C-Section Date Set

So, my OB just called and said she'd spoken with the perinatologist and, based on "new research" that mono/di twins should be born between 34 and 35 weeks which pushed my expected delivery date up 3 weeks from our original 37-week estimation. So...now I'm scheduled for a C-section on August 3rd which is 34 1/2 weeks!!! Needless to say, while I would love to not carry these twins around for my own comfort, I can't believe the babies would be better off born that early. I'm planning to call my perinatologist tomorrow to talk to him about it directly (I like him more than my OB). I basically want to find out if this is really in my (and babies') best interests or the doctor's! Man, this changes things - I have soooooo much stuff to buy that I didn't get at my showers. Have to get the nursery ready.... :shok:

 

This is why we had ours at 35 weeks! congrats!

 

I am surprised. I am 37 weeks and I am not scheduled for my C-section until next week at 38 weeks

 

Did they spend any time in NICU? DV, I'm just as surprised as you!! I wasn't expecting to have it scheduled until 37 weeks (what we had talked about before). I actually looked up the research and there are conflicting studies, but it is true that for Mono/Di twins they *do* often recommend getting them out between 34 and 35 weeks. I'll let you know what my peri says after I talk to him tomorrow....

 

I know some ob's tend to be more cautious with mono/di babies, but my ob wouldn't do my c section until before 39 weeks (though she knew I most likely wouldn't go that far.) My boys came on their own at 35 and 4 but my baby B had to spend a week in the NICU for respiratory issues. Are they going to check the boys lungs first to make sure they're mature before they take them so early? I think 34 weeks is too early (in my opinion.)

 

I have a peri appointment the week before the scheduled date - they're the ones that would do any amnios (isn't that how they check lung maturity?). The OB said she'd do steroid shots on or around July 30th. This OB is the epitome of cautious so far. More cautious than I'd like, to be honest, but...we're almost at the end and I'm DONE having babies, so that's ok, I guess.

 

Best of luck to you!! :hug: I hope you are able to get some good answers from your peri!

 

Did you look at the specific studies she cited? I would be very hesitant to do that if all other indications are that babies are doing fine. Maybe there is some middle ground, like 36 weeks but every other day NST, or ultrasounds from 34-36 weeks? I just think the chance they are going to get out of NICU time at 34 weeks is almost none, at 36 weeks you at least have a shot.

 

Good luck talking to your peri. I hope he gives you answers that makes you feel better about this. :hug: :hug:

 

Its so hard to know whats the right thing and unfortunately while they have the best intentions, even the best doctors are only guessing sometimes. I think that there are often no easy answers but we just have to do what seems to make the most sense based on the information available. Staying in longer seems like the best thing, but I found one of the birth stories posted today to be a really sobering reminder that even babies that stay in past 38 weeks can have problems and require NICU. Unfortunately there is no one size fits all answer and I think you're doing the right thing in talking to your doctors and doing your research.

I hope you get some good information from your doctors and that you find a solution that you're comfortable with and that is right for you and your little ones.

 

Good luck!! I had a singleton that went overdue and still had to have a 7 day NICU stay so as sparkle77 said we can't count on no NICU time at any gestation unfortunately. So I say trust your docs if you can and if need be do some research on your own to make you feel comfortable. Again GOOD LUCK!!! I am sure it will all work out perfectly!

 

Keep us posted definately on the news from the Peri!

I'd be completely blindsided if they moved mine up that early. :wacko:

 

Wow, that seems way too early to me. Maybe there's something I'm missing, but I agree with a PP who suggested compromising with NSTs and u/s. It would be tough if your doctors induce you so early on the basis of one new study and then find out later it was proven false. I'd do some research and make this decision carefully.

FWIW, I went to regular ultrasounds with my identical girls (2 sacs and one placenta but not sure if it was fused or not) and delivered at 39 weeks. Baby B was only 5.12. Can't imagine how small they would have been at 34 weeks.

 

Wow, that does seem early considering all is going well. I would definitely push for 35-36 wks with a lot of monitoring till delivery.

My LO's were born at 34w0d (IUGR with DD) and spent 24 days in the Level 2 nursery as feeders/growers. They didn't have any lung/breathing issues at all and never needed oxygen. They did get the steriod shots around 32 wks. DS was 5lbs 1 oz and DD was 3lbs 6oz at delivery.

GL with whatever happens. You are so close! Yay!

 

I thought about this a little bit overnight and I'd say try to get them to do it no earlier than 35 and 4 and no later than 36 weeks. They will do NICU at 34 (which is NOT the end of the world.)

Mine were in the NICU for 4 days because of body temp. They never had any breathing or eating issues or anything like that tho.

