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Twin A breech, Twin B vertex--undeliverable?

post #1 of 40
Thread Starter 
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
post #2 of 40
I don't have any knowledge about this, but thought I'd just offer some support and bump so maybe someone else can respond...
post #3 of 40
Well my twins were like that. Twin A was feet down though and Twin B was vertex. My OB said that she would not deliver them that way for fear of the cord for Twin A getting tangled around her neck. I had a csection at 38wks. She didnt want me going into actual labor either since labor with my son was only a couple hours and very very fast.

Good Luck. And remember no mattter how your twins are delivered, its as long as they make it here safely that counts.
post #4 of 40
My midwife had a list of things that would force you to be referred out to a doctor, and that was on the list. The risk to the babies is just too great. I hope he turns on his own soon.

Michelle G.
post #5 of 40
Quote:
Originally Posted by michellyn View Post
The risk to the babies is just too great.
I've seen no research showing that.

My dh is an identical twin- he was first and breech, his brother vertex. Uncomplicated vaginal delivery.

-Angela
post #6 of 40
I wouldn't say they are undeliverable that way BUT if you are planning a hospital birth I seriously doubt you will be able to find an ob to assist you in a vaginal birth with them in that possition. I hope they change possitions for you! My baby b flipped from breach to vertex at 36 weeks and I know other people who had babies switch late or durring birth. It doesn't seem like there is room in there but they can do it.
post #7 of 40
I should have said, "She thought that the risk to the babies is just too great for her to deliver them at home." With the knowledge I had (mostly relying on her knowledge), I would not have felt comfortable taking what I perceived as a high risk. I'd love to hear about what studies have shown in this area (since I may have been ill informed). Could you share some?

Michelle G.
post #8 of 40
Hi Tori.

My twins presented the same as yours at birth. Twin A was double footling breech and her brother was vertex. I also attempted to flip my dd by inversion, frozen peas and flashlights, as well as chiropractic, all to no avail. She was breech from 32 weeks on. At 38 weeks, she was footling, and a C-section was scheduled three days later.

I realize that C-sections, and particularly scheduled Cs are not looked upon with much favor here, but I made the decision that I felt was safest for me and my babies. I had a very quick labor with my second child, and I live an hour away from the hospital. I did not want their birth to become an emergency situation.

Regarding studies and the like - you will be hard-pressed to find much research on the subject. Most OBs do not support vaginal birth for breech first twins, and it would be almost impossible to find a doctor to support a footling breech first twin birth. A midwife might attend one, but those whom I interviewed would not.

Most of the research I studied re: first twin breech births compared neonatal and maternal morbidity outcomes between C-sections and vaginal births, and found little difference between the two. However, none of the studies I read made allocations for type of breech presentations. They were just vertex and non-vertex. Because my dd, like your twin A, was presenting footling breech, that position brings a whole new set of consequences, including increased risk of cord prolapse and head entrapment.

Let me emphasize that I was not uneducated and I was not pressured by my doctor to have a C-section. In fact, my doctor was recommended to me by midwives I had interviewed because of his natural approach to birth. He was completely in support of a natural vaginal birth for my twins, and would have supported a breech first twin birth (rare, indeed) had she been frank breech.

If anyone has read reserach that supports footling or complete breech/vertex twin birth I would love to see it.

ETA: I just re-read the op and realized that your twin A is not footling, but complete. Same risks apply to both positions, however.
post #9 of 40
I know chiropractors and accupuncturists have some things that might help a baby turn. Might want to find a good chiro or accupuncturist.

My midwife has said that she will do vaginal regardless of position and she also has a family practice doc that will do the same. I am hoping I won't have the need for that though.

Good luck, I hope baby A turns or you can get the vertex one into position!
post #10 of 40
my twins were still turning up till the last week and i went into labor at 40 weeks. i was trying EVERYTHING... pulsatilla (most movement), chiro, acupuncture, inversion... mine ended up breech/breech and i had c-section but the week before they were breech/vertex. in fact, i forget which week?, but sometime after 34 weeks my baby A and baby B switched spots and baby B was in position to come first. sooo, just wanted to let you know that movement is def possible this late in the game for you! best best best wishes on a great delivery!!!

just wanted to add...
i had some great advice from my chiro to try to labor as long as possible even if c-section was likely. as long as things look good and healthy, the contractions help their bodies, lungs, possibly positioning and the hormones of labor help prepare babies as well. not very scientific, i forget all the facts but i labored at home for as long as i could before going to hospital to find them breech/breech. i really searched hard to find out more about this, just have to dig a bit!
paige
post #11 of 40
My midwife (and I) would've been fine with a vaginal birth for a breech Twin A--basically for the same reasons we'd be fine with a vaginal breech singleton.

