Epidural required to birth twins vaginally??? - Mothering Forums

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#1 of 31 Old 02-25-2008, 10:39 AM - Thread Starter
 
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I am pregnant with b/g twins and last week I met with my OB for the first time. The meeting went pretty well. He is very willing to help me have a vaginal birth as long as baby A is vertex. But it did surprise me to hear that he pretty much "required" me to have an epidural. He said it helps in the safe delivery of the second twin and that it is pretty much standard procedure and recommended everywhere in Canada, U.S. and Australia. For example, if baby B is breech or transverse he can reach in there and do what needs to be done without me "crawling up the bed" (as he put it) as well as being prepared in case of an emergency c-section. Ultimately, it would be my decision but I was wondering what others experiences were. I kind of believe that not having an epidural is what helped me have fairly quick and easy births with ds and dd and was kind of disappointed to hear about his recommendation.

Karen - spouse to dh for 11 years, mama to ds (Nov '02), dd (May '05) and ds and dd (Jun '08)

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#2 of 31 Old 02-25-2008, 11:13 AM
 
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If, for whatever reason, there is a problem with baby B - let's say that they needed to c/s - you would have to go under general anesthesia. I don't know that it's "required" - but I understand why they want to do it. I don't know that it is "required," though - I birthed in the US and hadn't had an epidural with my pitocin. Nobody told me that the epi was mandatory - I opted to get it when the pitocin ctx were just too much, but then the girls were delivered so quickly after that that I kind of wish I hadn't. I would ask around to other local providers.
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#3 of 31 Old 02-25-2008, 11:14 AM
 
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Look at me, putting "required" like that twice. Redundant, much?
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#4 of 31 Old 02-25-2008, 12:29 PM
 
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It's probably one of my biggest fears with this birth! I am planning to have a home birth. If I needed a c-section or had to be induced (for Pre-e or something) I would just go for the epi, obviously. I will never do pit willingly without drugs already on board. Ever. Again. But in the case of PTL and having to give birth at the hospital, I'm not sure how I'm going to approach that. I don't want an epidural "just in case".
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#5 of 31 Old 02-25-2008, 12:38 PM
 
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I may have been duped. I trusted everything my OB said even if I didn't like it; I've wised up since!
However, my OB told us that she would let me attempt a vaginal without an epidural if I really wanted to but I needed to realize that if I did need a quickish section (the implication being that is more likely with twins) I would have to go under general anesthesia and would miss the birth. If they had an epidural in place they could turn it on or up in most cases and I could be conscious. I let them do the epidural but we didn't turn it up....until I ended up needing a section! In our case the epidural didn't cause the section I'm confident. My baby A boy was a misaligned posterior and got caught in the pelvis during pushing. Quite stuck crowning and just couldn't re-align no matter how many position changes we tried.

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#6 of 31 Old 02-25-2008, 12:53 PM
 
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No epidural "required" here, though my OB did mention that, if a c-section became 'necessary' on very short notice, I would be put under general anesthesia. Also, if for some reason, Baby B would need any sort of manipulation (extraction/version/whatever), it might be quite painful. Duh. Neither scenario happened.
I have heard of some twin moms having the epi catheter put in place, but w/o the drugs, for the "just in case."

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#7 of 31 Old 02-25-2008, 01:44 PM
 
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I have been a little nervous about this issue. I haven't met with my new OB yet (I thought we'd see her at our first appointment in the practice but they scheduled us with the midwife who alternates prenatal appointments to help with client load) so I haven't heard what she has to say or what she recommends/requires.

The issue of "if c-section is necessary" comes up for me, but also the issue that I would like to be able to be mobile, to be upright for the birth, to be able to try different positions to assist with facilitating the birth. And I would like to be able to feel the urge to push, to state it very mildly.

I guess the things I'll ask her are whether the twins being monochorionic (mine are) will influence how long we should be comfortable waiting between the births of the twins. Whether it's possible to wait to see how Twin B presents or whether she'd want to reach in and try internal version pretty much immediately following the birth of twin A (assuming a breech or transverse twin B.) And whether that is variable depending on if twin B's amnion is still intact, (which would make cord prolapse less of an issue before the baby is engaged one way or another, maybe?) So, if the second amnion is intact, would she be more comfortable giving the baby time to adjust his position on his own & perhaps engage?

