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Discussion Starter · #1 ·
My ob and I discussed today that I will be in the OR for the second stage due to hospital policy. He is going to see about having a regular birthing bed in there so that I won't have to be on the operating table. He says I will likely be able to choose the position I want to be in for pushing, I believe as long as I am on the bed. Is there a position or positions that are best for twins? My son was born after 20 minutes of pushing in a semi-reclined position with my legs being held up. I have read that squatting can cause tears if the baby comes out too fast, so I wonder if that wouldn't be a good position for me. Any insight? Thanks!
 

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Good for you having dialog with your OB in advance.....<br><br>
Keep on discussing these things throughout your pregnance. You may find as you get to know eachother better, your OB will give you more leeway once he/she trusts that you have only your babies' best intrest at heart. While I will take every opportunity in life to happily say that I pushed both of my twins out in a supported squat (whoohoo) I will suggest that the position that you push is both very personal and impossible to decide in advance. Lets say you decide that a supported squat is the birthing position for you... When the time comes, that might not be best. I was thrilled that for my first birth ever, once I was complete, no one said "it is TIME TO PUSH" or " GEt into this position to push" I was complete for 30-45 minutes before I pushed out my first daughter on the first push. I moved around the whole time to find the best position for me (I thought that hands and knees would be the one for me and when the time came, I couldn't stand it. I found that hanging from my husbands neck and kind of wiggling my hips with contractions allowed the babies to move down the best and when the time was right, I just yelled "someone catch the baby!" My OB was a little nervous about agreeing with my requests at first but we knew eachother so well by the birth that it really helped her to relax.<br><br>
So the moral of the story (man am I long winded today) Keep working to get the flexibility to push in whatever position is best, even standing next to the bed. and then wait until the time comes and allow your body whatever it needs. This is from someone who delivered my 2 first babies on my back and the second one IN STURRIPS (I still have nightmares) Don't let the OB take your freedom to birth in the best position away from you... BTW....I tore with DS and DD (6 and 2) and did not tear at all with the twins. Food for thought....<br><br>
GL!<br>
Tassy<br>
DS 6, DD 2 , Twin girls 6 months
 

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IMO, tearing is less in a squat. More even pressure to the perineum. Do what feels good and works at the time.
 

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I don't know how pushing out twins would be any differant then pushing out a singleton, except you have to do it twice. Be ready to try lots of differant positions and do what works. I haven't had my twins yet, but I'm practicing squatting so I can do that when the time comes. I didn't squat last time because being upright made me dizzy. I was in a sorta semi recline, sorta squat (I pushed with my feet on the squat bar LOL). Squat helps the pelvis open more and you have gravity helping bring the baby down resulting in less tearing in general. Do what feels right at the time!
 

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Discussion Starter · #5 ·
This is all great advice, thank you! I was planning on waiting to see what felt right, but when I had that conversation with my ob yesterday, he wanted to know what position I had in mind. I told him I would like to be in whatever position is comfortable at the time, and that I do not want to be on my back. Because he asked, it got me wondering if I <i>should</i> have a position in mind. And because it all seemed to happen so fast last time- my midwife checked my cervix, so I was already on the bed reclined and she didn't try to encourage me to do anything else, so that's just how it happened. I didn't really get a chance to listen to my body. Tassy it seems that it really helped you to be able to do that, without anyone telling you what to do when you weren't ready. Congrats by the way, your birth sounds wonderful! So I guess I kind of wonder if I will know what my body is saying, since I wasn't really given a chance last time. I really hope I get some good nurses. I will have a doula this time, so that will help a lot I'm sure.
 

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ooooo, lucky doula!!! I would love to doula for a twin birth!
 

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I agree...do what works/feels good at the time and having a doula can REALLY help. Mine did. I remember w/my daughter thinking the Bradley side-lying thing looked and sounded wonderful....well, when the time came, it was the most excruciating position to be in! For my twins, I did a semi-upright sorta squat. I was stupid enough to try side-lying again for a bit...total mistake. Duh.
 

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Squatting is a great way to help the baby move down throught the birth canal. The best way to NOT tear is to *ease* the baby out once it's head is crowning. So, instead of continuing to push, you can breathe the baby out--like pretending you're blowing out a candle very gently.<br><br>
I never liked side-lying either but it is a good position if baby is coming REALLY fast because it can help minimize tearing.<br><br>
Whatever position you choose, the idea is to be comfortable: hold your breath only as long as you feel comfortable and push only as long (or as hard) as you feel comfortable. More and more research is showing that closed-throat pushing isn't as good (for mom or baby) as open-throat pushing. Focus on pushing from your abdomen and not your face. And don't let everyone else in the room dictate how things are handled.<br><br>
Listen to your body. It knows what to do <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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I wanted to be on hands & knees. Unfortunately, my dr wasn't as agreeable as yours sounds. My doula said beforehand something to the effect of being in the position puts you in a good position. Meaning that if you get in a certain position, they likely won't physically maneuver you out of it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/wink1.gif" style="border:0px solid;" title="wink1"> But IME I get to a point during delivery that I need a bit of help to turn over when on a hospital bed attached to a monitor. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">: Just a long-winded way of saying, keep up the discussions with your dr. Remind him as many times as possible that he has said you may choose your positions, so that he doesn't try to bully you or the nurses/doula. Also, try to talk with any backup docs in case this particular dr is not the one who ends up attending. HTH <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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Discussion Starter · #10 ·
That is definitely a concern - that I will get an on-call doctor instead of mine, but he has said that he will likely be there even if it is a weekend, if he is in town. I guess twin births are exciting for him! All of your advice has brought me to a new question - how to deal with anyone in the room who is trying to dictate what is happening, as you said birthjunkie. Like yelling "push!" at me or whatever. I know I can talk to my doctor ahead of time about this, but what if it happens anyway? Should I tell them to shut up or just ignore them?
 

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Let your doula and/or partner/dh/whatever be your advocates if you're not comfortable with anything going on. At my boys' birth there was an anesthesiologist in the room "just in case" who *insisted* I wear this hideously tight blood pressure cuff. I said about 3 times I NEED this OFF of me! Finally, my doula and said, 'we're taking this off of her' and just did it. The anesthesiologist left the room at that point, miffed, I guess, and (as an aside) didn't congratulate us after the completely uneventful birth that didn't require his omnipresent intervention.
 

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<div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">how to deal with anyone in the room who is trying to dictate what is happening, as you said birthjunkie. Like yelling "push!" at me or whatever.</td>
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Discuss it <i>during the labor</i> with whoever is present (I'm assuming that they won't spring new labor support on you just as you're beginning to push?) And tell them that if they forget in the heat of the moment, that you have asked your doula to remind them. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> I'd suggest reading up on spontaneous second stage too, rather than doing the standard "pushing at full dilation".<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">He is going to see about having a regular birthing bed in there so that I won't have to be on the operating table. He says I will likely be able to choose the position I want to be in for pushing, I believe as long as I am on the bed.</td>
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That's good, but... some positions just are difficult in a narrow hospital bed, and difficult to maneuver into from other positions and maintain position. If you're most comfortable in a bed that's one thing, but not feeling able to really move around when you feel you need to could hinder the descent of the babies. You're also just very likely to default to reclining if you're in a bed, and that's definitely not best for the descent of the babies and could complicate second stage for them.
 

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Discussion Starter · #13 ·
Thanks cjcolorado & fourlittlebirds for your advice!<br>
fourlittlebirds (or anyone else who might know), do you have any suggestions of what to read about spontaneous second stage? There wasn't much when I tried a search. I'd love to learn more! Thanks!
 

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Try googling Michel Odent. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 
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