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#1 of 84 Old 01-02-2008, 05:09 PM - Thread Starter
 
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Okay- just in the research stage. I well may not be carrying twins... but my measurements are currently high enough that I'm doing my research now

If twins, I *will* plan a homebirth. I know my midwife will be willing to keep me- we've discussed the issue before (dh's family is FULL of twins) My midwife had twins herself- UC at home so there's not a lot of the usual fear there.

What questions would you ask? What would you want discussed ahead of time? What might I not have thought about only having a singleton birth so far?

What testing did you agree to that you wouldn't have otherwise? I am probably comfortable agreeing to 1 u/s if the midwife would be more comfortable with it. Otherwise we don't do any testing in pregnancy as a rule without medical reason- including no u/s and no doppler (I allow doppler in labor however)

fwiw I am close to a hospital in case of emergency (MAYBE 10 minutes.... faster if need-be)

thanks!

-Angela
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#2 of 84 Old 01-02-2008, 05:50 PM
 
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I had a homebirth turned transfer for a c-section with my second set, but I still count myself as a homebirth mama since that was my intention.

I would ask her about her comfort level with various presentations. My first was presenting frank breech until the day before they were born and my midwife was completely comfortable with a breech birth, having done many single breeches and one twin breech before. I would also ask about her comfort with how long to wait for the second twin to be born. And at how many weeks of gestation is she comfortable delivering them at home? Neither of my sets was born early (or small) but it's good to know that ahead of time to prevent any surprises.

And if you do agree to the one ultrasound, I would make sure there is a membrane seen between the babies because monoamniotic twins can definitely have their own set of complications.

Other than that I think it's a typical pregnancy, especially since they were conceived naturally. IF there are twins in there. As I'm sure you've read already, it's very important to have a high protein intake and drink plenty of fluids to decrease the possibility of pre-term labor. And congratulations - whether it's twins or not!

Mama to Hannah & Hailey 1/5/02 C.J. 2/18/03 Anthony & Jamie 3/23/05 Chuck 10/9/08 42-week Sam 8/9/10 Mae 4/22/12
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#3 of 84 Old 01-02-2008, 06:14 PM
 
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My biggest concern would be how many placentas and how many sacs.

Monoamniotic twins are INCREDIBLY high risk for cord entanglement and compression, which can lead to IUGR and a host of other serious complications. I would not feel comfortable having a homebirth for monoamniotic twins. I can't imagine any midwife would feel comfortable attending a monoamniotic twin homebirth.

Monochorionic diamniotic are at risk for Twin to Twin Transfusion Syndrome, which my boys had, and the pregnancy was high risk. I *think* approximately 15% of mono/di twins have TTTS. It's a dx based on markers, so I'd want a mono/di pregnancy monitored very carefully before deciding on a homebirth. If there's no markers of TTTS, I'd go for it but acute TTTS can occur just before birth, so that's a risk.

Dichorionic/diamniotic twins are low risk, I'd totally hb di/di twins.


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#4 of 84 Old 01-02-2008, 06:32 PM - Thread Starter
 
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I had a homebirth turned transfer for a c-section with my second set, but I still count myself as a homebirth mama since that was my intention.

I would ask her about her comfort level with various presentations. My first was presenting frank breech until the day before they were born and my midwife was completely comfortable with a breech birth, having done many single breeches and one twin breech before. I would also ask about her comfort with how long to wait for the second twin to be born. And at how many weeks of gestation is she comfortable delivering them at home? Neither of my sets was born early (or small) but it's good to know that ahead of time to prevent any surprises.

And if you do agree to the one ultrasound, I would make sure there is a membrane seen between the babies because monoamniotic twins can definitely have their own set of complications.

Other than that I think it's a typical pregnancy, especially since they were conceived naturally. IF there are twins in there. As I'm sure you've read already, it's very important to have a high protein intake and drink plenty of fluids to decrease the possibility of pre-term labor. And congratulations - whether it's twins or not!
Good ideas. I know she's comfortable with breech. If I do an u/s looking for separate sacks and placentas would be a priority.