Also: What are the conditions that determine an EMERGENCY second twin c-section versus one needed because we just can't get him/her out that way? And what kind of window of time (in minutes) is reasonable to expect if you have distress-plus-position issues, or if the placenta is abrupting? (Would you have a 5 to 15 minute window that would allow for a spinal & quick c-section, or would you be facing general anesthesia, no question?) What about the possibility of actually prepping the anesthesiologist for doing a quick spinal if necessary, and knowing that that's an option? (Not sure if that's a realistic proposition in our local hospital, though I'm sure it would be a do-able option at our tertiary center.)

If most second twin c-sections are of the "can't get them out this way" variety rather than "baby is in distress," then there may be time for a spinal if the surgery is going to happen. (It's my understanding that epidurals take longer than spinals, and general anesthesia is faster than a spinal. I've read that general can be as little as 3 minutes to set up, with spinals as little as 5 minutes, and epidurals taking 8-15 minutes & sometimes longer. I think those estimates are on the "speedy" side, "according to some people it can take as little as...." types of estimates, though.)

As far as whether epidural is "necessary" or "advisable" even in the event of 2nd twin breech positioning....I also have some questions about how hypnotherapy/hypnobabies might factor into things. It's entirely possible that it could take everything (in terms of discomfort, perception of pain) down a few levels, including extraction & internal version. Is that something that should be factored into my situation when making decisions and planning?

I'm hoping these all are things my OB will engage in discussion so that I can get a better sense of what is possible & advisable.

Anyway, I haven't really hashed through all this stuff yet and I'm still feeling up in the air, but maybe some of it will help you.
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#8 of 31 Old 02-25-2008, 02:29 PM
 
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FWIW, my OB said that if I was birthing vaginally and something happened that the babe/s needed to come out immediately, there probably wouldn't be enough time to up the epi enough to do the section... so he was fine to go without epidural because he said he'd just go straight to a general if there was a true emergency. That made it a little easier, actually...

You might want to ask your OB that -- there is a difference between time for a epidural to take effect for a c/s needed because of malposition, etc., after trying a zillion positions than if a babe's heart rate truly slows/stops, etc. So would you end up with a general anyway?

(I hope that makes sense! I'm not feeling very coherent today)
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#9 of 31 Old 02-25-2008, 03:17 PM
 
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I have heard of some twin moms having the epi catheter put in place, but w/o the drugs, for the "just in case."

I'm using a hospital MW and this is what I was told most of my backup doctors like, if Baby B was breech/transverse. I'm actually OK with this if it allows the doc to let me give a vaginal birth a go with a questionably presented second twin.

You might try and ask if that would be an option you & your doc could agree on. Another option would be to get the epi quite late in the game, to try to minimize the piticin need (my biggest fear).
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#10 of 31 Old 02-25-2008, 05:05 PM - Thread Starter
 
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So, I guess it is fairly common. That's a good idea to discuss putting the cathedar in but going medicine-free until it's needed. So much to think about!

Karen - spouse to dh for 11 years, mama to ds (Nov '02), dd (May '05) and ds and dd (Jun '08)

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#11 of 31 Old 02-25-2008, 07:39 PM
 
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I'm glad you posted this .... since this is something I've been struggling with, too.
I mentioned to my OB that I'd prefer for my labor to go similar to what I did with Rachel. Labored at home, showed up at 9 cm, delivered Rachel 20 min later.
She 'highly recommended' an epidural, even if both babies are vertex, 'in case' something happens, and I'd have to revert to a C section. She told me the same thing your OB told you .... if I don't have an epidural in, it means general anesthesia (something I DO NOT want), and that my husband would not be able to be in the room.

It makes sense to me that you could have an epidural catheter placed, but get no meds. I do think they have to give you some sort of 'test dose', in order to ensure that it's working properly. In other words, what if they put it in, didn't give you anything at all, then in the event that you needed it, gave you meds, that didn't work??

I used to work at the hospital I am going to deliver. I'm going to call one of my friends, who works in Recovery Room, and ask her how to be able to talk to one of the anesthestiologists. I want to hear it straight from the horses' mouth, about what I will, and won't be able to do, when I get there.

