My peri's thoughts on vaginal vs c-section

Well, I am 23 weeks and already obsessing over the whole vaginal vs c-section deal. I REALLY want a vaginal delivery if it is considerably safe for babies and myself. I spoke to my MFM today and got her take on things. She said that she will only deliver twins vaginally if they are BOTH vertex. She says that she is not comfortable with the risk to mom and baby if B needs turning. Now, it seems like from what I have read on here alot of docs will go ahead and deliver vaginally if A is down and they can turn B if need be when it is their turn to come out. I see 2 MFM's alternating every couple of weeks, and I am gonna get the other dr's take on it at my next visit. If her belief is the same, I was thinking of calling up my regular OB and seeing if she can help me out...any thoughts or ideas. Are my docs overly cautious??

 

doing a breech extraction can be a tricky manoeuvre - some docs simply don't feel they are competent enough with the necessary skills & so will only offer vaginal if both babies are vertex. although, i wonder what they would do if baby B flipped breech after baby A was born? :unknw: i would definitely chat with your other doc & see what they say. if you're still not happy with the answer, it might be worth seeing if you can move to another practice. GL with your decision!

 

My OB was the same. She said she HAS done vaginal deliveries where B was breech, but she prefers not to for several reasons. One was she said if A is smaller than B, than A may not make enough room for B to fit and then B could get stuck and end up needing a C Section. I certainly didn't want to end up with BOTH types of deliveries.

We decided on the C Section because my B is Bigger than A AND Breech also because I want my tubes tied. This way I don't have to do two surgeries.

If you are really wanting a vaginal, then I definitely suggest you talk to the other doctor at the practice and really see if they will budge. It's not impossible to do, but definitely more risks. Good luck!!

 

i wouldn't say there's more risks, just different risks, if that makes sense.

 

My obgyn is the same way. I am not seeing a peri though. But both doctors said that they will only let me deliver vaginally if both babies are head down. If baby b is breech then I have to have a c/s.

 

That's what I meant to say. :laughing:

 

Assuming there isn't a medical indication for a c/s, vaginal twin birth can be great, and can have benefits for babies and mom. Think I read somewhere that one of the biggest predictors of c/s vs vaginal birth is your provider. I'd take your peri's stance on positioning as a sign that she's generally opposed to vaginal twin births. And even if she gave you the OK, how many has she really attended?

If you're interested in a vaginal birth, you'll want a provider who is experienced and supportive. Maybe you could ask around your local twin club for recommendations. At 23 weeks you still have plenty of time. I switched at 30 weeks for this reason too, and ended up with a wonderful birth.

Good luck!

 

If you want a vaginal delivery plase find an OB who feels confident in their abilities and experience to do that. Although there are different risks, it always bothers me when I hear of docs who just won't deliver vaginally unless both babies are headdown. My Baby A was headdown, Baby B feet first and the decision was based on baby B and how he was doing AT THE TIME of delivery and not before. I had already expressed my desire to deliver vaginally and doc said as long as Baby B isn't in distress and my body cooperated we would try it. When the time came, Baby A was born, my cervix stayed open and Baby B was fine, no signs of distress, good heartrate...he was born 15 minutes later. Everyone has a different experience and mine was a good one. But it only happened because I had and OB who was willing to try.

 

There's another thread above showing that even if both babies are headsdown there can still be a c-section delivery. It was a chance I personally wasn't willing to take which is why I opted for a c-section. At the end of the day you just want healthy babies.

 

I agree that if you really want a vaginal birth then you should try to (and should be able to!) find an OB who is not only will, but experienced enough to handle a breech baby B. My OB was always 100% supportive of a vaginal birth whether baby B was vertex or breech. Baby B can always end up breech or transverse anyhow once A comes out! So even if both are vertex you really will want to have someone attending to you who can handle a breech delivery so long as all is going well with baby B as the pp said. Obviously no OB is going to try to deliver any baby breech or not who is not tolerating labour or is in distress or a really bad position to come out.

When I asked my OB straight out what he would tell his own wife or daughter re: vaginal vs c/s he said "Vaginal is safest for you, C-section is safest for the babies". Of course there are risks to either way, but I like that he put it simply, and he certainly didn't mean that vaginal was dangerous for babies or that c/s was dangerous for me. Anyhow, in the end I had a c/s since I just wasn't effaced or dilated at all at 38 weeks I felt that the likelihood that induction would lead to a c/s was just too much for me. I am one of those people who had a pretty easy c/s recovery, and I'd do it again for sure. The hardest part of the prep and c/s itself was my IV insertion. Epidural and c/s itself was a breeze for me, I felt great the entire time.

Definitely call around and consult with a few different OBs or peris and see if you can't find someone who is willing and able to support you!

 

I'm sure he means well and I think I know where he's coming from, but this isn't a known fact. Not sure that perspective is supported by science.

