Need advice! Do I push for an earlier delivery, or no? - Mothering Forums

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#1 of 23 Old 01-18-2010, 11:57 AM - Thread Starter
 
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Hi, everyone,

I've been lurking here for months, and finally, have decided to come out of lurking to seek some advice. I'm very conflicted on what to do, and I feel I could get good feedback from the women/members here.

So, quick history: I'm pregnant with boy/girl twins, currently 36 weeks 4 days. The babies are transverse/transverse at the moment, and we have a c-section scheduled for Jan 31st, when they will be 38 wks and 3 days. If they switch positions before then, we won't have the c-section, but that is the current plan as it stands today.

Last week during an ultrasound, they discovered what's called a varix in the girl's umbilical cord. Everything else (heartbeats, fluid levels, flow through cords, etc.) looked good. A varix is apparently some very rare umblilical cord complication that can lead to some terrible outcomes should something go wrong.

My doc said that in his experience, while the literature on this is dark, things typically turn out ok. He said they would normally take a baby earlier to avoid the risk of something going wrong, but he wanted to give our twins a bit more time. He said he would take the babies right then if we wanted (this was last week), but he felt it was best they stay inside a bit longer so they wouldn't have trouble breathing. He said if I notice a decrease in movements to head straight to the ER for monitoring. (And I've been beyond paranoid since!)

So, here's my question...

I have an apt tomorrow, for monitoring (NST) and ultrasound. I'm praying all will be ok. If all is ok, obviously they can stay inside longer. If things are not ok, I'm guessing they will be scheduled for delivery that day or the next.

HOWEVER, that said...

If things do look ok tomorrow, I'm wondering if I should ask to have the babies born a week earlier than we planned. Instead of at 38 weeks, at 37 weeks. I find myself so freakin' worried about this varix thing. I know it should be ok, and can be ok, but what if it's NOT ok, and I'm the one who insisted on going to 38 wks? I would never forgive myself.

I'm not sure what the right thing to do is. I'm at a total loss. Part of my heart feels all will be ok, and they deserve that extra week inside. While another part of me is terrified that leaving them there that extra week could have horrible consequences which I don't even want to think about, and if something did happen, it would be my fault. (My doc wanted to do the section at week 37, but I had asked for at least one more week.... that was before the varix, though. He would not let me just go into labor and have the c-section then, which was my first choice.)

Can any of you provide some advice? I don't want to make a bad choice based on emotions that are not based on facts, but I'm SO confused at this point! I don't know what is right. I tried for six years to have these babies, and experienced three early miscarriages... I know the past is affecting my thoughts now. But that's not helping be figure out what is right, and what isn't.

Help? Advice? Wisdom? What would you do?

Thank you,

~ Rachel

Rachel & Eli , with DS1 (7/99) and DS2 (11/01) twins DD1 & DS3 (01/10)
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#2 of 23 Old 01-18-2010, 12:31 PM
 
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Well. . . I'll start. My reply may be nothing more than wanting to "throw a bone" your way as I know how agonizing it can be to sit there and wait for replies to your thread about a troubling situation.

It's really a tough decision.

Disclaimer: I've never even heard of a Varix and I'm not going to bother googling it now as I'm not likely to uncover some obscure gem of useful information. I found that there is just way too little information about twin pregnancies and births anyway - nevermind rare complications.

I hope this doesn't sound callous in any way, because I think some of the most sobering thoughts come from love and concern. If I was in your shoes, I would probably be weighing what a "premium" both babies are at. And, yes, I guess that means "What are my chances of walking out with two healthy babies if I continue the pregnancy? What are my chance of walking out with just one and how will I feel about that? If the worst starts to happen for the twin with the varix, how much time will I have to save the second twin?"

And before everyone gets all up-in-arms and starts flaming me, allow me to explain further:
  • NO decision guarantees a positive outcome. You may relive and re-question yourself for the rest of your life.
  • If you choose a c-section now and one or both babies have respiratory issues, you will be staring that those outcomes, and wondering if it was worth what could have been a pretty small risk (of an albeit dreadful outcome).
  • If you choose a c-section now and both babies are well, you might wonder if your pregnancy past spooked you into an unnecessary early delivery and they might have done just a bit better (in difficult to pin-point ways) if they'd had a bit longer inside.
  • If, if, if. . .
Somewhat along the lines of: plan for the worst and hope for the best, this is some of what I would be considering in your shoes:
  • Is this likely to be "it" for you? Or are there more babies in your future? In this, I would be considering age, emotional and lifestyle considerations if pursuing another pregnancy (and these might be different depending on the outcome of this pregnancy).
  • Early miscarriages can be quite common. Was it just luck that made this pregnancy stick? Or was there a discovered medical issue that was addressed? (ie. likelihood of a future pregnancy lasting)
  • You mention 3 early miscarriages, but trying to have babies for 6 years. . . is the ability to get pregnant an issue as well? If yes, was there a difference this time in how the pregnancy was handled (ie. drugs) or was it just same routine, but happily a different result?
I know these are not happy things to contemplate. I'm suggesting it only with care, as for myself, trying to look at things in a really analytical way is helpful in difficult situations. Don't ignore your heart, but the more types of decision-making you can draw on, the better you'll likely feel about your choice.

