Tell me about your twin hospital birth experience - Mothering Forums

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Old 04-29-2006, 11:54 PM - Thread Starter
 
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I've just been asked to attend a twin birth as a doula. I'm so excited!

A little background: Mom is 36.5 weeks along and this is her second birth. Her first birth was fast and furious and mom would like an epidural if there is time (which I respect). Baby A is head down and Baby B is transverse. OB is still planning a vaginal birth and mom is eager to avoid a c/s. OB wants to induce at 38.5 weeks to avoid possible pre-eclampsia. If mom goes into labor naturally then OB suggested that she come in after one hour of consistent contractions cuz she can go very quickly.

Why am I here?: I realized that in all of our doula training there is NO information on twins. We are taught what to expect in singleton birth but not in multiple births. If anyone can tell me what the hospital protocol for twin births is I'd be so appreciative. I don't know how I can be a good support person if everything is surprise to me too!

Also, mom would like some suggestions of what she should ask her OB. This is what I came up with so far:

1.Where will I labor?
2.Where will I deliver?
3.Will there be constant fetal monitoring?
4.Will I be allowed out of bed?
5.What can I eat/drink?
6.Am I allowed a support person other than my husband?
7.What type of induction will you do?
8.What other staff will be in the room?

I'm know there is so much more, that is after 5 minutes of brainstorming, so please help me out! Thanks so much for sharing your wisdom and experience with me!
(x-posted in birth and beyond forum)
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Old 04-30-2006, 01:04 PM
 
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Well i personally had a c section due to the postition of my one twin. But ill answer the questions according to how its done here, ( i have two friends that were able to deliver theirs vaginally a few weeks after me.)

1. Where will I labor? Here at our hospital you are put in one room, your labor and delivery room, thats where you will labor and thats also where you will deliver.
2. Where will I deliver?
3. Will there be constant fetal monitoring? I was on constant fetal monitoring up until my csection and they were also on constant fetal monitoring. They said that too much can happen with a twin delivery so they monitor just to make sure nothing changes and the babies are handling well. They also do a couple ultrasounds while in labor to keep an eye on the babys postitions.
4. Will I be allowed out of bed? One of my friends was allowed up to move around up until 5 cm dilation. The other wasnt allowed out at all, but she had been on strict bedrest for a month or so.
5. What can I eat/drink? Here you arent allowed to eat or drink anything while in labor no matter what your having. Reason being is if you ahve to be rushed for an emergency c section. You dont need to eat if having a csection.
6. Am I allowed a support person other than my husband? Also at our hospital you are allowed 3 support people back with you. Doesnt matter who just 3
7. What type of induction will you do? Neither one was induced one went into labor at 33 weeks 2 days the other 30 weeks 1 day. I had problems with ptl. I delivered at 38 weeks 1 day.
8. What other staff will be in the room? Most of the time, you will have the pediatrician, the ob doc, your nurse, a nurse for each baby, and the anestithia (sp) if you choose to have one. But once again that just here. All hospitals are different!



Best of luck to her and all! Has she thought any of what will happen if she has to have a csection and NICU time for the babies?
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Old 04-30-2006, 01:07 PM
 
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Oh and also, My baby a was heads down and b transverse. They told me i could deliver vaginally, BUT strong possiblity of delivering baby feet first or him dropping and getting stuck then being rushed in for a csection.

I really wanted to deliver vaginally bc i knew strong possibilty i wouldnt have any more kids. But honestly i didnt want to risk all of it. Make sure she weighs her options out. I dont know how the other women on here have experienced it bc im still fairly new, but I didnt want to have to do through all of that then be rushed back for a csection, and risk something happening to him.

Also ive heard theres a strong possibility of embilical cords delivering first for the second twin if its transverse..anyone else heard that?
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Old 05-01-2006, 11:01 AM
 
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nak..

Kudos to you for going the extra mile for your client!

Let me say this before I answer your list of questions: I found with carrying multiples that docs/midwives tended to think I was going to give up my voice more than if I were carrying a singleton. I heard a lot of : You HAVE to X or you HAVE to Y since you're carrying twins. So what I learned was that I had to really shop around for the hospital and attendants that would respect my big issues.

