Anyone choose NOT to induce early (36/37 wks)?

I'm just wondering if anyone who had a mono-di pregnancy, were told they had to induce at 36-37 weeks and decided not to?

If so, what reasons did you give your OB/care provider, for not being induced early?
What was their reaction?
Did you end up inducing later? or having a spontaneous birth?
Do you regret your decision?
Were there any complications?

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I'm 35 weeks now and at my next week appointment, I am going to have to face the OB (or intern depending) who will probably try to get me to induce within that week. At the moment, I'm leaning towards making that decision in the 37th week, but ideally in my heart, I feel that I could go another week longer if need be... I'm just not sure how to handle the conflict with medicos - I always feel that some of them act slightly superior and I come away feeling I should stand my ground more and it gets to me because I am a naturally strong person... hmmph...

Just as an aside, I am going into a public hospital so I don't get a choice of which OB or doctor I will have.

 

I'm probably not the best person to answer your question as I went into (mostly) spontaneous labour at 34 weeks so wasn't in the position you find yourself, but the 36 week induction had already been mentioned to me & I already knew I was leaning towards not consenting to it (I will also say that at that time there would have been no indications for induction over & above having reached 36 weeks gestation). To be honest, I'm not sure what I would have done at the time as I was a lot less educated about birth & much less confident in my own ability to make decisions that were right for me. I'd also already been arguing for months against an elective c-birth so didn't have a ton of energy left for too much more arguing. Most likely, I would have let them schedule the induction & then just not shown up for it.

Now, I would probably start the conversation by asking my OB a ton of questions:
- Are there any indications other than my current gestation for an induction?
- Why do you induce at 36 weeks? (btw the only thing my OB ever said to me about why they induce is that she had one patient with twins who decided to carry her pregnancy past 36 weeks & even with additional monitoring, lost one of the babies unexpectedly at 37 weeks. This is, IMO, absolutely the worst kind of emotional blackmail that a doctor can place on a patient. While I know that that loss was tragic & awful for everyone involved, it doesn't help me make a decision about anything, it just makes me afraid. I don't even know if that anecdote involved a mono-di pregnancy or whether there were any additional risk factors involved or how applicable it was to my situation at all). If I got an answer along the lines of "Well, there's an increased risk of still birth" I would then request specifics - what does "increased risk" actually mean? I would also ask what that translated to in absolute risk (for example [and I'm just making these numbers up for the point, I'm not sure what the actual stats are], they may say that the risk increases 4x, but that could mean from a 0.025% chance to a 0.1% chance - flipping that on its head would mean that you still had a 99.9% chance of a healthy pregnancy & birth).
- What are the risks of induction? I would also ask about what additional interventions would be put in place because of the induction process (ie continuous fetal monitoring or fetal scalp electrodes, being required to stay in bed, IVs, epidurals, etc) and how those might affect my labour.
- What are the benefits of continuing the pregnancy & allowing labour to start on its own?
- What are the benefits of induction?
- What other options are available (ie continuing the pregnancy but with additional monitoring)? Would any of those be an acceptable compromise?

If after gathering all of this additional information, I felt ready to make a decision, I would probably say something along the lines of "Thank you for sharing all of that information with me, I really appreciate your knowledge & expertise. At this time, I prefer the risks & benefits of induction/continuing the pregnancy. What is the next step?" If I wasn't ready to make a decision yet, I would say something like "Thank you for all of that information. I'm going to go home & discuss this with my partner/think about it for a few days & let you know what we would like to do."

Absolute worst case scenario, just remember that they are legally not allowed to do ANYthing to you without your consent. :hug:

 

I know that I am not answering your question, but I wanted to say that I would have waited until the last possible day if I didn't have the pelvic pain on my left side and could walk pretty good. Which wasn't the case for me. I had to walk baby steps and I was afraid if I waited any longer I would not be able to move around at all. As it was after I had my twins I had to use a walker for a week. It was so embarrassing! I also was in so much pain before I had them that I had to sleep in a recliner because of the pain. It was a chose I had to make especially with having 2 older boys that needed me mobile. I wish I would have been able to wait the 2 more weeks my doctor was going to induce me by.

 

Thanks Rachel and Simone, for your replies.

Rach, I totally agree with all your comments which are very succinct and I am going to print out your suggestions as they seem really clear in what I want to portray/say.

At my last week's appointment, I asked the midwife what their stretch and sweep induction process was, and I was told that after the S&S, they would send me home to wait for labour to start! To me this sounds really risky and not an experience I wish to undergo, and nor do I want to stay in hospital waiting for labour to begin (which is not an option anyway).

Simone, I understand wholeheartedly about the pelvic pain as I have had it too since about 20 weeks, I've been wearing a PSD belt for the past two months and it has really helped and there are days where if I have done too much, that it is very hard to walk. But I'm not working, DD is at school all day (walks there and back by herself) and have been resting a lot and I think that if the pain was to get too much, I would look at the induction more positively.

