Twin delivery

[*Lindsey*]

I'm due with twin girls in 3 weeks and am looking for some advice, thoughts, opinions, reassurances, etc.

At my doctor’s request (family practice doc, will be delivering our babies) I met with one of the obgyn’s today. (There are two, Dr. Z-female, and Dr. Meyer-male.) I’ve met Dr. Z before, she did the D&C for my miscarriage last December and today I met with Dr. Meyer (who reminded me that he and Dr. Z were partners, and she wouldn’t come in with a different opinion than he had, they’re on the same wavelength.) Anyway, the point of this meeting was to discuss the delivery of Hazel and Lucy. My doctor will be delivering but an ob has to be on call should anything warrant surgery.

Dr. Meyer said it was up to me if I wanted to try for a vaginal delivery even though Lucy is breech. He said he was trained in an era that if a baby was breech, you delivered her breech. He explained to me some of the risks (cord prolapse, lack of oxygen to baby, broken/fractured bones) and said we had to decide if those were risks we were comfortable with and were willing to take. He said that a c/s was an even greater risk to mom, though, so it has to be weighed carefully. If it was his wife, would he want her to try for a vaginal birth? Yes. He’s “accustomed to reaching inside and trying to turn babies, and pulling them out by their feet if necessary.” I asked if the odds were good that she would flip vertex and follow her sister out. He said he can’t really say, sometimes they do, sometimes they don’t.

So, one of them will be on call the day/night I deliver, and they will be there but kind of in the background. When I am admitted, they’ll do an ultrasound to check/verify positions (since they can still flip up to the end…HUH? Hazel’s head is engaged…could she really move out of there?) He said that about the time I start pushing Hazel out, they will get the surgical team on standby. After she’s out, they’ll monitor Lucy’s heart rate and watch her via ultrasound, and which direction we go from there depends on how she does.


How does this sound? Thoughts, opinions, reassurances, etc.... ? I'm a bit scared!

[Jyotsna]

I'll jump in here. I'm a doula, so I can't give you the advice of a midwife, but let me say that your doctor sounds sensible to me, and while you don't really want to have a section, having the back up ready for your second twin is a good idea. I believe that if your doctor is on board with twin delivery, then everything will go well.

Twin deliveries occurred way before ceserean sections did, and breach delivery can definately happen. Internal version is there if needed, after the first twin comes, but I don't know details about versions after the birth of the first twin.

I may post more. I would definately try it, and I thought it was neat that the doc said the "my wife" thing. Most of the time, "my wife" is followed by, will have a cesearean!".

[JanetF]

That doesn't good to me at all, that sounds like the introduction of fear and panic to push you into surgery for both twins. Seriously, who wants a vb and a c/s to recover from? Reading all you can about homebirthing twins, freebirthing twins, normal physiological twin births will arm you much more than anything else. This is just a birth, after all. First one baby comes out, then after a while, however long the baby needs, the next baby comes out. It's not really a time for panicking and lining up theatre. That's weird obstetric fearmongering. I doubt I'd feel comfortable birthing knowing once this baby was out everyone was ready and waiting to cut the second one out. That's a helluva load for a birthing woman! If you can labour without monitoring, timing, VEs, hopefully in water which puts your body offlimits to these people you will have much more chance of a safe, gentle birth which since you'll be parenting two newborns rather than one, seems all the more vital to me. Twins and a c/s scar sounds horrific to me. Breech births aren't weird and complicated, they're basically simple. Since the best thing for a CP to do is NOT TOUCH then it's just not complex for them to help you catch your baby, right?

The biggest things you need to work out are how to labour unencumbered so you can be upright and drug-free, then how you'll handle the gap between your babies. If you want to be safest don't let people tell you an epidural "just in case" is a good idea. That would remove your chance to birth drug-free babies under their own steam. Hospitals like to rush in and move second twins around and try to pull them out before they or your body are ready. After the first twin is born your body, unsurprisingly, often has a little rest so you can greet baby #1 and your uterus can readjust to the new size of a singleton, the baby moves into position and then eventually is born. The timing of all that is to the baby's own design so that's when you're going to have issues with surgeons wanting to interfere. I hope you have lots of support to take into the hospital so you can stay safe and keep their fear out of your birth space. It does not belong with you, it's theirs.

[Zoo Loo Naturals]

I like what JanetF said!

[JanetF]

You're welcome

[chandasz]

I am absolutely thrilled that you have found an OB that supports a vaginal twin birth and is trained in breech delivery. Where oh where do you live?!

That is fantastic!! I also think it is incredible that you have an OB that acknowledges the risks of CS. Rare in this day and age.

Have a fantastic twin birth- you supermom you!

[*Lindsey*]

Thank you for your replies!

[cathicog]

Originally Posted by *Lindsey*

I'm due with twin girls in 3 weeks and am looking for some advice, thoughts, opinions, reassurances, etc.

Dr. Meyer said it was up to me if I wanted to try for a vaginal delivery even though Lucy is breech.

That's good, 90% of the time the second twin will turn head down for the birth. Usually before birth, if they don't induce. Please don't let them induce you...it makes the labor so much harder..

