Baby A vertex, baby B breech. Delivery outcomes?

Hello all,
I find myself at a crossroad today. My perinatologist believes that 39 weeks is way overdone for twins and has recommended that babies be delivered today or tomorrow. I have no issue with that. The problem is she is recommending a c-section due to baby B is breech (no other reason). I had discussed this issue with my OB when I switched to her at about 20 weeks and again at 37 weeks. Both times she had said as long as baby A is vertex and larger than baby B then she was willing to attempt a vaginal delivery. Well today she (OB) is firmly pushing a c-section. I understand about ending up with both deliveries, I also understand that each delivery comes with it's own risks. I am curious as to what others have done in similar circumstances. As of todays u/s baby A is estimated at 8lbs 1oz and B is at 7lbs 12oz. Baby A has consistently measured a week ahead since the 1st u/s while B has been anywhere from on target to a day or two ahead. Thanks for your responses.

P.S I thought I included a poll but it seems to have vanished. Basically who had a successful vaginal birth in this scenario? Did baby B flip as soon as A was delivered? Was baby B born via C-section? Thanks!

 

Can't offer an experience yet, since I'm only 17 weeks, but am VERY interested in hearing the answers as well. Adding a reply to keep this bumped.

 

There are reasons, but none of them medical, for a c/s when Baby B is breech. I don't have my fingers on the study, but I KNOW I did this research when I was pregnant. Science does not show improved outcomes for babies or mothers. Usually once Baby A born, B will move to a vertex. Many OBs have no problem with this positioning. But there might be a reason to worry if your OB is not experienced enough to deliver Baby B breech if B does not turn.

That said, at least in my area there is a real move to push twin moms into surgical births. My docs originally said they'd "let me attempt" a vaginal delivery of Baby A vertex and B breech, but I found out from a nurse that the hospital's twin c/s at rate was 80%.

FWIW - I would (a did) fight a non-medically indicated c/s birth tooth and nail. Recovery and care for 2 newborns is likely to be easier if you are not recovering from surgery. And if you're interesting in breastfeeding, that too will be easier without the surgery.

That's just my preference. There are arguments for agreeing with your docs and scheduling a c/s. Really, it's something you need to think about and decide.

Regarding 39 weeks being "way overdone," there is research out there that disagrees with your peri. At least 2 studies show better respiratory function and NICU time with twins born 39-40 weeks. And here's a link to my new favorite study, thanks to another TS MoM:

http://www.uptodate.com/home/content/topic.do?topicKey=labordel/5122

From what I've read (and experienced) I think it's a myth that twins should be born by 38 weeks, and firmly believe that the 38-weeks-optimal theory will be discredited in time. I just add this because I remember going straight from worrying about my girls coming early to worrying about them coming too late. You've done a great job growing your twins! Rest easy, or as easy as you can at this point! :laughing:

As far as your exact question - delivery outcomes. My girls were vertex vertex, but I have a story about it. My labor was somewhat dysfunctional. The last u/s showed the babies both head down, facing each other. To the extent we can know, my midwife and I theorized that it was like the girls were hugging each other upside down. Which meant the chin of Baby B was preventing the shoulder of Baby A from descending. My very experienced midwife, who works with the Amish, I was her 43rd twin homebirth, said she has the most problems with vertex - vertex positions for this reason. She had an assistant hold baby B up from the outside while I pushed. It worked wonders, and both babes were delivered quickly and smoothly. Made me think that vertex-breech might be a better position for the twins regarding delivery if not growing too. Just sharing in case you find it interesting.

Whatever you decide, I hope everything goes well! You'll be welcoming your twins soon! Best wishes.

PS - The combination delivery - vaginal for a and surgical for b is much more rare than OBs let on. I do have a friend that went through it, but the nurse I talked to at the hospital had never seen one in 18 years.

 

Thanks so much for the info Gena. I like you before, am currently fighting what I see as an unnecessary c-section at this point. It does worry me though that my OB, whom I was very clear on the subject with, would wait till this late date to inform me that she is more comfy with a c-section. Now I'm wondering if she's just going to be waiting for something to look even minutely wrong to go for an emergency c-section. She actually tried to scare me with having a child who is neurologically damaged due to being in distress if a c-sec is not performed quickly enough. I mean honestly we are already going to be in the OR, all equipment and medical staff ready so why try to freak me out even more??

