Amnio & Early Delivery!

I'm hoping some of you might have some advice or words of wisdom to offer on our situation...

We had an u/s yesterday that went far worse than anticipated. First of all, Baby A has had low fluid (2.8 cm) for 6 weeks, which is very stressful. However, so far, the u/s's have been consistently good, with both boys right around the 50th percentile for size. In the last 4 weeks, however, they have only gained 1 pound each (per u/s estimates) and are now in the 2nd- 4th percentiles! We are being offered the options of frequent monitoring (NST's 2x weekly) for the next 10 days until my C-section would be scheduled since both are breech, or we can just do an amnio and deliver. Our docs are the most reputable practice around (peri's), but sometimes I feel like they are a little too relaxed about things. It seems they are leaning toward NST's with the possibility of emergency delivery, rather than just ending the pregnancy with a C-section (which sounds better to me).

Here is a little more history... I have had hyperemesis for most of my pregnancy and am still extremely nauseous. I have been force-feeding myself for the entire 9 months, but I know I have not gotten anywhere near an appropriate amount of calories. Again, the docs are super-relaxed and don't flinch at the fact that I've only gained almost 20 pounds (starting out at just below-normal weight, not overweight at all). I don't want them to freak out about every little thing, but I do know they are relaxed about a lot of things over the past few months that I have seen many of you say your docs are concerned about.

I am afraid that another 10 days inside my body will not do them any good, and could even deprive them some more, because I feel so sick (nausea) and the babies are clearly not growing as they should. I feel like 36w4d is a lot longer than I had expected to make it, and I feel really comfortable with delivering at this point. However, the docs have told me that I could be endangering the babies by delivering them early. They will not tell me what to do, only saying that it's a 50/50 decision, and I should choose whatever I am "most comfortable living with". Ugh!! Is this just doctors trying to protect themselves legally? Or should I be less comfortable than I think I am with delivery at 36+4 and try to keep them in an extra 10 days?

Thanks for listening to my lengthy post. I'm very appreciative of all of your wisdom and advice... if you have anything to add, I'd love to hear it!

 

Honestly if you think its for the best, go ahead and go for it. If your worried that something will happen between the next few days i would go a head and do the amnio and all. But ive always been for one to trust a mothers intuition. They are almost always right.

 

Hey there. Sorry you continue to have such a rough time. I would be quite comfortable with 36w4d, especially if the amnio testing comes back showing lung maturity. You know I can relate to the worries about adequate nutrition, I think I would feel better having them out where you can really know their intake. Please do whatever makes you feel most at peace. Good luck and keep us posted. I will be thinking of you.
Nancy

 

Can you split the difference and wait 3 more days??... then you'd be at 37 weeks...perhaps your docs could do the c/s without even worrying about the amnio then??... I just question what an amnio will even tell them... let's say that their lungs aren't mature...well...is it still worth it for them to be inside if they aren't growing well???.... 36wks 4 days seems pretty darn good to me amnio or no amnio... I just question doing the amnio especially since your fluid is so low...but if you have a gut feeling about it and the docs insist on doing the amnio, then I guess I would get it done.

 

I would ask to deliver w/out the amnio. Like the PP mentioned, go til 37 wks then ask them to deliver. There is no reason for them to do an amnio at 37wks. I know I wouldn't even get one at 36wks....maybe at 35, but not 36. Good luck!

April

 

I am so sorry that things are so stressful for you right now! What a difficult decision you are faced with! You are at 36 weeks which is really great... I would talk to the doctor more about why they think there is a need for amnio at this point in your pregnancy, and then share your concerns with them. The bottom line is that you need to follow your heart and do what you think is best for your babies using all of the information you have available. Good luck! My thoughts are with you and your family!

 

I would deliver at 37 weeks without the amnio. If they need to come out, the amnio really wouldn't mean anything anyway - they need to come out. I agree with going 3 days and then delivering - but that would me my opinion. Definitely follow your heart!

 

I delivered at 36 weeks. The doctor and us had discussed having an amnio at 36 weeks and delivering, just like you are considering. We opted to deliver at 37 weeks with a scheduled c-section and no amnio. We ended up going into labor at 36 weeks on the dot, i delivered them c-section and the boys are perfectly healthy. We stayed for 3 days and they had NO NICU time. I would maybe if possible wait the 3 days and then deliver but if it's going to be a risk then go ahead and deliver.

 

I delivered at 36 weeks 3 days, babies weighed 6.9 and 6.2, no NICU, we spent 4 days in the hospital and that was only because I was not ready to be sent home, my girls were doing much better than me!

You have to do what you think is right but 36-1/2 weeks is really an excellent point to have made it to. If you are going to have a C-Section regardless it might be better to go ahead with it than to wait and maybe have babies in distress and end up in an emergent situation. Trust your instincts. Good luck with whatever choice you make.

 

I don't have any advice about the amnio and other specifics, but I'm just surprised the docs think that 36+4 is "early." I delivered by scheduled c/s at 36+5 -- my OB normally does it at 37 weeks with twins in any case, but Thanksgiving was coming up and she wanted to make sure I didn't deliver while the hospital was on skeleton staff. Point being that no one seemed to think that was particularly early!

 

I was induced at 36+4 days and we had no NICU timewhatsoever with delivering at that point. My peri said once you are at 36 weeks if there is anything else going on they would rather deliver than have them in any longer...we had growth discordance and did end up confirming twin-twin transfusion so I am extremely happy he made that decision. That being said, I would say go with whatever you are more comfortable with. If you are worried about keeping them in any longer I would push for delivery otherwise make sure you do the NSTs as often as you are suppose to, do not miss a day!

 

I don't think 36.5 weeks is early. My doctors say that is the goal for twins. My OB will induce if I go to 37 weeks.

 

Ditto you are far enough along for those babies to come out. I would push for deliver asap. Not that I think anything is wrong I just really believe in mom's instincts too. I had my boys at 35w5d and they were pink and perfect and NO NICU!

GOOD LUCK!

 

Thank you all SO much for your wonderful and insightful replies. You really helped me to feel much more at ease about my decision. We went ahead with the amnio today (only did amnio on Baby B, who has adequate fluid), and are going to be delivering tomorrow at 36w5d!!!!!! I am SO excited to meet my little guys! I can't wait to share my birth story and some photos with all of you. Hang in there, everyone... you are all doing an incredible job!

FYI, for those of you who are curious, amnio isn't fun but it doesn't hurt as much as you might think it would. It felt like a blood draw. The worst for me now, a few hours later, is a kind of bruised sort of feeling through the many layers of tissue, muscle, etc. punctured by the needle.

Again, Thank you, Thank you!!!! for taking the time to offer your insights. It really helps me to feel confident in what I already feel instinctively is the right move.