So saying all that, I just feel that as everything else seems to be okay for now, why hurry along ??? Does that make sense?

PS Rach, I agree with what you have said about your OB's reason for an early induction - I too am so much better at looking at stats than getting stressed from hearing about another mother's tragedy..

Thank you again for taking the time to reply

 

I went 38w2d and started labor spontaeously. I had a variety of opinions within the group of doctors I saw. My primary doc (who was out of town) had talked about 38 weeks, the doc I saw at 37 weeks said "term is term regardless of how many are in there" meaning he wouldn't induce until 41 weeks.

Rachel gave good advice above.

Good luck.

 

You're very welcome! I just wanted to reply to this part - the reason they send you home is that unlike other induction methods (prostaglandins or pitocin) a stretch & sweep isn't likely to have immediate results. You may over the next couple of hours feel some cramping & have some spotting, but it isn't going to bring on hard contractions like the other options have the potential for.

When I had my stretch & sweep, I started feeling crampy a couple of hours later. By the evening (11:00pm or so, about 8 hours later) I was feeling the crampy sensation come & go about every 10 minutes or so. It wasn't painful, just uncomfortable, but because I was 34 weeks we decided to go in & get checked. I was a stretchy 4 cm dilated & hung out at that dilation all night in triage despite the continued, regular contractions. Then the next morning after hanging out in the shower in triage for a good 40 minutes or so (off the monitors - I hated those things :laughing my water broke & things really started to pick up.

Similarly, when my sister had her stretch & sweep in the afternoon, she felt crampy on & off all that evening & through the night. The next morning, she had a bath which basically stopped all the crampy feelings & she was able to get some rest. That afternoon we went for a long walk & then within a few hours the crampy feeling was back (around 6:00pm). By 1:00am they had progressed into active labour contractions & we arrived at the hospital at 4:00am. I only share those anecdotes to show that it's a pretty gradual progression & you'll have lots of time to get back to the hospital if things are progressing.

If you do decide to go the stretch & sweep route, you could also ask your caregiver for a list of things that would be concerning & that you would want to get checked out right away (ex bright red bleeding, no movement from babies, etc) that would give you some reassurance.

 

You know what is best for you and your babies but I had mono di twins with TTTS and felt they were safer out than in after a certain gestation. Good luck no matter what!

 

Thanks for sharing those anecdotes, the OB I saw a few weeks ago told me that sometimes it can take up to a week for the stretch and sweeps to work. I will add that to my list, thank you Rachel for being informative as always

 

My two cents ...

I'm just wondering if anyone who had a mono-di pregnancy, were told they had to induce at 36-37 weeks and decided not to? My OB prefers to deliver mono-di twins at 37 weeks; my scheduled c-sections was at 38 weeks, 5 days.

If so, what reasons did you give your OB/care provider, for not being induced early? My previous birth, also a boy, was born at 39+ weeks - also scheduled c-section - had a surfactant deficiency which caused severe lung problems and a very scary five week stint in the NICU. Since the twins were also boys, I was worried about a repeat performance (the surfactant deficiency is more common in white male babies).
What was their reaction? My OB agreed based on my previous experience - he delivered that baby (who is a perfectly healthy four-year-old today) as well, so he had first-hand knowledge of my fear.
Did you end up inducing later? or having a spontaneous birth? I am a scheduled c-section girl all the way ...
Do you regret your decision? No - I feel like my OB and I made and educated decision based on my personal history. I do think baby A probably would've been better off had he come out sooner, although he has no lasting problems associated with his initial skinniness.
Were there any complications? Yes. The twins tracked within a couple of ounces of each other throughout my pregnancy with the exception of one ultrasound - maybe around 34 weeks? - when they were fairly off in weights (I can go back and study my ultrasound printouts if you'd like to know the exact gestation). By then I was having weekly ultrasounds and the subsequent scan showed them neck in neck in weight again. My final ultrasound, five days before delivery, guesstimated A = 6 lbs. 10 oz. and B = 6 lbs. 12 oz. My actual weights were A = 5 lbs. 0 oz, 19 inches and B = 6 lbs. 11 oz., 18 inches. Baby A was way, way skinny and pale pale pale - B was fat and red - they obviously had been experiencing some TTTS at the end (unequal sharing of the placenta was confirmed by pathology). Baby A did end up in the NICU on the 4th day because he could not maintain his body temp. He spent four nights in the NICU and was released without a hitch or complication.

 

Thanks Amy, interesting ready and food for thought.

 

My boys are fraternal, so it's a completely different ball of wax, but I did push off being induced as long as possible. I had ultrasounds and NST's 2 times a week after 36 weeks, and finally lamented to an induction at 40 weeks. (My boys were stubborn!) The only reason I even let them induce me then was because my Dr. told me that the placenta was starting to show signs of breaking down.

With this baby, and there's only one this time, I know the norm where I live is to not let woman go past 39/40 weeks, but thankfully I found the one doctor who has no problem with letting me go longer! I told him right from the start that I don't want to be induced again.