We made some difficult choices with our twin birth. I was 29, had 3 kids already, no issues getting pregnant, and not much of issues staying pregnant. We love our sons intensely and did even before their arrival. They are not "expendable". However, I know my birth choices probably would have been different if I was 42, no kids, 8 years of trying, and conceived through the medical involvement and expense of invitro.

Six kids, sixth sense, six degrees of separation. . . from sanity!
Not sure that I'm crunchy, but definitely a "tough chew".
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#3 of 23 Old 01-18-2010, 12:42 PM - Thread Starter
 
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Thank you for the reply!! And yes, I was hitting refresh way too many times, even though I know this board isn't really a "happening" place, so expecting fast replies is unlikely.

To answer some questions:
The umblical cord issue isn't related to the m/s, that I know, but they were related to infertility.
We got pregnant after many years of medicated and non-medicated cycles... the one that stuck was going to be our last try, as I didn't think I could do it anymore. I was SHOCKED when I got pregnant, and really excited, of course. B/c of all the trouble we had, I don't expect to have any more kids after this. There could always be a miracle baby, but I will not go through treatments again. It's too hard.

I'm not sure, though, how this should affect my choices this time? Maybe I'm missing something.... I mean, I know it DOES affect me, but whether it should or not is another question altogether.

AS for your If's, YES! All of that has gone through my mind! What if we have them earlier, and then they have trouble breathing? Or other issues? And what if we do that all for nothing? Those what-ifs are part of what makes this so, so hard...

But my thought is, if they have some breathing issues, or feeding issues, the chance at this stage of that being very serious is small. It will be upsetting and not something I want at all, but not a life-or-death situation (at least, that's very unlikely).

While with the varix, this is a life-or-death issue... but again, the risk is probably small.

Googling doesn't do much good. I googled like crazy, and found horrible studies (just as my doc warned me), and a few real people (about five?) who wrote about their experiences and had babies come out ok. They all had earlish delivaries, I think, tho, b/c of the risk.

I'm an info freak, and I wish I could find REAL stats to help me decide, but I can't. Which is another aspect that makes this is hard and frustrating...

Plus, I'm hormonal, so... you know... that affects thoughts too.

Rachel & Eli , with DS1 (7/99) and DS2 (11/01) twins DD1 & DS3 (01/10)
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#4 of 23 Old 01-18-2010, 01:24 PM
 
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Hugs, mama. If twin preganancy wasn't hard enough already!
I hope that you can dispel some of the energy around this (probably after swinging to both sides of the pendulum). I believe that you will know what is the best choice for you and your family. You will. Trust in your beliefs. That may mean walking in today and having the babies, or it may mean waiting until you are in labor (even if they won't "allow" that).
Technology is such a double edged sword, sometimes. We get information, but sometimes info that we're not prepared for, and what we do next becomes challenging. I'll be thinking of you and your little ones.
Blessings to all,
Elizabeth
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#5 of 23 Old 01-18-2010, 01:43 PM
 
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Note that this is coming from a momma who had twins at 30 weeks and spent 6 weeks in the NICU.

What is the health of your babies otherwise? Are they at a good size? Could you get an amnio to see how their lung development is going?

If I were you....given that it is a life/death sort of thing, I would take them early. To me, the respiratory issues would be minor compared to the death of one of my babies. At 37 weeks, it is unlikely your little ones would have any real breathing problems...you would probably have some NICU time for observation and perhaps growing/feeding depending on how big they were.

Do what you think is best for you and your family. But I would consider the health of your twins in all other regards, and if everything looked ok, like I said, I would take them early. 37 weeks is considered full-term, even for singletons.
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#6 of 23 Old 01-18-2010, 02:33 PM
 
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The question I used to ask myself during my pregnancy when complications arose was "What decision is most likely to result in all these babies being healthy in a year?"

Wishing you peace with whatever you decide and a healthy outcome for all of you.