I struggle with this a bit here, because if I mention it to anyone who is ultra birth friendly around here, the FIRST thing I hear is "you need to switch OBs.", or, "you need to switch and deliver at a different hospital". Neither of those are viable solutions for me. First, I LIKE my OB .... I have a good relationship with her, and I respect her opinion. Second, the hospital where I am delivering has a Level III NICU ... in case we need that, my babies will be down the hall, not in a totally different hospital. Last, the hospital that is touted as being 'natural birth friendly' by all the granola moms and doulas around here is another 10 minutes away from me (20-25 min to my hospital, 30-35 min to the 'birth friendly' hospital.)

I just want things the way I want, at my hospital of choice! I don't think that's too much to ask.

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#12 of 31 Old 02-25-2008, 07:43 PM
 
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I had the epidural and don't regret it at all! This was a big issue w/ me and I thought about it a lot durring my pregnancy. My OBs are pretty laid back and not really heavily intervention, but they both recommended an epidural incase of emergency. ALso my twin B was frank breech and there is no way to tell what will happen once twin A is out. In my case, we hoped B would slip down and be delivered breech (OBs had no problem w/ that, some do so be sure and ask if you can do a breech delivery). Instead he flipped kinda sideways and stuck his arm out. I ended up w a manual version (hand inside, freaky! Babies HR went down a few times, scary!) but was able to get baby B out w/o a section! I did have to have a bit of help w/ a vaccuum, and the version, but it went well IMO! I do not even want to think what it would have felt like w/o the epidural! Also, I was able to birth in the regular delivery rooms instead of the OR. That's another thing to ask about, some Drs. will only deliver in the OR. Best of Luck! I don't think an epidural is manditory, and I think w/ two head-down babies I may have went ahead and tried it, but w/ one breech the chances of a version went up, so I decided to go w/ it and I don't regret it at all! The birth still went very quickly and while I really did enjoy my natural, no pain meds birth of my DD, I felt that I made the best decision regarding my twin birth.

Oh, and I was told that if a true emergency happened they would probably do general anesth. no matter what, but if an epidural was placed they may be able to wait a few minutes and get the medicine in that way instead.
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#13 of 31 Old 02-26-2008, 12:33 AM
 
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The OB we finally settled on (yes, we switched) definitely recommended an epi - as in strongly recommended. We told her we weren't going to accept pain-relief drugs that would hamper my ability to move, be upright, sense what my body was doing, etc (Twin B was double-footling breech).

When she wasn't making progress on the epi, she tried again and again to get me to agree to a pudendal block. She asked what would happen if I "couldn't handle" the pain of a breech extraction. Our answer was that she was not allowed to do an immediate total breech extraction (as she wished) and that it would be consented to only in an obvious grave emergency. At that point, there wouldn't be time for anything - so if it was truly too painful, I guess my body would just "protect me" in that I would pass out from the pain. She was so incredulous about this response that she documented it (in shocked expression) in a letter to other doctors.

Re: speed.
There is another mama on here who was about 5 minutes from the decision that a crash c-section was needed, to first baby out (if I'm remembering our PM correctly. . . maybe she'll jump in here). They did a spinal that quickly. Her experience gave me further resolve that the hospital's normal "well, it can take 15 minutes just to get an IV in" wasn't necessarily accurate.

Re: trying to scare Mom that in a c-section with a general, Dad won't be allowed in the room.
The thing about doctors saying "you can't" is that it starts making me feel like "YOU can't". When they told us that my husband would not be able to be in the operating room if a c-section under general anesthesia became necessary, they found us equally absolute. We simply said, "If he's not in the room, there IS NO c-section". The OB then had to scurry around to advise her colleagues and to ensure it was properly documented that we had flouted their preferred procedures. Once there CYA was in place, it wasn't an issue they raised again.

When you see how many of their "must do" recommendations for twin births are based on near-hysterical fear, you just need to turn that fear to your advantage. As we found out (in reading letters she sent to another doctor), our OB was going out of her mind with worry that we would ditch the hospital altogether and have a "disastrous outcome".

And guess what happened? Gee, labour went fast and smooth and two perfect baby boys slid out 17 minutes apart. Breech Twin B was just as easy as Twin A. It just felt a tiny bit different b/c the "long part" of the sliding sensation came first. He was born in the caul.

Good luck to all you mamas confronting such an agonizing decision! It was an awful time of angst and self-doubt for us. I can be flippant now and wax on about how much we learned about ourselves. But it is quite the thing to be knowing that your decisions could so directly affect someone's health forever and has such serious implications for your family.

