L&D Question

[Sugar&Spice]

How and when did your labor start? Was it natural, planned c-section, induction? Everyone keeps asking me if I have a planned c/s (no) and I'm wondering how often moms of multiples go into labor naturally and deliver vaginally, and how early that tends to happen. Thanks!

[Flynn08]

From my first appt, my ob's said that they would not let a twin pregnancy go past 38 weeks. My boys were heads down pretty much the entire pregnancy and I had no complications. We wanted to do a vag delivery and I was a good candidate from my dr's perspective. Unfortunately, my guys were not interested in leaving. My induction failed and i ended up with a c-section. Recovery was not as bad as I expected and I had lots of help the first couple weeks so it worked out fine. In my multiples group, I know several women who had vag deliveries. I for sure know more MoM's who who had c-sections. It seems like a lot of them have stories about complications so I'm not sure how many were elective. Just out of curiosity, will your OB let you go past 38 weeks?

[MaryJane]

If your doctor tells you you can't go past 38 weeks just because you are carrying multiples you should run not walk for the door and find an ob who actually practices sound medicine. I know lots of twin moms who have gone to 40 weeks and even beyond and had a spontaneous labor and vaginal birth. It is beyond riduculous to induce twins early for no medical reason just as it is ridiculous to induce a singleton early for no medical reason. I had a c-section with my twins because my presenting twin was transverse. But if your babies are frank breech or vertex then you should be able to deliver vaginally. And you should find a doctor with the experience and knowledge to not push c-section just because you are having twins.

[cakegal]

If your doctor tells you you can't go past 38 weeks just because you are carrying multiples you should run not walk for the door and find an ob who actually practices sound medicine. I know lots of twin moms who have gone to 40 weeks and even beyond and had a spontaneous labor and vaginal birth. It is beyond riduculous to induce twins early for no medical reason just as it is ridiculous to induce a singleton early for no medical reason. I had a c-section with my twins because my presenting twin was transverse. But if your babies are frank breech or vertex then you should be able to deliver vaginally. And you should find a doctor with the experience and knowledge to not push c-section just because you are having twins.

Every thing Mary Jane just said!
I had a c/s due to pre-e. Planned on natural birth but I resigned myself to be OK with a c/s because as I got farther along it looked like it would be a good possibility.

[sharn]

I had an emergency c-section due to a placenta abruption at 32 weeks 5 days. I had gd but no complications until the abruption. My doctor told me 4 days before that she thought I would go to term. I never even had a Braxton hicks contraction. Baby a was breech so I was looking at a c section anyway. My doctor would let me do a vaginal delivery if baby b was breech though. I was also told that I had to deliver at 38 weeks. With my son they would only let me go to 41 weeks due to gd. He arrived on his own 3 days before my induction.

[MaryJane]

Just wanted to add that some ob/gyns will tell moms that twins develop faster than singletons and that the placentas start to break down earlier but that is a total load of crap. It's one of those medical myths that some obs seem to still be spreading around. It's NOT true. Twins need to gestate just as long. Gestation periods are individual anyway which is why labor starts at different times for different babies. 39-41 weeks is the average. Having multiples doesn't change that. It's just that carrying more than one baby means the risk of complications is slightly higher. But inducing early certainly doesn't follow medical evidence. Induction comes with more risks not less and should only be done if there are medical conditions that make staying pregnant riskier than what's incurred by inducing. With a healthy pregnancy the only reason for a c-section would be position issues which are more likely to occur with twins because of less space and maneuverability plus external versions aren't an option if baby A is breech. Some doctors will deliver vaginally if both babies are breech or baby A is head down and Baby B is breech. A doctor with good twin experience should at least be comfortable delivering vaginally even if B is breech. C-sections are more likely if Baby A is breech and B is head down or if Baby A is transverse as was my case. You can increase your chances of having babies in good positions by practicing good posture and getting good chiropractic care throughout your pregnancy. I'm in twin groups and so know a lot of twin moms all over the place and it is such a pet peeve of mine to hear their doctors tell them that they will have to have their babies early. It's just not true if there are no complications.

[Sugar&Spice]

Thanks, ladies. I like my Ob-Gyn a lot. He's never given me reason to worry (and actually, when I told him I was still nursing while PG, he said, "Well, that's how it should be, right? That's how women do it all over the world." ) But almost everyone else (RNs included) seem to think c/s are the natural route for twins. I've already made it clear to my doc that I plan to wait until the babies are ready to exit, and complained that I was told I'd have to induce at 41 wks with my first (he was 40w 3d) because my "fluid was low". However, when DS was born, the RN said, "I'm giving you a prize for the wettest, messiest birth I've ever seen." I went home 15 lbs lighter than when I went in, and I question whether the fluid was really low. I had a midwife, but had to continually fight the doc on call not to have a c/s because my labor had stalled for several hrs, and since this is Kaiser, you don't get the option of having your own doc there...it's whoever's on call. Anyway, I'm getting off subject, but it's just a concern of mine that they'll push for c/s and I wanted to hear others' experiences so I can have that knowledge going in. Thank you!

