need to labor in the OR for twin birth?? - Mothering Forums

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#1 of 30 Old 10-05-2009, 11:01 PM - Thread Starter
 
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I'm in Florida where it's (apparently) against the law for a midwife to attend an out-of-hospital twin birth. The hospitals around here will require me to birth both babies in the OR. I believe that I am "allowed" to labor in a normal room, however.

My question is this: what do you think will happen if I refuse to move to the OR?

I already plan to refuse the epidural catheter and an IV. My goal is to make it as hard as possible for them to bully me into a c-section.

Karen, mama to one toddler (9/07) and twin babies (10/09)
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#2 of 30 Old 10-06-2009, 12:23 AM
 
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Aaaahhhh, the challenges of just trying to deliver your twins! I hope all goes as well as can be. I was told that I'd have to labor in the OR, as well as birth there, but they changed their story the week before the birth. I seriously couldn't imagine doing it "naturally" if I had to labor in the OR. We were lucky enough to be in the right state (Oregon) and to have AWESOME midwives attend us. I asked all that I could about refusing things to our perinatologist, but it's pretty exhausting to always have to refute things. I know some mamas on the board here have made the best of their hospital births, so I hope they will help out.
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#3 of 30 Old 10-06-2009, 01:04 AM
 
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Nada, just I was so thankful to be in Texas when I had my twins. Birth should not have to be a battleground.
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#4 of 30 Old 10-06-2009, 05:47 AM
 
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... see next post below

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#5 of 30 Old 10-06-2009, 05:53 AM
 
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Originally Posted by Night_Nurse View Post
Can you hire a doula to help your wishes be known on the big day? My advice is to labor at home for as long as possible so your battles are kept to a minimum. As a patient, you always have to right to refuse something but I'm guessing you will have to preregister at the hospital and they'll know you are coming in with twins. So they may refuse to put you in any available room other than the L&D OR when you arrive. Also, hospital staff are more willing to skip protocol (if possible) if your OB is on board with the plan. Ask your doctor about birthing in a regular room and for him/her to write it as an order for L&D. That will make it a much smoother process. Good luck!
Sheesh! Nevermind...it's really late and I misread your post. I thought you meant you'd be required to labor and birth (not just birth) in the OR. So none of my suggestions really make sense (except maybe for the doula but I'm not sure if they'd allow her in the OR). I'm sorry. I have no idea except maybe convince your doctor to let you birth in the L&D room and just have the OR set up on stand-by for an emergency. I'm pretty sure they'd be more open to this suggestion though if you allowed the IV.

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#6 of 30 Old 10-06-2009, 10:23 AM
 
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I delivered my twins vaginally in an OR -- however, I was young and not well informed and didn't know much about birth. If I could go back, I would have done things differently. If I were pregnant with dichorionic, diamniotic twins, I'd have a homebirth. Even if midwives can't legally attend you, you can find one.

If you "refuse" things, the worst case scenario -- which has been known to happen! -- would be a court order against you, CPS, all kinds of drama.

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#7 of 30 Old 10-06-2009, 10:29 AM
 
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I plan on refusing the OR birth. I will inform my OB of this tomorrow. I discussed everything with him early on in the pregnancy and just kind of held in what I was really thinking ... knowing that making a battle out of it early on wasn't going to get me anywhere. So, I plan on telling him that I'm not birthing in the OR, doing the GBS, or being induced at 38 weeks. From the birth stories that I have read, MOMS who birth in the OR are surrounded by 20 different ppl who are all ready to whisk the babies away, or they are experiencing extra pressure to take interventions. No thank you! I'm healthy, the babies are healthy, we always have been healthy ... no need for all this extra attention.

I like what a previous poster said .... birth shouldn't be a battleground... and it does get exhausting have to fight all these battles.

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#8 of 30 Old 10-06-2009, 11:51 AM
 
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I haven't any great advice, but I have a similar situation, and here are my thoughts.

The first OB I saw (who discovered the twins) insisted that c-section was really the way she handled twins. She would allow me to try for vaginally if I was set on that, but she has never had a mother successfully deliver twins vaginally. She absolutely does not let twin mothers go beyond 38 weeks. She offered that we could schedule that very day (this was at 10 weeks ... I suppose that with week 38 being Christmas week, she was being nice in offering me a chance to plan my holidays!). And by the way, I was gaining too much weight, therefore she recommended a low-carb diet.

