moms of mono/di MZ twins...how late is "Okay"? - Mothering Forums
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#1 of 14 Old 07-13-2008, 02:17 AM - Thread Starter
 
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I wanted to poll MDC moms of mono/di twins about how late they felt (or would feel) comfortable going in their pregnancies before feeling it would be prudent to consider (or decide in favor of) elective delivery.

Also, what weighed in (or might weigh in) to that comfort zone?

I am 38 weeks along with my mono/di twins, an uncomplicated pregnancy thus far, and I decided to decline an induction for this coming week. I requested to be scheduled for an NST (Monday) and a BPP (Wednesday) to monitor fetal well-being, instead. I felt tremendous relief after making that decision and conveying it to my doctor's office, so it's obvious to me that I haven't reached my cut-off.

I feel like I just got to term, and I need a window in which to be free to birth spontaneously. But....I'm not oblivious about stats for increasing complications with increased gestation (in previously uncomplicated pregnancies) and I was curious about how others have decided, what they think/feel about risks, and what their bottom line or deadline was/is/might be. Or, if there's no bottom line (in terms of a definite cutoff point) in the absence of any sign of fetal distress or failure of placental functioning or some definite external indication that it's important for the babies to be born right away. Would you see no difference in this issue for mono/di twins and twins with two placentas?

I know some mono/di moms here gave birth early because their twins were affected by chronic TTTS. So that's a little different, since there was reason to deliver electively because of a monitored condition. Acute TTTS is a little more elusive, as a theoretical possibility, and I guess it's possible that the potential of developing acute TTTS during labor might influence some sort of cutoff deadline at some point.

I know nobody can decide for me but I was hoping that some feedback might help me sort things out. I wish there were two placentas....
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#2 of 14 Old 07-13-2008, 04:44 AM
 
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Best wishes in making your choice. I know this has to be hard for you.
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#3 of 14 Old 07-13-2008, 11:25 AM
 
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I had mono/di MZ twins, and never felt like induction was 'forced', but I was ready to fight it tooth and nail if need be. My personal 'goal' was to make it 36 weeks, and when I got there, I thought, "well ... I can make it to 38!" (My boys were born at 37w, 4 days)

At the end, I was miserable, tired, exhausted, grumpy, etc, but I kept telling myself that each day I kept those boys inside, the better chance I had of having healthy babies who were going to come home with me. I told my husband that he was not to mention induction to me, and if I mentioned it, he was to ignore me.I was getting pretty close to 'folding' near the end, just because I felt so miserable.

We were having BPPs/OB visits weekly with growth scans, and I had no complications, other than a bit of contractions. My OB took me off work at 35 1/2 weeks. No problems with TTTS here.

Looking over your post, I see no reason why I would induce, being in your shoes. It's a personal decision, I think. Good luck, and we will see you on the other side!!:

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#4 of 14 Old 07-13-2008, 11:41 AM
 
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I have mono-di twins. I went to 39wk 4 days.

In the absence of compelling medical concerns that would necessitate delivery, I would not have considered an induction earlier than 43 weeks.

I imagine this answer will probably be on the long end of timeframes you'll hear, but some of the things I considered were:
  • I know I "bake them longer" anyway. My other 3 kids were: 40 weeks 4 days, 41 weeks, and 41 week 4 days.
  • By the end, you are past the normal window for developing Chronic TTTs. Acute TTTS can come on instantly and without warning. That means there is certainly a chance it can come on during an induced delivery. Doctors know little about what triggers Acute TTTS. I wouldn't doubt if the various stresses of an induced delivery could add to the risk.
  • The "cascade of interventions" is well established. I did not want to do anything that would increase my already-elevated risk of having a c-section (elevated only b/c I was pregnant with two).

I imagine that you are also facing the stresses of considering that you don't want to "push it" or be "asking for trouble" in your desire for a natural birth. I know I felt this pressure keenly, both from the doctor and from within. (When I say "within" I don't mean that I was going against my personal beliefs. Simply that we become so acclimatized to an incredibly high level of medical management of pregnancies and births of multiples that all of a sudden "normal" starts to feel and sound "abnormal").

