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#1 of 36 Old 01-31-2007, 02:28 PM - Thread Starter
 
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Forgive my ignorance. I feel like I'm starting my research all over now that we know we've got twins.

I know that twins have a higher rate of premature birth, but from my recent reading it also sounds like lots of mothers of twins are induced rather than being allowed to begin labor spontaneously. I'm not referring to planned c/s but inductions to labor. I'm not sure that I understand the reasoning for these inductions. Unless the babies are experiencing measurable stress, or there is evidence of incompetent placenta(s) wouldn't it be better to avoid induction?
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#2 of 36 Old 01-31-2007, 02:54 PM
 
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Originally Posted by torio View Post
Forgive my ignorance. I feel like I'm starting my research all over now that we know we've got twins.

I know that twins have a higher rate of premature birth, but from my recent reading it also sounds like lots of mothers of twins are induced rather than being allowed to begin labor spontaneously. I'm not referring to planned c/s but inductions to labor. I'm not sure that I understand the reasoning for these inductions. Unless the babies are experiencing measurable stress, or there is evidence of incompetent placenta(s) wouldn't it be better to avoid induction?

Ah you are citing one of my BIGGEST complaints of a medical-setting twin birth. Doctors would like twins to come between 36 and 38 weeks. The earlier actually they are okay with because there are NICUs, an environment THEY can control. I had a nurse tell me, "Whew 32 weeks you are home free now." I thought she was nuts. At 32 weeks, as a general rule most preemies will not have everlasting effects and by age two years they are caught up. At 34 weeks my doc said anytime now. I don't know why OBs think our uteruses have a FedEx slogan of a two week delivery window. These are children, they come when they are cooked, and hopefully not sooner. There is NO evidence that shows multiples mature faster just because there is more than one. My first OB would have induced at 38 weeks. I switched OBs to avoid that. My boys came at 40w2d. My boys were having nonstress tests and passing with flying colors. My body was still handling the pregnancy very well and I was not about to evict my boys unless there was a valid reason concerning MY pregnancy and MY boys. Not mere statistics. They showed no signs of post-maturity. In fact Jacob had a thick layer of vernix still. The placentas were gorgeous and no signs of calcification or deterioration. But I did have to be an advocate to keep my babies inside!

Good luck to you!
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#3 of 36 Old 01-31-2007, 03:08 PM
 
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Study finds no benefit to delivering twins early

When I first found out I was having twins, a doula friend of mine who birthed her twins at 39 weeks sent me this link. Good info!

Wife of one and mom of five, including my HBAC twins!
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#4 of 36 Old 01-31-2007, 06:13 PM
 
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I was induced for really dumb, non-medical reasons and in hindsight would not have induced unless a problem arose. The induction led to a really icky, complicated birth experience. YOU know your body best. I seemed to forget that I had the control and let the circumstances take over. I hope you won't do the same. Best of luck to you!
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#5 of 36 Old 01-31-2007, 06:31 PM - Thread Starter
 
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Thanks for the responses. Sometimes the information provided by the medical community is so obviously counter-intuitive that I wonder where they left their common sense.

Slingwearin'mama, You've stated my concerns exactly.

We're in the process of figuring out how to handle the birth now that we've 'risked out' of the homebirth we were planning with our midwife. Homebirthing twins (or breeches) is illegal for FL midwives. We're interviewing a few recommended OBs which I think is probably a good idea so that we've got someone we can (hopefully) trust in the case of prematurity or some other complication. However, I haven't given up my hope of a homebirth if the pregnancy goes without complication. And just because we're interviewing OBs doesn't mean I'm ready to cave to their protocols. The support and links really makes a difference to me. Most people I know IRL think I should just relax and let an OB take over.:

christyc, How lucky am I that you conceived your twins a month before me?!!!! Thank you AGAIN for the research you're sharing.
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#6 of 36 Old 01-31-2007, 07:25 PM
 
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ITA with what was said above....I was ONLY induced at 37 weeks b/c I had significant pre-eclampsia. I had actually hoped to make it to 40! My babies did really well at 37, but really could have used another week or two or three, IMO.

mama to Joshua (9), Lily (8), Jude (6) and Ava (6)

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#7 of 36 Old 01-31-2007, 08:24 PM
 
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Originally Posted by christyc View Post
Study finds no benefit to delivering twins early

When I first found out I was having twins, a doula friend of mine who birthed her twins at 39 weeks sent me this link. Good info!
Christy, thank you SO MUCH for posting that link - that is exactly the information I've been looking for. Now I need to hunt around for the exact research study so I can bring it in to my doc at our next visit (will post the link if I can find the study).