 

I really wanted a vaginal delivery, but my doc had the same policy. In the end, I was induced because both babies were head down and not in distress. 30 hours of labor later... I had a c-section. I just never dilated past a 5 (started at a 3). People were so excited to see a twin vaginal delivery that I had no fewer than 10 nurses and medical students come to ask me if they could watch. I guess I disappointed a lot of people, but I wasn't disappointed. I was happy to have healthy babies and the recovery wasn't as bad as I had imagined.

I think your doctor's policy is rather standard these days. One stat I didn't know before hand is that (at my hospital) half of twin momma's attempt a vaginal delivery and half of those end up with sections anyway. So 75% of twin moms had c-sections at my hospital, maybe you could ask for that stat?

 

In my experience and research since being pregnant with the twins (so five years), I've found a lot of newer OBs are not well trained in breech births like previous generations of physicians. Our society in general, I find, to be very "surgery focused" (does that make sense?). Not just in obstetrics, but medicine in general. In terms of obstetrics, I find that unfortunate, personally. Seems kind of lazy, I guess. Just seems like it should be covered in detail for an OB. I don't know. Those are just my thoughts. I was glad to have an experienced practitioner who fully supported vag. births of twins when positions allowed and no other medical issues were in the way. If I had a choice, I don't think I'd see a practitioner who wasn't confident in a breech birth. I'd wonder what other areas s/he wasn't confident in that s/he didn't tell me about.

 

this is a good point! there's a whole generation of OBs who have no training in breech births because, for a long time, the standard was an automatic c-section for breech babies. the standard is starting to change however, but it's not making much difference on a practical level because there are so few doctors who have the training for it now.

interestingly, most midwives have to re-certify annually on vaginal delivery of breech births due to the fact that they may find themselves delivering an undiagnosed breech baby at home & need to know what they're doing. so you could say that midwives are better able to assist at breech births than OBs. ardon: that being said, most certified midwives will transfer care of a known breech baby to an OB if baby hasn't turned before labor begins.

 

Oh absolutely, I wasn't stating this as an absolute, just saying what he told me and I believe that he meant from the perspective of a c-section being sort of a "get in, get out" type of thing over an induction where I could potentially have laboured for a long time and the babies might not have tolerated it, or gone into distress or something. Of course there are risks with both, but he was pointing out that most of the risk of the c-section was to me, and that most of the risk of the induction was to the babies. Anyhow, he pretty much just confirmed how I was already feeling about just skipping the induction to avoid the pp's scenario of a LONG labour that was going to end in surgery anyhow. I know that wasn't a guarantee, but it felt like I'd been through enough! lol

 

I had a vaginal birth with the twins after having an earlier successful (though far from easy) vaginal birth. My doctor had always said she would go for vaginal as long as baby A was head down, no matter the position of baby B. The 5 other doctors in her practice would have done the same. I was lucky to give birth in a major reputable teaching hospital (and the largest birthing center in the Midwest). When I delivered, my OB was actually teaching the resident to do the extraction. I agree that this is less and less common, and I am sure it's not the same in all hospitals, far from it.

I firmly believe that vaginal is the "only" way unless there are medical reasons to choose for a c/s, and there are plenty reasons to do that, and in that case, I am all for it, don't get me wrong. I am just saddened by the fact that so many doctors and even patients choose c/s because they believe it's "safer". Like somebody said before, both options carry risks, different risks. Breech extractions have proven to be safe and a good option for a lot of patients carrying twins (breach extractions are not preferred for babies with low birth weight). But "safe" is of course a relative term ... if your doctor isn't experienced and/or qualified enough to do a vaginal (and/or breach) twin birth, I guess it's no longer as safe as it could be, and you might indeed be better off with a c/s. However, that doesn't mean c/s are safer in general.

I come from a country where it's all about vaginal, drug-free births (the latter not my thing ), I delivered my kids including the twins in the States where again I was lucky in terms of hospital and OB, and I now here in Asia, where, boy, they love to cut! C/s rates are sky high and I only know 2 other women who had their twins vaginal (all head down). People simply assume I had a c/s for the twins, it doesn't even cross their minds?! I find that sad.

If you're keen on a vaginal birth, and medically you are a good candidate, find a doctor that is experienced enough to give it a try. It's worth the try!

 

My OB's practice had the policy of encouraging a vaginal birth as long as baby A was vertex and bigger or the same size as baby B. The position of baby B didn't matter but it would be a no-go if baby B was bigger. Mine were both vertex when I went in to be induced and I delivered baby A vaginally. Baby B had a cord prolapse and needed an emergency c-section. So, even when things seem to be lined up just right, there can be complications. A vaginal delivery was important to me and there were no medical reasons not to attempt it so I am glad I did. Having had Katelyn(a) vaginally also made me a candidate for a VBAC in the future if we have other kiddos. In my area, VBAC is only allowed now if you have had a successful vaginal delivery.

 

the one OB in my practice was completely comfortable with breech extraction if necessary (he was also mid 50's in age and actually said to me one time "when I went to med school we delivered breech babies vaginally)...they tried to induce me but it didn't work out because I was only 36 weeks (I had pre-e) but both babies were head down at the time of delivery but I just never dialated...