally Posted by KeanusMomma

That is like saying that if your child (not a neonate) got hit by a car, or contracted AIDS, or something else that put him in critical condition, that no medical intervention was necessary because he was just going to die anyway. There have been plenty of preemies that go on to live long, healthy lives.

But if a child (or other family member) is, say, hit by a car and can't live without life support, it is the family's choice whether or not to keep that person on life support or to let them pass on. I don't think contracting AIDS is comparable here as it's not a sudden jump to critical condition.

You can't fault people for letting nature take it's course.

[boscopup]

Originally Posted by CryPixie83

But if a child (or other family member) is, say, hit by a car and can't live without life support, it is the family's choice whether or not to keep that person on life support or to let them pass on.

I think most people would choose the life support if it were only a temporary situation and full recovery were expected, and that's what we're talking about with a good number of preemies - they WILL LIVE, but need some support early on until they develop a little more and their own body can take over. When a baby is born early, they continue to develop pretty much just as they did in the womb. Once they reach "term", and often before, their body is able to do what any other newborn's body does. My son came home at 33w3d gestation. His body learned to breathe, regulate its temperature, and take oral feedings in that first 4 weeks of life. He needed a little help, but once his body took over, he was FINE.

I would compare this more to someone who is choking... Without help, they will die. But if you apply the Heimlich maneuver, you can save their life. The Heimlich maneuver will probably hurt pretty bad, and may leave bruises or other damage, but the person lives and heals and goes on with life. So if your older child were choking, would you let them continue to choke because you're letting nature take its course? That's how I see it with a preemie that does not have any fatal health problems - one that is just a bit early and needs some help the first few weeks or so.

[Spark]

Originally Posted by MamaTaraX

: Claire, I love the pics in your siggy, and I have to tell you that your recent birth story always pops into my head when I think of my birth (which wasj ust a few weeks later) It was like a prophecy

Namaste, Tara

nak

ooh, tara! i'm so glad your birth was so blessed! if yours was like mine, you liked it didn't you? I know that 90 minutes is fast, but ahhh, so nice! Thanks for liking my pics. That 3 1/2 month point is so nice... the 4th trimester is over and you begin feeling normal again! Also, I think every single post I have ever read from you, I did the whole time. You are so so so wise, mama!

[Spark]

Originally Posted by boscopup

That's wonderful! I'd heard stories about that too, but my labor decided to go on once they took me off drugs (why they took me off drugs, I don't know!). I had a gushing break though, and I've heard that those don't typically reseal (I could be wrong though!).

Anyway, I'm VERY GLAD I delivered DS in a hospital with a NICU.

Vera, it sounds like you made the absolute best decision for your situation. And how WONDERFUL that your son is so healthy and strong! I think my PPROM was a gush too. I'm not sure how it's defined though. I stood up,, felt a slight pop and then trickled all down my legs pooling on the floor. It was a pretty strict routine. monitoring, lots of supplements, homeopathy, food stuff, water, etc.

[boscopup]

Spark, I'm so glad yours resolved on its own!!! My contractions didn't start for 11 hours. But without drugs, I was going into labor. And when they took me off the drugs, I went into labor 10 hours later, and had a nice 2.5 hour labor (from first contraction to baby screaming). My midwife had had a client go full term like you did, but I guess she never went into active labor at the time her water broke. We were hoping I'd reseal and just go home if I got to full term - then I could still deliver with my midwife. But alas, Joshua wanted out right then and there! Thankfully, he only needed O2 overnight. The next day, he was breathing completely on his own (but they also gave him an artificial surfectant at birth). After that, it was mostly feeding and growing and learning to take oral feedings once he hit 32 weeks gestation. He only had an IV for about 3 days - for nourishment. After that, there was a tube from mouth to stomach for feedings (this tube didn't hurt), and there were heart and O2 monitors on him so the nurses would know if he had apnea (he did - just a gentle jiggle would remind him to breathe, and occasionally a few minutes of O2 might be needed).