Good luck with your decision!

 

Here's a link to my favorite article about twin gestation and delivery. It used to be available free. Unfortunately, now you have to pay $20 for a week of access. I'd recommend it, and there are useful links to mono-di articles.

http://www.uptodate.com/contents/delivery-of-twin-gestations

As I remember, the authors recommend OBs allow up to 40 weeks for labor to come on spontaneously in di-amniotic twins where there are no counter-indications. They do note that there is disagreement in the literature regarding mono-di twins, but as I recall they suggest that all twin moms (with the exception of mono-mono twins) should be given the chance to gestate 40 weeks unless there are signs of problems.

Anecdotally:
I was told my twins were di-di, but I have my doubts. Baby B was "discovered" at the routine 19 week scan, no prior indications. As time goes on it's harder to tell whether there was one placenta or two that fused, but I do remember the technician showing me "how thick" the membrane was at that point. That strongly suggests di-di, and this was a really good set of technicians who would have erred on the side of caution. On the other hand, at some point my placenta fused (or was one shared from the beginning). My girls turned out to be MZ, confirmed by cheek swab after 15 months of guessing. And at birth (39w) my girls were nearly a pound discordant for weight. Intuitively I just can't wrap my mind around how healthy, growing MZ twins could be that discordant unless there was unequal sharing. Sharing being the operative word, ie: mono-di. My very experienced midwife couldn't tell by looking whether the placenta was fused or started out as one. Didn't looked fused to my ignorant eye. That was one big placenta.

Personally:
It seems that mono-di twins carry a higher risk, for mostly unknown reasons. I'm not sure exactly what that risk is, statistically. When I was making these decisions, I thought I was carrying fraternal di-di twins (which run in my family.) Even then I waited until I was getting signs of imminent labor before going for home induction with castor oil (which I won't necessarily recommend.) Weighing the small risk of something going disastrously wrong in utero against the likely risks of late-prematurity (respiratory issues, NICU time, breastfeeding challenges, etc), I choose to let my girls come at least as close to their own time as possible. 39w was a compromise, and things turned out wonderfully for us. Small twins, but hardy and well developed. If my twins had been mono-di, and I had known it, I might have acted differently. Same equation, I just probably would have opted for a slightly earlier birth. Maybe 38 weeks instead of 39. As it is I have mixed feelings about inducing at 39 weeks. Baby A clearly could have used another week or two inside. Baby B, the smaller twin, seemed ready to come out. Which I couldn't have known - they were within a few ounces of each other at their 37w u/s. One last wrinkle, being vertex-vertex, my girls were facing each other like they were hugging. The effect was (probably) that the chin of baby b prevented the shoulder of Baby A to descend or put much pressure on my cervix. Good for long gestation, trouble for spontaneous labor. So if I hadn't pushed things along with the castor oil, no telling when the little ones would have busted out. That's just to say that I hated doing anything to evict the girls before they were ready, but there are always unknowns, and giving the babes a nudge when the time's just about right isn't always a bad thing.

Good luck with whatever you decide, and best wishes!

 

BTW - my final u/s at 37w was just about exactly like amymc72's. Both girls were guesstimated at just over 6lbs. Actual birth weights at 39w = 5.12 and 6.11.

 

Thanks Gena your very helpful anecdote and the link, I am of the same sentiment as you...

Kate, thank you too, just wanted to ask, what type of induction did you have?

 

I went into the hospital and was given pitocin in an IV. I was already about 90% effaced and 1-2 cm's dilated. The labor and delivery went very smoothly for me.

 

There was NO WAY I was going past 36. And mono di twins are completely different than di di. The placenta can begin to fail and they develop Acute TTTS. Me and my friend/coworker were pg w/ id twin boys at the same time (almost 4 yrs ago now) she lost one at 36 and 2!! We had the same Peri and she told me.. "better out than in after lungs are mature." We took mine at 35 and 2 cuz I wasn't takin any chances!

GL! Oh and we had an amnio for lung maturity at 35 weeks and were mature. Boys taken via C at 35 and 2 and came out healthy at 6 lbs each!

 

IF you have any more questions or concerns, contact Dr. De Lia. He is the master of mono di twins! LOVE his info!

 

I also was told about the same...unfortunately, I went into spontaneous labor at 32 and 4, and went on to have very healthy boys. They were 4lbs 4oz and 4lbs 14.5oz, and had an uneventful 3 weeks in the NICU as growers and feeders (no breathing issues! ). I would definitely do some research into the placenta condition past 37weeks, and have a list of questions for your doctor. Good luck!

 

Thank you for the contact - I just googled him, he is very highly recommended isn't he?. I have my next u/s and antenatal appt on Monday so I will keep this handy once I know more of what the hospital wants me to do....

 

I have a number of twin mommies who worked w/ him directly. He is WONDERFUL and always calls YOU back!

 

I agree with GemelliBoys 100%!!!!