Already working on the protein and water

-Angela
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#5 of 84 Old 01-02-2008, 06:36 PM - Thread Starter
 
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My biggest concern would be how many placentas and how many sacs.

Monoamniotic twins are INCREDIBLY high risk for cord entanglement and compression, which can lead to IUGR and a host of other serious complications. I would not feel comfortable having a homebirth for monoamniotic twins. I can't imagine any midwife would feel comfortable attending a monoamniotic twin homebirth.

Monochorionic diamniotic are at risk for Twin to Twin Transfusion Syndrome, which my boys had, and the pregnancy was high risk. I *think* approximately 15% of mono/di twins have TTTS. It's a dx based on markers, so I'd want a mono/di pregnancy monitored very carefully before deciding on a homebirth. If there's no markers of TTTS, I'd go for it but acute TTTS can occur just before birth, so that's a risk.

Dichorionic/diamniotic twins are low risk, I'd totally hb di/di twins.

Thanks for the input! I will not agree to a hospital birth unless I feel that my or my babies' health is at serious risk. This is a VERY medical town. I seriously doubt I would be allowed a vaginal birth with twins here. Period. Sad but true.

TTTS is always a risk in mono/di pregnancies- I accept that. It's a risk I'm comfortable with personally (just my own current head-space) My dh's family is full of healthy, naturally birthed identical twins (don't know the details of chrions/amnios obviously...) And I have a deep sense of fate/everything happens for a reason/peace with things being what they are for a reason.



Any other great ideas?

Breech positions
time between twins
things to look for *if* we do an u/s


-Angela
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#6 of 84 Old 01-02-2008, 06:38 PM - Thread Starter
 
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Anyone have a midwife identify twins by feel without or before an u/s?

Anyone have a known twin pregnancy without any u/s?

-Angela
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#7 of 84 Old 01-02-2008, 06:47 PM
 
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Originally Posted by alegna View Post

Anyone have a known twin pregnancy without any u/s?
Mine were formally 'found' by U/S. BUT prior to that U/S, I had a dream at about 3 weeks pregnant and woke up knowing that they were twin boys (won't know if they are boys until April!)... also, just had a feeling, you know?

Mama to twin girls Adele and Nadia, born 5/2008
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#8 of 84 Old 01-02-2008, 08:05 PM - Thread Starter
 
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Mine were formally 'found' by U/S. BUT prior to that U/S, I had a dream at about 3 weeks pregnant and woke up knowing that they were twin boys (won't know if they are boys until April!)... also, just had a feeling, you know?
I had that feeling with the last pregnancy (I m/c a blighted ovum at about 20 weeks...) but no twin vibes this time. We shall see.... With dh's family I don't rule out twins until I'm finished with labor

-Angela
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#9 of 84 Old 01-02-2008, 09:28 PM
 
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I knew my second set was twins for sure because I'd done it before and if I hadn't been so scared to have my first set I could have known then too. I was just in denial!

But take comfort in knowing that your husband's family having multiple sets of identical twins has nothing to do with YOUR chances of having twins. Identical twins just happen...no one really knows why the egg splits. And fraternal twinning comes through the maternal hereditary line, so your mom's side of the family (specifically HER mother's line) has more to do with it than anything. Not that this information should necessarily put you at ease because there are NO twins on my mother's side of the family and I have two sets!

There are, however, three sets of boy/girl twins in my generation on my dad's side with one of them being from his brother and two from his sisters. I don't often tell people that though because then they automatically assume that's why I have twins when really that has no influence.

Mama to Hannah & Hailey 1/5/02 C.J. 2/18/03 Anthony & Jamie 3/23/05 Chuck 10/9/08 42-week Sam 8/9/10 Mae 4/22/12
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#10 of 84 Old 01-02-2008, 09:39 PM - Thread Starter
 
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But take comfort in knowing that your husband's family having multiple sets of identical twins has nothing to do with YOUR chances of having twins. Identical twins just happen...no one really knows why the egg splits. And fraternal twinning comes through the maternal hereditary line, so your mom's side of the family (specifically HER mother's line) has more to do with it than anything. Not that this information should necessarily put you at ease because there are NO twins on my mother's side of the family and I have two sets!
Yeah.... thing is they have NO IDEA what makes an egg split. Given my dh's family I'm comfortable betting there's a genetic component...

