Twins -- C-Section/Vagina - Page 3 - Mothering Forums

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#61 of 83 Old 03-12-2009, 01:41 AM
 
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Just FYI, infant mortality is all deaths in the first year--it's not a measure of obstetric care. The US does very poorly because of bad access to primary healthcare. We actually do fairly well on perinatal mortality (deaths in the first 7 days)--something which comes at a big cost, and which could be achieved without that cost.

To the OP: I had a CS, though not for twins, and I would never do it again by choice. I would ask around for OBs. My understanding is that the usual requirement is that Baby A be vertex, but some OBs will do vertex-breech. With twins, you do need to be prepared for the strong possibility of CS in any case because positioning is more difficult, but I wouldn't rule out vaginal birth yet.

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#62 of 83 Old 03-12-2009, 06:34 AM
 
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I didn't read the whole thread, but have to chime in since we're talking about birthing twins.

I had both my sets of twins completely naturally. One of mine was breech too. It CAN be done. Not to mention all the risks involved with a c-section, both for you and the babies, and the longer recovery time.

Anyway, just thought I'd weigh in as someone who's BTDT--twice.

Tanya ~~ mother to: Beth, 12 -- Cali & Trent, 9 -- Melanie, 8 -- Jesse & Davin, 5 -- Baby Shae 9/1/2009
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#63 of 83 Old 03-12-2009, 12:23 PM
 
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Originally Posted by rhiandmoi View Post
My SIL delivered her twins vaginally, but they had to use vacuum extraction for TwinB, because he did not engage well and SIL was fairly exhausted at that point. TwinA is usually not the problem, unless that one is breech, it's TwinB that has a lot of the risk.
This is something I heard and went into my birth thinking too. It may or may not be true, but having been through a twin birth, I think difficulty with Baby B is more common when the twins share a sac. When they each have their own sac, Baby B can ride through birth of Baby A without a problem. It seems like just one birth after another in that case. And even if Baby B is breech, turning is a possibility after Baby A is born, either spontaneously or with help.

I wish the risks were broken down for the very different situations.

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#64 of 83 Old 03-12-2009, 12:29 PM
 
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I don't know of any twin moms who were induced, so if you have a statistic on that I'd be interested to see it. Multiples tend to be born preterm because of preterm labor, which is by far the most prevalent complication of multiple pregnancy. See e.g. Barbara Luke, "When You're Expecting Twins, Triplets or Quads" (1999), (ch. 5).

For every twin mom who had a blessedly uneventful pregnancy to term, there is another one who did not. I did not. I did vbac them, at the hospital, after going into spontaneous labor due to a gross rupture of membranes (as in, they could see hair) at 33w. Oddly enough, of the twin moms I know, they seem to be about evenly split between those who delivered at 37 weeks and those who delivered prior to 34 weeks like me (some well prior).

Some docs do tend to be a bit quicker to section twins, that much is true - about half are delivered by section, I think. But I don't know of any docs who would deliver early over problems that were not real. The nicu experience isn't remotely worth it.
Glad this is the case in your area. It's not in mine. Of the twin moms I know IRL, either they had preterm labor, scheduled c/s, or induction. Once you get to 38 weeks with twins in NoVA, you get induced or sectioned. It happens all the time. Many of my friends were induced, and I was really pressured. It's bad practice and results in preterm babies.

And I've read the 50% c/s rate for twins. I have no idea where that number comes from. It's MUCH higher here, around 80%.

No published stats for you, just my local experience.

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#65 of 83 Old 03-12-2009, 12:53 PM
 
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I don't know of any twin moms who were induced, so if you have a statistic on that I'd be interested to see it. Multiples tend to be born preterm because of preterm labor, which is by far the most prevalent complication of multiple pregnancy. See e.g. Barbara Luke, "When You're Expecting Twins, Triplets or Quads" (1999), (ch. 5).

For every twin mom who had a blessedly uneventful pregnancy to term, there is another one who did not. I did not. I did vbac them, at the hospital, after going into spontaneous labor due to a gross rupture of membranes (as in, they could see hair) at 33w. Oddly enough, of the twin moms I know, they seem to be about evenly split between those who delivered at 37 weeks and those who delivered prior to 34 weeks like me (some well prior).

Some docs do tend to be a bit quicker to section twins, that much is true - about half are delivered by section, I think. But I don't know of any docs who would deliver early over problems that were not real. The nicu experience isn't remotely worth it.


The nicu experience for whom? The Dr doesn't experience the Nicu, the child and parents do. Im not seeing that correlation? I do not want to sound like I hate Dr's, but I will tell you the major thing on their mind is the health and well being of their JOB. They have interest in a live baby and mom because their jobs depend on it. So it's better to have a live baby in the Nicu than to even *risk* an injury or death. They have been traumatized by malpractice suits and THAT is what shapes todays practices, fear, not facts.