Good luck with your struggles to find a satisfactory answer.

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#5 of 14 Old 07-15-2008, 01:03 AM - Thread Starter
 
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Thanks for the comments! I'm going to paste in a message I x-posted in my DDC....

Well, I inserted two EPO capsules vaginally last night and woke to some tightness and menstrual-cramp-type pain this morning. Everything pretty much resolved by the time I was up for the day. Had another non-stress test with no uterine activity, but good reactive babies.

My report from the last perinatologist consult & ultrasound (last Tuesday) still hadn't been faxed to my OB, but we did get the results from my GBS swab (negative.)

So later, my OB called me at home to let me know she got the faxed report. She gave me the weight estimates for the babies and said that the only thing she noted from the report (as concerning or questionable or whatever) was that twin B has dropped from his growth curve. She pulled out the stats from multiple scans, and said that he was tracking in the 97th percentile all along, and now he's in the 50th.

For what it's worth, I don't think 7 lb, 9 oz at 37w is 50th percentile, as she said. (Though the conversation happened quickly, and that "stat" might have been from her final "summing up" comment not her initial recap of the stats--I guess she might have been rounding down when she summed things up. I don't remember for sure, and the pen I grabbed to make notes wasn't working.) Granted, this is just the weight chart from the twin/multiples pregnancy book by Barbara Luke, but it has been consistent with the u/s reports (how many weeks ahead each baby has measured all along.) Anyway, 50th percentile for 37 weeks is 6 lbs, 11 oz.

Twin A (the smaller baby) was 7 lb, 2 oz at 37 weeks, which is 50th percentile for 38 weeks (he usually measures around a week or so ahead, when all his measurements are averaged out.) So twin B at 7 lb, 9 oz couldn't have been in the 50th. Down from the 97th percentile, yes. Much closer in weight to twin A than ever estimated previously, yes. A minimal weight gain for him in two weeks (only 4 oz), yes.

But not 50th percentile for 37 weeks.

My OB said his drop on the curve indicates that my placenta isn't functioning well enough, and he's not getting enough oxygen. (Oxygen? Really? This blows my mind, because we were just in her office hours before with a very good NST strip. And last week, at the time of the ultrasound report she was reviewing today, the babies were moving LOTS despite having "no space", the Doppler image of the umbilical artery showed the exact pressure of cord flow expected at this stage of pregnancy, and the babies both were working their diaphragms. Evidence of fetal well-being, and the peri explicitly said they wouldn't be expending energy on that behavior if they weren't getting enough nourishment and oxygen.)

My eating has slacked off and my weight gain has plateaued lately, but in the recommended total weight gain range of 40-56 lbs, I've gained 50 lbs.

The upshot was she said, "It's time for these babies to be delivered." She asked if I wanted the Wednesday induction. (That same one I refused last Friday.) Or if I wanted to keep the BPP appointment on Wed and see how that looked and go from there.

I opted to keep the BPP appointment.

Jiminey.

Oxygen? Really???? That sounds so bogus, but I guess I don't technically know how and what all the placenta delivers that leads to or impedes growth.

Here are Twin B's growth stats over time since our first detailed measurement scan at 20 weeks.

20w4d - 1 lb 2 oz

24w, 4d - 2 lb, 3 oz

28w, 4d - 4 lb, 1 oz

30w, 5d - 5 lb, 2 oz

32w, 4d - 6lb, 6 oz

33w, 6d - 6 lb, 12 oz

35w, 4d - 7 lb, 5 oz

37w, 4d - 7 lb, 9 oz


I admit I was keenly aware of the times when he (or they) seemed to slow down, though some of those scans were sort of close together, which the peris say doesn't give the clearest picture of true growth. And the last couple of times, the techs have admitted having a very hard time getting good images of the heads to measure, and just having a hard time getting measurements in general (because of fetal positioning and crowded conditions.) Plus, there's the +/- margin for error...10% or 15%, depending on who you talk to. (And my doctor does recognize this, but of course didn't mention it today.)