MIL is one of 8 girls- the last 4 are 2 sets of identical twins. MIL is one of those- she had identical twins. One of the other set of twins, had identical twins.

BIL (dh's twin) had frat. twins just to confuse things

But I'm comfortable accepting that choosing to have kids with dh is an increased risk of twins- probably identical. I know there is currently no science to prove that... but they'll figure it out in 100 years

-Angela
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#11 of 84 Old 01-02-2008, 11:30 PM
 
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Any other great ideas?

Breech positions
time between twins
things to look for *if* we do an u/s
I think it was already mentioned, but how many weeks gestation do you have to make it for her to go through the homebirth. I believe my midwife said 36 weeks but she would be willing to consider 35 weeks. I went to 40, so it wasn't a problem. As far as positions go, you may want to discuss with her what you and she are comfortable with if baby B changes positions. My baby B was breech and flipped transverse after baby A came out. My midwives were able to turn him vertex and that was great for me. Also, is she comfortable with waterbirth with twins? It would be good to ask her what she considers warning signs and at what point would she recommend transfering. Another thing is, will she have an assistant with her? Will that cost you extra? Hmm, what else......Is she comfortable letting Baby A's cord pulse or does she want to clamp it immediately? We were sure my babies had 2 placentas, but just in case they happened to fuse, my midwife didn't want A's cord to pulse too long because it could potentionally be harmful to Baby B if the placentas were fused or if there was only one. What does she plan to do in case of hemmorage? We didn't discuss this and I was surprised when my midwife whipped out a shot of pitocin when I let out a huge gush of blood. Hemmorage is very common with twins. I was fine with the pitocin, but it did surprise me that she had it. Hmm, that is all I can think of now, but I will be sure to add more if I think of it.

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#12 of 84 Old 01-03-2008, 12:00 AM - Thread Starter
 
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Good ideas thanks...

how early
how to deal with blood loss
positions and how to deal with
assistants- I already know she'll bring an extra midwife (usually brings one more, so with twins there would be 3 total- at a cost of $200 each for the extras)
cord

thanks! I'll be cutting and pasting from this thread, I can see already

-Angela
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#13 of 84 Old 01-03-2008, 03:11 PM
 
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Anyone have a midwife identify twins by feel without or before an u/s?

Anyone have a known twin pregnancy without any u/s?

-Angela

My midwife palpated and suspected twins before we had the u/s. She was pretty confident that she felt 2 heads. Then a few months ago she had another mom who refused u/s and had surprise twins!

Heather, Army wife & Mama to M (10), J (9), L & S (my HBAC babies are 7!), N & R (5), and A (born 11/30/12 UBA2C)
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#14 of 84 Old 01-03-2008, 04:32 PM
 
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My twins were detected by feel before u/s. She felt 3 fetal poles - I think it was baby A's head & butt and Baby B's butt (although I'm not sure - could have been his head). I did NOT want an u/s even then but she kind of scared me into it (can you say, 2 headed baby? yes - pg mamas (even well educated ones) get scared into things easily). Anyway, we had reason to suspect before she felt them - I was measuring large for dates. But that's how they were found. Oh - that was at 26 weeks, btw.

Mama to four remarkable kiddos, all born at home.
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#15 of 84 Old 01-03-2008, 05:36 PM
 
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Well, everyone else pretty much suggested what I would suggest! I would probably talk to her about what would happen if you did have to transfer and about doc's. I actually saw a doc during my pregnancy because if I went to the hospital I wanted to have him and not the other ob's here. He was willing to ignore the fact that I was planning a hb even though here doc's can't be backups for mw's because they would lose their malpractice insurance. I would also talk to her about your possition during labor and what she is comfortable with. I talked to one mw who said I would have to be on my back hooked up to monitors, yeah right!
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#16 of 84 Old 01-03-2008, 05:38 PM - Thread Starter
 
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My midwife palpated and suspected twins before we had the u/s. She was pretty confident that she felt 2 heads. Then a few months ago she had another mom who refused u/s and had surprise twins!
Cool. I'm wondering how far along to palpate and have a feeling one way or the other about twins....

