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Epidural required to birth twins vaginally??? - Page 2

post #21 of 31
Related question/clarification. If you had the epi line, but no drugs, would a c/s under general still be necessary?

And even if you had some epi drugs, wouldn't you need more for a c/s?

What is the IV line people are talking about: the epi line or a line in your arm??
post #22 of 31
Quote:
Originally Posted by worcma View Post
What is the IV line people are talking about: the epi line or a line in your arm??
I had a heparin lock (hep lock) placed in my arm/wrist 'just in case'--it provides a point of access and potentially saves a bit of time in an emergency scenario. It is a small IV port with about 6" of tubing that is then taped down. After it was placed and taped, I didn't notice it at all.
post #23 of 31
Quote:
Originally Posted by worcma View Post
Related question/clarification. If you had the epi line, but no drugs, would a c/s under general still be necessary?

And even if you had some epi drugs, wouldn't you need more for a c/s?

What is the IV line people are talking about: the epi line or a line in your arm??
As I understand it (from a nurse perspective)
... if you had a need for an emergent C section, and had an epidural in place, you would NOT have to be done under general. Yes, you would need more dosing of drugs, but they take effect relatively quickly. They would load you up with the numbing agent (Lidocaine, Buvipicaine, what ever the anesthesia guy likes), and maybe a bit of the pain med (duramorph, fentanyl, etc). When you get an epidural for pain relief, it's generally a combo of the numbing agent, as well as the pain med.

At most hospitals, if you have an epidural, it's pretty standard procedure to have some sort of IV access, in case they need to give you IV fluids, blood, medications, blah, blah blah. I'm going to request a saline lock (hep lock) .. the IV catheter is placed, then capped, ready to be accessed when needed.
post #24 of 31
Quote:
Originally Posted by OGirlieMama View Post
I hate to argue on the side of the hospital, but it can take 15 minutes to get an IV in and it can take longer than that to get an epidural in - there are so many variables. Of course it doesn't ALWAYS, but it can and I don't think it's unreasonable for someone to suggest that time frame. As with everything else, it should be your decision to get an epidural or not, but to imply that they are giving bad information, based on one mama's experience, seems unfair.
I didn't mean to suggest that they were giving information that is never true - I apologize for that. My mother is an extremely hard stick, so I do know all about the delays that can occur with IV.

To clarify: my objection was that the hospital staff presented all these things as "this WILL happen", rather than saying "There is a risk [ideally then quantifying that risk] that it could take up to XX minutes to insert an IV, although XX minutes is normally what it takes".

We just found that they continually quoted the worst-case scenarios of what could happen and how long things could take, and presented that as normal and likely to happen. Don't even get me started on the enthusiasm with which the OB hammered at the point that my cervix would so very likely close after birthing Twin A and that I would be unable to birth breech Twin B without her high-level interventions!
post #25 of 31
Quote:
Originally Posted by Mama to one View Post
I am pregnant with b/g twins and last week I met with my OB for the first time. The meeting went pretty well. He is very willing to help me have a vaginal birth as long as baby A is vertex. But it did surprise me to hear that he pretty much "required" me to have an epidural. He said it helps in the safe delivery of the second twin and that it is pretty much standard procedure and recommended everywhere in Canada, U.S. and Australia. For example, if baby B is breech or transverse he can reach in there and do what needs to be done without me "crawling up the bed" (as he put it) as well as being prepared in case of an emergency c-section. Ultimately, it would be my decision but I was wondering what others experiences were. I kind of believe that not having an epidural is what helped me have fairly quick and easy births with ds and dd and was kind of disappointed to hear about his recommendation.

I haven't given birth to my twins yet, but when i found out i was having twins i called all the hospitals in my network and asked them their standard policies for twin births and this DID come up when i called. they ALL said it (along with saying i'd be given a "trial of labor", but i had to labor and deliver IN the OR, not a labor/delivery room) BUT, ALL of the hospitals (and the cnm i asked about my options during a hospital birth before deciding on a homebirth) stated that what they could do is put the catheter in, but not put any medicine in if you don't want it in. This way if an emergency c-section is necessary, they won't have to give you general anesthesia. If i was having a hospital birth, it's what i'd do. but that's just my .02
post #26 of 31
In the hospital birth of our twins, epidural was suggested and expected but all I had to do was say, "NO." The only have to's in our case was I had to have an IV line (not hooked up to anything),we had to have an anestiologist (sp?) in the room 'just in case' and I had to deliver in the operating room. It was REALLY unneccesary and it really made me lose focus (I did AWESOME in the labor room and could have delivered there with no problems..or even at home for that matter!).
post #27 of 31
I did have an epi with my twins and thank goodness I did because I think I would not have saw tommorrow without it. Baby b decided he would flip and get cord wraped around his neck, so my dr literally dove in after him. I didn't like the idea of it either especially since I had 3 prev. natural vaginal deliveries, but I was told it's different your having twins!: Herd that enough times...
post #28 of 31
It seemed likely that an epidural would required at my local hospital for twins. I'm strongly against that sort of thing (my 1st baby was born at home) so I'd decided to go to a city 3 hours away to deliver. However, when I went into pre-term labor, a 3 hour drive was out of the question. I labored, on mag and in silence, for about 6 hours at the local hospital. I was 10 centimeters when they checked me, and there was no time for an epidural. My twins were born vaginally very soon afterwards.