Here's my info, in case it can be helpful. I delivered around 38 weeks, no induction, but rather natural onset of labor. I also have "fast and furious" labors (4 hours from time first water broke to delivery of both twins!) My goal, unlike your client's, was to avoid an induction, epidural, all the monitoring, etc. I also wanted to avoid delivering in the OR, which around here is where every single midwife and ob said I would HAVE to deliver. So what I did: I labored at home as long as possible before going in. I showed up 30 minutes before my son was born . No time to get me to the OR, or hook up monitors, etc. Since my midwife knew my wishes, she broke my water for my daughter right away to avoid any possible lengthy delay between twins that would give her supervising ob time to insist I go to the OR for #2. Result: both babes born vaginally in the "homey" family birhting room. Discharged 12 hours later.

As far as the second one being transverse, no big deal at this point. What matters is the position of baby A. Once A is out, B has a lot of room to flip and flop around; this is why some women go in with 2 heads down but end up with a c-s for B. What makes the difference is the attendant's experince with delivering multiples: will he/she even TRY to turn B if need arises, or will he/she immediately opt for c-section?

I think questioning the ob/midwife about how they feel about delivering the second one breech, and his/her view on c-section worthy scenarios is most important to see if they match your client's views. I'd also question further about the ob's desire to induce; is this b/c of the mom's previous history, or just b/c it's twins? Many women carry twins full term just fine. Induction, as I'm sure you know, can really lead to more complications for some. Has this ob ever assisted in deliverying twins vaginally? or have all resulted in c/s? Or no experience either way? BUT, at 36.5 weeks, I doubt she's going to switch attendants, for your future, though, I think the experience of the attendant makes a lot of difference for what will be considered with a multiple birth.

HTH! Good luck to you and the mom to be! Let us know how it all turns out!

.

"We think we're gliding down the highway when in fact we're slip sliding away." Paul Simon
DD-7 & B-G twins, 5
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Old 05-01-2006, 02:59 PM - Thread Starter
 
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Thanks for sharing your experiences! Every bit of information helps .

Elise, your twin birth story is amazing!

My client is more medically minded and is following her OBs directions. She will run to the hospital after only and hour of contractions (even without a set pattern) since she is afraid of another fast labor. Her OB wants to induce to avoid pre-e which he says increases after 38.5 weeks of pregnancy with twins. Is there any truth to this?

He IS willing to do a vaginal birth with the baby b transverse. He must be skilling in "reaching in and yanking the baby out by the feet" as he told the mom.

singlemomoftwins, she is hoping to avoid the NICU since the babies are full term. I did add a question to my list "Can my husband accompany the baby/babies to the nursery/NICU?" since you mentioned it. She is fully aware that she may end up with a c/s but is hoping for a vaginal birth.
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Old 05-01-2006, 04:55 PM
 
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Quote:
Originally Posted by 3daughters
Her OB wants to induce to avoid pre-e which he says increases after 38.5 weeks of pregnancy with twins. Is there any truth to this?

.
It is true that the placenta ages more quickly in twin than singleton pregnancies. However, I''ve never heard that you have to induce/schedule just to avoid pre-e., and I might ask for some medical documentation of the "fact". Pre-eclampsia is usually not an "emergency" condition in that it just pops up within an hour or two; I would think close monitoring would nip that in the bud.

If symptoms develop, then you can induce/do a c-section.

OB's just like to schedule. That way their sleep isn't interuppted

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Old 05-01-2006, 06:56 PM
 
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If baby B is transverse, I'd really STRONGLY recommend an epidural, just as a precaution. I really wouldn't want to deliver a breech baby w/o one, or have to have general anesthetic for a c/s.

Mine was my 3rd birth, and I was induced at 36 weeks. I just needed a nudge. I was starting early labor signs that night already. Both of my babies were head down, and I was at around 4-5 cms. My labor was also really quick, around 5 hours from IV to birth. I also got an epidural about 3 hours before they were born. For me, after the epi, I didn't feel any contractions until right before DD was born. It hurt at the peak, but I was okay with it because I knew she was almost there. She came out in less than 3 pushes. Then, my OB used an u/s to see the position on DS and make sure he was head down. If he had flipped breech I think he probably would have reached in and pulled him. But after his position was established, OB broke the 2nd bag and ds was born about 5 minutes later. The biggest difference between dd's and ds's birth was that after dd was born, I didn't feel any contractions and I didn't feel ds coming through at all until he crowned. I had to have the OB tell me when I was having a contraction to push. But it was all good. They were born 8 minutes apart.
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Old 05-01-2006, 09:41 PM
 