Most moms around here that have twins are induced. I have seen at least 6 cases of MILD PIH and all of a sudden it's better to have that 34-35 out? No, not so much.

Most twin moms here ARE pressured to induce around 36-37 weeks if they make it that long. I am not completely sure why? Convenience?

All I know is that babies that cook until THEY are ready usually result in babies that are in good position for labor, hence lowering complications that may result in a C section.

I am by no means saying if there is a true emergency you should not act, but knowing what is really an emergency is important.
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#66 of 83 Old 03-12-2009, 01:17 PM
 
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I could be wrong and maybe someone can confirm this (if they haven't already) but isn't it common for one twin to be breech and then turn for their birth after the first has been born?

I would definitely look for a HCP experienced in twins and breech births...in AND out of a hospital. Most twin births are called "unsafe" for vaginal birth, not because mom can't do it, but because most HCPs have little or no experience because their training primarily, or solely, consists of cesareans for twin births. Don't let someone's ignorance-based inexperience determine what's safest for you and your babies.

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#67 of 83 Old 03-12-2009, 02:46 PM
 
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I have not had twins, but I have had one c/s and one vaginal birth and you cannot even begin to compare the two. I had severe bonding issues with my son after his birth (c/s), trouble breastfeeding, pain for weeks, etc, etc. My daughter was born at 31 weeks due to a placental abruption (possibly caused by my previous c/s) and even though she was not able to breastfeed right away and we were seperated almost immediately after birth (had to go to the NICU) I had no bonding issues or troubles nursing (once she had a better sucking reflex around 34 weeks, before that she was getting my milk through a feeding tube). I was also worried about tearing, but I didn't (granted, she was small). Also, since twins usually come earlier, they will probably be smaller than singletons, and you may be less likely to tear (assuming there are no funky presentations, like hand up near the face).

IRL, I know of 4 twin mothers who all gave birth vaginally. 3 of these mothers had both babies head down, and one had baby A head down, baby B breech (OB turned baby B before it came out). Oddly enough, I don't know of any twin moms who had c-sections (and these are not crunchy people by any means).
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#68 of 83 Old 03-12-2009, 03:08 PM
 
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Just my 2 cents.

I haven't carried twins, so I can't comment on that. I have one child. Born via forced c-section because she was breech (that's a whole other story). I completely understand you wanting to be under the care of an OB instead of a midwife, even though I would never opt for that after my experience. The midwifery care I experienced was exceptional, even through the c-section. I also understand you wanting to be in a hospital environment for the birth of your children. I did for my first. I do not for my next. We are told things prior to experiencing child birth that we just can't believe or understand fully until we experience them for ourselves.

That said, I will never agree to another c-section unless it is blatently obvious that either my life or my child's life is in danger. Barring my not-so-good surgical experience because I was obviously not in agreement, the recovery just isn't worth it, and have been told by multiple health care providers that I healed extremely well and quickly. I felt completely helpless. The physical inability to properly take care of an infant because you've just had surgery is heartbreaking - and you are having 2. The frustration and pain. You will NEED help. Lots of help. Your DH will be taking care of you and 2 babies for weeks. He will have to do everything. You will be extremely limited in what you can and should do. Is he prepared for that? He will have to change all the diapers, bring the babies to you for feedings, bring you food and drink, help you move around, help you get set up for breastfeeding, just to name a few. He has to be completely on board. It will be a lot of work for him, and you will need even more rest because you will also be recovering from surgery. I also had a hard time with breastfeeding because of thrush, likely the result of the antibiotics they give you for surgery. So, ignoring the dimished birth experience, the medication required for the c-section, the risks involved with a c-s (for mom & baby), and the problems a c-s leads to with subsequent births, I would try to avoid one based on recovery alone.

I would suggest you look for another OB that is more skilled in or comfortable with multiples delivery, or at least comfortable with flipping the second twin. If they aren't, it could become more risky.

I would highly recommend looking into the benefits of going into labour, even if you choose a c-section. I did that with mine, and will never regret it.

If I were you, I would not give up on the chance at a vaginal delivery. Good luck with your decision, and your pregnancy.
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#69 of 83 Old 03-12-2009, 03:51 PM
 
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The nicu experience for whom? The Dr doesn't experience the Nicu, the child and parents do. Im not seeing that correlation? I do not want to sound like I hate Dr's, but I will tell you the major thing on their mind is the health and well being of their JOB. They have interest in a live baby and mom because their jobs depend on it. So it's better to have a live baby in the Nicu than to even *risk* an injury or death. They have been traumatized by malpractice suits and THAT is what shapes todays practices, fear, not facts.

Most moms around here that have twins are induced. I have seen at least 6 cases of MILD PIH and all of a sudden it's better to have that 34-35 out? No, not so much.

