Twin A breech, Twin B vertex--undeliverable?

[torio]

Hi, another twin positioning question. We've made small (but inadequate) progress moving our son's feet off my cervix so our daughter, who's vertex can get into position. Our midwife has said that if they don't move substantially within the next 1.5 to 2 weeks (I'm at 37 wks now) we'll have to accept an c/section.

Does anyone have experience with this? Is the combined position of Twin A breech and Twin B vertex always undeliverable? The midwife has mentioned that their chins can lock.

Our twins are fraternal and placentas have not fused. Both are facing in toward the center with their backs at the sides of my uterus. The boy (thus far called Twin A) is a complete breech with his feet dangling over my cervix. The girl is vertex, but a bit off to my left side with her head toward my cervix (boy's feet are in her way).

We've been doing the head below knees exercise as seen on spinningbabies.com for 5-10 min. a day, also a supported bridge pose with DH massaging babes toward the positions they need to be in for delivery.

Any advice or shared experience would be welcome.

Thanks.
Tori

[alegna]

It's a recent paranoia. I'd find a more flexible midwife personally.

Chins can't really lock in fraternal twins. Two sacs between them.

My dh is an identical twin. He was twin A and breech. His brother (twin B) was vertex. They were born vaginally without complication.

-Angela

[pamamidwife]

the whole idea of locked twins is very. very rare!

its not undeliverable....but start looking for a provider that will help you now.

sorry, nak

[Juvysen]

I don't know if it works for twins, but chiropractors have good luck turning babies w/out pushing on your belly... Check out http://www.worldchiropracticalliance...g/aug2001l.htm

[Maggi315]

I've delivered twins like this before, no problems. Besides, twins are going to move once the first one is born, so Ithink it's impossible to predict this.

I read somewhere that "locked twins" was hypothetical and there are no documented cases of this. Anyone know about this?

[mwherbs]

the old texts have case reports, may even have study numbers %

and there are some case reports- on pub med there are about 40 abstracts on the subject many case reports-- one full text report back when they still used forceps --- the link at the bottom of a sample few of the abstracts on pub med.

Acta Obstet Gynecol Scand. 2001 Mar;80(3):275-6.
A case of locked twins successfully treated with nitroglycerin sublingually before manual reposition and vaginal delivery.
* Johansson BG,* Helgadottir EA.

Department of Obstetrics and Gynecology, Trondheim University Hospital, Norway.
PMID: 11207496 [PubMed - indexed for MEDLINE]
--------------------------------------------------------------------------
J Obstet Gynaecol. 1997 Jun;17(4):366-7.
Locked twins: a successful outcome after applying the Zavanelli manoeuvre.* Saad FA, * Sharara HA.
Women's Hospital, Hamad Medical Corporation, Doha, Qatar.

PMID: 15511888 [PubMed
-----------------------------------------------------------------------
Chia KV, Jayaratne T. Locked twins: a successful outcome.
Acta Obstet Gynecol Scand. 1992 May;71(4):311-2.
PMID: 1322628 [PubMed - indexed for MEDLINE]
-------------------------------------------------------------------------
Sevitz H, Merrell DA.The use of a beta-sympathomimetic drug in locked twins. Case report.
Br J Obstet Gynaecol. 1981 Jan;88(1):76-7.
PMID: 7459295 [PubMed - indexed for MEDLINE]
----------------------------------------------------------------------
http://www.pubmedcentral.nih.gov/pag...22&pageindex=1

[Maggi315]

Thanks! Is pubmed where you get your studies? Do they just have abstracts or the full text? Anywhere else to find research studies? When I'm teaching, I have more access to texts, but right now, I don't have any, really.

thanks again,

[mwherbs]

pub med, medscape- directly at the U library-- yahoo / yahoo scholar
is where I search- and more- yes you can find full text sometimes and if you have subscriptions or you can pay for a month of viewing at some places just depends on how much you want to read the info--- having an abstract reference gives you a way to find what you need-
I like that these abstracts all had some good outcomes- and things to do like reposition baby even during birth....

[torio]

mwherbs,
Thanks for the abstracts. I had seen the titles of some but hadn't gone so far as to subscribe to be able to read them.

One document about malpresentation that I read states that interlocked chins are rare enough that only inexperienced doctors prescribe c/sections for breech/vertex twins. Of course the diagrams and descriptions of the removal (often destructive) of at least one locked twin were pretty gruesome. What I keep wondering though is how it's possible for fraternal twins to get locked unless both amniotic sacs are broken, and don't refill, before the breech twin is fully born. Wouldn't the amniotic sacs keep the twins' bodies somewhat separated?

Meanwhile we are making small, though not yet adequate, progress with moving the babes. We haven't been trying to turn our breech son to vertex, just to move him high enough that our daughter's already vertex head can slip lower into my pelvis. This seems like it should be easier to accomplish. Our midwife is comfortable dealing with any position Twin B is in EXCEPT the combinations of breech/vertex or if Twin A is transverse.