Another thing is, back at 32 weeks, twin A was measured and had only gained 9 oz in two weeks. Twin B, on the other hand, had gained the more expected 1 lb, 4 oz in the same time frame. I was convinced that it was a measurement error, just a little glitch or two that threw off the calculations and dropped him off his curve, but they ended up convincing me to do the 3-hour gestational diabetes test since his small gain had widened the size disparity between the twins. (Even though it wasn't because the bigger twin had suddenly gained way more...)

A week later, an ultrasound put him at 1 lb, 1 oz heavier. So....either he gained a whopping 17 oz in one week, or the previous measurements were a bit off.

Last week's ultrasound estimates show that disturbingly small gain for my "bigger" twin, of only 4 oz in two weeks. But at the same time, the smaller twin gained 12 oz in two weeks. Would that have happened if the placenta were failing? Or is this another case of measurements being off? Or just measuring too close together in time to get an accurate idea of how they really are growing (it was supposed to be only a BPP last week, but the tech knew the previous tech had had trouble with measuring so she opted to give it a try....)



Anyway, I've been taking the EPO, walking more, I had a massage tonight, I'm seeing an acupuncturist tomorrow morning. The full moon is this week, but not until Friday.

The OB basically said she would induce Wed or Thursday, since she wants to start with Cervidil and it would/could be a 2-day thing if the Cervidil did not send me into labor....follow up with Pitocin the next day. So, I know where she stands. (I was thinking more like, taking it off the table for this week and maybe considering it next week depending on what we find with the monitoring, NSTs, BPPs. From the sound of it, she is not comfortable going past the end of this week. Which makes it all interesting.)

Can these babies please come on their own soon? (And don't even ask me how I feel about hurrying them like this. I mean, it's all so I can avoid the difficulty and unpleasantness of arguing and stonewalling against medical pressure. And so that I can avoid getting boxed into a corner if things start to look "iffy" on the NSTs or BPPs. So I keep rushing them. How messed up does that feel?) I'm taking evening primrose capsules orally and also inserting them vaginally each night, just in hopes of getting my body more ready, so it can eject them, so they have a best-odds chance of an uncomplicated, "spontaneous" (ha) vaginal birth.
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#6 of 14 Old 07-15-2008, 01:41 AM
 
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First of all, from my personal experience, it was more than just a "little" hard to get accurate measurements on late term u/s. Even at 35 weeks I'm not sure we got good ones. My scan at 38 weeks and change took FOREVER and it still overestimated baby A by almost a whole pound and couldn't even get anything remotely accurate on B because of positioning.

Secondly, no, your twins are not going to look that good on a BPP or NST if your placenta is failing. Nor would the other baby have gained so much since you have ONE placenta. My guess is inaccurate measurements. Nutrients and oxygen are two different things as well, which your OB darn well knows. Sounds like she's starting the pressure and scare tactics to get you to induce.

As for hurrying them on your own, there's no way to tell if you can get it started. If you're close, you might be able to jump start a few days before you normally would have gone on your own.

It IS just as simple as saying no. From what I can glean from your post, I see no compelling reason why *I* would induce if I were in your shoes. I've had two inductions for singletons and I wouldn't sign up for it again in the absence of really compelling data.

Where did she stand on TTTS?
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#7 of 14 Old 07-15-2008, 02:25 AM - Thread Starter
 
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Originally Posted by Intertwined View Post

Where did she stand on TTTS?
No mention of it. Last Thursday, she did mention that we seem to have avoided it and are outside of the usual window (of course I knew that already) and she mentioned acute TTTS vaguely. I am not sure if she knew or differentiated between chronic TTTS and acute TTTS before I had brought it up 3 or 4 weeks earlier, but it sounded like she'd become more familiar with it because she did mention acute TTTS by name.

Honestly, the perinatologists never have suspected TTTS, even with a fairly large disparity between the boys (20% difference was pretty standard with them, though it fluctuated some between 18-20%. And at one point, the week twin A had the faulty measurements, the disparity jumped to 25%. But again, it was because the smaller twin had a less-than-expected gain...it wasn't the other twin taking off. And one week later they were "back" to their expected disparity...)