Tori, my OB and I have been haggling over this issue. He's a friend and I'm certain that we can negotiate this issue as we get closer to delivery, but I did some research to find out why this is such a big issue among so many OBs. I found this article, which explained a lot to me:

http://www.greenjournal.org/cgi/content/full/100/4/638

I'm not trying to persuade you that induction at 38 weeks is the best thing, not at all! I just think it's important to be informed on all sides of the issue in order to have intelligent discourse about it. After reading this article I had a clearer understanding of why induction at 38 weeks is so common. It also gave me the information I needed to suggest things that would make my OB feel more comfortable with me going beyond 37 weeks (NSTs, biophysical profiles, amniotic fluid checks, etc). I know this is probably more than many mamas here would want to agree to in order to avoid induction, but like I said my OB is a friend and I want him to deliver my babies... we just need to work out a few issues . Lots of mamas here might just find a new OB who doesn't feel strongly about this issue.

Good luck .
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#8 of 36 Old 01-31-2007, 08:49 PM
 
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I was induced at 38 weeks/5 days for no reason at all. I wanted the best for my babies and I agreed to this, not knowing or trusting my own body. The induction didn't work. I was on petocin for 14 hours w/o labor (small contractions/4 cm dilation), then they placed a balloon thing (I don't know technical term) in my cervix for the whole night to dilate, then started petocin again the next morning for another 12 hours. Nothing, no change. I was exhausted, uncomfortable, and wanted to go home. So, I went home. At my next appointment Monday morning, 3 days later, my blood pressure was high. I was induced for high blood pressure again and they were very aggressive this time...ended with a c-section in less than 12 hours. My boys were healthy and I was relieved to have my babies with me and healthy.

But, I wish it could have been more natural. I didn't know much about twin births, even though I researched almost every day of my pregnancy. It is definately something to be aware of, non-medical inductions.

Oh, I want to add that I knew 2 women, personally, that lost a twin in the very last weeks of pregnancy and I was terrrified of that happening to one of mine. It played a role in agreeing with the dr's for induction.

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#9 of 36 Old 01-31-2007, 09:43 PM
 
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Keep in mind you have the right to say NO! I had mine at home but I did see a doc the whole time and starting at 36 weeks he started bugging me about incucing and as I got closer to 40 weeks he started making notes in his chart every time that I refused unduction. I ended up having them at just over 40 weeks and docs think that is just crazy to let it go that long.
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#10 of 36 Old 01-31-2007, 10:45 PM
 
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Jackson's mama... Thanks for posting that link-- I hadn't seen that article yet. I'm working my way through that article now (dh is out of town for a few more hours, so I can use the distraction...).

Quote:
our data demonstrate a gestation-related trend for the risk of stillbirth. This increase in stillbirths is likely to be a consequence of complications related to the monochorionic placentation and intrapartum and peripartum events. Although data on chorionicity were not available in the current study, previous studies have found elevated perinatal mortality rates associated with monochorionic twin gestation.
Hmmmm.... That caught my eye, for some reason.

I guess what I was looking for (and didn't find) was any reference to the placental calcification or deterioration or whatever. I've heard some folks mention that in multiple pregnancies the placenta sometimes starts to deteriorate after 38 weeks or something... I can't help but wonder how much of that is due to nutrition. I don't want to get into the "blame the mama" game, but you'd be amazed at the number of moms I've met online who say things like "well, my OB/peri told me I need to eat about 300 more calories a day than I would if it were a singleton, and to boost my protein a little, but they didn't really offer specifics." ARGH! This is totally an educated guess on my part, but I can't help but wonder if a lot of the placental deterioration stuff is nutrition-related? Who knows.