-Angela
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#17 of 84 Old 01-03-2008, 05:41 PM - Thread Starter
 
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Well, everyone else pretty much suggested what I would suggest! I would probably talk to her about what would happen if you did have to transfer and about doc's. I actually saw a doc during my pregnancy because if I went to the hospital I wanted to have him and not the other ob's here. He was willing to ignore the fact that I was planning a hb even though here doc's can't be backups for mw's because they would lose their malpractice insurance. I would also talk to her about your possition during labor and what she is comfortable with. I talked to one mw who said I would have to be on my back hooked up to monitors, yeah right!
Thanks for the info! Yeah, midwives don't work directly with OBs here. And the most midwife-friendly OB is moving away from the "riskier" stuff (stopped taking vbacs all together : ) I *think* that if I end up transferring it will be an emergency situation and whoever is on duty. Luckily the closest hospital to me would actually be one of my choices... lower section rate than most of what's around.

I'm sure she won't leave me stranded on my back She's a big fan of squatting....

-Angela
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#18 of 84 Old 01-03-2008, 05:48 PM
 
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I have never heard of a MW taking on twins without at least 1 US. Knowing if they are mono amniotic is essential. As my MW put it..."It's not IF the are intangled, it's how." As someone else pointed out there are also other issues to watch for.

I'm all over birthing twins with at home and treating them normal until something else presents. It was very important to me to limit ultraasound technology. (I had three) one at 19 weeks, on at 28 and then one at 37. My girls had one palcenta and 2 sacs. Both were head down, although mine became interlocked and we had some troubles during delivery. It was all fine, but I needed the experience and skills of the MW's I had with me.

i would ask about breech skills. If they will consider a breech/breech or if the first needs to be vertex.

I'd ask about their perspective on cord clamping. Some literature suggests clamping the first babies cord in case of 1 placenta or if they have fused. The concern is that the body may release the placenta before the second baby is born.

I would ask her about her level of comfort with the amount of time between twins and how she handles that.

If you want a water birth I would ask her about birthing both babies in water or baby A only. One of my MW's was only comfortable with me birthing Baby A. She wanted to be able to asses blood loss. But my second baby had other plans and came RACING out and she as a water baby too

Ask her about how many attendants she wants for the birth. some Mw prefer having 1 Mw or trained person in rescucitaion for each person.

Some Mw plan mandatory Pit for twins. i tossled with this a lot. I declined it mandatory, but i ended up needing it.

Your lucky your MW takes twins- that can be a real challenge to find support for -especially where i am at. i would definately plan a second twin birth at home. KUP!
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#19 of 84 Old 01-03-2008, 05:58 PM - Thread Starter
 
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I have never heard of a MW taking on twins without at least 1 US.
Answering in parts- feeling scattered today

Midwives and what they will take on varies greatly from midwife to midwife and location.

If my midwife is comfortable with it- then I will be comfortable with it in this case

-Angela
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#20 of 84 Old 01-03-2008, 06:02 PM - Thread Starter
 
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i would ask about breech skills. If they will consider a breech/breech or if the first needs to be vertex.

I'd ask about their perspective on cord clamping. Some literature suggests clamping the first babies cord in case of 1 placenta or if they have fused. The concern is that the body may release the placenta before the second baby is born.

I would ask her about her level of comfort with the amount of time between twins and how she handles that.

If you want a water birth I would ask her about birthing both babies in water or baby A only. One of my MW's was only comfortable with me birthing Baby A. She wanted to be able to asses blood loss. But my second baby had other plans and came RACING out and she as a water baby too

Ask her about how many attendants she wants for the birth. some Mw prefer having 1 Mw or trained person in rescucitaion for each person.

