Homebirthing twins?

I am currently 23 weeks pregnant with fraternal twins. My husband and I have been seeing a midwife for a homebirth. We just found out we were expecting twins last week! We are now trying to figure out if we want to continue with a homebirth or go the hospital route. I had a c-section with my 1st and a vbac with my 2nd, so if I go the hospital route, I'll be forced to have a c-section. Any thoughts, suggestions, or personal experience with this?
Cammie

 

They don't allow home births of twins here, so I cannot help with that, but are you sure about the forced c-section with twins? You might want to research different hospitals and clinics in your area, often each has slightly different policies on VBACs. Especially considering you had a successful VBAC already, if the twins ae head down when the time comes there seems no reason not to have another one.

 

Welcome to TS and congratulations on your twin pregnancy


Dianna

 

Many twin births are mandatory c-section anyway because Baby A is breech. But even when A is vertex, a vaginal delivery of both is not guaranteed. B can turn breech/refuse to turn vertex (but skilled doctor can delivery the baby breech), B can refuse to engage in the pelvis, B's cord can prolapse - which is an absolute emergency c-section, etc.

Have an honest, straight forward talk with your midwife about your options. Regardless of where you deliver, you should be seeing an OB as back-up for the complications that seem to plague twin pregnancies. She can probably steer you to an OB who shares her philosophy on birthing. I saw a midwife until discovering twins at 22 weeks. Her malpractice insurance would not cover multiple births, so she referred me to an amazing OB. Yes, I had to deliver in a hospital - and in the c-section room in case something came up - but I had a wonderful experience. My OB slept at the hospital with me and took charge of all my care while I labored. Mine were both born vaginally 21 minutes apart. I wouldn't change anything about the experience.

 

Welcome to Twinstuff and congrats on your twins!

I agree, you may want to research different hospitals in your area to see which ones allow VBACs. I know the hospital in our town does not, but the one 30 min. away, which my OBs go to as well, does all VBACs.

I am not sure about homebirting twins though, that would scare me. Good luck.

 

NO one can force you to have a section. That is assult. You have had a sucessful vaginal birth prior to this pregnancy, so there should not be a problem there.
I was planning a home birth, would have done it if not having twins. My DD was a section a very unnecessary section and since I don't have a sucessful vaginal birth I was not a home candidate for twins. We have several local homebirth Midwives that are great, but do to their insurance they have to have a proven vag after a section before home with multiples.
Good luck!

 

QUOTE(Cammie @ Jan 21 2008, 02:27 AM) [snapback]581904[/snapback]
I am currently 23 weeks pregnant with fraternal twins. My husband and I have been seeing a midwife for a homebirth. We just found out we were expecting twins last week! We are now trying to figure out if we want to continue with a homebirth or go the hospital route. I had a c-section with my 1st and a vbac with my 2nd, so if I go the hospital route, I'll be forced to have a c-section. Any thoughts, suggestions, or personal experience with this?
Cammie



You may want to check out the MDC forums (mothering.com). There are lots of mommas there who have experiences with home births, and they may be able to answer some of your questions.

 

Congratulations on your twins and welcome to TS! There have been some successful homebirths of twins but I haven't read about any unsuccessful ones. This leads me to believe that there have been a few but the subject is too hard to write about for those parents. I am a big advocate of homebirth but, with twins, I'd go with the hospital. Since you have a successful VBAC, if both babies are vertex you can always stay home until the birth is imminent. I would think it would definitely be difficult to find a midwife experienced in twin homebirths. Since your twins are in separate sacs that increases your chances of a problem-free pregnancy though. I would have a deep talk with your midwife and also research your hospital options. Good luck!