ETA: I found the full article showing no benefit to delivering twins early.

http://linkinghub.elsevier.com/retri...0293780600706X

To access it through their patient thing, you have to pay $4.95 to get the document. I left my wallet in my car, and it's too cold (and I'm too lazy, and have a bad headcold, and wah wah waaaaaaaah) to go out and get my credit card this time of night. But it's there.

Wife of one and mom of five, including my HBAC twins!
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#11 of 36 Old 01-31-2007, 11:44 PM
 
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I had a doctor that clearly prefered c-section and kept telling me that its pretty normal for twins to end up c-s even while I would tell him how I wanted as natural a childbirth as possible...
he was really nervous about them coming early and most people I talked with said that too, so we expected them to come early, then the weeks kept going by and the doc finally relaxed, but then said "I'd be happy to induce any time you are ready" and we kept waiting and waiting, I kept all my weight in the uterus, so I was getting really uncomfortable at the very end, I was trying to take short walks, squatting, sitting on a labor ball, I even had my doula friend teach my husband some pressure points to induce labor, and a few other techniques... the doc kept "threatening" that we would really "need" to induce if we got to 40 weeks.

anyway, I ended up going in the day before their due date and taking a half prostoglandin (sp?) pill to see if that shook things up enough, and it did the trick, about an hour after, during a long walk around the grounds I squatted down and my water broke, the boys were both born the early morning ON their due date.

things didn't go quite as I hoped, I got to have "A" naturally but then "B" swam the other direction in his sudden free space and the doc declared he'd have to do a c-s. I still today wonder why if he said it wasn't an emergency and that they could do it under epidural, why he couldn't just reach in and face him head down...

I think doctors these days are generally pretty c-s happy, its sad. Like one of the pps said, its something they feel like they have control over.

If you have options, do what feels right, talk to positive experienced people (like on this site!), change docs if you have to or can.

mom of twins.gif boys born 9/13/05 and dog2.gifdog2.gif

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#12 of 36 Old 02-01-2007, 01:20 PM
 
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i had a great ob! he was fine w/ natural if baby a was vertex and fine with "going the distance" with me. last saw him at 39 weeks and asked "what if i went past 40", fully expecting him to start talking induction, but he ageed to go to 42 with me! yay! my water broke and i had them on my due date via c/sect...breech/breech. but just a shout out there to say that, assuming good health for the mom, good dr's are out there willing to let things be...you just have to dig a bit
Paige
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#13 of 36 Old 02-01-2007, 04:32 PM
 
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I was induced at 34w for complications from TTTS -- mostly it was IUGR with baby A. I was fine with it, I had cervidil and went on to have a lovely vaginal hospital birth. B was feet first breech and he just came out that way. However, for the average normal twin pregnancy, there's nothing magic about 38w except that the docs seem to start salivating. A friend of mine had a 7lb and a 8lb at 39w, I was so impressed!

My boys were in the NICU for a week, learning to suck. I was grateful, because the NICU was full of really sick babies, and mine were very healthy.

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#14 of 36 Old 02-01-2007, 05:06 PM
 
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I think most of the placenta problems are more diet problems than just being twins. Some twins moms have a hard time eating at the end or just are not eating right from the start for carrying twins. When my boys were born at 40w 3d their placentas were very healthy.