Most twin moms here ARE pressured to induce around 36-37 weeks if they make it that long. I am not completely sure why? Convenience?

All I know is that babies that cook until THEY are ready usually result in babies that are in good position for labor, hence lowering complications that may result in a C section.

I am by no means saying if there is a true emergency you should not act, but knowing what is really an emergency is important.
Here's a little study that discusses the different causes of preterm delivery for twins (I didn't do any kind of big search, it was just in the bibliograpy of the book I cited earlier. So I don't know what else is out there). I'll try to underline the relevant portions. http://www.ncbi.nlm.nih.gov/pubmed/7898832
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METHODS: The March of Dimes Multicenter Prematurity and Prevention Study included a total of 33,873 women who delivered between 1982-1986, 432 (1.3%) of which delivered twins. Women were classified by reason for preterm birth and ethnicity. RESULTS: Of the deliveries in the data set, 54% of twins were preterm compared with 9.6% among singletons. Of those born preterm, twins were born at a significantly earlier gestational age than were singletons. Only 2.6% of all neonates born were twins, but they represented 12.2% of all preterm infants, 15.4% of all neonatal deaths, and 9.5% of all fetal deaths. Spontaneous labor accounted for 54% of twin births, premature rupture of membranes accounted for 22%, and indicated deliveries accounted for 23%. Of the indicated preterm births in twins, 44% were due to maternal hypertension, 33% to fetal distress or fetal growth restriction, 9% to placental abruption, and 7% to fetal death.
Unfortunately I have only seen the abstract; it would be interesting to see the data, charted by gestational age and so forth.

I realize this isn't going to change anyone's mind, and so we'll have to agree to disagree, but I think a lot of people would be surprised at the amount of effort that goes into avoiding prematurity.
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#70 of 83 Old 03-12-2009, 04:08 PM
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Just FYI, infant mortality is all deaths in the first year--it's not a measure of obstetric care. The US does very poorly because of bad access to primary healthcare. We actually do fairly well on perinatal mortality (deaths in the first 7 days)--something which comes at a big cost, and which could be achieved without that cost.
I don't think that's true. If you look at the list, there are *several* countries with notoriously bad health care that are actually ranked ABOVE us in terms of infant mortality.

Also the US has one of the worst maternal mortality death rates as well.
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#71 of 83 Old 03-12-2009, 07:15 PM
 
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Just FYI, infant mortality is all deaths in the first year--it's not a measure of obstetric care.
How do we know? Babies born by c/s have higher rates of respiratory distress, so how do we know that there are other serious consequences of c/s to the baby that haven't been identified?

The history of obstetrics (like many other endeavours) is heavily laced with practices that were considered benign, and that later research proved were not benign - or even safe, in many cases. There is no reason whatsoever to believe that we've identified all the repercussions of c/s - for moms or babies.

The woman I knew who had her twins vaginally and c/s had a rough time. Twin B dropped into a bad position and someone said the arm was blue. All hell broke loose, and the mom was put under for an emergency c/s. Because of the problems they "knew" the baby was going to have, due to the - entirely unproven - oxygen deprivation, the baby was transferred to a different hospital for the first week, so that she could be monitored. The mom, home with a toddler and the other newborn and a fresh surgical incision couldn't get there. She made it once, with the help of family (there were problems with the toddler melting down over mommy not being there, too). The baby was then transferred back to the original hospital for another...can't remember - 4 or 5 days, before being allowed to go home. That baby is almost 6. She's never had a hint of a health problem, is bright, active, etc. There was never any evidence, in any of the monitoring going on, that she had any kind of brain damage, whatsoever. Nonetheless, she was separated from her mother and her twin, because the staff thought she'd been off colour at birth.

I was lucky. DD's breathing problems (as in - she frequently stopped breathing, for no apparent reason) didn't result in any such drastic actions. They were brushed off with "that's common for c/s babies". If stopping breathing is common with c/s babies, I'd say it's fairly obvious that the surgery carries some odd consequences for the babies, yk?

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#72 of 83 Old 03-12-2009, 07:39 PM
 
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If anyone is interested, the book Cesarean Voices (and the associated website here) discuss some possible implications of c/s on the babe. I'm going to be very up front and say I think some of their conclusions are off the wall, but it's an interesting area of study (physical, emotional, psychological impact of cesarean surgery/birth) that hasn't gotten a lot of attention as yet.

I'm guessing that as the rate of c/s continues to rise there will be more research done, if for no other reason than these kiddos are going to be the cohorts in other research programs and there will be a need to "rule out" c/s as a factor in those studies.

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#73 of 83 Old 03-12-2009, 09:27 PM
 
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Since wombatclay brought up psychological impact, I'll throw one other comment in here.