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After 36weeks, 5 days, they discovered I had developed pre-eclampsia and was induced. My babies ended out being born at 37 weeks, but in retrospect I wish that I had been put on bedrest or something so that there would have been less intervention in the birth. The induction started on a Monday night and I did not start pushing until 11:30pm Tuesday. I was in the birthing room until then. They attempted to constantly monitor both babies, but it was driving me crazy because it meant that I couldn't move around so finally I talked them into letting me walk and work with the labor. I think that they do try to use the twin excuse to force moms to do things they normally wouldn't do so it's going to be great for your client to have your support .

As with the others, I found that everyone insisted the babies be born in the OR so, at 11:30 I was moved to the OR to push. Baby A was head down and Baby B was breech. I was really insistent that I did not want a C-section and they let me push for 4 hours until the babes came out. I did wind up with an episotomy, which I fought for hours, but once they did it, Baby A came right out and they reached in for Baby B. They pulled her by the feet, but her head got stuck. I was kind-of clueless that that was going on because I was really focused on my first baby. DH said that it was a pretty stressful four minutes.

I can't remember what or if I ate or drank anything but I guess I must have at least had something to drink in that time.

The only person I had in the room other than the staff was my husband and that is the only person they would allow in the OR (in the birthing room I could have had more). Once in the OR there were two doctors (one a student) and four nurses. It is a lot of people but the group was made up of some really amazing people. I was pushing on New Years Eve and there they were so incredibly supportive. Overall, even though there was MUCH more medical intervention than I had ever wanted, it was an incredible, mostly positive experience

Have fun with this twin birth. I'm sure your client is really going to appreciate all of your preparation
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Old 05-02-2006, 12:25 AM
 
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There was a study that came out of Harvard Medical School a few years ago (maybe 5) that concluded that twins born after 37 weeks had just as many complications as those born before 37 weeks. Something to do with the lack of space, the general lack of desire to eat, hense poor maternal nutrition, etc. I seem to remember. I seem to recall that there were also more of some hormone present in twin births earlier than they saw with singletons, leading the researcher to conclude that a full-term twin pregnancy is 37 weeks, rather than the 40 that is considered for a singleton.
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Old 05-02-2006, 01:53 AM
 
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TTTS had started with my twins around 35-36 weeks they think. A i was told mainly bc of lack of room so one was taking all. If i hadnt delivered when i did i was told my precious son might not have been here. It still kills me to thi nk about it

Here at our NICU> Only parents are allowed back there. Mom and Dad then theres a viewing room for other relatives and friends
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Old 05-04-2006, 12:36 PM
 
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I had a vaginal birth at 34 weeks. Baby A (Sam) was head down. Baby B (Jack) was transverse.

Here's how it went for me (in Iowa)

1. Where will I labor?---in a reular birthing room

2. Where will I deliver?--- in the OR (just in case)

3. Will there be constant fetal monitoring?---yes

4. Will I be allowed out of bed?---no

5. What can I eat/drink?---ice chips

6. Am I allowed a support person other than my husband?---I could have another support person in the birthing room but not the OR. I chose to just have DH only.

7. What type of induction will you do?---I was induced due to blood pressure, and slight IUGR of baby B. At 34 wk 4 days. I had also been battling PTL since 23 weeks. I was dialated to 3 before the induction started. They broke my water, contractions started almost immediately, got an epidural and some pitocin. 6 hours later, my boys were here!! Born 20 minutes apart.

8. What other staff will be in the room?----In the birthing room, while laboring, just me & DH and the nurse.
---In the OR: me, DH,my L&D nurse, my OB, his resident, a neonatologist, 2 NICU nurses for each baby, an anesthesiologist, (just in case- I already had an epidural), an U/S tech to "watch" baby B, to see if he flipped after baby A was delivered. I think that's it.
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Old 05-04-2006, 09:23 PM - Thread Starter
 
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Thanks! Her OB told her she could bring in the whole "mishpacha" ("family") so I'm IN .