I began looking elsewhere. I discovered that here in Maryland, CNMs can't do out-of-hospital homebirths. In fact, the high risk cases are cared for by the OBs. The CNMs participate, but they are not in charge. And with twins, I found that I am always considered "high-risk" and treated a bit like a walking time-bomb! The first CNM I talked to quietly gave me the name of a CPM (not recognized here, legally) who has lots of experience with twins.

I got on MDC and sought advice from other people in my area. I managed to find a hospital with a group of CNMs and OBs that are not quite so c-section happy, but they still like OR for delivery. And the same CPM's name kept coming up.

In the end, I have decided that when in labor, I will hardly be up for fighting hard for what I want (natural, vaginal, no OR). This pushed me to settle on home-birth with the CPM. But I am doing parallel care with the CNMs/OBs that I liked pretty well. This way, I stay on good terms with the hospital folks. My CPM and I have talked about the situations where she or I would not be comfortable with HB.

For now, I am just doing my best to myself and these babies healthy, and for as long as everything looks and feels right, I will be planning HB.
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#9 of 30 Old 10-06-2009, 07:22 PM
 
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Just chiming in to say birthing in the OR ended up being no big deal for me. I thought it would be. I thought the NICU team and all the people being there would bother me. None of it mattered by the time it was time to deliver. But I had a wonderful quiet labor in the room next door, with one amazing nurse and my DP, and I told them when it was time to push, and in I went to the OR, still in that labor zone, and 30 minutes later, there they came. And I didn't really notice the "crowd" in there.

My Twin B needed a little help at first, too (just some O2... she presented with two feet and a fist and ended up being a double footling breech extraction), so having the NICU people there was better than having her whisked away.

So I am just saying if you *have* to deliver in an OR, it can still be a great delivery.
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#10 of 30 Old 10-06-2009, 07:32 PM
 
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I delivered my twins in the OR. But it all went fine and really was no big deal. I had delivered naturally with my older dd (at the same hospital and with the same ob/gyn) and both twins were head down, so my docs saw no reason I couldn't deliver vaginally with the twins and told me to "go for it". So I actually had quite as natural a birth as possible, just in the OR. My docs were just erring on the side of caution.

NICU was standing by, but really were not needed. My twins were monitored in the NICU for less than a day and then came back to my room to stay with me. I was very fortunate and am grateful.

Loon , dh , dd , and twins ds1 dd2 **Thoughts become things. - Mike Dooley**
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#11 of 30 Old 10-06-2009, 09:14 PM
 
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I gave birth in an OR and it was less than ideal... but there were MANY people there since it was a premature birth and the lights were very bright... they tried to get me to get off of the hospital bed and onto the metal operating table with no sides and I flat out refused. (I mean, are you kidding? Who can give birth on a cold table with no sides with bright lights and all of these weirdos staring at her?!?) I can laugh only b.c I am happy I had a vaginal delivery and despite all of these factors it was still the best day of my life. But all of these factors made it ideal conditions for this mama who dreamed of no drugs to cave and have an epi when she was 10 cm dilated and ready to push.... I was like a deer in headlights!

I would refuse to go to the OR if I were term... the scare tactics got me. Blindsided is a good way of putting it!

Mama to lovely twin girls 1/08
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#12 of 30 Old 10-07-2009, 02:00 AM
 
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Well...my certified nurse midwife informed me quite some time ago that they require her to delivery all of her multiples in the OR. I will be able to labor in a regular room, but once I get close they will haul me off the the OR for any "just in case" situations. She said it won't really be a big deal and they can still keep the lights down and I have play my music and whatever. It must be a pretty serious law/rule cause I know like with the erythromycin in the eyes thing, I am able to just sign an AMA form so they don't do that. But, pretty sure they will not change their minds about the OR thing. Oh well, it doesn't seem like a big enough battle for me to fight, since my midwife made it sound like it wasn't really a big deal.
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#13 of 30 Old 10-07-2009, 09:35 AM - Thread Starter
 
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Those of you who have already given birth in the OR--was everybody suited up in caps & masks? That would freak me out.

My only other child was a homebirth, so I'm really kind of a novice about how hospital births work. I'm really comfortable signing any AMA forms; so is my husband.

I have an appointment today with the OB, and I'll try to ask her some questions in a calm and non-confrontational way (and then I'll come home and cry and slam doors or whatever).