Some Mw plan mandatory Pit for twins. i tossled with this a lot. I declined it mandatory, but i ended up needing it.

Your lucky your MW takes twins- that can be a real challenge to find support for -especially where i am at. i would definately plan a second twin birth at home. KUP!
Breech- she hasn't attended a breech (last I asked... ) personally as she's been able to turn them all. But she is comfortable doing so. She would bring another midwife with breech experience. As I mentioned, I'm pretty sure that if it's twins she will have two other midwives in attendance, for a total of 3 (one per babe and one for mom)

I will ask about cord clamping. Good to think about.

I'm sure she's not mandatory pit. But I will confirm she will have it on hand if needed.

I will ask about water. Dd was her first water birth but she's done a number since.

I know I'm lucky to have found her She really does have an approach to birth as a natural process.

Since she personally had twins, she has less twin-fear than most.

-Angela
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#21 of 84 Old 01-03-2008, 06:22 PM
 
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How many weeks along are you? If you are thinking of one U/S (to either rule in or rule out twins), you might want to consider sooner as I think there is an optimal time to see if they are monochorianic or di. I had mine at 18 weeks and it was too "late" to see the lamba (or was it delta?) that is evident at 12 weeks or so that indicates mono-di. The membrane between my girls was really hard to see though (some techs couldn't see it and panicked about mo-mo) so they presumed it mono-di and had more regular U/S to check for TTTS. Pathology of the placenta after birth showed it was, in fact, one big one. But... I imagine there are people who have later U/S and they aren't sure so do tons of U/S followups to track for TTTS who turn out to be di-di.

All of this rambling is to say that you might be able to rule out something by acting sooner (if you are interested in U/S at all, of course!)

Good luck, and keep us posted!!!
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#22 of 84 Old 01-03-2008, 07:55 PM - Thread Starter
 
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How many weeks along are you? If you are thinking of one U/S (to either rule in or rule out twins), you might want to consider sooner as I think there is an optimal time to see if they are monochorianic or di. I had mine at 18 weeks and it was too "late" to see the lamba (or was it delta?) that is evident at 12 weeks or so that indicates mono-di. The membrane between my girls was really hard to see though (some techs couldn't see it and panicked about mo-mo) so they presumed it mono-di and had more regular U/S to check for TTTS. Pathology of the placenta after birth showed it was, in fact, one big one. But... I imagine there are people who have later U/S and they aren't sure so do tons of U/S followups to track for TTTS who turn out to be di-di.

All of this rambling is to say that you might be able to rule out something by acting sooner (if you are interested in U/S at all, of course!)

Good luck, and keep us posted!!!
I'm almost 22 weeks. I wouldn't agree to an early u/s just for twins. I know they're more accurate, but it's not a risk I'm comfortable with.

I won't agree to frequent checks for TTTS anyway and my midwife will be okay with that.

thanks for the info!

-Angela
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#23 of 84 Old 01-04-2008, 03:42 AM
 
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Eat wisely for twins, alegna.
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#24 of 84 Old 01-04-2008, 04:14 AM
 
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So, I'm not a twin mama, but if I were expecting twins, I'd really like to know more about what she "does" - I don't know if you could arrange it, but it would be soooo cool to watch some twin videos off youtube, and see her commentary.
Just as there are unspoken things about what I midwife "should or should not" do at a singleton birth, there are even more for twins. I would specifically ask about monitoring - how much, when, by whom - are they gonna round up an EFM or use two fetoscopes and tap it out? Or two dopplers? What positions would be okay? Is she gonna do a more medical second twin delivery - as soon as Twin A is born, a deep vaginal exam and possible flip of Twin B to vertex or footling for extraction? Or a laid back style of waiting for Twin B to show something at the introitus?

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#25 of 84 Old 01-04-2008, 12:32 PM - Thread Starter
 
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Eat wisely for twins, alegna.
Thanks! Already working on plenty of water and protein.