The day before my water broke, I felt DS being *really* active, and I wonder if he was wiggling his way into birthing position. Whatever he was doing, he wanted out, apparently! I'm praying that #2 will stay in full term (watch me be walking around mid-December going "Ok, you can come out now!!!"), but if PPROM happens again, I at least know that the hospital isn't as bad as I feared it would be as long as I'm educated and stand up for what I want, and the NICU isn't that bad either. It's scary when your child is "sick", and there are some archaic rules at my hospital's NICU, but I also now know what things I can fight for in there too (like kangaroo care), and they are at least VERY supportive of breastfeeding at my NICU. So all in all, the experience was not the horrible thing that some would expect. And I think it made me and DH stronger about standing up for what we want when it comes to labor and delivery, etc. I can't say enough good things about DH being my advocate, especially since he's skeptical about most natural things including midwifery, but he listened to my midwife and listened to the doctor's and nurses, and determined that my midwife made more scientific sense! It's just too bad my midwife can't prescribe labor-stopping drugs and the like.

Absolutely, I believe that a homebirth is the safest, gentlelist place for a healthy full term baby to be born. Unfortunately, sometimes our bodies decide to kick the baby out early, even if the baby is healthy. That happens more often in twins and triplets. I'm so thankful that we have such great medical care available for these early evictees.

[bamamom]

this situation....the one where your baby is sick and has to stay in the hospital and you have to go home.....has always been one of my worst nightmares. I feel like I can voice this here....

When my dd was still inside me, I used to have night terrors of having to leave her behind.

I imagine that I would just go crazy to have to walk awa;y from a tiny preemie and leave them in the care of strangers. or any baby for that matter.

I come from a background of birthing with midwives, and my second was born at home with just my dh, and i did the births with midwives so that i could be assured that no one would take my baby from me!!

I have always feared that being separated , and the baby being attached to tubes and wires would leave us scarred for life.

Did it not drive you crazy to have to walk away??

[1stTimeMummytoLore]

Just a couple of comments-

For one, even if the woman in the triplet HBAC story had done an u/s, there is actually no 100% gurantee they would have identified the third baby. Sometimes u/c doesn't find a twin or triplet and it becomes a suprise anyway, even in a hospital setting. Even the most advanced obstetrical technology isn't fool-proof.

Second, the statistics on multiple births are often somewhat skewed when you actually examine the break downs. Many OBs recommend induction or scheduled c/s as early as 36 weeks for twin mothers and the twin moms that birth at home at 40+ weeks don't always make it into the statistical pool when they opt out of the mainstream medical system. Also, sadly many mulitple moms don't get the proper nutritional counselling necessary to help prevent PTB and other complications. Many midwives believe that the most common reason for PTB in multiples is due to inadequate nutrion. And lastly IMHO, there is also something to be said for the psychological effect of repeatedly telling a multiple mother that she probably wont go past a certain point in pregnancy that may condition her mind and body to keep her from going to term.

Personnally, I'm not really too sure how I would feel if I was carrying triplets or if I was VBACing, but I do know how I feel with my twins I'm carrying now. For me, I have been seeing a homebirth midwife from the very beginning of my pregnancy and I don't believe myself to be "high risk". After researching mainstream concerns about monoamniotic twins, I did decide to have an u/s which confirmed our twins are dichorionic and dizygotic (AKA fraternal) which I must admit helped me be even more comfortable with my homebirth plans. I have not seen an OB once and considering that I am now 34 weeks and having no issues at all, I doubt I will need to. Midwives who practice in hospitals in my state are not "allowed" to attend multiple moms, so had I chosen to enter the mainstream medical system, I would have had to see an OB and a peri and would have had to fight my way through my pregnancy refusing excessive u/s and other alarmist testing all the while being told I'd be lucky to make it to 36 weeks. After refusing a scheduled c/s at 38 weeks and if my presenting twin was vertex and I was "allowed" to "attempt" a vaginal "delivery", then I still would have had to prepare to birth on my back in an OR no matter what "just in case" and would have faced extreme pressure to birth with an epidural, again "just in case." (I am a doula and CBE and have had twin clients who have been through this hospital experience- their residual birth trauma break my heart!) Instead, I have experienced nothing but encouragement and support and love and information (in addition to outstanding medical care) on how best to care for myself and my twins during pregnancy and birth. My BP, weight gain, urine, general health, fundal heaight, and the babies' FHTs are monitored regularly by my midwives who, in their 20+ years of experience between them have never had a twin mom birth earlier than 38 weeks with less than 7 lb babies-- How many OBs can say that? As long as everything continues as well as it has been, when the time comes, no one is going to "deliver" my babies. I will be monitored regularly and suppprted by my midwives, but my body and I going to birth my twins. They were concieved safely and naturally at home, I've grown them safely and naturally at home, and I'll birth them safely and naturally at home.