I really think that not having an epidural helped me out. I'd advise against it. I will say that it can be very hard to so no to drugs when you're actually in the hospital. I'm glad the question never came up. When I tried to refuse the mag, they threatened to air-lift me to Phoenix. I don't know about you, but laboring in a helicopter didn't sound too appealing to me.
post #29 of 31
Quote:
Originally Posted by devilish_fetish
ALL of the hospitals (and the cnm i asked about my options during a hospital birth before deciding on a homebirth) stated that what they could do is put the catheter in, but not put any medicine in if you don't want it in. This way if an emergency c-section is necessary, they won't have to give you general anesthesia. If i was having a hospital birth, it's what i'd do. but that's just my .02
(Interestedly following this discussion, here!! I have twins due in July, and have recently changed doctors but am waiting to discuss protocol etc. and be sure that I want to stay with this practice....)

I don't know that having an epi line in place with no meds would ensure that general anesthesia is unnecessary in the event of an emergency c-section. It's not even completely clear that having an active epi during labor ensures that the extra boost of meds necessary for a c-section could take effect in time (via epidural) to accommodate a really serious emergency.

I think it might be worthwhile to clarify the degree of emergency we are talking about when we mention the possibility of "emergency c-section," or maybe distinguish whether the c-section is "necessary" (we can't get the baby out this way) versus "emergency" (the baby is in danger.) Would a doctor really be comfortable assuring someone that under no circumstances would you need general anesthesia if you had an epidural going and ended up in an emergency c-section situation??? That there's no chance of even an active labor-dose epidural taking too long to bump up and take effect for a really serious emergency? And would the doctor say the same about the spinal line running saline (no meds) and starting "from zero"?

I guess it's worthwhile to ask whether the spinal line with no meds even would be viable for a truly urgent emergency? And if not, and if the "necessary" (versus "emergency") c-section for position problems is the more likely scenario in 2nd twin births anyway, would there typically be a window there for a quick spinal prep (not an epidural) before the c-section?

If the answer to that is "probably yes," maybe it makes more sense to avoid the epidural and the spinal line entirely if the main reason for opting for them is "avoiding the need for general anesthesia in the event of a c-section." If a true urgent emergency would likely result in general anesthesia IN SPITE OF having an epidural in place, why not labor without the epidural and plan on having a spinal if c-section becomes a reality and there's time for the spinal? (Realizing that general anesthesia may still result if the urgent type of emergency comes up, just as it could with an epidural in place and running.)

If position issues are statistically more likely than distress-plus-position issues in second twin c-sections, it seems like general anesthesia is an unlikely prospect whether you have an epidural in place or not. There typically would be time to prep for the procedure. (And spinals are supposed to be faster than epidurals, regardless.)

I guess the potential issues of internal version and extraction are the remaining ones to consider, whether it makes sense to have the epidural there for the mother's comfort during these procedures. But maybe the window of time applies here, too. After all, if you have the epidural line with no meds in place, is there going to be time to start up the meds and have them take effect before the procedures need to happen? And if there is, would it be just as possible to wait and opt for a spinal at the point that internal version comes up, as well? (Is there a 5 minute window, or not? And how long does it take the meds to take effect once they start running them through the epidural line, anyway?)

And I guess if one of the "potential issues" to consider is a previously vertex Twin B turning breech or transverse after the first twin is born, I'd want to know the OB's thoughts on what people have shared in recent threads about "holding the spot" externally and preventing the vertex baby from turning once the womb space is opened up. As in, what about these approaches to managing the situation?

Part of my reservations at this point (at the point of discussing options with my OB) is that I've read that there are similar risks to the mom from the saline version (no meds) of the epidural line placement. So apart from the issue of epidural meds, just by having the line in place, you run the risks for spinal headache, lingering epidural backache, and the possible need for a blood patch. Not that they wouldn't be a worthwhile trade for the option to have muscle control and remain vertical while laboring, so setting the spinal line with no meds might be worth it. But I would wonder if it really were such a truly necessary step to avoid general anesthesia, so that's where I'd start.

("Can you guarantee that I wouldn't need general anesthesia anyway, in an urgent situation, even if I have an epidural?" "In a typical situation such as deciding on c-section for positional reasons with no associated distress, would there typically be time for a spinal ANYWAY?" "Even with some distress or emergency, is there likely a 5-15 minute window that might allow for a spinal ANYWAY?")

I'm still a couple of weeks away from my appointment with my OB, so majorly musing over these things right now!
post #30 of 31
No one ever pushes mommas of singleton babies to get an epidural "just in case" they end up in a section. This is one of my pet peeves - - I labored and delivered preterm so it never came up but I was fully prepared to put up a fight about the "required" epidural. I've seen too many babies crash after the epidural is placed, especially twin mommas. So you know. we all need that epidural so that when we end up in the c-section that the epidural caused, we'll be able to witness it
post #31 of 31
I have heard that some hospitals "require" epidurals with twin births. I have even heard that some "require" the mom to labor and deliver in the OR in case something goes wrong. But lately I've been hearing from more and more parents telling me a c-section was "required" to deliver their mono-di twins.

I feel pretty lucky that no intervention was ever even suggested for my mono-di twins.

However, I did learn on arriving at the hospital that CFM was "required". (It was not required for my first, a singleton, delivered at the same hospital.) I wish I had known that it would be in advance so I could have had time to decide whether I wanted to decline it or not.

* Jaime
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