 

Meg, I don't know how you are doing it! You are a super woman to still be comfortable enough to type a coherent post like this at 39 weeks with twins!!

I just wanted to let you know that I am a week past my c-section and I'm doing fine. I took a Percocet in the middle of the night but I'm pretty much done with the pain and my swelling was gone the day I came home.

My c-section was a Monday and my milk was in on Wednesday (but I was in active labor) and my breastfeeding issues have more to do with my twins slight pre-maturity and not my surgery.

Now your babies will be a little more active than mine probably since they will be "older"(mine are still sleeping about 20 hours a day).

But anyway, just wanted you to know that you can take care of two babies after a c-section. You'll need some help in the hospital but you'll be fine in no time!

 

Thanks Christy, recovery time has been a concern of mine as well and I am glad to hear you're doing well. I am so so ready to be on the otherside though The anxiety is killer! ^_^ Hopefully this time tomorrow I'll have a lovely birth experience to share with everyone ..... <_< or I'll have one to scare other soon to be moms with, we'll see.

 

Hi Im only 31 weeks but after having discussed this A LOT with my midwife she said it comes down to the skill and confidence of your OB. My OB is very comfortable with this. He has made it clear that if he has to he will be reaching in to grab baby b if he has to but thats what the epidural is for. My previous delivery was an undignosed breech and shocked everyone. He was healthy and happy after a couple of days in NICU. Good luck. I will be thinking of you.

 

Good luck and fill us in on everything!

 

I was also told in my twin pregnancy that this was an acceptable situation for vaginal labor. HOWEVER, you need to feel confident that your doctor is comfortable doing breech extraction or you WILL wind up with a c/s after your baby A is delivered IF your baby b doesn't flip on his/her own. Out of 4 doctors I saw in my twin pregnancy, 2 were comfortable pulling baby B out breech... 2 were not. So I knew if I had this scenario it was a definite possibility that I would wind up with a vaginal delivery and a c/s should the 2 non-favoring ob/gyns be on call. It's a tough choice.

In your situation I would also consider the likelihood of successful induction. In general, only 50% of inductions will be a success. You are more likely to have a successful induction if you are already dilated and signficantly effaced. If you are totally closed and firm then I would probably consider c/s over induction simply because along with the positions of your babies you the odds are stacked against you.

It is a possibility that your baby B could flip after baby A comes out. It's fairly unlikely that your baby B will flip prior to that at this point!

 

Thanks guys. I go in to L&D at 5pm this evening to be monitored overnight (really not sure why?). Induction will start at 8am tomorrow. Honestly I feel like such a drama queen right now :help:
Thanks as always for listening!

 

ITA with this... it really, really comes down to the doctor's comfort level. You can't ask a doctor to do a breech birth if they aren't trained to do it or comfortable with it because it can be dangerous if you don't know what you are doing. Unfortunately a lot of medical schools are no longer training for it...so if your doctor is on the youngish side, odds are they will not be willing to do it. And some doctors will not clue their patients in that the actual hospital has a policy banning breech births. (many hospitals will not allow them!)

Also, I agree that the epidural is the way to go in this situation. I'm not pro-epidural as a rule because it can cause issues...but if you are looking at induction along with possible breech birth you definitely want an epidural...and you want it early enough to know that it is working, but not too early to slow down labor. Definitely somewhere after 3cm...but no later than 8cm...probably somewhere between 5 and 7 would be ideal, just before transition hits! But you never know, my sister had her epidural after hours and hours of labor and she was only 1cm when she got the epidural. After the epidural she was at a 10cm within an hour! Anyway, this is the way I would go if I were in your situation!

 

My OB has told me that both babies have to be head down in order for me to deliver vaginally. My Sister in law who lives in the UK said that over there unless there was a medical reason to have a c-section then they would want me to have a v deliver. When I signed my billing papers at my OB's office I noticed that it was cheaper for a c-section than a v birth. I asked why that was and the billing lady told me that they have more control of the situation. I also wonder if its just more convienant for them.

Having said all this Meg, I just want to say 'way to go' for getting to 39 weeks and having good size babies...you certainly did great...I am praying that mine will make it to 32 as I have PTL issues....good luck with your decision !!