He said he was trained in an era that if a baby was breech, you delivered her breech. He explained to me some of the risks (cord prolapse, lack of oxygen to baby, broken/fractured bones) and said we had to decide if those were risks we were comfortable with and were willing to take. He said that a c/s was an even greater risk to mom, though, so it has to be weighed carefully.

This is good, that he sees vaginal birth as more normal than surgery, however, how much is telling you what you probably want to hear, and how much is truth? Can you get some former clients who have had him as their doc, and who let them birth twins vaginally? Not to be untrusting, it is just the standard, for the most part, that twins get cut out of the mom, to cover the hospitals/docs' behind, and most of the time it is unnecessary...REad Having Twins, by Elizabeth Noble. And Sheila Kitzinger, an anthropologist in Oxford England, had her twins at home, with a midwife. I highly recommend homebirth, with a mw for most twins, but you need to know the risks of homebirth, which are generally far less than hospital birth. By any chance, is this Dr. Meyer in Roanoke VA? Please pm me if he is, cuz I know him and he is a very good doc...can tell you cool stories of good births he has allowed...

(since they can still flip up to the end…HUH? Hazel’s head is engaged…could she really move out of there?)

Yep, they can and they do move up until the time they are moving out the birth canal..., but the engaged baby is more likely to stay there.

He said that about the time I start pushing Hazel out, they will get the surgical team on standby

It still takes 20 min usually, from decision to incision--keep that in mind

. After she’s out, they’ll monitor Lucy’s heart rate and watch her via ultrasound, and which direction we go from there depends on how she does.

And most times, it can be anywhere from 5 to 20 min or more until the 2nd baby is born, and that is perfectly normal. it takes a few minutes for the uterus to shrink to the point that it knows there is somebody else in there, and to start pushing again. Read Robin Elise Weiss' birth story about her twins, at www.about.com/pregnancy ...she had hers at home.

My recommendations, fwiw,
1) stay home for as long as you can: til the ctx are 60-90 sec long and 2-3 min apart from the beginning of the ctx, to the beginning of the next one. This gives your body a chance to labor on its own, and the ctx are not as painful as with the pitocin, which is artificial.
2) spend some time on hands and knees, in case first baby is posterior(back to your back). This can produce severe pain in the moms back as the back of the baby's head rubs against her spine moving down...it is avoidable, and hands and knees can turn the baby around.
3) Get in water during labor, it relieves most (if not all) pain, and can make labor far more manageable without drugs....which is better for the babies, and you can feel how to move to get them to move down....


Hope this helps, and I am looking forward to your birth story...
a c/s shouldn't be necessary, just cuz there are two...find the UC twins stories on Bornfree.com....Laura Kaplan Shanley's website....

[SublimeBirthGirl]

Sounds extremely frightening to me, but I'm a homebirther so...

[Jyotsna]

I agree that getting on hands and knees will be helpful, in lowering your pain and helping baby to turn before decent.

If you want a hospital birth, I think you have a good plan. I agree with another poster that you should try to find some of his patients, to see if they did indeed have a twin birth through him, including birthing both twins vaginally.

Good luck there, and definately tell us all how it goes!

[lovingkindnessdoul]

Reassurance

Hi Lindsey,
I am a doula practicing in San Antonio, Tx. It sounds like you have an amazing doctor. Most doctors now wouldn't even give you that option. They are worried about lawsuits so therefore go straight to c-section. Do you have an experienced labor support person to be with you at the birth? I highly recommend you hire a doula to be at the birth with you. She can offer you many options for natural pain relief and help make the process a lot less scary & overwhelming. It sounds like your doctor is really willing to let you have the type of birth that you want which is a wonderful thing. I know it is a little scary but you are going to be amazed at how strong you can be.
Best Wishes
Carol Marley

[*Lindsey*]

We were planning a homebirth, but risked out when we found out we were having twins.

We do have a doula.

I will not go in until I can no longer walk or talk through my ctx, just like my last two labors.

I know it sounds scary, it is scary, but I have no other options, so I will make the best of the situation at hand.

Thanks!

[BetsyS]

This is coming from a former very medically minded midwife, so keep that in mind.

I think he sounds pretty reasonable for a hospital provider, honestly. I've worked with docs who tell women that they can birth vaginally twin B "IF" twin B turns vertex. They never even explain the option of birthing breech. I say a doc that is comfortable with breech for twin B is a good one to have around.

[Free Thinker]

Just a lurker here wishing you good luck! I'm about 10 weeks behind you!

[homewithtwinsmama]

I have given birth vaginally to twins twice. I would not accept a second twin ceasarean. There is very little reason why a second twin can't be pushed out quickly and easily given that baby A made the way and you are very open and stretched. Your doctor sounds about as reasonable as docs get these days. I had to refuse consent at the time when my last OB twin birth (was to be homebirth but too preterm so I got on call doc at hospital) I told the OB I wasn't being sectioned for breech and he gave me this song and dance about reaching inside and turning baby B head down and I told him, "no you won't do that because I won't risk cord prolapse, uterine infection and placental abruption, you will stand there and I will push fast and the baby will come breech." And then I pushed Baby B out and --wait for it--he missed her, totally fell out on the bed! Heeheeeheeeheeheee!