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#14 of 31 Old 02-26-2008, 12:58 AM
 
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Wow, you guys are a lot better than me. I had an intense surge of anger that flared when reading the OP. IMO, twin birth or not, the final say on what (possibly) harmful drugs enter my body for hypothetical circumstances are mine to make- noone else's.

I calmed down after reading your thoughtful and heart-filled responses, but I will at least pipe up on what my story was. I changed OB's (also a person I really liked) at 32 weeks. I had finally, after several visits, said the 'e' word was forbidden. He still wouldn't stop bringing it up and the line was drawn. I quit him and gave birth drug-free, using Hypnobirth, vaginally 3 weeks later with a doctor who would leave the room when he wanted to control the situation. He admitted that to me later. I had a midwife there acting as a doula, so I was never alone without expertise.

As for some concessions, yes, I made them. I allowed a dry IV to be set up so in case of emergency, there would be no time lost. And at one point I was desperately thirsty and they gave me some kind of fluids through it, as well as me drinking water. Yes! In spite of the impending doom of almost certain C/S they still 'let' me drink water. Oh, the things a woman goes through just to have some dignity in such a natural process. :

I know everyone has to go through their own journey and figure out what their comfort zone is, but it's so important to educate yourself as much as you can. And not just through the things the OB says. At the last visit with my fired OB, he slipped up and said something about needing to cover his butt legally. They have a different vantage point than the mother does. It's that simple. And I'm not so crunchy to say I wasn't very happy to have people waiting on me hand and foot after my body went through birthing two babies at the hospital, instead of being at my house for a homebirth. But had to fight tooth and nail for the hospital birth I got.
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#15 of 31 Old 02-26-2008, 01:09 AM
 
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To the OP, I also wanted to say ESPECIALLY since you've successfully birthed 2 kiddos already vag, you're body is prime to be your ally. Positioning is your only real concern, don't you think?

Dianna, not all of us here hate hospitals, LOL. I really respected mine. They had beautiful birthing rooms I could labor in. It wasn't until I was 10 cm that I got rolled into the OR room. There were 14 (my MW counted) people hanging out waiting to 'save me' in the next room.

The best thing EVER they did for me was roll me into that OR in a birthing bed. The head nurse said they would just hoist me up onto an OR table if the situation warranted. That was so cool and even my OB didn't think it was allowed, so it really paid off that I was so persistent.
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#16 of 31 Old 02-26-2008, 02:39 AM
 
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To the OP, I also wanted to say ESPECIALLY since you've successfully birthed 2 kiddos already vag, you're body is prime to be your ally. Positioning is your only real concern, don't you think?

Dianna, not all of us here hate hospitals, LOL. I really respected mine. They had beautiful birthing rooms I could labor in. It wasn't until I was 10 cm that I got rolled into the OR room. There were 14 (my MW counted) people hanging out waiting to 'save me' in the next room.

The best thing EVER they did for me was roll me into that OR in a birthing bed. The head nurse said they would just hoist me up onto an OR table if the situation warranted. That was so cool and even my OB didn't think it was allowed, so it really paid off that I was so persistent.
oohhh ... I should have clarified ....
I meant PHYSICALLY around here, meaning in my town! Sorry!
I do get the impression that the pro-natural birth folks in my area, ARE anti-medicine for the most part. We have a pretty active birth care network, and an ICAN chapter, and a lot of them are on the local AP circles. I had asked a question re: birth plans for twins. Of the minimal responses I got, most of rwhat I heard was all about the hospital that I chose had a high epidural rate, high c section rate, etc; and how I CERTAINLY needed a doula.

I understand hospital rates for epidurals, C sections, etc .... but that does not mean that I'll be one of those people, ya know!
After all ... what's the divorce rate for second marriages?? Didn't stop me from taking the plunge, and being blissfully happy!!

Once again, sorry for the confusion! I have found that on this board, and in my DDC, we are all mutually respectful of our birthing decisions, and that's the way I like it!

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#17 of 31 Old 02-26-2008, 02:42 AM
 
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FWIW I had a homebirth and my baby B was breech but turned transverse after baby A came out. My midwives did an external version and I don't remember it hurting one bit. Alot of about my birth hurt, but the external version didn't at all. There is so much room in there after baby A comes out, it is not that hard to move baby B.