All along, the difference between them has been fairly substantial, but not with any signs indicating reason to suspect TTTS. Fluid levels always good for both, bladders always visualized, cord flow good, Twin B in the upper percentiles (~97th for much of the pregnancy) but Twin A always tracking above the fiftieth, too. (More recently, I think he'd been in the 65th percentile or so.)

The thing I always heard was that they were two big babies, with one quite big. "Have you been tested for gestational diabetes?" But nothing about TTTS.

And nobody seems to talk much about acute TTTS.
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#8 of 14 Old 07-15-2008, 11:27 AM
 
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I feel so much empathy for the position you're in right now. Takes me RIGHT BACK - to days I'm not so keen to recollect quite as clearly as I can! :

When I read through your post, it seems to me that you have a pretty strong feeling the induction idea is a bunch of bunk. I see a "gut no" in your thoughts, and also a lot of logical objections to the information that's being presented to you.

I'll just echo Intertwined on this one about the unreliability of measurements this late in the term. Also, as you may know, discrepancies from one ultrasound to another are far more likely when different techs are performing the exam - as you have mentioned happened in your case.

You are so right to be questioning how a shared "failing placenta" can be suppressing the growth of one twin while the other seemingly thrives when there is no sign of TTTS.

I think this boils down to your doctor being extremely confident that the gestational age of your twins coupled with neonatal care abilities will result in "a good outcome" if they are delivered now. Back to classic tendencies that it's easier to try to control a situation.

If you decide you are settled in your choice to refuse induction, the easiest way to deal with the pressure from your doctor will be to limit your frequency and length of contact and to not get into explaining yourself - it just invites objections.

My last ultrasound before our twins were born was at 38 weeks. In the hospital that day, my husband and I decided the we were absolutely at the end of our rope and that we were not walking back into a hospital until I was in labour, or we had good reason to suspect something was wrong.
  • We did not tell the OB of this decision, though she knew well our stance on interventions as we had been battling about that for a few months.
  • We left.
  • We phoned a couple of days later and cancelled the ultrasound that was scheduled for 39 weeks.
  • A day or two after that, the OB called about the cancelled ultrasound.
  • I didn't go into any detail about why we weren't coming in for it. I didn't offer up any sort of reschedule notions.
  • OB made strong urgings about us coming in for another one "if these babies haven't been born by 40 weeks".
  • I kept my responses limited to "Mmmm. . . " non-committal.
  • OB seemed to get the idea and an ultrasound was not scheduled for any date 40 weeks or beyond.

Sometimes, you just need to build yourself a cocoon of protection from this onslaught. It troubles me that you are doing to the Evening Primrose Oil capsules when you are feeling:
Quote:
Originally Posted by AmyC View Post
How messed up does that feel?
Although we mothers cannot command labour to begin, there is no doubt that the mental and emotional state of the mother influences when labour begins. By doing something to yourself that you aren't fully onside with, you are sending your body/babies mixed signals. That doesn't sound to me like it's a good recipe for an unencumbered birth.

GOOD LUCK!! Draw what strength you can in knowing so many of us are rooting for you.

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#9 of 14 Old 07-15-2008, 02:46 PM
 
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I, regretably, allowed myself to be induced at 37 weeks. I had measurements done at 34 weeks that showed both babies at approximately 5 1/2 pounds each and then when I went back at 37 weeks both the sonographer and the perinatologist struggled to get accurate measurements but I was told that it appeared that the babies weren't growing well anymore and that I should be induced. That, in addition to the fact that only one of the 4 ob's at the practice I was going to was willing to do a vaginal birth for the 2nd baby if he came out breech, made me agree to the induction.

