Trying to go for 40 weeks

My dr. wanted to practically force me to go to 40 weeks, or as long as possible. Now, when I first came to this site, I've read about moms going pretty far, even reaching 40 weeks and I thought that was awesome. The longer the baby is in there, the better off they are. But then I started doing research and learning about more things with regards to trying to go that long.

here are a few medical articles that discuss going past 34-36 weeks and fetal demise.

http://www.pubmedcentral.nih.gov/articlere...i?artid=1160595
http://www.pubmedcentral.nih.gov/articlere...i?artid=1160585
http://www.pubmedcentral.nih.gov/articlere...i?artid=1160580

So I just wanted to put this out there for other pregnant moms with ID twins.

 

I'm 21 weeks with ID twins. My OB and I have already discussed this issue and agree that we will plan to deliver between 34 - 35 weeks as soon as lung maturity can be confirmed. He said that if the babies look absolutely perfect when we get to that point, we could consider possibly waiting until closer to 36 weeks, but we didn't discuss it in any detail and based on the research, it would make me a bit nervous even though I hate the idea of early babies and NICU time unless absolutely necessary. If we could find a monitoring plan that would allow it to happen safely, I would love to be able to wait longer, but we'll wait and see how things progress over the next few months and then revisit the issue again.

Sigh...I wish that there was more research or further reaching research on this. It seems to me that if the hospitals (and insurance companies) would see the risk and be willing to allow it, I would be very willing to go into the hospital sometime between 34 and 35 weeks and be on constant monitoring for a week or more just to get some extra gestational time for the babies before delivery, but have the reassurance of constant monitoring to make sure that if anything acute started happening, we'd be right there to deliver them immediately.

 

This is also an interesting study: http://www.ispub.com/ostia/index.php?xmlFi...vol5n2/twin.xml.

It's more about twins in general, but the study shows (and that's what most doc believe) there isn't much benefit in going way past 38 weeks, however there are benefits (in general, not sure how this works for ID) to go at least past 36 and 37 weeks. I think a lot of people are being induced / scheduled at 36 / 37 weeks without medical reason (whether it's ID or not), and agree or not, but before 37 weeks is considered premature (even though some babies do fine) and could involve several risks including LBW (especially when the day of conception is not 100% clear and/or growth has been a little slower).

Again, this study is about twins in general.

 

That is a good study too, and definitely relevant for twins in general.

I think it should be clarified too that in my case, and in the case of the research studies I've read on "identical" twin delivery timing, it is specifically referring to ID twins that are monochorionic ~ meaning a true sharing of only 1 placenta (vs a fused placenta, or separate sacs/placentas) and additional risks that situation poses for the babies.

 

I am almost 37 weeks with mo/di twins. Unless I go into labor before, my c-section (they are breech) is going to be when I am 38w4d. I have also seen these articles. I have been talking with my peri. I have been monitored weekly with extensive u/s and BPP's since 18 weeks and I know my peri will not hesitate if the medical conditions require I deliver earlier. But, right now, everything we see doesn't warrant an earlier delivery. Our peri is VERY conservative. But as of now, the placenta looks good, blood flows are good (dopplers) and babies are growing and fluid is good and no signs of pre-e for me. So, I'm going with it.

Jenny

 

It's so hard to tell! If I could pick a day, it would be after I hit 36 weeks, but before getting to 38. That's just me and it isn't to say that a baby wouldn't be okay before or after those times, but that's where I would feel safest. Right now, I'm on bedrest for PTL and 34 wks sounds like a nice week to reach, but it wouldn't surprise me if a baby born around that time would end up in the NICU even if for a short time.

 

I actually printed up these articles for my OB and she absolutely refused to acknowledge them or discuss it. But that same visit I demanded a perinatologist to work with us and she got soooo offended. I could have cared less, I'm about ready to change OB's, but I worry about being in the same situation again - and it being too late to change again. She just kept on saying "Absolutely NOT." so later on that day she called me and said that she talked with the head perinatologist from UCDavis and he definitely said no later than 37 weeks.
Mary at the TTTSFoundation.org site said not to deliver past 36 weeks. In the books When you're expecting Twins, triplets or quads; What to expect when you're expecting; and Mayo clinic complete book of pregnancy:
for a singleton preterm delivery is before 37-38 weeks gestation but for twins the ideal time is 36-38 weeks.