 

I know, I'm checking now on midwives in the area to see if one can come support me tomorrow. No luck yet though. I'm leaving it all in God's hands now. Time to head out :unsure:

P.S I have been dilated to a 2 and 50% effaced for over two weeks now. I've done a lot of walking and up/down stairs and some bedroom action over the last few days so I'm really hoping it has helped.

 

My baby B flipped to breech at 38 weeks (stinker!) and A was vertex from 35 weeks on. I went for the vaginal delivery as this was always my preference. I had no issues and baby B did flip to vertex once A came out. There was 16 mins. between their births b/c she needed to flip then decend down. Everything was fine and everyone was healthy. She was actually bigger than A as well by 3/4 of a lb. Oh, I was induced as well. I was very happy with the outcome and couldn't have asked for anything better.

 

I had A vertex and B breech. They were 4 minutes apart, and B was a breech extraction. It was always said I would go vaginal unless A was breech or unless B was estimated more than 2 pounds heavier. He did not turn after A came out.

At my 34w u/s they measured 6lbs1oz and 6lbs15oz (but one measurement with my boy was way off, so they were estimated both in the lower 6lbs range, which turned out to be correct).

They were born with Apgars 9/9 and 5/9 (my boy was a little stressed by the feet first birth and didn't breath right away but as you can see 5 minutes later no problems).

She was 7lbs11oz and he was 7lbs10oz at 38w2d. My oldest was over 9lbs.

 

I believe this definitely plays a role ... cost & convenience. I just had an abdominal hernia repair / full tummy tuck, and while I never had a c/s, I'm recovering quite easily (same with my vaginal births) but I would still prefer vaginal, you'll be on your feet quicker for sure!

 

Sorry to sound dumb, but is vertex when they lay across instead of up and down?

 

vertex = head down
transverse = across
breech = head up / butt down

 

Just wanted to wish you luck! I'm glad they are letting you do the induction since it sounds like that is what you want. I'm impressed that you advocated for yourself

 

This may be too late for you, but helpful for other moms. I had 2 great deliveries when Baby A was head down and Baby B was breech. Baby A came out, baby B moved to lay across my uterus, and the OB turned him (from the outside) for about a 1/2 hr. She pushed and pushed on my uterus - thank goodness for the epi as I didn't feel it! He moved head down and out he came! My uterus was very sore the next day - like it was some pizza dough that had been kneaded. I'm guessing the OB's arms were pretty sore too from all that work.

And my OB did say while I was 30ish weeks along that if needed, he would stick his hand in and do a breach extraction of feet first. Glad it didn't resort to that. Right before he told me that, I had just seen an episode of "Dirty Jobs" where the guy did that with a cow giving birth, so I had a visual. :blink:

 

Hello! Still here in L&D, after much discussion of the "what if's?" OB is now on board and has gotten a partner to assist her. Yay!!! She checked me and I was at 3cm dilated but stll 50% effaced. Went ahead and broke baby A's water about 20 minutes ago. Nothing's happening yet. Wish me luck! :banana:

 

Look at you, still posting online while in labor! Good luck!!! So exciting!

 

I know!! The dawn of the mordern age huh How are your little ones?

 

Fantastic news! Rest as much as you can in early labor, and get as much fluid as you can.

Sending lots of smooth labor vibes your way!

 

Good luck!!!

 

Babies are here!!! I'll include full details later! Successfull vaginal delivery!!! Baby A 6lbs 15oz, baby B 6lbs 9oz! Thank you all so much for your unwavering support!!

 

CONGRATS MOMMA! Give those babies lots of kisses and congrats for sticking up for yourself!

 

How exciting! Congratulations!! I can't wait for the details...

 

Yeah to a successful (vaginal) birth! Good weights! But still about a pound of compared to the estimates, shows how hard it is in those last weeks.

Enjoy!!!

 

Wow, momma! Fantastic news, so glad it went well. Look forward to more details when you can share. Enjoy those big babes! :woman:

 

If baby A is breech than we are going for a vaginal delivery. My OB is well seasoned which is great! If Baby A is breech than a c-section it is! We'll see what happens in the coming weeks.