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#18 of 31 Old 02-26-2008, 09:45 AM
 
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There is another mama on here who was about 5 minutes from the decision that a crash c-section was needed, to first baby out (if I'm remembering our PM correctly. . . maybe she'll jump in here). They did a spinal that quickly. Her experience gave me further resolve that the hospital's normal "well, it can take 15 minutes just to get an IV in" wasn't necessarily accurate.
I hate to argue on the side of the hospital, but it can take 15 minutes to get an IV in and it can take longer than that to get an epidural in - there are so many variables. Of course it doesn't ALWAYS, but it can and I don't think it's unreasonable for someone to suggest that time frame. As with everything else, it should be your decision to get an epidural or not, but to imply that they are giving bad information, based on one mama's experience, seems unfair.

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#19 of 31 Old 02-26-2008, 10:36 AM
 
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I am pregnant with b/g twins and last week I met with my OB for the first time. The meeting went pretty well. He is very willing to help me have a vaginal birth as long as baby A is vertex. But it did surprise me to hear that he pretty much "required" me to have an epidural. He said it helps in the safe delivery of the second twin and that it is pretty much standard procedure and recommended everywhere in Canada, U.S. and Australia. For example, if baby B is breech or transverse he can reach in there and do what needs to be done without me "crawling up the bed" (as he put it) as well as being prepared in case of an emergency c-section. Ultimately, it would be my decision but I was wondering what others experiences were. I kind of believe that not having an epidural is what helped me have fairly quick and easy births with ds and dd and was kind of disappointed to hear about his recommendation.
I didn't birth with an OB. But I did birth my breech twins without an epidural.

Personally, I wouldn't be comfortable if anyone, midwife or doctor said that to me.
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#20 of 31 Old 02-26-2008, 10:43 AM
 
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I did not have an epi. I did consent to their "required" IV "just in case". In retrospect I might have argued even that point more. It did take them several attempts and quite a while to get it placed, although it often does with me (I guess I have weird veins or something ). And I ended up with some pretty serious bruising from the IV itself. The doc did an external version of Baby B. After A was born, B apparently flipped sideways. It did hurt, a lot, and I wonder if it contributed to the lengthy stomach pain I had pp. But an epi wouldn't have helped with that. I also consented to going under general if an emergency c-sec was required.
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#21 of 31 Old 02-26-2008, 11:21 AM
 
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Related question/clarification. If you had the epi line, but no drugs, would a c/s under general still be necessary?

And even if you had some epi drugs, wouldn't you need more for a c/s?

What is the IV line people are talking about: the epi line or a line in your arm??
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#22 of 31 Old 02-26-2008, 01:13 PM
 
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What is the IV line people are talking about: the epi line or a line in your arm??
I had a heparin lock (hep lock) placed in my arm/wrist 'just in case'--it provides a point of access and potentially saves a bit of time in an emergency scenario. It is a small IV port with about 6" of tubing that is then taped down. After it was placed and taped, I didn't notice it at all.

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#23 of 31 Old 02-26-2008, 03:25 PM
 
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Related question/clarification. If you had the epi line, but no drugs, would a c/s under general still be necessary?

And even if you had some epi drugs, wouldn't you need more for a c/s?

What is the IV line people are talking about: the epi line or a line in your arm??
As I understand it (from a nurse perspective)
... if you had a need for an emergent C section, and had an epidural in place, you would NOT have to be done under general. Yes, you would need more dosing of drugs, but they take effect relatively quickly. They would load you up with the numbing agent (Lidocaine, Buvipicaine, what ever the anesthesia guy likes), and maybe a bit of the pain med (duramorph, fentanyl, etc). When you get an epidural for pain relief, it's generally a combo of the numbing agent, as well as the pain med.

At most hospitals, if you have an epidural, it's pretty standard procedure to have some sort of IV access, in case they need to give you IV fluids, blood, medications, blah, blah blah. I'm going to request a saline lock (hep lock) .. the IV catheter is placed, then capped, ready to be accessed when needed.