In dr. luke's book, she estimates weeks of gestation at birth with days in the hospital and 35-38 weeks = 4 days. Prior to (31-34) that is 12 days. And for 39-42 is 3 days (which doesn't mean a whole lot less time in my eyes).

I've been debating the whole issue about delivering sooner as well, I would love to be an inpatient at a hospital with constant monitoring at 34 weeks. Especially because Acute TTTS can occur at any moment and happen so rapidly. Im not willing to rule it out until these babies are born. Trigger on the TTTSFoundation.org forum had a perfectly normal twin pregnancy but lost her babies at 34 weeks. I'm just not willing to put their lives in risk.The same thought goes with regards vaginal or c-section. If they can be monitored for TTTS until the day they are born, I would definitely go vaginally (if they cooperate) as opposed to c-section.



If I make it that long, I'm going to absolutely try to exclusively breastfeed - and I'm going to demand to stay in the hospital as long as they are to be able to provide the breastmilk they need. That's what my sister did with 2 of her babies that stayed in NICU.

 

Bernice,
That's a shame that she became so offended over your asking to involve a Peri in your care. The minute my OB (who is awesome and is the chief of OB at my hospital) saw the twins on the U/S, he was writing consult papers with a high risk Peri. They collaborate on my care and it's so reassuring. I'm glad that she did end up contacting the Peri!

 

My dd's twins were Mo/Di and she was seen almost weekly by both an OB and a Peri. They both agreed (independently) that 36 weeks is best. The boys were born at 36w 1d and spend no time in the NICU..

 

I delivered at 36w on the nose - but that was because I got pre-e pretty bad pretty quickly...fortunately the kids didn't notice...the peri said he would have me deliver between 37 and 38 weeks (no later than 38) but the OB was like - well we'll let you go to the end...the peri was NOT happy with that answer (it didn't matter in the end anyway)..

mine were definitely frat though (b/g)

 

That is sad about your OB not being open to hearing about these articles.

We see a peri exclusively - she took us on for all of our prenatal care. We got referred to a peri when we noticed a size discordance and no fluid in Baby B at 16 weeks. We've been with the peri ever since. We actually have been diagnosed with TTTS at one time, but is stable now (I can't remember if you have been or not). I am not attempting a vaginal delivery, and probably wouldn't unless they were vertex/vertex (and even then I would be nervous about acute TTTS), but since both of mine are breech, we're getting the c-section. I thought that the risks for acute TTTS happened more during delivery, but I could definitely be wrong.

I know everyone on the TTTS foundation site says before 36 weeks, but I also believe that it's an individual and personal decision based on the health of the mom and the babies.

I understand why you are worried - I have been worried this whole pregnancy too. I never thought I would get to the point where we talk about when we should deliver - I thought I would have dleivered long ago.

Jenny

 

SoBlessed: yeah... and she wonders why I see the glass as half empty and not half full. I'd see it as more half full if I knew I could trust my babies care to her. But since I don't feel that way at all, I feel like I have to fight her all the time to get what we need. I didn't know they had high-risk perinatologists. I'm going to have to ask about that one! I was actually shocked that she admitted she was wrong about the weeks thing. I'm not sure how future visits with her will go. I effectively wrote a very assertive and respectful letter listing what I want and that if she and I can't come to an agreement than I will find a new OB. She certainly knows I will too, as towards the end of the visit, she actually practically begged me to let her be my OB. I have another OB name all lined up to call.

Nana2C&C: that's awesome news! That's what I want...

AmynTony: I'm glad your peri was advocating earlier!! Ian and Abigail are soooo cute!

All these cute twins! I can't wait to see mine!

Jenny: we had some serious issues with DD's health back in June where we trusted doctors, oh so many, to provide the best care and be on top of things, but we had to. And in the end, I learned not to entrust that much belief in the doctors capabilities until they are willing to be as open with you as possible. We had to tell many doctors that they were not to care for our daughter any more, as they held their egoes higher than her life. This seems to be so common, ya know? I'm glad your babies are stable now. I would worry about Acute TTTS as well, since you've already seen problems. I think the main thing is vaginally, when the baby in the birth canal is being squished out, their blood is being squished out into the other one - causing one to be red and one to be pale. I've read that this leads to kidney and blood issues that in the extreme can only be fixed with blood transfusions and possible kidney transplants. I haven't been diagnosed, but I'm trying to keep up on the monitoring needed to be sure until they come out. So far, that's why I'm demanding a perinatologist. What I've gotten back from them through my doctor (not sure how she presented the case) is that they may even deem it unecessary to see them. Which has ticked me off royally. I feel like I'm stranded in a silent box. I'm so tired of worrying, you know? Please update me when you have your babies and let me know how it all went. All the good news the better!