All that being said-- I do know that some women will never feel the same way I do and would never be able to bring themselves to a place where they felt safe having twins at home. I can respect that they are struggling to make the best decisions possible in the best interests of their children and that's what mothering is all about. I am just grateful that I have access to qualified midwives with multiple homebirth experience so that I can birth where I feel safest for myself and my babies.

[boscopup]

Originally Posted by bamamom

I imagine that I would just go crazy to have to walk awa;y from a tiny preemie and leave them in the care of strangers. or any baby for that matter. <snip>
...
Did it not drive you crazy to have to walk away??

Yes, leaving the hospital without my baby was one of the hardest things I've ever done. I was ok while in the hospital (and frankly, I didn't really feel like a mom yet), but when I was discharged, they wheeled me to the car with my flowers and balloons, just like any other mother, except that my baby wasn't with me. I saw other moms being wheeled to their cars with their babies. I got in the car, and as we drove home, I broke down crying and cried the entire way home. No, I will never forget that.

Am I scarred for life? I don't think so. I am totally able to function, never suffered PPD, etc. But I'm also an optimist and tend to think about the good things in life. My baby was healthy, and I knew he WOULD come home in a matter of weeks. So I concentrated on that. But yes, I did cry - several times! It's hard not to when you're postpartum and can cry at the drop of a hat anyway. It got easier as I got used to the situation and just made peace with it. For one, I was happy that my baby was alive - there are many complications that can happen with PPROM resulting an a stillborn baby. Those didn't happen with me, and I thank God for that.

After 4 weeks, I was able to bring my baby home. The day I walked in to get him, I actually got slightly panicked because he was NOT attached to monitors - he was laying in an open crib with no wires at all on his body. He was dressed and swaddled, but not monitored. He'd been like that for several hours, and all I could think was "What if he'd had apnea and the nurses wouldn't have noticed?!?" That took some getting used to. He hadn't had apnea in 5 days, which is the criteria of that NICU for going home, but I still was paranoid about it. We got him home, and I got over the apnea paranoia though, and enjoyed holding my baby 24/7 with no wires attached.

[boscopup]

Originally Posted by 1stTimeMummytoLore

Second, the statistics on multiple births are often somewhat skewed when you actually examine the break downs.

Totally agree here. Many women these days opt for scheduled c/s instead of "attempting vaginal birth", as I mentioned my triplet friend did. She was given the option (and some OBs don't even do that!), but I think since so many are done by c/s, she probably figured she was unlikely to get a vaginal birth with all 3, or maybe she didn't want to deal with 3 vaginal births at once? I don't know. I know she did research it, and she did consider the vaginal option, but she went with scheduled c/s (sort of scheduled - they scheduled it once her PTL was getting to a point where she wasn't going to make it much longer). I know lots of twin mamas do the same thing (although here at MDC it's probably alot lower number of moms who opt for c/s).

Originally Posted by 1stTimeMummytoLore

Also, sadly many mulitple moms don't get the proper nutritional counselling necessary to help prevent PTB and other complications. Many midwives believe that the most common reason for PTB in multiples is due to inadequate nutrion.

I think we need to be careful here though... Yes, poor nutrition would most likely contribute to PTB, but even good nutrition under the care of a midwife can still result in a mom (singleton or multiples) having PTB. And sometimes people seem to think that if a mom has good nutrition, there's no way they'll have a preemie. NOT TRUE. You didn't say that of course, but I just want to make sure that people don't think nutrition prevents all PTB. It helps, but doesn't 100% prevent it. There are other causes of PTB.

Question: Is there any link between IC and poor nutrition? Seems like a good number of PTB in multiples is probably due to IC. I've heard of multiples women having IC with their multiple pregnancy, but not having it with their subsequent singleton pregnancies. This is just a curiosity question.

Originally Posted by 1stTimeMummytoLore

And lastly IMHO, there is also something to be said for the psychological effect of repeatedly telling a multiple mother that she probably wont go past a certain point in pregnancy that may condition her mind and body to keep her from going to term.

That's a good point. Definitely something to keep in mind when talking to multiples mamas, I guess!