 

We had our DS at a birth center, and our DD at home, and were very disappointed to find out at 21 weeks that we were having twins, not because of the twinness, but that it made our decision of where to have them much more difficult. We had been planning a homebirth, and were able to find a midwife who would attend us (we live in NH, which seems to be pretty accepting of midwives), but decided that we would feel more comfortable in a hospital. We actually have a midwife clinic associated with a hospital in our city, which is who we went to for care, but because they are in the hospital, they have to answer to the OB on call for high risk births. Unfortunately, the OB on call would not attempt a breech birth (the first was born vaginally, then they tried to turn the second, with no luck), so I did end up having a csection. The worst part is that there is a doctor in the practice who will deliver breech, but he wasn't on call. BUT, we came very close to being able to accomodate the birth we were looking for, without feeling that we were compromising our children's safety. If you look around, you may find OBs or midwives through an OB practice that will try to approximate a homebirth (as best as you can in a hospital...)

 

Personally, I think a home birth is WAY TOO RISKY for twins. If the first one is head down then it would be okay for that one, but you have to remember that the second one goes under more duress than the first because it has to be in there twice as long for contractions and pushing. This is why a lot of women have birthed one vaginally and then had to have an emergency C/S for the second. I am not one for home birth to begin with - it's just too risky in my own eyes. However, you couldn't pay me all the money in the world to risk a home birth with twins. Either way - it's up to you. I just hope that whatever you choose, the babies come out well and happy!

 

I also feel that with twins, the safest place is the hospital. There are any number of complications that could arise, and it is so much better to be safe than sorry when it comes to them and you. Sorry you are disappointed.

 

I have also not seen too many homebirth of twins stories...out of those that I have seen some seem to be "accidental." And a rare few are planned. Like the pp said, I personally would not attempt homebirth of twins. Like yourself, I have now had a vbac and I'm a big proponent of them. There are a few things that make vbac with twins a little more complex... 1. the twin b thing....makes it more likely you'll need a c/s due to positioning... 2. Even when things are "a go" for vaginal delivery many docs will induce to get twins out early (there might be medical reasons for this....or their might not really be great reasons other than the typical "with twins it's better to deliver by 38-39 weeks"...whether or not you buy into that is up to you.) But obviously you should already know that induction with vbac is never a good idea unless the cervix is already favorable. Cervical ripening gels which are commonly used to induce in non-vbac patients are not a good choice for vbac patients. So even if everything looks good for attempting a vaginal birth you have these other complexities to deal with. I think you and your dh have to sit down and evaluate all of these angles.

Like the other pp said...no one can force you to have a c/s. But you need to look at the issues of 1. babies positions...are you comfortable dealing with the possibility of breech baby B...is your doctor comfortable with it?? (like it or not, you don't want a doctor attempting to deliver a breech baby if they don't have experience doing so.) 2. going past the 'ideal' timeframe set up by your doc (most will want them out no later than 39 weeks.) your body might accomodate that on it's own..but some women hold them in until 40 weeks or more if given the opportunity. 3. And also consider the possibility that with a twin pg crazy unpredictable things can happen... bp getting out of wack...growth discordance between the babies toward the end... one baby not having enough fluid...and on and on. I think it's important to consider these things, not to say they'll happen to you, but to prepare yourself for the possibility that you may need another c/s.

I needed a c/s with my twins...both were transverse. I was disappointed b/c I had my older dd vaginally, and wanted more kids...and didn't want to deal with the vbac issues. But I was really glad I had mentally prepared myself for the possibility. When my baby A turned transverse I was totally at peace with the whole thing.

 

After my experience 10 days ago, I would have to advise you against a twin homebirth. Twin births are just more complication-prone than singleton births...

In my case, after laboring for 8 hours with 2 head-down babies (my ob was pretty certain that I'd be able to have a vaginal delivery), I was dilated around 5-6 cm, and Baby A's heartrate became very erratic, and started plummeting with each contraction. I was rushed to the OR for an emergency c-section, and, at delivery, Baby A's heartrate was around 70. I am so so so very thankful that we were at the hospital. From start (Baby A's first erratic heartrate) to finish (pulling Baby B out), less than 15 minutes passed. If more time had passed, I don't know if both babies would have made it.