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#24 of 31 Old 02-27-2008, 10:43 AM
 
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Originally Posted by OGirlieMama View Post
I hate to argue on the side of the hospital, but it can take 15 minutes to get an IV in and it can take longer than that to get an epidural in - there are so many variables. Of course it doesn't ALWAYS, but it can and I don't think it's unreasonable for someone to suggest that time frame. As with everything else, it should be your decision to get an epidural or not, but to imply that they are giving bad information, based on one mama's experience, seems unfair.
I didn't mean to suggest that they were giving information that is never true - I apologize for that. My mother is an extremely hard stick, so I do know all about the delays that can occur with IV.

To clarify: my objection was that the hospital staff presented all these things as "this WILL happen", rather than saying "There is a risk [ideally then quantifying that risk] that it could take up to XX minutes to insert an IV, although XX minutes is normally what it takes".

We just found that they continually quoted the worst-case scenarios of what could happen and how long things could take, and presented that as normal and likely to happen. Don't even get me started on the enthusiasm with which the OB hammered at the point that my cervix would so very likely close after birthing Twin A and that I would be unable to birth breech Twin B without her high-level interventions!

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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#25 of 31 Old 02-27-2008, 04:24 PM
 
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Originally Posted by Mama to one View Post
I am pregnant with b/g twins and last week I met with my OB for the first time. The meeting went pretty well. He is very willing to help me have a vaginal birth as long as baby A is vertex. But it did surprise me to hear that he pretty much "required" me to have an epidural. He said it helps in the safe delivery of the second twin and that it is pretty much standard procedure and recommended everywhere in Canada, U.S. and Australia. For example, if baby B is breech or transverse he can reach in there and do what needs to be done without me "crawling up the bed" (as he put it) as well as being prepared in case of an emergency c-section. Ultimately, it would be my decision but I was wondering what others experiences were. I kind of believe that not having an epidural is what helped me have fairly quick and easy births with ds and dd and was kind of disappointed to hear about his recommendation.

I haven't given birth to my twins yet, but when i found out i was having twins i called all the hospitals in my network and asked them their standard policies for twin births and this DID come up when i called. they ALL said it (along with saying i'd be given a "trial of labor", but i had to labor and deliver IN the OR, not a labor/delivery room) BUT, ALL of the hospitals (and the cnm i asked about my options during a hospital birth before deciding on a homebirth) stated that what they could do is put the catheter in, but not put any medicine in if you don't want it in. This way if an emergency c-section is necessary, they won't have to give you general anesthesia. If i was having a hospital birth, it's what i'd do. but that's just my .02

SAHM to 2 year olds Tesla and Lucius. twins.gif
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#26 of 31 Old 02-28-2008, 09:41 PM
 
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In the hospital birth of our twins, epidural was suggested and expected but all I had to do was say, "NO." The only have to's in our case was I had to have an IV line (not hooked up to anything),we had to have an anestiologist (sp?) in the room 'just in case' and I had to deliver in the operating room. It was REALLY unneccesary and it really made me lose focus (I did AWESOME in the labor room and could have delivered there with no problems..or even at home for that matter!).
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#27 of 31 Old 03-01-2008, 12:24 AM
 
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I did have an epi with my twins and thank goodness I did because I think I would not have saw tommorrow without it. Baby b decided he would flip and get cord wraped around his neck, so my dr literally dove in after him. I didn't like the idea of it either especially since I had 3 prev. natural vaginal deliveries, but I was told it's different your having twins!: Herd that enough times...
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#28 of 31 Old 03-01-2008, 10:13 PM
 
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It seemed likely that an epidural would required at my local hospital for twins. I'm strongly against that sort of thing (my 1st baby was born at home) so I'd decided to go to a city 3 hours away to deliver. However, when I went into pre-term labor, a 3 hour drive was out of the question. I labored, on mag and in silence, for about 6 hours at the local hospital. I was 10 centimeters when they checked me, and there was no time for an epidural. My twins were born vaginally very soon afterwards.

I really think that not having an epidural helped me out. I'd advise against it. I will say that it can be very hard to so no to drugs when you're actually in the hospital. I'm glad the question never came up. When I tried to refuse the mag, they threatened to air-lift me to Phoenix. I don't know about you, but laboring in a helicopter didn't sound too appealing to me.
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#29 of 31 Old 03-02-2008, 01:17 AM
 
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Originally Posted by devilish_fetish
ALL of the hospitals (and the cnm i asked about my options during a hospital birth before deciding on a homebirth) stated that what they could do is put the catheter in, but not put any medicine in if you don't want it in. This way if an emergency c-section is necessary, they won't have to give you general anesthesia. If i was having a hospital birth, it's what i'd do. but that's just my .02
(Interestedly following this discussion, here!! I have twins due in July, and have recently changed doctors but am waiting to discuss protocol etc. and be sure that I want to stay with this practice....)

