Another C-Section vs Vaginal scenario

Since I'm seeing a regular OB for this pregnancy and won't see a peri unless things go downhill, I seem to think the OB is treating this as any other twin pregnancy....no extra scans (still wanting them 4-6wks apart and no concerns that mine are actually 7wks apart) etc.

What is the mentality of perinatologists and other OB's out there who specialize in twins on the best way to deliver mono/di twins??? My placenta is fundal - so very high up in my uterus, just wrapping around the top to the front. They are 99% sure that they are mono/di and not a fused placenta.

The OB has no worries about my delivering vaginally if they are in vertex position, but I was worried about the placenta issue...is there not risk that the placenta will start to detach once Baby A is out? This is not good as Baby B still needs it....what are the chances of that? Or because baby b is still using it, does it 'know' to stay in??????

Anyway - just wondering what the general consensus is.

 

my OB pushed me hard for a c-section but because my girls were both vertex & i had no other complications, i fought her on it & had a vag delivery for both girls, with no major complications (they did use a small kiwi extractor on Danika, my baby B, because she was having some minor decels).

there is a risk that the placenta can detach before baby B is born - but really, there's a chance that the placenta can detach at any time, unfortunately, even before labour begins. i'm not sure how much higher the risk is during delivery or for mono/di twins - i think that would be a great thing to discuss with your doc. all that being said, the placenta can also detach early during a c-section & there would be the same issues for baby B - all things being equal though, they would likely be able to get baby B out faster in that case if you had a c-section.

i definitely think these are concerns you should raise with your doc - they should be able to give you more info on it. GL!

 

See, that's the thing....I did ask the doctor and she looked at me like she'd never heard the question before. She said "Oh? the placenta detaching?? oh no, no, that's not an issue" and changed the subject to the fact I'd not had the GTT test yet.

Those are good points you brought up about the placenta....I wish my doctor was more specialized in twins...

 

QUOTE(ChaoticMum @ Jun 11 2009, 02:03 PM) [snapback]1350828[/snapback]
See, that's the thing....I did ask the doctor and she looked at me like she'd never heard the question before. She said "Oh? the placenta detaching?? oh no, no, that's not an issue" and changed the subject to the fact I'd not had the GTT test yet.

Those are good points you brought up about the placenta....I wish my doctor was more specialized in twins...


wow - that sucks. are there any other doctors at the practice that you could maybe chat with, just to get a second opinion? i think you have a very valid concern & i know if i were in your position i would want more reassurance than you got. :hug:

 

Here's a little article answering a question that is similar to yours:

http://www.storknet.com/cubbies/multiples/excf31.htm

Usually the placenta will stay put until both babies are out. One thing you can run into with mono/di twins is something called acute twin-to-twin transfusion syndrome (TTTS). It can happen during pregnancy or labor. It's not very common but it is one reason some people suggest a c-section for mono/di twins. You have to weigh the risks of a c-section with those of acute TTTS when making your decision though because both are theoretical.

Finally, you really need to push your OB to do ultrasounds at a minimum of every two weeks with growth measurements every four weeks. Most di/di twin pregnancies can be treated as any other pregnancy but mono/di twins need extra monitoring because of the risk of chronic TTTS. 85% of mono/di babies do not get TTTS but you need to be educated on the signs because action must be taken quickly if your babies begin to exhibit symptoms. Catching those symptoms is why you need such frequent ultrasounds. When TTTS begins, every day makes a difference.

 

There are 4 other OB's (we have FIVE now in our area! WHOHOO! LOL) so I'm going to talk to a friend of mine who was a peds nurse and see what her opinion is on who I should talk to.

As for extra u/s, that unfortunately is not going to happen. There is a 4-6wk wait for u/s around here. They put urgent on my last one and I got in 3wks after it was ordered - BUT it wasn't ordered til 4wks after the 1st....so there is 7wks between. After that I can possibly hope for 3wks, but more likely 4-5wks.

 

QUOTE(ChaoticMum @ Jun 12 2009, 08:36 AM) [snapback]1351814[/snapback]
There are 4 other OB's (we have FIVE now in our area! WHOHOO! LOL) so I'm going to talk to a friend of mine who was a peds nurse and see what her opinion is on who I should talk to.

As for extra u/s, that unfortunately is not going to happen. There is a 4-6wk wait for u/s around here. They put urgent on my last one and I got in 3wks after it was ordered - BUT it wasn't ordered til 4wks after the 1st....so there is 7wks between. After that I can possibly hope for 3wks, but more likely 4-5wks.


Congratulations on your twin pregnancy!!

You might want to travel outside of your area to seek better medical attention. It's way too important to you and your babies not to. I agree with a previous poster, you need special attention with mono/di twins. By the time I was 20 weeks pregnant with my mono/di baby girls I was having scheduled U/S every 4 weeks and scheduled doctor visits with my specialist every 2 weeks, in which he performed an ultrasound at each visit. So, I had an U/S every 2 weeks for a couple of months and then they become more frequent after that.

Wishing you a happy, healthy twin pregnancy and beyond!!