My babies were born at 37 weeks weighing 5 lbs 2 oz and 5 lbs 4 oz. Now, knowing what I know now about the inaccuracy of the u/s measurements, I am skeptical about whether or not the induction was needed. The OB said that the placenta looked "okay" but he never gave me a firm answer as to whether or not it could have sustained my babies for another couple weeks so they could have put on a little more weight. They were my first babies so I was VERY nervous handling such little guys and had some early struggles with breastfeeding them and getting them to put on weight (thank goodness for my la leche league leader mother and her support or they probably would have ended up being supplemented and/or bottle fed).

Anyway, hindsight is 20/20 and I still don't know if I did the right thing or not. I'm thankful that I didn't have a c-section and that we were able to leave the hospital 36 hours after they were born though so I guess I don't have any complaints about anything other than I wish I would have done a little more research. I plan on using midwives with my current pregnancy and birth though
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#10 of 14 Old 07-15-2008, 03:22 PM
 
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Novella's post hit everything right on the head. I second, third, and fourth her insights and suggestions.
Follow YOUR instinct.
(my mono/di were 42 weeks. huge, healthy placenta. healthy babies.)

Mama to twin girls Adele and Nadia, born 5/2008
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#11 of 14 Old 07-15-2008, 03:35 PM - Thread Starter
 
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Thank you so much for the feedback. And, oh, thank you for the support. Even processing this stuff as it comes up (I thought we were clear on no induction this week until my doctor's call Monday afternoon, and the whole growth curve thing) pulls me away from nurturing feelings of safety and security that should be important to a mammal looking to birth. I mean, I need to process it so I can make decisions and know where I stand, but the STRESS of it! Thank you for the hugs and empathy.

My feelings and thoughts have been evolving a lot on this issue in the last week.....Originally, my keenest fears or misgivings were about the possibility of acute TTTS, and that somehow going "too long" was just giving it more of a chance to happen. Although I knew it was unpredictable and all that. I also felt that probably the best insurance against it (as long as this occurred before the onset of acute TTTS, which also is impossible to predict) would be a scheduled c-section. As in, that type of elective delivery would be the best way to "protect" against the onset of acute TTTS during labor. (Better than induction, which offers the possibility of a vaginal birth, but not the same efficient "protection" that a c-section would offer against that one potentially grim mono/di complication.)

Still, since nobody seems to have any hard data on odds/statistics of acute TTTS, it seemed a huge leap (to get to the point of consenting to a scheduled c-section.) It's not what I want, it's not what I believe is best for my babies, it's not best for me. Even scared of acute TTTS, the risks of the elective surgery outweigh whatever the TTTS-related benefit may be.

But....I was sort of operating on this "eventually an elective birth will be a reality if they don't come spontaneously" agreement, but thinking it wouldn't come to that. I didn't believe that "twins come early" (even though I heard it like a zillion times, in books, from random people, from doctors) although on some level I guess I thought they'd likely come earlier than a singleton. (I have one child, and she was born at 41 weeks. On the day, seven days past her EDD. And I was charting, and very sure of my dates as far as conception.)

Now that I've completed 38 weeks and am counting along toward 39 (this Friday I'll complete week 39), I am thinking more about that agreement that "eventually they'll have to come out." This reluctant agreement was based on their chorionicity: I was telling myself that if there were two placentas, there would be a lot more leeway. But now as I think things through, I realize that if my main reason for nervousness is the unpredictability and scariness of acute TTTS, I'm not exactly sure that I have a reason to think there's a deadline. Even with monochorionic twins.

If, like my OB, I am worried about placental function and postmaturity, babies ceasing to thrive in the uterine environment, twins being "term" earlier and therefore postmature earlier, then I have reason to think about elective delivery. But if I don't believe those assumptions, at least not with clear indications of such in my case, then exactly when is my "willing induction" date?

This is what I've been realizing....that the pressure to induce has little to do with acute TTTS (which is the main unsettling blip on MY radar, over which I assume I have no control), and most to do with the calendar, the fact that I have twins, and those older studies by Luke and by Leveno that suggested (and, effectively, established) that twins achieve pulmonary maturity earlier than singletons of the same gestational age, and may have complications of postmaturity sooner, as well. So, if I don't buy those reasons, I'm left realizing that I don't have a nice, sane compromise to show how reasonable I am.