I found this recent study:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

and these:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

IMO, the biggest factor determining a good outcome is choice in care provider (skills, confidence, experience).
post #12 of 40
I saw a perinatologist toward the end of my pregnancy who suggested I could try a vaginal birth with my Twin A presentation if I went in for a CT scan of my pelvis to make sure it was wide enough for a breech baby to pass through. He was an older doctor and South African, so I assumed he trained in a time and place in which surgical birth was less common.

I didn't follow up on it because I was like 34 weeks or so and it seemed like a lot to go through and prepare for when I'd already accepted a C-section, if Twin A did not turn.

We thought she was in a frank breech position, but when they did the surgery, they said she was transverse. I don't know if she moved at the very end, of if we'd been wrong in thinking she was frank breech.
post #13 of 40
Thanks for the link to that article. Though the morbidity rate was the same, note that more than half of the women allowed to try vaginal births also ended up with C-sections. I still think I'd be afraid to try a homebirth in this scenario.
post #14 of 40
I'm surprised nobody has mentioned homeopathic pulsatilla. Babies don't have much room to turn at this point, but the pulsatilla works for a lot of women.
post #15 of 40
The studies linked in a pp are the ones I found as well. Notice they don't mention type of breech presentation. I also would have been comfortable with a vaginal birth of my twins had twin A been frank breech.

This study specifically mentions footling presentation:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
post #16 of 40
I don't have twins, but my son was breech until about 36 weeks (and 10 lbs) so not a lot of "wiggle room" in there. I realize it's not exactly the same but some things I tried...
homeopathic pulsatilla
moxabustion, acupuncture
Webster Technique (chiropractic)
Handstands in the pool, floating, swimming
Squats
The Ironing Board technique


I'd think it would be worth a call to the MWs at The Farm to see what their take on the presentations is since they have had so many successful vaginal twin deliveries. Maybe they have some advice or insight none of us have thought about yet?
post #17 of 40
Quote:
Originally Posted by michellyn View Post
Thanks for the link to that article. Though the morbidity rate was the same, note that more than half of the women allowed to try vaginal births also ended up with C-sections. I still think I'd be afraid to try a homebirth in this scenario.

Just because 1/2 of the women got c-sections does not mean they needed them
post #18 of 40
Quote:
Originally Posted by sarahloughmiller View Post
Just because 1/2 of the women got c-sections does not mean they needed them
This whole discussion is a bit odd for me. I gave birth to my twins at home, even after a friend informed me that to do so was "irresponsible." Both were vertex and had separate placentas (so no TTTS), so it seemed reasonably safe. All went well (first arrived as an unplanned UC), and both were very healthy.

I have a friend whose (singleton) baby had shoulder dystocia and died in a homebirth. I would not wish her agony on anyone. While I know that such complications are rare, I do not want to paint a rosier picture of possible complications to a fellow twin mom. At the same time, she must decide for herself which risks are acceptable for her and her babies (just as I had to).

I remember reading somewhere (a year or more ago) that C-section rates for the Farm were about 2%. It reminded me that some C-sections really are necessary. Unfortunately, more are necessary when doctors/midwives don't know how to handle this sort of situation--regardless of whether someone can do it, your risks go up if that person can't. Anyway, maybe I'm just speaking from fear. I don't know. I'm hoping the baby will turn soon and make all our discussion unnecessary.

Michelle G.
post #19 of 40
I remember reading somewhere (a year or more ago) that C-section rates for the Farm were about 2%. It reminded me that some C-sections really are necessary.

Oh, sure. Some c-sections are necessary. No one's arguing that. But a 50% c-section rate for twins is ludicrous.

The thing is, thousands of women have c-sections EVERY single day because of a breech baby. Most of those surgeries could be avoided with the right care provider. Same goes for twins. IMO, that's what it all boils down to.

Finding the right care provider doesn't mean the risks go away. They never do. But they can surely be minimized and brought to a level of acceptable when you find a care provider that has a broader range of skills, confidence, and experience: one who doesn't automatically sound the alarms at the first sign of "variation".
post #20 of 40
Quote:
Originally Posted by birthjunkie View Post
I remember reading somewhere (a year or more ago) that C-section rates for the Farm were about 2%. It reminded me that some C-sections really are necessary.

Oh, sure. Some c-sections are necessary. No one's arguing that. But a 50% c-section rate for twins is ludicrous.
I agree completely (which is why I had my twins at home). But we're not talking about 50% for twins in this thread. We're talking about twins in this specific presentation (baby a breech, baby b vertex). The cord issues can be more complicated. What is a reasonable rate for this presentation?

Also, unfortunately, very few doctors/midwives have experience with this presentation. Her midwife doesn't feel she can't deliver twins in this presentation. My midwife, a big homebirth advocate, doesn't recommend a homebirth in this presentation (and she's done lots of singleton breeches and baby b breeches). It's hard to find someone skilled and experienced in this area, especially in this short amount of time.

Anyway, I really didn't mean to make this an argument. I hope we can agree to disagree. Mostly my fear talking.

Michelle G.
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