 

QUOTE(ChaoticMum @ Jun 12 2009, 11:36 AM) [snapback]1351814[/snapback]
There are 4 other OB's (we have FIVE now in our area! WHOHOO! LOL) so I'm going to talk to a friend of mine who was a peds nurse and see what her opinion is on who I should talk to.

As for extra u/s, that unfortunately is not going to happen. There is a 4-6wk wait for u/s around here. They put urgent on my last one and I got in 3wks after it was ordered - BUT it wasn't ordered til 4wks after the 1st....so there is 7wks between. After that I can possibly hope for 3wks, but more likely 4-5wks.


Hi Tamika,
It's probably not making you feel any better with everyone telling you that you need more care and ultrasounds. We have to remember that mostly everyone on here is from the states being cared for by doctors who are sued more than anyone else in the world. While TTTS is a legitimate concern, I think alot of American OBs do a lot of investigations just to cover their butts. I'm in Canada too but in Toronto at Mt. Sinai which is one of the premier perinatal hospitals in the world and I don't get half the care that most women on this board get. Not one woman in my twins prenatal class is on bedrest - there is just less intervening in pregnancy here. I think the attitude in Canada is more..."you're just pregnant lady, not sick...millions of women have done this before and are fine". Mind you, I'm the worrier type so there are times I'm convinced that something is wrong with the babes. But my doc will talk me out of ultrasounds even though there are several machines down the hall and no wait here. She says that there aren't even studies to show that multiple ultrasounds are safe and there are no studies to confirm the longterm outcome of ultrasounds.

In your position though I would still be worrying mostly because I'm a worrier and this is my first pregnancy . I know with myself I have to convince myself that I'm not in control here, what will happen will happen and the odds are in my favour that everything will be fine. This is very hard for me to do. You're a mom so you of course want to everything you can for your babes. Maybe at this point you can ask your doc to reassure you about why they don't think you are at risk for TTTS and what are the other signs you can look for to determine if there has been a change that should alert you to worry. It is the OB's job to help you get to the same place she is at, obviously one of little concern. If this doesn't help you and you continue to worry and the worry is robbing you of any joy or peace of mind with this pregnancy...make a run for the border! But then you'd have to worry about the risks of lengthy journey! This mom-worry never stops does it!?

Take care *hugs*

 

UGH. I'm really not liking the health care you ladies are getting in Canada! How frustrating! I was seen for an u/s every week from wk 19-28 then we went two weeks b/c things were going well. My water broke at 33 weeks. While I agree that if things are going well you don't need to be seen as often, 4 weeks is ridiculous. I don't want to scare you, but you may want to do some research on TTTS and print it out for your doctor. It can happen VERY quickly...in even less than a weeks time. It can go from "fine" to "life-threatening" extremely quickly. I agree that US docs cover their butts, but rightfully so! Can't they schedule all your U/s at one time that way you don't have to wait so long?

Big hugs. I'm sorry you're not getting the help you need.

 

QUOTE(mommymeg @ Jun 13 2009, 09:24 AM) [snapback]1352929[/snapback]
UGH. I'm really not liking the health care you ladies are getting in Canada! How frustrating! I was seen for an u/s every week from wk 19-28 then we went two weeks b/c things were going well. My water broke at 33 weeks. While I agree that if things are going well you don't need to be seen as often, 4 weeks is ridiculous. I don't want to scare you, but you may want to do some research on TTTS and print it out for your doctor. It can happen VERY quickly...in even less than a weeks time. It can go from "fine" to "life-threatening" extremely quickly. I agree that US docs cover their butts, but rightfully so! Can't they schedule all your U/s at one time that way you don't have to wait so long?

Big hugs. I'm sorry you're not getting the help you need.


actually, our health care system is phenomenal. and i think that traceyp made some very good points, especially about ChaoticMum's doctor needing to explain to her why he isn't concerned. yes, TTTS can be serious & can happen quickly and that's why it's important to learn what we can & advocate for ourselves, but we also need to be careful not to create panic & unnecessary stress. i'm glad you got the care that you felt you needed but it's not the be all & end all of how twin pregnancies should be followed - each pregnancy is so personal & unique.

 

QUOTE(mommymeg @ Jun 13 2009, 11:24 AM) [snapback]1352929[/snapback]
UGH. I'm really not liking the health care you ladies are getting in Canada! How frustrating! I was seen for an u/s every week from wk 19-28 then we went two weeks b/c things were going well. My water broke at 33 weeks. While I agree that if things are going well you don't need to be seen as often, 4 weeks is ridiculous. I don't want to scare you, but you may want to do some research on TTTS and print it out for your doctor. It can happen VERY quickly...in even less than a weeks time. It can go from "fine" to "life-threatening" extremely quickly. I agree that US docs cover their butts, but rightfully so! Can't they schedule all your U/s at one time that way you don't have to wait so long?

Big hugs. I'm sorry you're not getting the help you need.



ITA!!