[Synchro246]

Originally Posted by torio

Of course the diagrams and descriptions of the removal (often destructive) of at least one locked twin were pretty gruesome. What I keep wondering though is how it's possible for fraternal twins to get locked unless both amniotic sacs are broken, and don't refill, before the breech twin is fully born. Wouldn't the amniotic sacs keep the twins' bodies somewhat separated?

I knew that it's certainly not all of A-breech B-vertex have interlocking twin syndrome, but MAN I have to say that some of those descriptions you talk about (the one from 1970's obstetrics illustrated) scared me throughly. And I'm not usually the scarable type. It's good to hear that it's very very uncommon even with that presentation combo.
I do have to say that I don't think the sacks would be that incredibly protective of the locking possibility, but what do I know. I think the babies would be more likey to move based on other factors besides a thin membrane (uterus, twin interaction, the rotations that happen during delivery).

Good luck! I hope you find a care provider that works for you and I hope you keep making progress to get the babes into a more favorable position so you don't even have to worry about it at all

[Maggi315]

See, I have a problem with basing medical decisions (or others, I guess) based on illustrations. Illustrations are a joke, someone DREW them. They could have drawn any crazy picture. I mean, sometimes when I am teaching my nursing students they are amazed at what real organs, surgical procedures, scars and even deformities look like. Why? Because all they have seen are those silly illustrations and they are shocked at how useless they are.

so I wouldn't let someones drawing of what it "could" look like scare you into anything.

I still say that delivering them is not impossible, there are worse positions to deliver. And as midwives, i don't think we can start looking at every minute possibility of a complication, or we would have to become obs and "manage" every birth. There's a possibility of tons of complications everytime we walk into a birth, many with higher statistics than whats being talked about here.

Just my humble opinion...and my illustration pet peeve (goodness sakes, why can't nursing/midwifery texts have some real pictures of organs, etc? We had someone pass out watching our birthing simulator "nicole" give birth last semester, that's funny! They'll be great when they see a real birth, LOL)

[Synchro246]

Just to clarify Obstetrics Illustrated is just a book. The illustrations are pretty cartoonish actually. It is kind of a funny thing to base a text title on since it's not even a *well* illustrated text. The picture they happened to draw of interlocking twins wasn't particularly scary, but the description was awful. My fear of it comes from the description of how to manage interlocking twins. Now, it's just as silly to let a description scare me into anything. . .which is why I was being up front about the silly source of my fear.

[MamaRabbit]

The OB who started the natural birth unit here (he's really more like a midwife!) is now retired. I talked to him about my twin options here and he said my options are pitiful. But he also said that in his 40+yr of attending births, he had only seen ONE case of locked twins. But then he went on to say that it was obvious from early on that that was what it was. Does make me wonder though if that ONE case would have fixed itself if given time or were they locked at all? If it was truly one case... 1 locked set out of how many births? Sounds like good odds to me.

Have you tried homeopathic pulsatilla? They may have way less room to move, but it's worked before.

[torio]

MamaRabbit,

I think I replied to you in the multiples forum about this, but I will do it again, as you might be more likely to see it here.

I have tried pulsatilla--30C one pill once a day for two days. One of the birth center midwives mentioned that 200X is better, but that dose is hard to get. I don't remember how the dosages work with homeopathics (does more C = X for example?) Any suggestions? At this point I'm trying everything.

A midwife from Utah with whom I talked with today acknowledged that chins locking is rare. However, she has delivered a set and has a technique for separating them in labor. If only I were in Utah or she wasn't already booked up...

[pamamidwife]

the reason why locked twins are virtually unheard of is that most of the time babies have their heads tucked - their chins towards their chest.

I have never met anyone that has seen 'locked twins'. Of course, in today's environment, it's really rare to meet anyone that has attended a twin vaginal birth that wasn't incredibly managed.

[cfiddlinmama]

torio - I'm not a huge believer in dreams, but I had a dream last night about you. I don't know you, but in my dream I knew it was you. I've been following your story. The babies moved into position and everything went perfectly. Think positively. Everything will end up just the way it's supposed to.

[GatorNNP]

I personally know someone who used homeopathy/pulsatilla and visualization for turning her 2nd twin to vertex/vertex for a vaginal birth.

[torio]

Originally Posted by cfiddlinmama

torio - I'm not a huge believer in dreams, but I had a dream last night about you. I don't know you, but in my dream I knew it was you. I've been following your story. The babies moved into position and everything went perfectly. Think positively. Everything will end up just the way it's supposed to.

cfiddlinmama,
Thank you so much for your post. We've been meditating on a positive outcome and I have tremendous faith in my body and these incredible babies. I'm not sure if this makes sense, but somehow the effort I've put into to research and networking to gain info and support seems an important part of the process.
Thanks for the beautiful, supportive thougt--it means a lot to me.
xo