Difference btwn 36 & 37 weekers; concerns about my OBs

I had another OB appt yesterday (a follow-up since they couldn't get all the measurements at my anatomy scan 9/5) and I was talking with the OB a bit more about childbirth options. Both OBs I've seen so far (out of the 6 in the practice) are telling me to assume the babies will come by 36-37 weeks and said they'd be willing to schedule a C-section if I want one any time at 36w or beyond. (I am hoping to deliver vaginally.)

I've gotten the impression that, while making it to 36w is good, that the extra week makes a difference in terms of lung development and immune system development. The OB said that week doesn't make much difference but I'm curious what the rest of you all have heard (or experienced!) from your OBs, pediatricians, and other reliable sources.

Also, I have to admit, the OBs at my practice haven't totally won my trust yet--starting when they admitted they're "more aggressive than many and less natural than most"--but I haven't found a good alternative yet. (And I did try contacting my local MOTC for recommendations but didn't come up with much.)

The OB also said that "most" MoMs these days opt for C-section, that the "double whammy" (delivering Baby A vaginally and Baby B by C-section) is not uncommon--which he thinks is a good reason to go straight for a C-section--and that good weight gain with a twin pregnancy is 30-40 lbs, all of which contradict what I've read elsewhere ... which is also why I'm feeling a little skeptical.

I'd love to get feedback and insights from the rest of you on these issues!

 

Mine would not do a scheduled c/s before 37 wks w/o a compelling medical reason. He said that was an important week. He would have had no trouble letting me try vaginal if I hadn't been prior c/s and nowhere near labor when I ran out of space for my amnions. It was too risky to induce me because I might have ruptured at my scar.

 

I would definitely not schedule a c/s for before 37wks. I think 38 wks would even be better! That said, I too am hoping for a vaginal delivery and thankfully my OB actually recommends it.

I think I read somewhere that roughly 5% of vaginal deliveries of Baby A ended up with a c/s for baby B. It sounds like your OB's just do c/s's because it's more conveinient for them. <_<

You definitely need to feel comfortable with your healthcare!

 

I was told by my ob I could schedule anytime after 36 weeks. I too had a previous c-section and v-bac was not an option due the previous complications. I delivered at 36W 5 days and my twins had no Nicu. I was so ready to deliver with being so umcomfortable. Even now knowing they didn't have NICU I sometimes feel guilty I didn't let them keep cooking. I showed no signs of dilating or anything. crazy since they were fine anyway! Just from watching birthing shows I have seen many moms deliver twins vaginally even with the second turning they just reach in and get them head down and it is usually okay since second one is smaller and baby a paved the way so to speak. Good luck with your decision! maybe the other 4 doctors will give you more to go on.

 

personal opinions only here... I'm not a Dr...

Wait, do you have momos or mono/dis? If you have momos, I'd DEFINITELY get them out as soon as possible, and opt for a C-section.

For mono/dis... I wish I had your doctors! I wish my Dr. would want them out at 36 weeks, he said 37 weeks (and it's Kaiser) and now I have to switch peris due to distance, and I'm worried it will be 38.... I've done way too much reading on all the risks that can happen to mono/dis, and I *wish* my Dr. was at 36 weeks... I'm also still torn myself about C-section vs. vaginal... I don't think we agree on this, and they are both of our babies, (and he is worried about my health). and I don't want to risk anything happening to our babies (I've read studies that show risk of bad things happening to baby B vaginally) .... will talk to new perinatologist on October 8th, but again, I've done way too much reading on this and need to talk more to a peri about what is realistic and what isn't...

If you are still worried I'd ask your doctor why they want at 36 weeks, and I'm sure they will tell you...

if you had di/dis, I'd say that yeah, 37 or 38 weeks is better.... there is less risk to them than mono/dis or momos... and less risk during natural birth to the babies (but not less to you).

 

My understanding is the longer they can stay in there the better. Unless complications arise, why would they want to choose to get them early? (ETA: I mean you as in your OBs, not YOU!)

Also, many doctors will get baby B out vaginally even if it turns... will your OBs do breech extraction? I don't think the "double whammy" birth is that common and it is totally worth the chance for me to at least try for a vaginal birth. But that is very much a personal decision. You'll know what feels right to you. Don't let them bully you. It is good you're seeking information elsewhere.