 

QUOTE(miss_bossy18 @ Jun 13 2009, 02:34 PM) [snapback]1353060[/snapback]
actually, our health care system is phenomenal. and i think that traceyp made some very good points, especially about ChaoticMum's doctor needing to explain to her why he isn't concerned. yes, TTTS can be serious & can happen quickly and that's why it's important to learn what we can & advocate for ourselves, but we also need to be careful not to create panic & unnecessary stress. i'm glad you got the care that you felt you needed but it's not the be all & end all of how twin pregnancies should be followed - each pregnancy is so personal & unique.


I'm glad that health care is good there as the US is trying to emulate it, but all I keep hearing is how Canadian women can't get u/s when they need them. Obviously this is a problem if a woman who has a high risk pregnancy (any twins are and mono-di is even more so) can't get growth or fluid scans in a timely manner. I'm sure there is a lot of legal/government regulations, but you would think they could purchase a few more u/s machines.

You are absolutely right that each pregnancy is unique. I'm just someone who would rather be safe than sorry over little things like being on time for something and I can't imagine not being able to do that with my future children b/c there isn't enough medical equipment.

Anyway, I just wanted to encourage OP to do everything in your power to insist on more u/s and help your dr. understand why. You may be able to ask if he/she knows of a different doc with more experience w/ multiples.

 

QUOTE(mommymeg @ Jun 13 2009, 02:12 PM) [snapback]1353122[/snapback]
I'm glad that health care is good there as the US is trying to emulate it, but all I keep hearing is how Canadian women can't get u/s when they need them. Obviously this is a problem if a woman who has a high risk pregnancy (any twins are and mono-di is even more so) can't get growth or fluid scans in a timely manner. I'm sure there is a lot of legal/government regulations, but you would think they could purchase a few more u/s machines.

You are absolutely right that each pregnancy is unique. I'm just someone who would rather be safe than sorry over little things like being on time for something and I can't imagine not being able to do that with my future children b/c there isn't enough medical equipment.

Anyway, I just wanted to encourage OP to do everything in your power to insist on more u/s and help your dr. understand why. You may be able to ask if he/she knows of a different doc with more experience w/ multiples.


i think that this is more a rural vs urban issue than it is a Canadian system vs American system issue. i went for u/s every 1-2 weeks after they discovered my girls were mono/di & never had trouble being booked in. traceyp states specifically in her post that the issue for her also isn't lack of equipment nor is it wait time. the OP doesn't say where she's from so i can't speak for sure but i was under the impression that she's from a more rural area with less access to everything.

my apologies for highjacking this thread, but i really felt the need to defend the Canadian health care system as i believe quite strongly in it.

 

QUOTE(miss_bossy18 @ Jun 13 2009, 04:12 PM) [snapback]1353159[/snapback]
i think that this is more a rural vs urban issue than it is a Canadian system vs American system issue.



That is totally true. I am quite rural.

I posted this map on another thread, but I'll post it here too.
http://www.manitoba.ca/health/rha/map.html

I live in the Assiniboine Regional Health Authority. We have NO obstetricians employed by this RHA. If you live in the northern part you would go to the Parkland for care, and the rest goes to Brandon. Brandon RHA has 5 OB's for both regions. We have 4-5u/s machines in Brandon, and one u/s machine in another town called Neepawa. That is it. For those two regions. There is just a HUGE population that is served by these machines/OB's.

I am going to discuss with my OB having my care transferred to an OB in the City of Winnipeg. I will live at my parents who live near there, and then see if I can have care taken over by an OB there. It will mean having the babes in the city and being 3 hours from my husband, but it may make me feel more reassured in the long run.

Its so hard to know what is 'right' when there is such a difference in what doctors believe. I did speak with a couple mum's at a twin group this week and they also thought that the 7wks was a bit extreme..

 

QUOTE(ChaoticMum @ Jun 13 2009, 04:44 PM) [snapback]1353206[/snapback]
That is totally true. I am quite rural.

I posted this map on another thread, but I'll post it here too.
http://www.manitoba.ca/health/rha/map.html

I live in the Assiniboine Regional Health Authority. We have NO obstetricians employed by this RHA. If you live in the northern part you would go to the Parkland for care, and the rest goes to Brandon. Brandon RHA has 5 OB's for both regions. We have 4-5u/s machines in Brandon, and one u/s machine in another town called Neepawa. That is it. For those two regions. There is just a HUGE population that is served by these machines/OB's.

I am going to discuss with my OB having my care transferred to an OB in the City of Winnipeg. I will live at my parents who live near there, and then see if I can have care taken over by an OB there. It will mean having the babes in the city and being 3 hours from my husband, but it may make me feel more reassured in the long run.

Its so hard to know what is 'right' when there is such a difference in what doctors believe. I did speak with a couple mum's at a twin group this week and they also thought that the 7wks was a bit extreme..


:hug: i think this sounds like a great idea - it does suck being 3 hours away from DH, but feeling reassured & like you're getting the care you need is HUGE.

you're so right - it is hard to know what the "right" answer is when everyone (even doctors) has a different opinion. i think in cases like yours, you need to take in all the info from all the different sources & then just trust your gut (easier said then done, i know). as a mother, you will naturally always want to do what is best for your babies & i think that gut instinct really comes strongly into play at these kinds of times.

KUP!