Karen, mama to one toddler (9/07) and twin babies (10/09)
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#14 of 30 Old 10-07-2009, 09:48 AM
 
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Originally Posted by verycozy View Post
Those of you who have already given birth in the OR--was everybody suited up in caps & masks? That would freak me out.
You know, I don't even remember... clearly I was focusing inward and not on "them"... I can't even picture it in my head (although I can remember still, four years later, the amazing feeling of Twin B moving around after Twin A was born! And the thrill and "are you nuts" feeling when I heard "She looks beautiful (Twin A)... now let's do it again!"

I know, that's just one person's experience (one who had a low key OB who had TONS of multiples experience) and others have had MUCH more invasive experiences... but I definitely thought delivering in the OR would bother me and when the time came, I clearly didn't notice much about it at all! Good luck, mama...
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#15 of 30 Old 10-07-2009, 02:34 PM
 
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I was a planned HB turned hospital transfer w/my twins. We had a very supportive OB w/lots of twin experience at a fairly laid back hospital. I was full term.

Here are some answers to your questions:
I don't remember masks... no, no masks. The MW and my DH had to put on those cheap scrubs, but I wasn't focused on the fact that they looked like smurfs.

Moving from the hospital bed to the operating table was stupid. I remember thinking, 'You've got to be f*cking kidding me.' So, yeah, if you can avoid shuffling on your back from a bed to a cold, hard table while contracting and pushing, I highly recommend it.

I remember thinking that there were not that many people in the OR. I suppose it was b/c I was full term and the OB was rather relaxed.

I had feared and dreaded an OR birth, but it really was not bad. As w/Louis Lane, I was too 'in the zone' and was able to labor mostly at home and then in an L&D room until it was time to push. The worst part of it, to me, was the fact that the hospital staff whisked the babies away to the other side of the room as soon as they were born, to weigh, measure, & suction. I didn't see the babies until after they were already wrapped up in blankets. Bleh. I don't like to look at the OR photos b/c there is one of twin B laying in a pool of blood between my legs, on the metal table, immediately after the breech extraction. She should have been handed to me. So if I had to do it again*, I would make sure that the babies were handed to DH or I immediately after birth and insist that the weighing and measuring wait for at least 20 minutes or until we were ready for it. I would have more talks w/my OB in case of hospital transfer to assure that a hospital birth would be as "nice" as possible.

*If I had to birth twins again and they were di/di, I would find a competent provider & plan a HB or travel to the farm. If they were mono/di, as mine were, I'm not sure if I'd plan another HB.

Mama to twin girls Adele and Nadia, born 5/2008
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#16 of 30 Old 10-07-2009, 03:12 PM
 
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Thanks for all the responses and experiences, as I'm facing the same situation.

My mw will be with me in a labor room until I start to push. Then I'll be transfered to the OR where my OB will meet me. I'm ok with that, since they are so laid back. My impression is the midwife can even deliver, so long as there are no complications. I will check on staying on a l&d bed vs. the table and about holding the babies immediately.

J A with DD1 7/06, lost twins 9/08
DD2 12/09 & DS1 12/09
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#17 of 30 Old 10-08-2009, 01:26 AM
 
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Originally Posted by verycozy View Post
Those of you who have already given birth in the OR--was everybody suited up in caps & masks? That would freak me out.

My only other child was a homebirth, so I'm really kind of a novice about how hospital births work. I'm really comfortable signing any AMA forms; so is my husband.

I have an appointment today with the OB, and I'll try to ask her some questions in a calm and non-confrontational way (and then I'll come home and cry and slam doors or whatever).

I remember DH being in scrubs. You know those green pants and tops and a cap, but I don't remember a mask.

Honestly I don't remember much about anyone else.

I DO remember singing along with the a Journey song that was playing in the room, which made one of my nurses laugh and say I must be relaxed. And I DO remember chatting with my OB about buying a house, because his wife was a real estate agent.

So really all in all, it was quite a comfortable situation. No trauma, just a great birth. My babes were 8 minutes apart though, because I was TIRED after pushing out DS and I needed to rest a bit before pushing DD.

Loon , dh , dd , and twins ds1 dd2 **Thoughts become things. - Mike Dooley**
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#18 of 30 Old 10-08-2009, 01:41 AM
 
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I birthed in the OR as well with no big deal. Lots of people who were really bored- the OB, the anesthesiologist, the surgical team, the NICU team...all standing around with nothing to do. I was lucky that they had just installed new padded operating tables, so no cold metal for me!