 

I don't know about 37 weekers but mine came naturally at 36 weeks and did not spend any time in the nicu and are home doing great! They are having a hard time getting used to the eating thing, but I think all babies have to adjust to that. Mine were both 5lbs 15oz. I still believe the longer the better, but nature thought it was just time for mine to come out

 

i was told by my ob i had a choice to make. he doesnt recommed going past 36weeks because of complication in both my prior pregancy. he said 36week babies may have to spend a few days in nicu if any (my youngist spent 20hrs). than he told be c section for twins is easier, however as long as baby a is head down & i had a epadurail , than we could do it vaginaly , but if anything happens that the docs didnt like i was going for a c section,
my doc is a high risk doc that i have alot of trust in, no other ob in my city though my youngst would make it past 20 weeks, if i listen to them i wouldnt have my 2yr old. find someone you are comfortable with. ask questions untill your brain hurts from asking so many, once your comfortable make your choice.,
good luck

 

They do sound aggressive. I believe the stat for "double whammy" deliveries is about 5% but I would guess it's higher in that practice since they sound like the type who start shouting for a c-section as soon as something isn't following their perfect plan. If you want a vaginal delivery, you'll have to be proactive about it and make sure DH is vocal about talking with the OB about everything single thing that happens in the delivery room.

I also wouldn't be surprised if most MoMs in their practice do opt for a c-section because of what they tell them. Many women don't really put any research into their pregnancy and just go on what the doctors tells them. If the doc says most people do c-sections and that c-sections should be scheduled to avoid the "double whammy" then many women are going to opt for that.

Since you're only 22 weeks, I'd just sit back and wait to see what your body and the babies do. It's still a long time to the 36 or 37 week mark and you'll have a better idea by that time exactly what your needs are.

 

My OB wouldn't electively deliver me at 36 weeks unless I had an amnio and she encouraged me to wait until 37 weeks for a planned delivery.

 

QUOTE(December Miracle @ Sep 23 2008, 10:41 AM) [snapback]993686[/snapback]
I think I read somewhere that roughly 5% of vaginal deliveries of Baby A ended up with a c/s for baby B. It sounds like your OB's just do c/s's because it's more conveinient for them. <_<

If that's true, they do sound aggressive.

I had mine emergency C at 36 W 1 D and no NICU time but my cousin had her boys at 37 weeks and 1 had a few days of NICU time so you just never know. I really do think the longer they stay in the better.

 

I had a csection at 36 weeks due to ttts. My babies were fine and came home with us weighing 3lbs 11oz and 4lbs 15oz. We had no choice due to our circumstances dr's wanted them out by 36 weeks (did amnio to make sure the lungs were ok) earlier if we'd have taken a turn for the worst and taken or chances with nicu. Now if we wouldn't have had the ttts they wanted them delivered by 38 weeks. I had no other complications whatsoever and gained 24lbs despite eating everything and drinking protein shakes. I almost had the double whammy. I was trying for natural pushing A out and B flipped and was tangling in her cord. They immediately started a csection and had to literally push and pull baby A back in to take her by csection. Glad I didn't have both though. I had wonderful doctors so I trusted whatever they recommended.

 

I was told by my doctor, she would not STOP labor anytime after 34 weeks. She thinks the babies will come between 36-37. If they don't come on their own she will induce by 38weeks. She would only change this if something major happened. She is 110% ready to deliver vaginaly, C-section for her is only for emergencies/medical issues or TWO breech babies. Mine has a very low percentage of twin moms who end up with both vag and c-sect. She will do a breech extraction if need be. Sounds like they are a little pushy in what THEY want. Its not too soon to find a doctor that is better for you.

QUOTE
Since you're only 22 weeks, I'd just sit back and wait to see what your body and the babies do. It's still a long time to the 36 or 37 week mark and you'll have a better idea by that time exactly what your needs are.


110% AGREE

 

Here are the abstracts of a few studies done on twins born prior to 38 wks vs. after:

http://www.pubmedcentral.nih.gov/articlere...i?artid=1397866

http://www.nature.com/jp/journal/v20/n4/abs/7200354a.html

http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum

Hope that is helpful some!

 

My doctor practices by himself and he's been doing it for 25 year (just about to retire).
He told me right away that he was old-school enough to deliver vaginally as long as the first one was presenting headfirst (thankgoodness both have been headfirst since about 18 weeks). But he did mention that that's not the case with newer doctors to the field. (I just see my regular ob/gyn since I'm carrying di/di twins).
He said that after 36 weeks he wouldn't do much to stop labor but would would try some minimally invasive stuff...but at 37 weeks he would just let things go naturally. He thinks I'll make it to 38 weeks.
Good luck!

 

In canada they would start to induce at 37 wks because after that its more harmful to the babies-that said in other countries 37 wks isnt the norm and you can go 40 wks! I went to 36 wks and one more week probably would have been few days less in the NICU and maybe a few more ozs on the babies-hard to speculate thou since my Eve baby B was breech and had a forceps delivery and complications to follow-if i Opted for a C-section she might have been spared that

 

QUOTE(desolation_anonymous @ Sep 23 2008, 04:14 PM) [snapback]993960[/snapback]
personal opinions only here... I'm not a Dr...