I don't know that having an epi line in place with no meds would ensure that general anesthesia is unnecessary in the event of an emergency c-section. It's not even completely clear that having an active epi during labor ensures that the extra boost of meds necessary for a c-section could take effect in time (via epidural) to accommodate a really serious emergency.

I think it might be worthwhile to clarify the degree of emergency we are talking about when we mention the possibility of "emergency c-section," or maybe distinguish whether the c-section is "necessary" (we can't get the baby out this way) versus "emergency" (the baby is in danger.) Would a doctor really be comfortable assuring someone that under no circumstances would you need general anesthesia if you had an epidural going and ended up in an emergency c-section situation??? That there's no chance of even an active labor-dose epidural taking too long to bump up and take effect for a really serious emergency? And would the doctor say the same about the spinal line running saline (no meds) and starting "from zero"?

I guess it's worthwhile to ask whether the spinal line with no meds even would be viable for a truly urgent emergency? And if not, and if the "necessary" (versus "emergency") c-section for position problems is the more likely scenario in 2nd twin births anyway, would there typically be a window there for a quick spinal prep (not an epidural) before the c-section?

If the answer to that is "probably yes," maybe it makes more sense to avoid the epidural and the spinal line entirely if the main reason for opting for them is "avoiding the need for general anesthesia in the event of a c-section." If a true urgent emergency would likely result in general anesthesia IN SPITE OF having an epidural in place, why not labor without the epidural and plan on having a spinal if c-section becomes a reality and there's time for the spinal? (Realizing that general anesthesia may still result if the urgent type of emergency comes up, just as it could with an epidural in place and running.)

If position issues are statistically more likely than distress-plus-position issues in second twin c-sections, it seems like general anesthesia is an unlikely prospect whether you have an epidural in place or not. There typically would be time to prep for the procedure. (And spinals are supposed to be faster than epidurals, regardless.)

I guess the potential issues of internal version and extraction are the remaining ones to consider, whether it makes sense to have the epidural there for the mother's comfort during these procedures. But maybe the window of time applies here, too. After all, if you have the epidural line with no meds in place, is there going to be time to start up the meds and have them take effect before the procedures need to happen? And if there is, would it be just as possible to wait and opt for a spinal at the point that internal version comes up, as well? (Is there a 5 minute window, or not? And how long does it take the meds to take effect once they start running them through the epidural line, anyway?)

And I guess if one of the "potential issues" to consider is a previously vertex Twin B turning breech or transverse after the first twin is born, I'd want to know the OB's thoughts on what people have shared in recent threads about "holding the spot" externally and preventing the vertex baby from turning once the womb space is opened up. As in, what about these approaches to managing the situation?

Part of my reservations at this point (at the point of discussing options with my OB) is that I've read that there are similar risks to the mom from the saline version (no meds) of the epidural line placement. So apart from the issue of epidural meds, just by having the line in place, you run the risks for spinal headache, lingering epidural backache, and the possible need for a blood patch. Not that they wouldn't be a worthwhile trade for the option to have muscle control and remain vertical while laboring, so setting the spinal line with no meds might be worth it. But I would wonder if it really were such a truly necessary step to avoid general anesthesia, so that's where I'd start.

("Can you guarantee that I wouldn't need general anesthesia anyway, in an urgent situation, even if I have an epidural?" "In a typical situation such as deciding on c-section for positional reasons with no associated distress, would there typically be time for a spinal ANYWAY?" "Even with some distress or emergency, is there likely a 5-15 minute window that might allow for a spinal ANYWAY?")

I'm still a couple of weeks away from my appointment with my OB, so majorly musing over these things right now!
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#30 of 31 Old 03-03-2008, 01:14 AM
 
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No one ever pushes mommas of singleton babies to get an epidural "just in case" they end up in a section. This is one of my pet peeves - - I labored and delivered preterm so it never came up but I was fully prepared to put up a fight about the "required" epidural. I've seen too many babies crash after the epidural is placed, especially twin mommas. So you know. we all need that epidural so that when we end up in the c-section that the epidural caused, we'll be able to witness it
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