I had asked the doc I was seeing how long he would let me go just out of curiosity (I had no intention of doing what he said unless I REALLY felt it was needed) and he said he would want me to get another u/s if I got to 42 weeks. I was really surprised he would even let me go that far since he had been asking about incuding for weeks but I guess he knew I was not going to let him induce me
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#15 of 36 Old 02-01-2007, 08:16 PM
 
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I made it to 38 weeks then had to get induced because my blood pressure went crazy--I had gotten a severe headache, luckily I was already 5 cm, doc broke my water, then very low dosage of pitocin and out came the babies, It was a great vaginal birth. I wish I didn't have to otherwise I think I would have made it to 39 weeks.
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#16 of 36 Old 02-02-2007, 11:31 PM
 
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I was induced at 36 weeks with my twins. I had a healthy pregnancy but the dr. said he would like to induce because the twins were too far apart in weight. He said it was called discordant? twins and they should be 20% within weight of each other....my twins were born weighing 6 lb 12oz and 4lb 13 oz.
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#17 of 36 Old 02-03-2007, 01:12 AM
 
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My twins were born at 40 weeks 7lb 12 oz and 5lb 12 oz. They didn't share a placenta or a sac and I never fully understood the whole size issue/induction? Forgive my ignorance, feel free to educate me! They had me worried half the pregnancy that I would be induced because of their size difference and I would pray each day that Baby A would "catch up" so I could keep the drs at bay. The funny thing was that the whole time they had the twins mixed up!!! Baby A was the larger baby at birth by 2 pounds, while during pregnancy Baby B was the larger on ultrasound...: I can't imagine if I were induced early for this when they had it all backwards!
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#18 of 36 Old 02-03-2007, 01:48 AM
 
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I remember reading that "they" don't let twin pregnancies go past 38 weeks, generally. I asked my OB how long he would "let" me go. He kind of looked at me like I was crazy and said as long as the babies were healthy there was no reason to intervene. I was really relieved by that. And then I ended up delivering at 29 weeks, so the point was pretty moot! And let me say, anyone (doctor) who thinks having babies in the NICU rather than the womb is a good idea really needs to have his/her head examined.

Betsy, mama to beautiful, strong MZ twins Lillian and Kate, born 11 weeks early on January 10, 2006.
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#19 of 36 Old 02-05-2007, 03:24 PM - Thread Starter
 
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We're starting our quest of interviews today. We've got a list of OBs, one who works with a CNM and one possible birth center with a doc who would give approval/back up. Both DH and I are a little concerned that our midwife, who's coming with us to at least a couple of the appointments, seems to think that we need to approach these interviews in a reserved way--i.e., not bringing up all of our concerns immediately to give the doc time to get to know and like us before we let him know just how 'alternative' we are. (Geez, when did wanting a natural vaginal birth become so alternative?!!!) DH and I are both very direct people. I don't want to waste time with an OB who's not going to be supportive of our needs. We'd like the docs to know where we're coming from right from the start. We're meeting with our midwife tonight so hopefully we can get a bit more on the same page about this.

We've joked about making some requests that are even more hardcore than what we want (the entire birth team will share with us a ritual eating of the placenta... ) just so that we have something on our list that we'll be willing to compromise on.

Sorry to be rambling. I'm just feeling nervous about finding someone we can trust. Thanks for listening. xo
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#20 of 36 Old 02-05-2007, 04:01 PM
 
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My girls were born prematurely, so the induction part does not apply. my doc was pretty mainstream (as am I) but she had no intention of inducing them early. She also had no intention of doing a c/s - unless medically necessary. I did deliver (vaginally) in the OR instead of the regular birthing room, but as I said we were early and had some other issues. In my opinion, I would be upfront with your doc while you are interviewing on the issues that are dealbreakers for you. Your docs may be more understanding than you think. And I would hate to have to change docs midstream because of a disagreement on treatment.
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#21 of 36 Old 02-06-2007, 01:25 AM
 
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Trying to "hide" things from our OB is sort of what led to my early induction to begin with. If I had it to do over I would have been totally upfront with him and then found someone else when I realized that he wasn't on board with our birth plan.
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#22 of 36 Old 02-07-2007, 07:23 PM
 
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QUOTE=torio;7216395]

We've joked about making some requests that are even more hardcore than what we want (the entire birth team will share with us a ritual eating of the placenta... ) just so that we have something on our list that we'll be willing to compromise on.