Originally Posted by 1stTimeMummytoLore

After researching mainstream concerns about monoamniotic twins, I did decide to have an u/s which confirmed our twins are dichorionic and dizygotic (AKA fraternal) which I must admit helped me be even more comfortable with my homebirth plans.

I've not been in a twin position (yet), but I think for me, this is what I'd probably feel comfortable with too. I would want that u/s to help rule out some of the complications in a twin birth, as you've done. And once ruling those out, I'd likely be more comfortable with a homebirth for those twins. I trust my midwife, and I know she has attended twin births, breech births, etc.

For triplets, I'd probably have to just do alot more research to make a decision. But I would want to at least have some diagnostic u/s done to help make that decision. I think that's a good use of the technology we have. It also helps that I have an open minded OB (he calls himself "gullible"), and so I'd be able to see him in this event and get any benefits of technology I would want, and also have him lined up in case a preterm birth happened. That's actually what I'm doing this pregnancy with a singleton. I had a preterm birth last time, and I don't want to end up in the hospital assigned to some OBs I don't know (and frankly never saw - I saw the residents who did the work, and the attendings made the decisions but didn't talk to me directly). My hospital experience was not the horror show that I was expecting, but there are things that would have been better if I'd had a good OB lined up. I love my current OB, but at the same time, I'm still optimistic that I'll get that out-of-hospital birth with my midwife whom I also love!

[singleton+twins]

***Just so you don't go back to Babycenter and think that homebirth means not monitoring labor... During a homebirth, as discussed here, a midwife or doctor is attending. The baby/babies are monitored via doppler or fetoscope. If the heartones on your baby were dropping during a homebirth, action would be taken. They would not let "nature take it's course" because homebirth is about being proactive not reactive. Who knows, at home that might have not been an issue for your baby anyway. Sometimes problems occur because of the hospital environment and because of interventions. Were you laying on your back? Were you induced? Was your bag or bags of water artificially ruptured? Were you encouraged to move during labor? Did you have pitocin? Etc?***

Why is it that you think I am from babycenter? Why do you feel the need to be insulting? Am I calling you a hippie mama who has an irrational grudge against the medical community?

As far as my girls....NO I wasn't on my back, NO I didn't have an epi, No I wasn't induced, NO I didn't have pitocin. I had no trouble pushing baby A out. But baby B refused to engage in the birthing canal. She was free floating, and with each contraction her hb dropped. Tell me what should have been done? Wait and see. Sorry not gonna play that risky game with the life of my child.

I educated myself during my pg and knew what was needed and how much I needed to eat. I'm not sure why many ladies think that Dr. limit your food intake while carrying multiples. I was encouraged to gain 40-50lbs. I was told to stay active, eat TONS of protein and drink a gallon of water a day. I didn't have "internals" I didn't have invasive testing. Give me some credit, you know the kind you as would want.

***Again, since when did choosing a homebirth mean choosing a practitioner who would do nothing at a time like that? I think most UC'rs would receive care to stop labor then, too.***

Actually that isn't necessarily true. Again check out the CUC site....many ladies do NOT seek outside medical care.

***I think singleton+twins is going a lot on what she *thinks* homebirth is, not necessarily what it actually is.***

And I think I am not so narrow minded to see there are many faucets to birthing. There are GREAT hospital deliveries, and there are bad ones. The same can be said with home deliveries. Don't be so quick to judge me, I have several friends who homebirth. My mother did a homebirth. I think homebirths ARE great for low risk pg, but NOT for multiples. I am not judging you on your decisions, nor am I putting you down for them...do you think you could do the same? As a person who has NEVER carried multiples, perhaps you could educate yourself before you start slinging labels on people and insulting them. You also might want to stop painting everyone with the same paint brush. There are a variety of ppl who homebirth who I am sure you don't want to be compared to as ladies who choose something different don't want to be lumped into the same category either.

[CryPixie83]

Originally Posted by singleton+twins

I think homebirths ARE great for low risk pg, but NOT for multiples.