Kate
mother of Patrick (7/31/03), and Michael, William, and Jocelyn (4/27/07)
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#7 of 23 Old 01-18-2010, 04:52 PM
 
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If it were me I would do as suggested above, I'd have the OB check all other information like weights, lung dev't, etc. and go from there. If the babies looked good then I'd likely schedule the c-section (or whatever). Stress isn't good for you or the babies either and chances are the issues would be minimal if they were born now.

But, if the babies weren't quite ready, super little, lungs not ready, I'd wait until they look a little better. But I likely wouldn't wait long. The fear would likely get to me.

I don't know what this varix is either, never heard of it, but there's really no way I'd chance losing a baby versus some time in the NICU. And, I have two kids already, no trouble getting PG, and I'm not sure if these are my last. A loss is a loss and IMO you have much less of a chance of losing a child by going a little earlier than you anticipated.

Regardless, you seem to have thought through a lot of this already, and you will come to the decision that works best for your family.

Valerie, wife to Kevin, mother to Elena (4), Jonathan (2), and twins, Andrew and Benjamin (2/2010)
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#8 of 23 Old 01-18-2010, 10:38 PM
 
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Hi there OP,

I hope you didn't feel put on the spot to answer my questions! I wasn't posing them as information that we needed you to reveal in order to comment. Certainly wasn't trying to pry out more than you were offering - just explaining what questions would be among the many going through my mind if I were in your shoes.

I'll throw this one out there for everyone: How accurate are medical assessments of fetal lung development and such? Many doctors advocate c-sections based on late-term ultrasound estimates of baby size and it's well-established that late-term ultrasounds are highly unreliable for this. Is it the same with lung development and other assessments to assist in a decision to deliver early? Or is there more evidence that those assessments are accurate?

Wishing you well.

Six kids, sixth sense, six degrees of separation. . . from sanity!
Not sure that I'm crunchy, but definitely a "tough chew".
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#9 of 23 Old 01-18-2010, 10:45 PM
 
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Your insurance will factor in to if this is a reasonable choice or not. Could your doctor order hospital bed rest with frequent monitoring so as to keep you pregnant longer yet also monitor the babies closely?

Twin boys (2/05) and little sister (10/07)
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#10 of 23 Old 01-18-2010, 10:58 PM
 
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Ok so what I recall about varix...it's an enlarged vein/artery and it can possibly rupture. It can also be a part of a larger problem, such as reduced blood flow to the heart and brain.

So things I would be thinking about:

~When was this found? Varix can appear and shrink randomly. They are typically likened to varicose veins. Yours was diagnosed very late in pregnancy...which unless the doc thinks he missed it means initial development was not affected.

~How big is it and which vessel is affected? Is it arterial? Is the cord normative or a 2 vessel cord?

I would add these questions to the other ones mentioned...

~Baby weight
~Lung development

Do you know their conception date or is it an EDD? Has your doctor talked about any lung treatments?


Ok now the opinion part:

IMO I would be trying to delay birth for as long as possible unless the size and type of varix seemed particularly worrisome to me. I think a week is a huge difference for pre-term twins. This can be a heated issue. I am not saying what to do, just giving my two cents. I think a varix is much like any other strange and scary thing in our life. I could walk out the door and be hit by a car and die. But the things in the here and now affect us for our entire life. (Aka pre-term status and breathing problems, extended stay in the NICU, etc).

Mama to expecting Babe 2
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#11 of 23 Old 01-18-2010, 11:06 PM
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Would getting admitted for bed rest and monitoring be helpful as an option for letting the babies stay put for a little longer? Balancing mindful watching and peace of mind with giving babies the best chance of staying in until they are ready? Not sure if that just sounds ridiculous or not! But just thought I would ask.

Hugs mama! Warm positive wishes to u and your bubs!

wbg...constantly amazed by Z , cherishing I , inspired by P , adoring K and still getting butterflies when I wake up with B !
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#12 of 23 Old 01-18-2010, 11:16 PM
 
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Quote:
Originally Posted by hergrace View Post
The question I used to ask myself during my pregnancy when complications arose was "What decision is most likely to result in all these babies being healthy in a year?"
I think this is a great way to think of things hergrace!

Big hugs mama, I can only imagine how difficult this must be for you. I don't have much advice to offer, but just thought I'd mention that my girls were born at 37 weeks (via c-section) and were the picture of health (just short of 6 lbs each). They never went to the NICU (in fact they were pretty much never out of my arms!) and we were all home by day 3, breastfeeding like pros.