That is one thing I would add, be ready for a super cold room. My MW had them bringing warmed blankets to me every 5 minutes.

Joanna - wife to Mike, mamachicken to Cub(8/98), Kitten (4/07), Dew-man, and Woe-boy(twins, 10/08)
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#19 of 30 Old 10-08-2009, 06:39 PM
 
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I gave birth naturally to my mono/ di twins in an OR after laboring across the hall in a normal room. There were a ton of people in the room and only my husband for comfort. My twins were small so had to go to the NICU and out of the whole experience I'm still haunted by the fact that I didn't get to hold my first or really see him and that we weren't allowed to take any photos of their amazing birth. Other than that, I feel like where you labor is more important for healthy unmedicated birth than where you deliver- and having your HCP/ doula advocate for you.
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#20 of 30 Old 10-09-2009, 09:11 AM
 
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I delivered my twins vaginally, in the OR, with one being a breech extraction. No worries on laboring in the OR, since I did all of that at home. (showed up crowning Baby A)

You know my answer to everything .... if you stay at home as long as you can, you get to eat, walk, and labor as you wish.

Catholic homeschooling mom of 5 - a teenager, a kindergartener, twin boys and a tiny princess. Follow the Adventures! 

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#21 of 30 Old 10-09-2009, 09:13 AM
 
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things I would change:
I HATE &(*&()&)*^(^ Stirrups!!!! ARGH! I begged them not to make me get in those darn things.

I wanted a break between Baby A and B, since I was pooped. No dice. They were born 6 minutes apart.

Catholic homeschooling mom of 5 - a teenager, a kindergartener, twin boys and a tiny princess. Follow the Adventures! 

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#22 of 30 Old 10-09-2009, 11:59 AM
 
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Originally Posted by verycozy View Post
Those of you who have already given birth in the OR--was everybody suited up in caps & masks? That would freak me out.

My only other child was a homebirth, so I'm really kind of a novice about how hospital births work. I'm really comfortable signing any AMA forms; so is my husband.

I have an appointment today with the OB, and I'll try to ask her some questions in a calm and non-confrontational way (and then I'll come home and cry and slam doors or whatever).
by baby 'b' everyone was suited up like that. baby 'a' was born too fast - right in the doorway.

i was annoyed at having to get on the bed and be run down the hall for the births, but i was glad to be in the OR in case i did need a surgical birth. i had a dr with a good track record for vaginal twin births though so it made me feel less like i had to fight for that. i was also glad for the iv though as i had been puking so much i would have been dehydrated otherwise. plus i was able to get antibiotics - so nobody had a problem with me and the babies leaving at 24 hours. i had a hep lock thing (but not with heparin? don't remember what it was) so i could move around and walk the halls. i just docked once an hour to tank up and be monitored.

Mama to Jet 6/05, Marvel 8/06 and Cash and Fox 2/09
Expecting Ada Marianne 11/14
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#23 of 30 Old 10-09-2009, 10:48 PM
 
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I delivered my twins vaginally, in the OR, with one being a breech extraction. No worries on laboring in the OR, since I did all of that at home. (showed up crowning Baby A)

You know my answer to everything .... if you stay at home as long as you can, you get to eat, walk, and labor as you wish.
Exactly! Stay home for as long as possible and show up ready to go... I am very happy with how my labor went at home... LOTS of walking, that is for sure. And lots of privacy.

Mama to lovely twin girls 1/08
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#24 of 30 Old 10-19-2009, 10:09 AM
 
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Exactly! Stay home for as long as possible and show up ready to go... I am very happy with how my labor went at home... LOTS of walking, that is for sure. And lots of privacy.
I'm facing this same situation in Florida as well. I totally get not showing up until pretty much crowning, but do you have any advice about how to time this? My last child was born 2.5 hours after I decided I was really in labor. Thank goodness he was a UC, or he probably would have been born in the car.

Shel - mama to three ages 8, 6 and 3yo
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#25 of 30 Old 10-21-2009, 12:13 AM
 
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My hospital's policy with twins was, with two vertex presentations, labor & pushing in one of the regular labor/birthing suites was fine. With the second twin breech, birthing in the O.R. was standard procedure. It seems like overkill because the birthing wing is so small, and the O.R. is RIGHT THERE, you certainly could be taken there just as quickly as a singleton emergency would. I guess it's the idea that it's known there's an increased risk, because of the breech presentation of the second twin?