I think herein lies the problem. You're making the mistaken assumption that carrying multiples automatically means a pregnancy is not low risk. Like somehow a woman's body is less capable of carrying two babies than it is of carrying one. That seems like a mighty disempowering line of thought to me

[singleton+twins]

Originally Posted by CryPixie83

I think herein lies the problem. You're making the mistaken assumption that carrying multiples automatically means a pregnancy is not low risk. Like somehow a woman's body is less capable of carrying two babies than it is of carrying one. That seems like a mighty disempowering line of thought to me

twins "can" be high risk but not necessarily. Our bodies are NOT meant to carry litters...the more the babies the more problems that arise. I think twins should be monitored more carefully. There are many issues that are more likely to arise than in a singleton pg. I think it is ignorant to assume that twin pg do not need any special care.

I'm not sure why many of the ladies here are making the assumption that twins pg don't get info on adequte nutrition. Most of the ladies I have talked to were told to gain 40-50lbs. Dr. Luke's book has similar recommendations to that of the Brewer's Diet. I am wondering how much research the woman here have done concerning multiples. There are lots of biased sites out there(for both the homebirthing and medical communities), and not a lot of evidence that illustrates birthing multiples at home is safer.

[CryPixie83]

Yes, twins *can* be high risk, so can singles, that's generally the exception rather than the rule though. I would hardly call twins a "litter" triplets, maybe, quints definately but twins? nah.

[singleton+twins]

Originally Posted by CryPixie83

Yes, twins *can* be high risk, so can singles, that's generally the exception rather than the rule though. I would hardly call twins a "litter" triplets, maybe, quints definately but twins? nah.

"can"??? Show me the the stats that twin complications are the "exception" rather than the rule?

[alegna]

Show me the stats that twin complications are the RULE. (over 50%?) I have never seen anything to insinuate that other than the mentality of the OB community.

-Angela

[CryPixie83]

Originally Posted by singleton+twins

"can"??? Show me the the stats that twin complications are the "exception" rather than the rule?

In all honesty I think it would be difficult to produce factual statistics considering most multiple pregnancies are managed by obstetrics which automatically means higher intervention rates, which would of course affect the outcome of any study. I would love to see a study done in a group of multiple pregnancy moms under the care of hands-off midwives. With OB/GYNs too many "routine procedures and interventions" would throw the results of any study into a tailspin.

[bamamom]

That is a good point.... since most women in the US seek obstetric based care anyway, which can be high intervention in it's own right, it would be skewed unless you could find a bunch of multiple pregnancies and put those women into the care of good midwives. Experienced skilled midwives who have done multiples before...that would be excellent!!

[1stTimeMummytoLore]

Originally Posted by boscopup

I think we need to be careful here though... Yes, poor nutrition would most likely contribute to PTB, but even good nutrition under the care of a midwife can still result in a mom (singleton or multiples) having PTB. And sometimes people seem to think that if a mom has good nutrition, there's no way they'll have a preemie. NOT TRUE. You didn't say that of course, but I just want to make sure that people don't think nutrition prevents all PTB. It helps, but doesn't 100% prevent it. There are other causes of PTB.

I wouldn't argue this. In fact, I would wager that just about all the multiple moms you'd find on this forum were/are dilligent about excellent nutrition and some of them unfortunately experienced PTB anyway, but one trip to my local Mothers of Multiples meeting revealed a large number of sadly uneducated mothers who were not counselled about prenatal nutrition much beyond what is normally recommeded in mainstream obstetrics for singletons and had some woefully traumatic hospital birth/NICU experiences.

[singleton+twins]

Originally Posted by CryPixie83

In all honesty I think it would be difficult to produce factual statistics considering most multiple pregnancies are managed by obstetrics which automatically means higher intervention rates, which would of course affect the outcome of any study. I would love to see a study done in a group of multiple pregnancy moms under the care of hands-off midwives. With OB/GYNs too many "routine procedures and interventions" would throw the results of any study into a tailspin.

I agree...it would be difficult so neither you or I can say as fact that complications for a multiple pg are the exception.

What intervention rates and procedures are you speaking of? Please clarify. I have several ladies on another forum who had no interventions as I understand the meaning yet had complications during the birth. I am sure you can find lots of ladies who had normal homebirths with their twins. Somewhere in the middle is a statistic. As I stated before I had no epi, no pit, wasn't on my back(I was in a break away bed, had a mw, sat in a jacuzzi tub for most of the labor. Yet I had complications.

A mw is a great option if the mother is in good health and the twins are di/di and the mw is experienced. If the twins are momo, or mo/di(75% of id twins have this configuration) then the pg needs to be monitored.