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homebirthing twin mamas- midwife questions - Page 2

post #21 of 84
How many weeks along are you? If you are thinking of one U/S (to either rule in or rule out twins), you might want to consider sooner as I think there is an optimal time to see if they are monochorianic or di. I had mine at 18 weeks and it was too "late" to see the lamba (or was it delta?) that is evident at 12 weeks or so that indicates mono-di. The membrane between my girls was really hard to see though (some techs couldn't see it and panicked about mo-mo) so they presumed it mono-di and had more regular U/S to check for TTTS. Pathology of the placenta after birth showed it was, in fact, one big one. But... I imagine there are people who have later U/S and they aren't sure so do tons of U/S followups to track for TTTS who turn out to be di-di.

All of this rambling is to say that you might be able to rule out something by acting sooner (if you are interested in U/S at all, of course!)

Good luck, and keep us posted!!!
post #22 of 84
Thread Starter 
Quote:
Originally Posted by LoisLane View Post
How many weeks along are you? If you are thinking of one U/S (to either rule in or rule out twins), you might want to consider sooner as I think there is an optimal time to see if they are monochorianic or di. I had mine at 18 weeks and it was too "late" to see the lamba (or was it delta?) that is evident at 12 weeks or so that indicates mono-di. The membrane between my girls was really hard to see though (some techs couldn't see it and panicked about mo-mo) so they presumed it mono-di and had more regular U/S to check for TTTS. Pathology of the placenta after birth showed it was, in fact, one big one. But... I imagine there are people who have later U/S and they aren't sure so do tons of U/S followups to track for TTTS who turn out to be di-di.

All of this rambling is to say that you might be able to rule out something by acting sooner (if you are interested in U/S at all, of course!)

Good luck, and keep us posted!!!
I'm almost 22 weeks. I wouldn't agree to an early u/s just for twins. I know they're more accurate, but it's not a risk I'm comfortable with.

I won't agree to frequent checks for TTTS anyway and my midwife will be okay with that.

thanks for the info!

-Angela
post #23 of 84
Eat wisely for twins, alegna.
post #24 of 84
So, I'm not a twin mama, but if I were expecting twins, I'd really like to know more about what she "does" - I don't know if you could arrange it, but it would be soooo cool to watch some twin videos off youtube, and see her commentary.
Just as there are unspoken things about what I midwife "should or should not" do at a singleton birth, there are even more for twins. I would specifically ask about monitoring - how much, when, by whom - are they gonna round up an EFM or use two fetoscopes and tap it out? Or two dopplers? What positions would be okay? Is she gonna do a more medical second twin delivery - as soon as Twin A is born, a deep vaginal exam and possible flip of Twin B to vertex or footling for extraction? Or a laid back style of waiting for Twin B to show something at the introitus?
post #25 of 84
Thread Starter 
Quote:
Originally Posted by hotmamacita View Post
Eat wisely for twins, alegna.
Thanks! Already working on plenty of water and protein.

-Angela
post #26 of 84
Thread Starter 
Quote:
Originally Posted by Apricot View Post
So, I'm not a twin mama, but if I were expecting twins, I'd really like to know more about what she "does" - I don't know if you could arrange it, but it would be soooo cool to watch some twin videos off youtube, and see her commentary.
Just as there are unspoken things about what I midwife "should or should not" do at a singleton birth, there are even more for twins. I would specifically ask about monitoring - how much, when, by whom - are they gonna round up an EFM or use two fetoscopes and tap it out? Or two dopplers? What positions would be okay? Is she gonna do a more medical second twin delivery - as soon as Twin A is born, a deep vaginal exam and possible flip of Twin B to vertex or footling for extraction? Or a laid back style of waiting for Twin B to show something at the introitus?
I would expect two dopplers for monitoring. She wouldn't get an EFM And I can't see her extracting short of an emergency.

She had twins. UC.

-Angela
post #27 of 84
As you know from my sig, I have zero perspective on a "normal" twin birth. But you are killing me here with all this planning and not knowing for sure. KILLING. ME.

I think I missed a post - are you planning to refuse all u/s or are you waiting for some optimal date? I'm not judging your decisions - I just want to know if my own curiosity has to wait a few months or what.
post #28 of 84
Thread Starter 
Quote:
Originally Posted by OGirlieMama View Post
As you know from my sig, I have zero perspective on a "normal" twin birth. But you are killing me here with all this planning and not knowing for sure. KILLING. ME.

I think I missed a post - are you planning to refuse all u/s or are you waiting for some optimal date? I'm not judging your decisions - I just want to know if my own curiosity has to wait a few months or what.
Yeah... my non-medical and more laid back ways drive many batty

I will consider an u/s if my midwife will be more comfortable with it. Last appt. was just an eyebrow raise and a "you're sure there's only one in there?" (I was 19 weeks, measured 27cm)

We've discussed twins in the past (given family history and I like doing my research well ahead) and she has said she often likes an u/s to confirm twins so that she can have enough hands on deck so to speak.

If next time around (not this weekend, but next ) I'm still large.... we'll discuss.