[/QUOTE]

lol i wish i had read this idea 2 weeks ago- the look on my ob's face would have been priceless

i got bullied into a 38 week induction despite my better judgement- i'll be back with more details when i'm not tandem naking (so 6 months or so haha)
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#23 of 36 Old 02-10-2007, 04:17 PM
 
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I'm so glad I was able to have an out-of-hospital birth with a midwife who encouraged me to carry them as long as possible. It just angers me to no end when I hear women saying they weren't "allowed" to go past such and such a date. How arbitrary and condescending!!!

Babes were born 40w2d. Their placentas were perfect.
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#24 of 36 Old 02-13-2007, 01:30 AM
 
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From the article linked earlier, THIS chart would be the biggest reason any OB who would like to remain in practice would push for delivery by 38 weeks.

http://www.greenjournal.org/cgi/cont...l/100/4/638/F2

*If* you happened to be one of the mothers who delivered a dead baby(ies) after 38 weeks, any lawyer worth a dime would blow that chart up to billboard size. What excuse would the doctor be able to come up with that would satisfy a jury that 'they did all the could', when statistically, the chances of stillbirth after 38 weeks SKYROCKET with a twin pg.

A dear friend of ours delivered stillborn twin girls at 39+ weeks. Both babies showed absolutely no signs of distress, passed NSTs with flying colors, amniotic fluid levels were normal, etc etc.

And then they were both dead. Cord compression/accident with one baby that led to the death of her identical twin sister less than 24 hours later.

That doctor's malpractice policy paid through the nose, as it should have, because there simply is too much documented research that indicates delivery at 37-38 weeks leads to the BEST overall outcomes for twins.

But her girls are still dead. It was/is a horrible situation, and I'd much rather take my chances on a set of twins not being 'ready' at 38 weeks than take my chances on them dying in utero after I'd made it that far. Going past 38 weeks with twins is MUCH MUCH riskier (look at the chart) than going past 42 weeks with singletons, something you'll rarely see OBs advocating, so it's little surprise that most do not advocate going past 38 weeks with twins.

All that said, if you look at the research and still feel ok with carrying longer, that is certainly a choice that should be up to the mother. She is, afterall, the one who will ultimately live with that choice. The doctor in question should have the right to document their recommendation to deliver at whatever gestation, the mother's refusal, and that really should be enough to 'cover' the doc in question. Unfortunately, that's not how it works with obstetrical litigation.
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#25 of 36 Old 02-13-2007, 10:24 AM
 
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wifeandmom, I'm sorry to hear about your friend's tremendous loss. Truly a sad situation.

However, there are too many factors to say (across the board) that twins should be delivered early. Identical twins (mono/mono) are at greater risk for things like cord entanglement and "locking" at birth. I'd really be interested in seeing the data behind that chart. Do you have access to it? I'm mostly interested in knowing what the inclusion criteria were for the population being studied. My guess is that the chart reflects data on ALL twin pregnancies--even those in which the pregnancy was complicated by underlying medical issues.

Here are a couple of recent studies that support the choice to continue a twin pregnancy to term:

http://www.nature.com/jp/journal/v20.../7200354a.html

http://www.pubmedcentral.nih.gov/art...?artid=1397866

Like I said before, the *rule* to evict ALL twins before 38 weeks is arbitrary and unsubstantiated.
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#26 of 36 Old 02-13-2007, 11:42 AM
 
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What Lisa said.

What were the criteria for inclusion? Were monoamniotic twins included? Was it twins only, or did it include triplets and higher? Were any of the stillbirths the result of some other complication, such as pre-eclampsia or other health problems? Looks like the percentage of stillbirth in that study was around 1.5%. I wonder what it would have been if only healthy twin pregnancies were included?

I think there are LOTS of very, very sad stories out there of folks who made one choice or the other in life, from which we could draw all sorts of conclusions. My heart breaks for the mom who lost her twins so late in the pregnancy... Just as my heart breaks for anyone who had any extremely rare complication that led to their child's death. So sad and tragic...