I went over the list of questions with her and I'm hoping she'll get back to me with the answers.
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Old 05-08-2006, 02:49 PM - Thread Starter
 
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Bumping with a new question...

What is the real "risk" to baby b in a twin vaginal birth?

My friend who is an OB says that the risk is due to the uterus decompressing quickly which could affect baby b's heartrate. She also said that in her opinion, baby b is at the same "risk" regardless of its position since it can change position once baby a is out.

I'd love to hear your thoughts.
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Old 05-08-2006, 03:15 PM
 
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I can only speak from my own experience and what our OB discussed with us.

Part of the problem with delivering Twin B vaginally is that many, many doctors are not as familiar with breech vaginal births these days, and so delivering Twin B, who will often move with glee once Twin A is gone, can quickly turn tricky.

Our OB had delivered lots of multiples and was very comfortable delivering Twin B vaginally in whatever position as long as Twin A was vertex. (His comfort increased when he learned I had birthed a larged-headed, sunnyside up singleton three years earlier.) In our case Twin B tried to come out with a fist and both feet (my husband said it looked like she was getting ready to give the world the finger...). Our OB was able to grab her ankles, tuck her hand back up and pull her out by her feet.

Later the nurses told me that any other OB in our town would have done a C/S for the second twin as soon as that fist came out -- that they had never seen an OB so calmly and confidently do that. Our OB's experience delivering twins, and willingness to deliver vaginally even if Twin B was in a wonky position, was one of the reasons we picked him.

I don't know about the decompression issue. Good luck to your client!
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Old 05-08-2006, 08:24 PM
 
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Originally Posted by 3daughters
Bumping with a new question...

What is the real "risk" to baby b in a twin vaginal birth?

My friend who is an OB says that the risk is due to the uterus decompressing quickly which could affect baby b's heartrate. She also said that in her opinion, baby b is at the same "risk" regardless of its position since it can change position once baby a is out.

I'd love to hear your thoughts.
For us, there were some respiratory issues. My baby B was (is) a boy, and there is a theory that boys dont do as well when born early. Like I mentioned they were born at 36 weeks, and ds's lungs were just a wee bit sticky still. He spent a week in the NICU and had surfactant treatments, which is a soap-like fluid they drip into the lungs through a tube. It was really scary forthe first few days, but in the end it wasn't a huge deal, and certainly I feel we were lucky. But it was still traumatic for all of us. I was told that this happened because he was 2nd born and came out so fast his lungs weren't compressed enough coming out of the birth canal.
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Old 05-08-2006, 08:58 PM - Thread Starter
 
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That does sound scary! The question is whether he would have faired better with a c/s.

Anyways...here's my update. Mom is being induced tomorrow! OB and perinatologist gave her the the OK for a vaginal birth!!! We're prepared for a last minute change of plans but are praying for a successful natural birth.
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Old 05-08-2006, 09:29 PM
 
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Quote:
Originally Posted by 3daughters
That does sound scary! The question is whether he would have faired better with a c/s..
My guess is he probably would have faired about the same if not worse. I probably wouldn't have done as well though. I loved my vag twin birth!! It was the best and easiest one by far!!

Quote:
Originally Posted by 3daughters
Anyways...here's my update. Mom is being induced tomorrow! OB and perinatologist gave her the the OK for a vaginal birth!!! We're prepared for a last minute change of plans but are praying for a successful natural birth.
YAY!!! GL! Let us know how it went!
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Old 05-09-2006, 09:43 PM - Thread Starter
 
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IT WENT GREAT!

Mom responded beautifully to the pitocin and was fully dialated after a few hours. She had a fantastic epidural that took away the pain but was able to move her legs. Baby Boy A came down and out in about 12 pushes. Baby Boy B wedged himself high up but the OB reached in and he was extracted footling breech. He needed a bit of help breathing but his apgars were up to 9 at 5 minutes! Mom is so relieved that it went so well and that she doesn't have to recover from a c/s . Boys are good sizes and both latched nicely too!

What a fantastic experience! Thank you wise moms for all your input and information.
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Old 05-10-2006, 09:28 AM
 
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I didn't respond earlier because I didn't have a hospital birth, but 3daughters, I'm so glad to hear it went well! Your client was so lucky to have her advocating for her! I doulas!

Trying to get my bearings...
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