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inducing twins - Page 2

post #21 of 36
Trying to "hide" things from our OB is sort of what led to my early induction to begin with. If I had it to do over I would have been totally upfront with him and then found someone else when I realized that he wasn't on board with our birth plan.
post #22 of 36
QUOTE=torio;7216395]

We've joked about making some requests that are even more hardcore than what we want (the entire birth team will share with us a ritual eating of the placenta... ) just so that we have something on our list that we'll be willing to compromise on.

[/QUOTE]

lol i wish i had read this idea 2 weeks ago- the look on my ob's face would have been priceless

i got bullied into a 38 week induction despite my better judgement- i'll be back with more details when i'm not tandem naking (so 6 months or so haha)
post #23 of 36
I'm so glad I was able to have an out-of-hospital birth with a midwife who encouraged me to carry them as long as possible. It just angers me to no end when I hear women saying they weren't "allowed" to go past such and such a date. How arbitrary and condescending!!!

Babes were born 40w2d. Their placentas were perfect.
post #24 of 36
From the article linked earlier, THIS chart would be the biggest reason any OB who would like to remain in practice would push for delivery by 38 weeks.

http://www.greenjournal.org/cgi/cont...l/100/4/638/F2

*If* you happened to be one of the mothers who delivered a dead baby(ies) after 38 weeks, any lawyer worth a dime would blow that chart up to billboard size. What excuse would the doctor be able to come up with that would satisfy a jury that 'they did all the could', when statistically, the chances of stillbirth after 38 weeks SKYROCKET with a twin pg.

A dear friend of ours delivered stillborn twin girls at 39+ weeks. Both babies showed absolutely no signs of distress, passed NSTs with flying colors, amniotic fluid levels were normal, etc etc.

And then they were both dead. Cord compression/accident with one baby that led to the death of her identical twin sister less than 24 hours later.

That doctor's malpractice policy paid through the nose, as it should have, because there simply is too much documented research that indicates delivery at 37-38 weeks leads to the BEST overall outcomes for twins.

But her girls are still dead. It was/is a horrible situation, and I'd much rather take my chances on a set of twins not being 'ready' at 38 weeks than take my chances on them dying in utero after I'd made it that far. Going past 38 weeks with twins is MUCH MUCH riskier (look at the chart) than going past 42 weeks with singletons, something you'll rarely see OBs advocating, so it's little surprise that most do not advocate going past 38 weeks with twins.

All that said, if you look at the research and still feel ok with carrying longer, that is certainly a choice that should be up to the mother. She is, afterall, the one who will ultimately live with that choice. The doctor in question should have the right to document their recommendation to deliver at whatever gestation, the mother's refusal, and that really should be enough to 'cover' the doc in question. Unfortunately, that's not how it works with obstetrical litigation.
post #25 of 36
wifeandmom, I'm sorry to hear about your friend's tremendous loss. Truly a sad situation.

However, there are too many factors to say (across the board) that twins should be delivered early. Identical twins (mono/mono) are at greater risk for things like cord entanglement and "locking" at birth. I'd really be interested in seeing the data behind that chart. Do you have access to it? I'm mostly interested in knowing what the inclusion criteria were for the population being studied. My guess is that the chart reflects data on ALL twin pregnancies--even those in which the pregnancy was complicated by underlying medical issues.

Here are a couple of recent studies that support the choice to continue a twin pregnancy to term:

http://www.nature.com/jp/journal/v20.../7200354a.html

http://www.pubmedcentral.nih.gov/art...?artid=1397866

Like I said before, the *rule* to evict ALL twins before 38 weeks is arbitrary and unsubstantiated.
post #26 of 36
What Lisa said.

What were the criteria for inclusion? Were monoamniotic twins included? Was it twins only, or did it include triplets and higher? Were any of the stillbirths the result of some other complication, such as pre-eclampsia or other health problems? Looks like the percentage of stillbirth in that study was around 1.5%. I wonder what it would have been if only healthy twin pregnancies were included?

I think there are LOTS of very, very sad stories out there of folks who made one choice or the other in life, from which we could draw all sorts of conclusions. My heart breaks for the mom who lost her twins so late in the pregnancy... Just as my heart breaks for anyone who had any extremely rare complication that led to their child's death. So sad and tragic...
post #27 of 36
Quote:
Originally Posted by wifeandmom View Post
From the article linked earlier, THIS chart would be the biggest reason any OB who would like to remain in practice would push for delivery by 38 weeks.

http://www.greenjournal.org/cgi/cont...l/100/4/638/F2
That's the chart that made me understand where my OB was coming from too. That and the "results" quote:
Quote:
RESULTS: The risk of stillbirth in multiple gestations increased from 1:3333 at 28 weeks’ gestation to 1:69 at 39 or more weeks’ gestation. The stillbirth risk in multiple gestations at 39 weeks surpassed that of postterm singleton pregnancies (1:526).
I'm not saying the study didn't have it's flaws or that more recent research has illustrated that carrying twins to term doesn't have those inherent risks, but this was a fairly large study (4193 multiple births to residents of the North-East Thames region of London from 1989 to 1991), and as the chart above shows, the results were rather dramatic.

There was no exclusion criteria for pregnancies with any sort of complications, all multiple pregnancies were included. The study states that triplet pregnancies were included as well (but that twin pregnancies accounted for over 99% of the multiple pregnancies in the region).