 

The latest studies support that ID should be delivered before 36w. I was induced at 34w6d. My girls had acute ttts. one red, had blood taken off, saline added, jaundice. one white, had blood added, anemic and on extra iron for months.

now they are healthy 21 month old kids.

at 34-36 wks, they may be better in the nicu than inside you. by 36 wks, they should be OUT!!!!!!!

(We lost our first set of twins to very bad TTTS, so it's very impt to become educated about this)

 

QUOTE
I actually printed up these articles for my OB and she absolutely refused to acknowledge them or discuss it. But that same visit I demanded a perinatologist to work with us and she got soooo offended. I could have cared less, I'm about ready to change OB's, but I worry about being in the same situation again - and it being too late to change again. She just kept on saying "Absolutely NOT." so later on that day she called me and said that she talked with the head perinatologist from UCDavis and he definitely said no later than 37 weeks.


I'm really impressed at your extensive research and your persistence. Looks like it paid off. Way to go to bat for your babies!!

 

QUOTE(Safari @ Nov 14 2007, 02:37 AM) [snapback]494981[/snapback]
The latest studies support that ID should be delivered before 36w. I was induced at 34w6d. My girls had acute ttts. one red, had blood taken off, saline added, jaundice. one white, had blood added, anemic and on extra iron for months.

now they are healthy 21 month old kids.

at 34-36 wks, they may be better in the nicu than inside you. by 36 wks, they should be OUT!!!!!!!

(We lost our first set of twins to very bad TTTS, so it's very impt to become educated about this)


okay, that just confirms what I've been thinking. They saw TTTS is so rare and all, but a lot of OB's don't know what it is and fail to confirm it. So how many cases are slipping by the way side? They say it's only a 15% chance of happening, and what are the chances that it'll happen to you TWICE, safari?? I bet the % of it happening is way more common than we know... scarey. I'm glad your babies are okay and I'm so sorry for your first loss. That's so what I'm afraid of, death, TTTS, all of that. That's why my OB infuriates me.

36 weeks is what I'm looking to hear and so far, from the perinatologist my DR. talked to they are saying 37 weeks and that I don't need as much monitoring now. I'm so ticked off at all of this, at how hard I'm working and how stressful it is and how hard headed everyone is being.

 

I have no experience with TTTS but I do want to say that I think you are doing a smart thing by switching OB's. Your current one sounds very rude and should be listening to you, instead of brushing aside your worries and thoughts. You are the voice for your babies and you need to do what is right for them.

 

Gordana: thank you! all the backup helps motivate me to keep going.


Has anyone else's doctors been bone-headed about this?

 

QUOTE(Bernice @ Nov 15 2007, 06:54 PM) [snapback]497758[/snapback]
okay, that just confirms what I've been thinking. They saw TTTS is so rare and all, but a lot of OB's don't know what it is and fail to confirm it. So how many cases are slipping by the way side? They say it's only a 15% chance of happening, and what are the chances that it'll happen to you TWICE, safari?? I bet the % of it happening is way more common than we know... scarey. I'm glad your babies are okay and I'm so sorry for your first loss. That's so what I'm afraid of, death, TTTS, all of that. That's why my OB infuriates me.

36 weeks is what I'm looking to hear and so far, from the perinatologist my DR. talked to they are saying 37 weeks and that I don't need as much monitoring now. I'm so ticked off at all of this, at how hard I'm working and how stressful it is and how hard headed everyone is being.



I had an emergency c- section at 33w 3d because of severe preeclampcia. When they came out, ayden was purple and cyle was pale because of TTTS. I'm glad that they were taken out when they were because I had an u/s that day and they should have picked up the TTTS, but they didn't. They didn't know until after they were out.

 

QUOTE(AD/CD827 @ Nov 16 2007, 12:09 AM) [snapback]498236[/snapback]
I had an emergency c- section at 33w 3d because of severe preeclampcia. When they came out, ayden was purple and cyle was pale because of TTTS. I'm glad that they were taken out when they were because I had an u/s that day and they should have picked up the TTTS, but they didn't. They didn't know until after they were out.


I wonder why this is so frequently missed or not taken account of. I'm glad you didn't deliver vaginally...