Monochorionic or not.

Quote:
Originally Posted by Novella View Post
It troubles me that you are doing to the Evening Primrose Oil capsules when you are feeling:

How messed up does that feel?

Although we mothers cannot command labour to begin, there is no doubt that the mental and emotional state of the mother influences when labour begins. By doing something to yourself that you aren't fully onside with, you are sending your body/babies mixed signals. That doesn't sound to me like it's a good recipe for an unencumbered birth.
You are right....it is because of that evolution of thought I described above that I am conflicted, now, about urging birth on. I believed it was entirely possible that I'd go to 38 weeks or even longer, but in my heart I was hoping to reach 38 weeks and then have them come. It seemed the easiest route. Reach "term," but not go too long for the OB's comfort or approval or whatever. And they always were tracking big for gestational age, which I thought would bode well for that "plan."

Realizing that I'd reached 38 weeks with no signs of physical readiness for labor sort of blew my mind. The stoic, strong cervix that got me through the risky weeks for pre-term labor, and let me breeze right through the weeks when near-term issues could have been problematic if we'd birthed then, suddenly seemed a liability. I found myself suddenly afraid that I was carrying a couple of 40+ weekers and realized that this would put me at odds with my doctor and make things really difficult.

The evening primrose oil seems (to me) like more of an encouragement of readiness or ripening, as does sex/prostaglandin "deposits." Not that it's going to throw my body into active labor, but that it could encourage readiness, certainly over time.

I had one pelvic exam during my first pregnancy, and it was at 40w5d. My cervix was high, firm, and closed. Knowing that the next week would start with more scrutiny, NSTs and BPPs, the midwife at my appointment that day gave me some suggestions for activities and positions that might encourage better positioning of the baby (to help apply pressure to my cervix) and she mentioned EPO. I bought some and took it, and at 11 pm I passed the mucous plug and began contracting. It was a long road from there, since I was starting at 0% effaced (most of the next day was spent with contractions that thinned the cervix and I was maybe 2 cm dilated at midnight the following night.) After that long day, I did progress slowly on and I spent the next day dilating. My daughter was born at 11:12 p.m. at 41 weeks.

I know lots of people start taking EPO around 36 weeks, to help with preparing things, but I didn't want to do that because I was afraid it might do the same thing (start up my labor, even if it was long) and I didn't want to interfere with the twins' timing as early as 36 weeks! I now see that EPO isn't going to throw me into passing the plug and contracting, because I've taken it for the last few days (Friday and over the weekend, about 4 days now) and it hasn't been the same.

I feel I couldn't do castor oil at this point because of what you point out....I'm not fully onside with that action, at least not at this point.

When I bought the EPO and started taking it, I was hoping that I could encourage readiness and even encourage labor so that I'd be going naturally right around the time of the proposed induction (tomorrow) that I'd declined. I was hoping it would prepare me favorably for whatever influence the full moon might exert. I was hoping it would get me the spontaneous labor before whatever arbitrary deadline I might eventually have to agree to came along.

But then I started realizing that the only reason I was thinking that at SOME point I'd have to compromise was that I wanted to be the reasonable, compromising person....showing my doctor that even if the answer for now was no, I wasn't unreasonable and I knew that our monochorionic status meant we would have some sort of deadline. Once that premise came into question more sharply for me, I began to feel that telling my babies that it's okay to come, and casting about for ways to encourage them physically, was "messed up."

I guess that doesn't mean I think that EPO is a bad thing, because as I understand it, its "benefits" pay off whenever labor does start. So I don't feel particularly conflicted about that. Or about the sex, when we actually manage the logistics to make it work! (We're about 2 for 4 on that one, so far.)
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#12 of 14 Old 07-15-2008, 04:29 PM
 
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I hear it behind your words. You trust them and you trust your body but it's hard to commit because you feel you're higher risk.

But ARE you?