-Angela
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#26 of 84 Old 01-04-2008, 12:34 PM - Thread Starter
 
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So, I'm not a twin mama, but if I were expecting twins, I'd really like to know more about what she "does" - I don't know if you could arrange it, but it would be soooo cool to watch some twin videos off youtube, and see her commentary.
Just as there are unspoken things about what I midwife "should or should not" do at a singleton birth, there are even more for twins. I would specifically ask about monitoring - how much, when, by whom - are they gonna round up an EFM or use two fetoscopes and tap it out? Or two dopplers? What positions would be okay? Is she gonna do a more medical second twin delivery - as soon as Twin A is born, a deep vaginal exam and possible flip of Twin B to vertex or footling for extraction? Or a laid back style of waiting for Twin B to show something at the introitus?
I would expect two dopplers for monitoring. She wouldn't get an EFM And I can't see her extracting short of an emergency.

She had twins. UC.

-Angela
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#27 of 84 Old 01-04-2008, 02:58 PM
 
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As you know from my sig, I have zero perspective on a "normal" twin birth. But you are killing me here with all this planning and not knowing for sure. KILLING. ME.

I think I missed a post - are you planning to refuse all u/s or are you waiting for some optimal date? I'm not judging your decisions - I just want to know if my own curiosity has to wait a few months or what.

Betsy, mama to beautiful, strong MZ twins Lillian and Kate, born 11 weeks early on January 10, 2006.
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#28 of 84 Old 01-04-2008, 03:52 PM - Thread Starter
 
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Originally Posted by OGirlieMama View Post
As you know from my sig, I have zero perspective on a "normal" twin birth. But you are killing me here with all this planning and not knowing for sure. KILLING. ME.

I think I missed a post - are you planning to refuse all u/s or are you waiting for some optimal date? I'm not judging your decisions - I just want to know if my own curiosity has to wait a few months or what.
Yeah... my non-medical and more laid back ways drive many batty

I will consider an u/s if my midwife will be more comfortable with it. Last appt. was just an eyebrow raise and a "you're sure there's only one in there?" (I was 19 weeks, measured 27cm)

We've discussed twins in the past (given family history and I like doing my research well ahead) and she has said she often likes an u/s to confirm twins so that she can have enough hands on deck so to speak.

If next time around (not this weekend, but next ) I'm still large.... we'll discuss.



-Angela
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#29 of 84 Old 01-04-2008, 05:17 PM
 
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This just a from personal experience comment, but if your mw wants to do pit automatically after I would do it. I think pretty much everyone I know that had twins at home hemoraged and ended up with it anyway and it would have been really nice to avoid the major blood loss. My baby A's placenta did not come out for 2 hours after the birth and then 4 hrs later I hemoraged and it was no fun and left me incredibly drained for weeks and made it really hard to care for my kids. I am not normally into medical stuff but in retrospect I wish I had just done the pit right after the birth but at the time I did not think it was necissary. One test I would suggest is a hemoglobin check so that you can solve that problem ahead of time and then if you did hemorage it would be easier to recover from. I think measuring that far ahead I might want an u/s to rule out too much fluid, I would be more worried about that than having twins!
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#30 of 84 Old 01-04-2008, 05:32 PM
 
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This just a from personal experience comment, but if your mw wants to do pit automatically after I would do it. I think pretty much everyone I know that had twins at home hemoraged and ended up with it anyway and it would have been really nice to avoid the major blood loss. My baby A's placenta did not come out for 2 hours after the birth and then 4 hrs later I hemoraged and it was no fun and left me incredibly drained for weeks and made it really hard to care for my kids. I am not normally into medical stuff but in retrospect I wish I had just done the pit right after the birth but at the time I did not think it was necissary. One test I would suggest is a hemoglobin check so that you can solve that problem ahead of time and then if you did hemorage it would be easier to recover from. I think measuring that far ahead I might want an u/s to rule out too much fluid, I would be more worried about that than having twins!
: Yes to all of that - well said!

Mama to four remarkable kiddos, all born at home.
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