OP: I've been focusing on having had my babies by c-section in this thread. I was also a c-section baby. I've hated that fact my whole life. I hate that my mom's scar was how I got here (kind of off the wall, as the scar originally came from my brother, anyway). I hate that I was born like an alien pod person, by an OB, instead of by my mother, the way the whole of humanity was born until recently. (This isn't a result of my natural birth leanings - if anything, the converse is true. I value natural birth, because I wasn't born.) I couldn't begin to quantify the impact that my method of arrival on this earth had on me, psychologically - but it's real.

To be fair, I'll add that this seems to be a highly individual thing, and I've only ever talked to a very few other people who share it - but it's real, and there's no way of knowing who will be affected by it, and who won't.

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#74 of 83 Old 03-12-2009, 09:57 PM
 
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This is something I heard and went into my birth thinking too. It may or may not be true, but having been through a twin birth, I think difficulty with Baby B is more common when the twins share a sac. When they each have their own sac, Baby B can ride through birth of Baby A without a problem. It seems like just one birth after another in that case. And even if Baby B is breech, turning is a possibility after Baby A is born, either spontaneously or with help.

I wish the risks were broken down for the very different situations.
If the twins share a sac (Mo-Mo) it's an EXTREMELY high risk pregnancy and (AIUI) the babies are born by c/s, usually early to prevent the babies from strangling each other. Thankfully, this is very rare.

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#75 of 83 Old 03-12-2009, 09:59 PM
 
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If the twins share a sac (Mo-Mo) it's an EXTREMELY high risk pregnancy and (AIUI) the babies are born by c/s, usually early to prevent the babies from strangling each other. Thankfully, this is very rare.
This is what I was going to say. Momo twins are not as common as people think- I say this because people assume twins do share sacs or at least identical twins do. Not true. Most twins have separate sacs.

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#76 of 83 Old 03-12-2009, 11:26 PM
 
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I haven't read all the responses but I just wanted to chime in.

My water broke at 34 weeks and baby A, ( the baby coming out first ) was breach. For me, there was risk of the twins locking chins and since my water had already broken the chances of baby turning was very small. Which is why I needed a c/s. It sucked, even knowing I was out of options wasn't enough to make me feel good. It is not just physical, but tonnnnnnnnssssssssss of emotions that comes along with it.
Postpartum with twins is rough as hell. I never want to go through it again.
Never ever choose a c/s if you don't need one.
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#77 of 83 Old 03-13-2009, 10:47 AM
 
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One last thing, dealing with breeches is dependent upon the drs. training. Med schools aren't teaching how to deal with breech babies, and so if you have a dr. who doesn't know, you are going to end up with a c/s.
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#78 of 83 Old 03-13-2009, 12:24 PM - Thread Starter
 
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Thank you ladies for so much valuable input.

I've made up my mind in 2 ways:
1) I will deliver in a hospital
2) I will not change my OBGYN.

I hope all of you have wonderful births. I know all of us will choose what's best for our bodies. I know myself well enough to know that the above 2 items mentioned are best for me.

Happy Pregnancy Mammas=)
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Everybody has to make their own decisions. I wish you a good recovery, if you do have a c-section.

All the best.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
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#80 of 83 Old 03-13-2009, 01:24 PM
 
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Best wishes!!

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#81 of 83 Old 03-13-2009, 02:17 PM
 
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Thank you ladies for so much valuable input.

I've made up my mind in 2 ways:
1) I will deliver in a hospital
2) I will not change my OBGYN.

I hope all of you have wonderful births. I know all of us will choose what's best for our bodies. I know myself well enough to know that the above 2 items mentioned are best for me.

Happy Pregnancy Mammas=)
LA Mamma, I just wanted to give you a link to a very inspirational video that a friend of mine put together after her twin vaginal birth (and VBAC!)

http://www.youtube.com/watch?v=7E-wULAaD50

I also wanted to let you know that there is an EXCELLENT CD set sold by Hypnobabies that helps women feel more confident about their twin pregnancies and births. It's an excellent way to help you overcome or at least minimize your fears, so you don't have unnecessary stress interfering with your pregnancy or happiness at what should be a really wonderful time in your life.

http://hypnobabies.com/store/shop.ph...&cid=4&start=0

If it turns out that you do need a c-section, there is also a great CD for preparing yourself for that as well. It even has handouts talking about ways to minimize trauma and risk for the babies if surgery becomes necessary. And of course, there is also the wonderful childbirth preparation home study program that could help you learn more about the process, and understand all the choices you have along the way, and how the risk/benefit ratio fits your situation. And it also gives excellent information on avoiding or minimizing tears.

Good luck with a very healthy, happy pregnancy, birth and life with your obviously much-loved twins!
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#82 of 83 Old 03-13-2009, 02:43 PM
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Good luck.
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#83 of 83 Old 03-13-2009, 04:39 PM
 
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