-Angela
post #29 of 84
This just a from personal experience comment, but if your mw wants to do pit automatically after I would do it. I think pretty much everyone I know that had twins at home hemoraged and ended up with it anyway and it would have been really nice to avoid the major blood loss. My baby A's placenta did not come out for 2 hours after the birth and then 4 hrs later I hemoraged and it was no fun and left me incredibly drained for weeks and made it really hard to care for my kids. I am not normally into medical stuff but in retrospect I wish I had just done the pit right after the birth but at the time I did not think it was necissary. One test I would suggest is a hemoglobin check so that you can solve that problem ahead of time and then if you did hemorage it would be easier to recover from. I think measuring that far ahead I might want an u/s to rule out too much fluid, I would be more worried about that than having twins!
post #30 of 84
Quote:
Originally Posted by sarahloughmiller View Post
This just a from personal experience comment, but if your mw wants to do pit automatically after I would do it. I think pretty much everyone I know that had twins at home hemoraged and ended up with it anyway and it would have been really nice to avoid the major blood loss. My baby A's placenta did not come out for 2 hours after the birth and then 4 hrs later I hemoraged and it was no fun and left me incredibly drained for weeks and made it really hard to care for my kids. I am not normally into medical stuff but in retrospect I wish I had just done the pit right after the birth but at the time I did not think it was necissary. One test I would suggest is a hemoglobin check so that you can solve that problem ahead of time and then if you did hemorage it would be easier to recover from. I think measuring that far ahead I might want an u/s to rule out too much fluid, I would be more worried about that than having twins!
: Yes to all of that - well said!
post #31 of 84
Quote:
Originally Posted by alegna View Post
Yeah... my non-medical and more laid back ways drive many batty
Well they wouldn't drive me batty in any other situation, but I want to know if you're having twins now!
post #32 of 84
Quote:
Originally Posted by OGirlieMama View Post
Well they wouldn't drive me batty in any other situation, but I want to know if you're having twins now!
I'm more concerned that it's fluid overload or an abnormality.
post #33 of 84
Thread Starter 
Eh, I'm not going to stress about fluid overload or an abnormality.



Just not my nature.

What will be, will be.

-Angela
post #34 of 84
Pretty much what everyone else has said. I'm assuming she'll have the normal neonatal resuscitation stuff and pit (I needed two shots after the trips) on hand, but make sure. Ask what she does for breeches (especially if she's never actually delivered one). My midwife's protocol was to call EMS when Max was presenting breech, regardless of problems. The EMS didn't deliver him or anything, they were just there 'just in case'. They did give him (and my dh, ) some oxygen and gave me fluids, but that's it. If that's something you don't want done, you need to find that out now.
post #35 of 84
Kathryn, how did EMS react to you homebirthing triplets? Were they concerned or did they try to convince you to transfer? I would be so scared to let any medical team into my house during a multiple birth. But if I wanted to have triplets at home and that was my midwife's condition, I would allow it!
post #36 of 84
Yeah, I would not want to call them either! I can't beleive you actually got them to leave without any of you!
post #37 of 84
Thread Starter 
Quote:
Originally Posted by Kathryn View Post
Pretty much what everyone else has said. I'm assuming she'll have the normal neonatal resuscitation stuff and pit (I needed two shots after the trips) on hand, but make sure. Ask what she does for breeches (especially if she's never actually delivered one). My midwife's protocol was to call EMS when Max was presenting breech, regardless of problems. The EMS didn't deliver him or anything, they were just there 'just in case'. They did give him (and my dh, ) some oxygen and gave me fluids, but that's it. If that's something you don't want done, you need to find that out now.
I will ask- we've had breech conversations before. I doubt she'd call EMS without an active reason. And she knows all the "right" hands-off-the-breech answers

-Angela
post #38 of 84
This has been bothering me since yesterday...

I wouldn't look lightly on TTTS markers, or think "whatever will be will be." TTTS has an extremely high fatality rate -- last I knew it was 80% for one or both. I know several women irl who lost a twin to TTTS after birth, or lost both twins during pregnancy due to TTTS. There are treatments if a provider knows what he or she is looking for.
post #39 of 84
Thread Starter 
Quote:
Originally Posted by YumaDoula View Post
This has been bothering me since yesterday...

I wouldn't look lightly on TTTS markers, or think "whatever will be will be." TTTS has an extremely high fatality rate -- last I knew it was 80% for one or both. I know several women irl who lost a twin to TTTS after birth, or lost both twins during pregnancy due to TTTS. There are treatments if a provider knows what he or she is looking for.
I appreciate the thought. I would rather this not go off track into that subject right now. Suffice it to say that I am not uneducated on the subject, but that I would simply make different choices than many would. My dh and I have discussed the issue and we're on the same page.

thanks!

-Angela
post #40 of 84

Lurking EMT here ...

I have to say thumbs-up to the EMTs who stayed to give fluids and O2!
I've attended and delivered at both mw-assisted and unassisted homebirths that have taken an unexpected turn. I think you can expect -- in most jurisdictions -- that if you call 911 in a medical emergency where children are involved (especially multiple infants!), you might have to have a plan for if the EMTs call CPS and/or the cops to enforce transport. Most EMTs freak out at the thought of homebirths, being that we end up assisting at spontaneous ones where the parents wanted an institutional birth or even CS. As well, in my region, I would be disciplined, if not stripped of my license, if I violated my protocol, which demands that I transport if certain risk factors are present.
I don't want to be alarmist ... on the contrary, I'm just suggesting that all families birthing at home would do well to have a good solid plan (in writing) and an articulate advocate on hand or available who is not directly involved in the birthing process (... other AP folk? Sister-in-law?)
And part of that plan would hopefully include your own, self-identified signals that it's time for transport.

That all said, blessings on you all for your homebirth choice! If I attended, I'd put on my pom-poms and be your cheerleader! Rah-rah, sisboombah, gooOOOoo mamas!
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