I had a breech twin B (who turned after his brother was born and was born vertex) and I did go into the O.R. for the births.

I also got onto the skinny operating table as prompted, when I got there. I was standing on the table for both babies, as upright felt right to me. So crazy!!

I guess they'd have put masks on if there were an emergency requiring surgery? I don't remember any masks.

I was definitely focused inward, though. I specifically recommend HypnoBabies to anyone planning to birth twins in a hospital. We arrived and had to meet the on-call OB (not my regular doctor), who proceeded to try to bully me into an automatic c-section for the breech twin. He didn't think versions (internal or external) were safe or advisable, and he didn't recommend a breech extraction either. In the end, we had agreed on a breech extraction (I really believed the baby would turn, regardless) because I refused the automatic c-section. But basically, I progressed actively that whole time, in spite of the arguing that could have shut me down. I stayed in hypnosis while talking and debating (HypnoBabies allows for that, unlike some other birth hypnosis programs), and I was able to keep the adversarial stuff outside my "bubble."
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#26 of 30 Old 10-22-2009, 01:20 AM
 
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I also labored in a L/D room until I was pushing baby A, then got a short ride down the hall to the OR. We knew this was the plan and didn't argue with it -- just brought my doula and my best friend with me. As I was surrounded by these loving and kind faces (no masks), and since I was really in "the zone" by the time we went to the OR, I didn't notice the other people in the room.

They did have me slide over onto the table, which in retrospect I wish could have been avoided. I wanted to squat or crouch for pushing, but once I was on the table the only option was to lye flat on my back. I definitely think that slowed things down, but this was my first birth so I just didn't really know any better.

Once dd was born, my OB did an external version for my breech ds. I thought this would be awful but actually I hardly even noticed... thank goodness for the fog/amnesia of labor! Then, wonder of wonders, my OB politely excused herself and sent us BACK to the L/D room to have my ds with our CNM! Even in my stupor I was thrilled. Ironically though, I also pushed and delivered him lying in bed, because I was too exhausted to do anything else.

I know nobody looks forward to birthing in the OR, but I think that to some extent you can bring your desired birth experience with you, in the form of your partner and other birth companions, and your attitude and expectations. It does mean accepting some limitations, but doesn't have to be the end of the world, in my opinion.
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#27 of 30 Old 10-23-2009, 12:59 AM
 
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I never really found out my hospital's policy, because I went into labor so early. But at 29 weeks, vertex-vertex, I labored and delivered my baby A in a regular L&D room. They gave me the room that was at the end of the hall, closest to the OR. Good thing, because that's where I was brought to deliver baby B 35 minutes later. Good times.

Betsy, mama to beautiful, strong MZ twins Lillian and Kate, born 11 weeks early on January 10, 2006.
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#28 of 30 Old 10-24-2009, 08:23 PM
 
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What type of twins do you have? If they are mono-chorionic it is probably best to deliver in the OR. TTTS can happen even during delivery although that is very rare. If you twins are di-di then I would not agree to deliver in the OR.

My twins were di-mo so I went with the OR. It wasn't terrible. I had a vaginal delivery so that is what is important. I did not get to nurse right away which was not good. I didn't care about the people there except for my dh and my mom. My real complaint is one of the nurses who coached me to hold my breath and told me I was wasting my energy when I tried to breathe through contractions. She also yelled at me once baby A was born that I wasn't holding her. I was in a daze, someone should have been supervising more closely, that stupid metal bed was narrower than I was.

So, if di-di don't go, otherwise do some research about complications before you decide.
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#29 of 30 Old 10-31-2009, 01:00 AM
 
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I'm so glad to find this thread. I'm 15 weeks with di/di babes and I so don't want to deliver in the OR. I'm hoping to wait as long as possible and see if DH can learn how to check how many CMs I am. If I get to the hospital at around 7 or 8 CMs then maybe I can just get there and push w/o any time for them to start talking ORs and epidurals. My peri looked at me like I was a lunatic when I asked about delivering sans pain meds...

welcomed my boy/girl twins on 04/22/10 after cooking them for 40 weeks
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#30 of 30 Old 11-01-2009, 01:17 AM
 
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I delivered in the OR after laboring w/o intervention in a regular labor room. It was fine. The lights were dimmed at my request, there was no pressure to hurry up and deliver, I felt very in control and peaceful.

SAHM to twin kindergarteners

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