It's hard to say. I felt like I was walking a fine line my whole pregnancy. I came into it as a UCer who just didn't feel comfortable for some reason UCing again. Lo and behold we had twins at 20 weeks. Every single risk factor was missing so we continued with a home birth plan but that nagging feeling of being "high risk" stayed. And I had to make some tough calls on how many ultrasounds to have (I chose to have 4 routine and one the day before I went into labor because we couldn't figure out positioning) and whether or not to consult with a peri (we did not), and ultimately whether or not to birth a double breech presentation at home. It's not the same situation, but I can recall clearly that feeling of being higher risk and wondering if I could trust the process the same way I did before.

And you know what? It worked just how it was supposed to this time as well. And I followed my gut instincts and I avoided an unnecessary c-section and countless interventions. It was a hard birth in many ways but it was a good one. You have that deep gut feeling because I can hear you coming round to your conclusions in your posts. I think you know what you are supposed to be doing. And it makes sense to me as well. Continue monitoring them and avoid rushing them because, well, there really isn't a reason to rush them. From what I understand acute TTTS is completely unpredictable and will happen just as readily in an induced labor as a spontaneous one. If I'm going to pick I'm going to go with what nature gives me, if that makes sense. Your body has a deep wisdom on growing and birthing your children. I think you're balancing that with your risk status beautifully. Hang in there.
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#13 of 14 Old 07-16-2008, 11:38 AM
 
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I just wanted to add my 2 cents here... Both of my sets of twins are/were mono/di. My first set of twins were born at 39w1d. They did have acute TTTS but there is no way of knowing when it developed other than it was very close to their birth.

There is so little research out there about acute TTTS. I'd venture a guess that an induction would likely increase the chances of it developing just because it increases the chances of fetal distress.

Induction was never an option for me as I'm a VBAC mom. I was scheduled for a repeat cesarean but did not show up. I was comfortable going to at least 40 weeks if the babies looked good on BPPs.

Same deal this time around. I anticipate going into labor before 40 weeks but would not consent to a cesarean if the babies still look good.

I think you are right that an elective cesarean has risks that outweigh the small chance that acute TTTS could become an issue.

Good luck and I'm hoping those babies are born soon!

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 14 Old 07-16-2008, 05:00 PM - Thread Starter
 
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I had a BPP this morning and was a little nervous because Baby A wasn't doing much in terms of movements & diaphragm action. Because of that he scored an 8, while Twin B scored a 10. But the fluid levels were easier to find than the last time (I was drinking a lot yesterday, in anticipation) and I got on the monitor for a non-stress test immediately after and both babies were reactive.

Looking good. ("Today," my OB made a point of saying. Yes, they look good today.)

She asked us point-blank about our feelings/decision about her wanting to do an elective induction this week, and that started the conversation. In the end, she said just to call with our decision, which she acknowledged could be "I don't want to be induced until my due date," or whatever.

She made known her feelings & recommendations, she told me we're making her very nervous, but I left the office feeling okay about things (not prepared to cry off and on for a day or so, like last week) and sort of inside my own bubble.

I had my husband drop me off on the college campus where he works, and I took a walking trail, and contracted the whole time. I've been contracting most of the afternoon....the uncomfortable, menstrual cramp type. Probably just thinning the cervix at this point, but I feel so happy and mellow.

We are thinking of getting a room in town (we scoped out some near the hospital with jacuzzi tubs and gardens on the grounds, and plenty of sidewalks nearby for walking) maybe as soon as today and just laboring there. I am pretty clear on not getting to use a birthing room at the hospital, anyway, or laboring in water or anything that we were assured would be fine, because now she is saying I need to be monitored continuously. So I'm not keen on doing much of my birthing work at the hospital, in the end.

I'm not sure exactly how I'll know to go to the hospital, but I hope this is "real" enough (even though it's early in the process) that it'll all play out. My cervix was high, firm, closed on Thursday and these are the first "regular" contractions I've had, though I've been using EPO and having sex and I had some acupuncture yesterday. So I'm assuming it will be awhile of just ripening & softening....

I am 38 weeks, 5 days today.
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