Wishing you peace with your decision

Tammy, Canadian Mama to 4 girls May-02...March-05 and...identical twin girls Jan-09
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#13 of 23 Old 01-18-2010, 11:47 PM
 
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I think I'd take them early. I'm sorry you are under this stress. But I agree with other posters that a bit of help with breathing or eating the first week or two is better than the worse case scenario.
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#14 of 23 Old 01-18-2010, 11:54 PM
 
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Wow. What a stressful position to be in. I like the ideas of weighing the info: the weights, lung dev,. etc. I also completely agree that I would trade a bit of NICU time, if it is even needed, to ensure that this umbilical cord problem not lead to anything that would endanger your child/children. I think if it was me, I would probably opt for the 37 week c-section. Has your doctor mentioned giving you steroids for lung development? I don't know if that is possible given that you are so much further along than I was, but the steroids were a major help for my girls. (Born much earlier at 30 weeks.) Whatever you decide, please keep us updated. I will keep you in my thoughts!

Mama to lovely twin girls 1/08
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#15 of 23 Old 01-19-2010, 10:22 AM
 
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Originally Posted by Kirsten View Post
I think I'd take them early. I'm sorry you are under this stress. But I agree with other posters that a bit of help with breathing or eating the first week or two is better than the worse case scenario.
Respectfully, I think this is trivializing the original poster's concerns. Pre-term birth can lead to a whole lot more than "a bit of help with breathing or eating the first week or two".

The very difficult decision this twin mother is facing is simply due to the likelihood of various outcomes versus their severity.

For example: My child could get hit by a car walking to school and be killed. That might be a "worst case scenario". However, it's very unlikely this actually will happen (despite being a possibility). The odds are far greater that: a) child will be perfectly fine and b) child might get hurt, but will recover well. Walking to school confers many benefits to my child and me, so it's a reasonable risk. The lack of good, neutral, medical study of twin pregnancies and twin pregnancy complications make it very difficult for this mother to decide what risks are reasonable for her family.

Her decision would be much easier if health was simply a single presence or absence and not a sliding scale.

Six kids, sixth sense, six degrees of separation. . . from sanity!
Not sure that I'm crunchy, but definitely a "tough chew".
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#16 of 23 Old 01-19-2010, 03:46 PM
 
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With all respect Novella, I don't know that everyone here truly understands or even has any knowledge of what a varix is, we're simply giving our opinions based on the information given.

Valerie, wife to Kevin, mother to Elena (4), Jonathan (2), and twins, Andrew and Benjamin (2/2010)
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#17 of 23 Old 01-19-2010, 11:26 PM
 
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Quote:
Originally Posted by Novella View Post
Respectfully, I think this is trivializing the original poster's concerns. Pre-term birth can lead to a whole lot more than "a bit of help with breathing or eating the first week or two".

The very difficult decision this twin mother is facing is simply due to the likelihood of various outcomes versus their severity.
I am not trivializing anything. She is weighing two possible negative outcomes. One is a challenge/scary/not what anyone would hope for - but at 36 or 37 weeks, not life-threatening in all likelihood. The other option is worst case scenario. If she were 26 weeks, I can see how it would be harder to accept a birth that prematurely. But a few weeks, even for twins, would be something *I* would accept given the other risk she is facing.
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#18 of 23 Old 02-04-2010, 09:52 AM - Thread Starter
 
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I just wanted to update all of you...

What happened was I went for monitoring and an ultrasound, and they found the varix had enlarged. WE decided to move up the c-section date to the next day. But 3 hours before my scheduled c-section, my water broke! So I went into labor on my own afterall.

My twins were born Jan 20th at 4 am, at 36 wks and 6 days... we had some issues, but overall, they were ok. We all came home together five days after the c-section. Now, our biggest challenge is breastfeeding (which I'm going to post about seperately...)

~ Rachel

Rachel & Eli , with DS1 (7/99) and DS2 (11/01) twins DD1 & DS3 (01/10)
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#19 of 23 Old 02-04-2010, 10:49 AM
 
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Good update! Congrats!

Joanna - wife to Mike, mamachicken to Cub(8/98), Kitten (4/07), Dew-man, and Woe-boy(twins, 10/08)
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#20 of 23 Old 02-05-2010, 11:38 AM
 
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Glad to hear you had the reassurance of going into labor on your own! Congratulations on the birth of your babies! I will go read your bfing thread to see if I can help...
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#21 of 23 Old 02-05-2010, 04:23 PM
 
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Congratulations on the birth of your babies!

Cindi, mama to Hannah (7/04) :, Eli & Sam (6/06) :
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#22 of 23 Old 02-06-2010, 12:58 AM
 
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I missed this post the first time around, and I am so glad to see it end with a happy, healthy update. Congratulations on the birth of your twins!

Betsy, mama to beautiful, strong MZ twins Lillian and Kate, born 11 weeks early on January 10, 2006.
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#23 of 23 Old 02-06-2010, 06:32 PM
 
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Congratulations!
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