(Again, I'm not saying that all twin pregnancies should be induced at 38 weeks, I'm just trying to illustrate how this widely-held belief among OBs is NOT completely arbitrary and unsubstantiated.)
post #28 of 36
Quote:

(Again, I'm not saying that all twin pregnancies should be induced at 38 weeks, I'm just trying to illustrate how this widely-held belief among OBs is NOT completely arbitrary and unsubstantiated.)
That was my point as well.
post #29 of 36
I would really like to see more research on the studies claiming that stillbirths "skyrocket" with twins after 38 weeks. I carried my twins to 40 weeks 1 day and they were born at home in perfect health. There are MANY, MANY mamas on this forum alone who carried their twins well past 38 weeks. Yes, stillbirths happen, and they are tragic, but that is no reason to get into scare tactics and urging twin moms to induce. I have much more to say but my babies are waking up....

Ok, I am back. Some things I ask myself when I see a chart like that are:

-were these moms under the care of high risk OBs or homebirth midwives?
-were these moms induced (even at 39 or 40 weeks) or allowed to start labor naturally?
-were there membranes artificially ruptured?
-were they allowed to labor and birth in the positions they felt most comfortable in?
-were they heavily monitored with ultrasounds, fetal monitoring, etc?
-what was their nutrition like?

Twins need as much time in the womb as singletons and forcing them to be born before they are ready can have lasting consequences. Stillbirths do happen and they are tragic, but stillbirths happen with singletons, too. If anything, I am convinced that inducing, rupturing membranes, increased interventions, etc. increase the chance of stillbirth, rather than prevent them. Mothering is a natural parenting community and I really don't see how talk of inducing and suing doctors for not inducing is appropriate here.
post #30 of 36
Quote:
Originally Posted by gemelos View Post
Mothering is a natural parenting community and I really don't see how talk of inducing and suing doctors for not inducing is appropriate here.
I think this discussion is absolutely appropriate here. If you read back through this thread, some of the mamas who posted were induced - making it a relevant issue.

Many natural parenting advocates find themselves in a whole new world when they become pregnant with twins... many who were planning homebirths and no longer feel comfortable doing so, many with midwives who find themselves suddenly under the care of an OB with very different viewpoints. The subject of induction of twin pregnancies is something that many of us will come up against with our health care providers, and I think it's important to be well-educated on the issue in order to have an intelligent discussion about it. That means being aware of all sides of the issue in order to know what kind of conclusions are being drawn by the medical professional - you can better argue your position if you understand where your OB is coming from. THAT is the purpose of discussing induction here on MDC, not to advocate that everyone submit to the will of their almighty OB.

My bias on the matter is that I don't feel it's necessary to get into a pissing match with the person I've chosen to be my prenatal care provider and birth professional. I'd much rather retain a good working relationship, which means having discussions about things rather than just laying down the law. For me, being on good terms and having mutual understanding leads to a better, more comfortable birth experience.
post #31 of 36
Quote:
Originally Posted by jackson's mama View Post
My bias on the matter is that I don't feel it's necessary to get into a pissing match with the person I've chosen to be my prenatal care provider and birth professional.
I'm so thankful that I have the kind of provider that this isn't even an issue... I haven't been made to feel as if a pissing match is necessary, ya know? As long as my twin pregnancy remains healthy and has no other complications, she's comfortable with me going to term, and I'm comfortable with that as well. I don't have problems with evidence-based practice and informed consent and all; I just get frustrated whenever someone feels bullied into an intervention that may not be necessary. Sometimes that's the case with twin inductions, and other times it isn't.

I think there are LOTS of great reasons for doctors to suggest inductions or other interventions for twins... One of my real life friends has twins in separate NICUs over an hour away from each other because they were born at 29 weeks via cesarean just before Christmas due to TTTS complications. I'm thankful for her family that they're doing okay, and both expected to recover and grow! I'm not completely anti-intervention, just cautious about intervention and the reasons for it. That's all. If research can't be questioned, it isn't research... It's faith-based medicine.
post #32 of 36
There is a difference between being induced for medical reasons and being induced just because a twin pregnancy reaches 38 weeks. Discussing valid reasons for inducing is totally appropriate, but saying that doctors should be sued because they let a twin pregnancy go past 38 weeks is ridiculous. And I understand educating yourself on that point of view so you can see where your OB is coming from, but there is a difference between understanding their point of view and advocating it, kwim? I am mainly referring to wifeandmom's posts.
post #33 of 36
Quote:
Originally Posted by gemelos View Post
There is a difference between being induced for medical reasons and being induced just because a twin pregnancy reaches 38 weeks. Discussing valid reasons for inducing is totally appropriate, but saying that doctors should be sued because they let a twin pregnancy go past 38 weeks is ridiculous. And I understand educating yourself on that point of view so you can see where your OB is coming from, but there is a difference between understanding their point of view and advocating it, kwim? I am mainly referring to wifeandmom's posts.

I certainly didn't mean to imply or advocate automatic induction at 38 weeks for twins regardless of the individual situation, only that I can understand why it would be hard to find an OB willing to go along with continuing a twin pg much past 38 weeks.

I completely understand where OBs are coming from, and by the time I was 38 weeks pg with my twins, both were showing clear and obvious signs of needing to be born, so it really didn't matter in my case since I was no longer at the point of being able to say all was well with me and both babies.

Of course, had I not been following the traditional medical model for testing with a twin gestation (twice weekly NST, weekly BPP, weekly AFI, twice weekly BP checks that increased immediately once signs of pre-e showed up, etc), I would have been clueless that both of my girls were showing signs of distress in utero and could have EASILY ended up on the wrong side of the statistics since my body was no where close to laboring and delivering without intervention.
post #34 of 36
Thanks for clarifying, wifeandmom! I understand what you are saying now.
post #35 of 36
Bump! More good info on "term" and routine induction.
post #36 of 36
the 2nd link you posted, what is the name of the article that you wete referring to reading? i can't seem to find it.eyesroll.gif
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