[MaryJane]

Just remember that you have the right to refuse as well as the right to consent. They can't force you into anything. On a side note, it's hard to measure fluid accurately with ultrasound. It's generally better to have several ultrasounds over a period of time to confirm low fluid as it's dependent on so many factors. It seems though that low fluid has become the new big baby card. Sounds like you have a good doctor that you trust, so just ignore all the naysayers and make sure you and your doctor are on the same page. And if you aren't happy with the doctor on call you can always request someone else. There are things you can do as a twin mom to increase your chances of vaginal birth. Good nutrition is always important, and I already mentioned good chiropractic care to help with positioning. Some things to request birth wise is no induction for non-medical reasons, no epidural line, laboring at home, laboring in the delivery room rather than in the OR. Some doctors will only deliver twins in the OR, but some will let you deliver in the regular delivery room if the OR is close. Also making sure doctor is willing to do a version on baby B if they are breech once A is born or willing to deliver B breech vaginally. Some doctors will try to talk you into having an epidural line placed just in case, but a spinal would take less time in an emergency than even setting up the epidural so it's not necessary and usually just something that will keep you in bed and by having that access already in place it's easier for them to talk you into an epidural too early.

[MxMomma21]

I had to have a c-section due to twin to twin transfusion syndrome and baby a was the donor and was a lot smaller. I was told if my twins were fraturnal then I could go term but probably not past 38 weeks because of higher risk to me. When I found out they were identical my high risk OB told me 36 weeks would be great anything further we would be at dr every other day just because they are identical and Mono-di twins. I was also told I would go full term and then 3 days later at 28 weeks TTTS suddenly changed everything and they wouldnt allow me to go past 32 weeks because of the risk of losing one or both boys. Everyone is different, their bodies all react differently. I was aiming for vaginal but had to opt for c-section. Good Luck!!! Hope you get the delivery you want!

[As Is]

I just delivered trips on Monday @ 36 weeks via repeat c-section. Released tonight. Recovery has been awful but my internal cut is pretty big and I've been on at least modified bed rest for almost the whole pregnancy.
While I was on hospital rest there was a twin mama who delivered vaginally, not induced but at 33 weeks. Not sure if it was natural or not.

[twinmom34]

I had a c/s with my twins due to previous stroke placing me at high risk for more arterial damage in my brain from the pressure of pushing.


I went into labor on my own at 34.5 weeks and one again b/c of my stroke history they were not able to give me any of the meds to try to stop or slow labor.


My recovery was easy but, as a nurse I did all the things I know are important after surgery...cough & deep breathe, walk at least every 2 hours and eating a good diet after birth to improve healing.

[Sugar&Spice]

Just remember that you have the right to refuse as well as the right to consent. They can't force you into anything. On a side note, it's hard to measure fluid accurately with ultrasound. It's generally better to have several ultrasounds over a period of time to confirm low fluid as it's dependent on so many factors. It seems though that low fluid has become the new big baby card. Sounds like you have a good doctor that you trust, so just ignore all the naysayers and make sure you and your doctor are on the same page. And if you aren't happy with the doctor on call you can always request someone else. There are things you can do as a twin mom to increase your chances of vaginal birth. Good nutrition is always important, and I already mentioned good chiropractic care to help with positioning. Some things to request birth wise is no induction for non-medical reasons, no epidural line, laboring at home, laboring in the delivery room rather than in the OR. Some doctors will only deliver twins in the OR, but some will let you deliver in the regular delivery room if the OR is close. Also making sure doctor is willing to do a version on baby B if they are breech once A is born or willing to deliver B breech vaginally. Some doctors will try to talk you into having an epidural line placed just in case, but a spinal would take less time in an emergency than even setting up the epidural so it's not necessary and usually just something that will keep you in bed and by having that access already in place it's easier for them to talk you into an epidural too early.

Thank you for all the great info! I'm going to talk with my OB about the bolded part to see what's customary at Kaiser so I can make a plan beforehand. I think I need to go in with a good birth plan in hand and a strong advocate because with my son, I was very much in the zone and found I did much better when I blocked out all the chaos happening in the room. I don't want to seem compliant just because I'm in the zone.

I just delivered trips on Monday @ 36 weeks via repeat c-section. Released tonight. Recovery has been awful but my internal cut is pretty big and I've been on at least modified bed rest for almost the whole pregnancy.
While I was on hospital rest there was a twin mama who delivered vaginally, not induced but at 33 weeks. Not sure if it was natural or not.

Congrats! I hope you're all doing great. It's good to know that about the twin mama, but 33 wks seems so early. Eek!

[MaryJane]

Thank you for all the great info! I'm going to talk with my OB about the bolded part to see what's customary at Kaiser so I can make a plan beforehand. I think I need to go in with a good birth plan in hand and a strong advocate because with my son, I was very much in the zone and found I did much better when I blocked out all the chaos happening in the room. I don't want to seem compliant just because I'm in the zone.



Congrats! I hope you're all doing great. It's good to know that about the twin mama, but 33 wks seems so early. Eek!

Have you considered hiring a doula? A doula with twin experience can give you so much information and help you with the right questions to ask and help you with your birth plan as well as be a great support and advocate for when you go into labor.

[Sugar&Spice]

Mary Jane, I have been looking into hiring a doula. I hadn't thought about someone with twin experience (thanks!), so I'll add that to the list of questions.