Wife of one and mom of five, including my HBAC twins!
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#27 of 36 Old 02-13-2007, 03:48 PM
 
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Quote:
Originally Posted by wifeandmom View Post
From the article linked earlier, THIS chart would be the biggest reason any OB who would like to remain in practice would push for delivery by 38 weeks.

http://www.greenjournal.org/cgi/cont...l/100/4/638/F2
That's the chart that made me understand where my OB was coming from too. That and the "results" quote:
Quote:
RESULTS: The risk of stillbirth in multiple gestations increased from 1:3333 at 28 weeks’ gestation to 1:69 at 39 or more weeks’ gestation. The stillbirth risk in multiple gestations at 39 weeks surpassed that of postterm singleton pregnancies (1:526).
I'm not saying the study didn't have it's flaws or that more recent research has illustrated that carrying twins to term doesn't have those inherent risks, but this was a fairly large study (4193 multiple births to residents of the North-East Thames region of London from 1989 to 1991), and as the chart above shows, the results were rather dramatic.

There was no exclusion criteria for pregnancies with any sort of complications, all multiple pregnancies were included. The study states that triplet pregnancies were included as well (but that twin pregnancies accounted for over 99% of the multiple pregnancies in the region).

(Again, I'm not saying that all twin pregnancies should be induced at 38 weeks, I'm just trying to illustrate how this widely-held belief among OBs is NOT completely arbitrary and unsubstantiated.)
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#28 of 36 Old 02-13-2007, 06:57 PM
 
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Quote:

(Again, I'm not saying that all twin pregnancies should be induced at 38 weeks, I'm just trying to illustrate how this widely-held belief among OBs is NOT completely arbitrary and unsubstantiated.)
That was my point as well.
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#29 of 36 Old 02-15-2007, 12:00 AM
 
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I would really like to see more research on the studies claiming that stillbirths "skyrocket" with twins after 38 weeks. I carried my twins to 40 weeks 1 day and they were born at home in perfect health. There are MANY, MANY mamas on this forum alone who carried their twins well past 38 weeks. Yes, stillbirths happen, and they are tragic, but that is no reason to get into scare tactics and urging twin moms to induce. I have much more to say but my babies are waking up....

Ok, I am back. Some things I ask myself when I see a chart like that are:

-were these moms under the care of high risk OBs or homebirth midwives?
-were these moms induced (even at 39 or 40 weeks) or allowed to start labor naturally?
-were there membranes artificially ruptured?
-were they allowed to labor and birth in the positions they felt most comfortable in?
-were they heavily monitored with ultrasounds, fetal monitoring, etc?
-what was their nutrition like?

Twins need as much time in the womb as singletons and forcing them to be born before they are ready can have lasting consequences. Stillbirths do happen and they are tragic, but stillbirths happen with singletons, too. If anything, I am convinced that inducing, rupturing membranes, increased interventions, etc. increase the chance of stillbirth, rather than prevent them. Mothering is a natural parenting community and I really don't see how talk of inducing and suing doctors for not inducing is appropriate here.

Blessed mama of four
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#30 of 36 Old 02-15-2007, 03:56 AM
 
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Originally Posted by gemelos View Post
Mothering is a natural parenting community and I really don't see how talk of inducing and suing doctors for not inducing is appropriate here.
I think this discussion is absolutely appropriate here. If you read back through this thread, some of the mamas who posted were induced - making it a relevant issue.

Many natural parenting advocates find themselves in a whole new world when they become pregnant with twins... many who were planning homebirths and no longer feel comfortable doing so, many with midwives who find themselves suddenly under the care of an OB with very different viewpoints. The subject of induction of twin pregnancies is something that many of us will come up against with our health care providers, and I think it's important to be well-educated on the issue in order to have an intelligent discussion about it. That means being aware of all sides of the issue in order to know what kind of conclusions are being drawn by the medical professional - you can better argue your position if you understand where your OB is coming from. THAT is the purpose of discussing induction here on MDC, not to advocate that everyone submit to the will of their almighty OB.

My bias on the matter is that I don't feel it's necessary to get into a pissing match with the person I've chosen to be my prenatal care provider and birth professional. I'd much rather retain a good working relationship, which means having discussions about things rather than just laying down the law. For me, being on good terms and having mutual understanding leads to a better, more comfortable birth experience.
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