Wait, do you have momos or mono/dis? If you have momos, I'd DEFINITELY get them out as soon as possible, and opt for a C-section.

For mono/dis... I wish I had your doctors! I wish my Dr. would want them out at 36 weeks, he said 37 weeks (and it's Kaiser) and now I have to switch peris due to distance, and I'm worried it will be 38.... I've done way too much reading on all the risks that can happen to mono/dis, and I *wish* my Dr. was at 36 weeks... I'm also still torn myself about C-section vs. vaginal... I don't think we agree on this, and they are both of our babies, (and he is worried about my health). and I don't want to risk anything happening to our babies (I've read studies that show risk of bad things happening to baby B vaginally) .... will talk to new perinatologist on October 8th, but again, I've done way too much reading on this and need to talk more to a peri about what is realistic and what isn't...

If you are still worried I'd ask your doctor why they want at 36 weeks, and I'm sure they will tell you...

if you had di/dis, I'd say that yeah, 37 or 38 weeks is better.... there is less risk to them than mono/dis or momos... and less risk during natural birth to the babies (but not less to you).

It's very important to take into consideration what type of twins you have as PP has pointed out. I applaud mommies who carried their babies until 37, 38 even 39 weeks, but that's not a possibility for me with mono/di twins. I know it's been done before, but my medical team feels so strongly about the sudden death risks that occur with mono/di twins after 34/35 weeks that they will not allow me to go beyond that point. Again, I'm very comfortable with their advice and the success rate for my specific hospital with 34 week deliveries. My c-section will be sceduled for 34 weeks 4 days. They will do everything possible to stop PTL up until that point and prepare me with steroid shots at 33 weeks.

If you're that uncomfortable with your doctors, schedule a meeting with a few other OBs in the area to talk about that specific issue. You need to be comfortable with your medical team and in the end, I believe that we as moms know what's best for our babies. Good luck with your decision!

 

I also agree with the PP about gestational times. What I dont understand is why the weight thing has you bothered. Carrying twins does mean extra weight gain and 30-35 pounds sounds healthy for gaining. I gained 42 an my BFF who had boys at 35 weeks gained 37.As long as its a healthy gain with exercise and not a sweet and fat induced weight gain with couch time. The AMA has new guidelines for pregnancy but its all inclusive. Every person is different and I dont think that the people who make up these things have been preggie with multiples. I think they are men and women in a room with no real clue about real women. Chances are they are fat, old and bald (the men) anyway. I work in a hospital and see all sorts of "fit".

 

What I meant about weight is that they *only* suggested a 30-40 lb gain (just 5 lbs more than for a singleton pregnancy) whereas everywhere else I read 35-45 lbs, or more in Dr. Luke's book.

 

QUOTE(SC_Amy @ Sep 23 2008, 01:23 PM) [snapback]993644[/snapback]
I had another OB appt yesterday (a follow-up since they couldn't get all the measurements at my anatomy scan 9/5) and I was talking with the OB a bit more about childbirth options. Both OBs I've seen so far (out of the 6 in the practice) are telling me to assume the babies will come by 36-37 weeks and said they'd be willing to schedule a C-section if I want one any time at 36w or beyond. (I am hoping to deliver vaginally.)

I've gotten the impression that, while making it to 36w is good, that the extra week makes a difference in terms of lung development and immune system development. The OB said that week doesn't make much difference but I'm curious what the rest of you all have heard (or experienced!) from your OBs, pediatricians, and other reliable sources.

Also, I have to admit, the OBs at my practice haven't totally won my trust yet--starting when they admitted they're "more aggressive than many and less natural than most"--but I haven't found a good alternative yet. (And I did try contacting my local MOTC for recommendations but didn't come up with much.)

The OB also said that "most" MoMs these days opt for C-section, that the "double whammy" (delivering Baby A vaginally and Baby B by C-section) is not uncommon--which he thinks is a good reason to go straight for a C-section--and that good weight gain with a twin pregnancy is 30-40 lbs, all of which contradict what I've read elsewhere ... which is also why I'm feeling a little skeptical.

I'd love to get feedback and insights from the rest of you on these issues!


YES, THAT WEEK MAKES A DIFFERENCE!!! Mainly with the immune system - not as much with lung development. Although if you're having a boy, a little extra time for the lungs isn't a bad thing.

My OB did say that past 38 weeks, the docs begin to worry about "litter syndrome" - that there are too many babies and not enough nutrients.

Don't let them pressure you into a C-section. In my first pregnancy, I had a preemie, and my docs were amazing. They totally supported a Vaginal Birth, even in the face of emergency. (I always felt like they were keeping both me and my baby safe.) I recovered unbelievably quickly from the birth!