Oh and we did an amnio the day before and were "VERY" mature. Chances are when they do the amnio at 34 weeks they won't come back mature anyway so it's a moot point. They can't do an elective w/o mature lungs because insurance wont' pay!! You don't want that It will all work out. Do keep us posted

 

Well... I just talked to the Perinatologist. I called him this morning and he said he hadn't spoken with my OB, but it was possible his partner had and he'd call me back after speaking with the other peri. My OB did talk with the partner and he said that he recommended having them between 35 and 36 weeks. They both agreed that they wouldn't recommend earlier but that my OB may have other reasons. Here's where I get a bit steamed : I KNOW (for a fact) that my OB will be out of town when I hit the 36 week mark. I know it because I've got all my appointments booked through 37 weeks and that week I'm set to see her partner. Soooo....my guess (and we WILL bring this up with her next week at our appointment) is that maybe she leaves for vacation before or right at the point when I hit 35 weeks and wants to do it earlier so that she can follow up on recovery, etc. Just a guess. In my opinion, that isn't really a good enough reason, though I think it's probably unethical for her to schedule a C-section for when she's out of town meaning her partner would have to do it, right?

In answer to the question about looking at the studies myself - I did that last night and they conflict (of course!). Of the two big studies done most recently (both published in 2006), one says that there is a substantial risk (4.3%) of unpredicted antepartum death (aka stillbirth) beyond 32 weeks gestation and because of that risk, they recommended elective preterm delivery at 32 weeks (other studies have the 34/35 week recommendation - I haven't read them, yet). In that study, they looked ONLY at problem-free pregnancies (eliminated malformations, growth problems, TTTS, etc.). In the second study the risk of stillbirth was only 1.2% and they didn't exclude any pregnancies regardless of existing problems. One would think that would lead to a higher risk rather than lower - both studies had pretty decent-sized sample populations - 455 in the first and nearly 200 in the second, and both did bi-weekly ultrasound monitoring, amniotic checks and dopplers, up to 30 weeks. The second study upped that to weekly after 30 weeks. Study 1 results would indicate betweeen 23 and 30 cases of early fetal death for every 140 pregnancies at 34 weeks of gestation, compared with only 1 early fetal death per 140 pregnancies in the second study.

A perinatologist wrote a letter to the editor after the second study citing the difference between the two studies, here is a quote from the end of his letter: "...there is a great need for a large prospective and likely multicenter study with long-term pediatric follow-up to definitively answer the question when is the ideal time to deliver monochorionic twins.4 Until the question is answered, delivering apparently 'uncomplicated' monochorionic diamniotic twins at 34-35 weeks’ gestation after administration of antenatal steroids, although by no means standard of care, in our opinion, is reasonable provided that the patients have been counseled about the risks and benefits."

The response from the authors of the second study basically said they recognized the discrepancy and that it was probably even bigger due to the exclusion of some patient types in the first one. They said, "Elective preterm delivery at 34-35 weeks, for example, an essentially empirical practice suggested by Cleary-Goldman and D’Alton, is admittedly unsupported by evidence. However, it is a potential solution if the prospective risk of fetal death is indeed unacceptably high and outweighs the risks of preterm birth." They attributed the lower level of fetal death to more intensive fetal assessment of mono-di twins.

If anyone wants the citations, let me know and I'll happily provide them.

My OB quoted the near 5% risk and said that was the main reason, but when asked about NICU didn't really go into any depth there. We will talk about it and see if we can at least push it to the 35-week mark which would be August 6th (so only a few days beyond her desired date). We may be having them early, though, it appears. Will let y'all know!

On another note - does anyone know of any other stats besides this forum's on lengnth of NICU stays based on weeks of gestation? I am not actually opposed to NICU - my husband, on the other hand, is completely freaked out about it. He's questioned why they would need to be there at all and has even gone so far ast to say his babies aren't going in any plastic boxes. I've told him that if they are having problems breathing, eating or keeping their body temps up, I'm all for them being in incubators. He's got this thought in his head that they shouldn't be in plastic boxes but should be in my arms as much as possible - I'm not sure why he's got such a negative view on the benefits of NICU. Any advice on calming him down on that note? I'm sure that the NICU won't keep them if they don't need to be there - the hospital we're going to is a Level III-b NICU (the only one in the near region), so I'm sure their space is at a premium. Who knew that having twins would lead to so much drama?? :blink:

 

is there anything going on with the babies that would suggest that they be born that early? i'd tell them "um no, i'm not having it done that early, i will not be there for it" it seems really "off" to me to have it done then, especially if there is NOTHING physically going on with your babies to suggest the need for it..i say screw the research!

 

The babies have been fine all along - big for their gestational age, healthy as far as my frequent ultrasounds suggest. I do take Procardia for frequent B/H contractions but so far the contractions have not been having an effect on my cervix (was 3.2 cm at last appt - 31 weeks). So, nothing going on with babies. I hate the B/H contractions - they are really not fun or comfortable, but they are tolerable.

 

i'm taking procardia as well..it's the first time i've ever had to take anything like this in any of my pg's...my babies always go over the date and i've been induced the last 4 times...i agree they are annoying, but tolerable...it's been going on for over a month now...ugh...it's good that the babies are doing well at least...i know that will be a little reassuring..i do agree that the doc scheduling the section so early because she is going on vacation is a bit off...maybe she should talk to her partner about scheduling it with her while your main ob is gone....that seems like the best solution possible...