I can't decide!

Hi girls -

My OB has recommended that my twins be delivered on Monday (36.5 weeks) due to baby A's IUGR. Both babies appear to be doing well - still growing, good fluid, good dopplers - so there's no immediate issue or concern. He just seems to think it's time now that they are close to term. I'm a little nervous that we are essentially taking them out electively, but I have always been a nervous nelly about the stillbirth risk associated with IUGR so I think on balance this is a good decision.

Since both babies are vertex, my OB has left the decision whether to have a c-section or vaginal birth (induced) up to me. He says he doesn't feel that there is any medical reason to choose one option over the other at this point - he thinks either is a legitimate choice. I need to decide this today, because if we choose the induction I will go in to start the process tomorrow evening. I was up essentially all night thinking it over and I just cannot decide.

All things being equal, I would choose vaginal because of (1) avoiding potentially unnecessary major surgery - other than the fact that I have twins I don't know that there is any real indication for a c-section; (2) an easier recovery that will better enable me to take care of my babies; and (3) the respiratory benefits the babies will receive from being born vaginally.

However, I just cannot get around the fear - perhaps unfounded - that a c-section, while more inconvenient and painful for me, must be at least somewhat safer for my babies (particularly twin B). The risk factor is really the only thing driving me toward the c-section option - but if it is true that it's safer, then I think I HAVE to choose the c-section. I couldn't live with myself if something went wrong because I made the other choice. I know that if anything goes awry with the vaginal delivery they will do an emergency C to get the babies out, but I don't know if all vaginal birth problems that might arise can be solved that way.

Anyway, I know that nobody can make this decision for me, but I'm interested in what you ladies have read/been told about the safety of a c-section versus vaginal birth for the babies and what factors you considered in making this decision for yourselves.

Thanks and sorry to ramble - this is such a big decision!

 

How close are their weights? My doc told me that he wouldn't deliver vaginally if baby A was smaller by 20% or more, because baby B can get stuck if baby A doesn't stretch you out enough.

Good luck with your decision! I would have a very difficult time deciding too, because I really want a vaginal delivery.

 

QUOTE(Jordan Lee @ Nov 8 2008, 10:39 AM) [snapback]1062340[/snapback]
How close are their weights? My doc told me that he wouldn't deliver vaginally if baby A was smaller by 20% or more, because baby B can get stuck if baby A doesn't stretch you out enough.

Good luck with your decision! I would have a very difficult time deciding too, because I really want a vaginal delivery.


This is actually one of my concerns, I'm glad you brought it up. Yesterday's u/s estimates baby A at 4 llbs 12 oz and baby B at 5 lbs 9 oz (so baby A is 15% smaller). My peri thinks A may actually be a little bigger than that - her head is so low in my pelvis that it's difficult to get a good measurement. But there definitely is a size difference between the two.

 

I had a c-section and do NOT recomend it. It was horrible, but I have heard of people who prefer them so it could have just been my experience.

 

The c-section is tough, but you don't have any issues in your lower regions (I don't know what to call them on this forum)...you do have the incision and the muscle pain from surgery, but you're also in the hospital longer and have more access to nurses, the nursery (send the babies there if you can...don't be a hero like I was) and lactation consultants. Don't get me wrong...it is major surgery and your recovery time is longer (make sure you have help around), but it does keep some things normal. Good luck with your decision...

Oh, and understand where I am coming from...I can't understand for the life of me why people would want vaginal deliveries...I just don't get it...I never will. I prefer surgery, but that's just me!

 

I would do a v-birth for all the reasons you listed. I know you are concerned for baby b but if something were to go wrong they could do just a c section for bb. I have only had v-births and understand that the healing time and process is much worse with a c-section.

 

There is evidence that vag birth is safer for baby and you. Do a search "c-section versus vaginal delivery". You should listen to your Drs advice about when the risk of a vag birth outweighs the benefits. The 5% chance of having one of each was well worth the risk for me.

From my own experience, I can't imagine not having a vaginal birth if I have the choice. I had one with DD and then with the twins. Baby B was born breech as well. The vaginal birth pushes extra fluid from the baby's lungs which is really important. Even with a vag birth, my baby B struggled with fluid for about 8 hours. I had no stitches with the twins. I was up and in the shower within one hour of birth then down the hall to the NICU to be with my girls. My recovery was so easy. I felt bruised down there but that's about it. After 2 vag deliveries (DD was 8.5 pounds) I don't have any issues with leaking or any other problems.

With twins, I can't imagine having to spend weeks recovering myself. If your Dr says right now there is no reason not to go with vag, do it.

 

I had my girls vaginally and if you have the choice I would suggest going that route. It was tough...especially since they came 4 hours apart but it was totally worth it! My girls were born at 35 weeks and were 4 lbs, 6 oz and 6 lbs. 5 oz. Cameron, my smallest, had a 2-vessel cord which was the reason she was 2 lbs smaller than her sis. They had no breathing problems and came home with me on the 3rd day. The docs and I don't think we would have been so lucky had we gone the c-section route. Good luck in whatever you decide!

 

That is a tough decision--I too would lean toward vaginal for the three reasons you listed. I did also read the article indicating there was an increased risk of mortality for Baby B in vaginal deliveries versus C-sections, but from what I recall, the incidence was still VERY low, and the sample size was actually much smaller for the C-section group (compared to the sample size for the vaginal delivery group) so I don't know how big of a factor that should be in your decision. Ultimately though of course, it's whatever you feel most comfortable with; that's just my two cents.
Hugs and best wishes. I hope all goes well!

 

Good luck on your decision :hug:
Go with what you feel is best ~ and that will be the 'right' decison for you.

QUOTE(Sara E @ Nov 8 2008, 10:49 AM) [snapback]1062380[/snapback]
I had a c-section and do NOT recomend it. It was horrible, but I have heard of people who prefer them so it could have just been my experience.


I had a c-section (scheduled) & it was WAY easier that what I had expected. Sure there was some pain/discomfort in the first 2 days afterwards, but the recovery was very easy for me?! I had no problems caring for my babies afterwards due to the surgery and recovered really well.
Everyones experience is different though.

 

Honestly, I would do a c-section - but this is coming from someone who had a pretty easy recovery. I had one or two bad days in the hospital - but i was taking my "walks" at 2 weeks post partum. Maybe I have amnesia, but I really felt like my recovery wasn't that bad.

For me, I didn't want the stress of labor ( I had been on bedrest for 11 weeks for high bp and jakes' iugr) and an induction has its own issues. I had read stories here and heard from friends of labors that didn't progress and ended up with a c-section anyway.

The bottom line is everyone is different and it's impossible to know how it will go for you.

Finally, I knew these were our only kids, so there was no concern about future deliveries.

 

I had to have a c-section with my twins because Twin A was breech. I wanted to do a vaginal so bad! I had a VBAC (vaginal after a c-section) for my 10 lb singleton. It was great.. even though he was huge! There are so many benefits of having a vaginal delivery that I would at least try for that route. If things don't go well, you are already in the operating room and they can do a c-section in no time at all. I had a good c-section with a fairly easy recovery. I had a great vaginal birth. Good luck with your decision.

 

QUOTE(tamaras @ Nov 8 2008, 03:29 PM) [snapback]1062508[/snapback]
Go with what you feel is best ~ and that will be the 'right' decison for you.
I had a c-section (scheduled) & it was WAY easier that what I had expected. Sure there was some pain/discomfort in the first 2 days afterwards, but the recovery was very easy for me?! I had no problems caring for my babies afterwards due to the surgery and recovered really well.
Everyones experience is different though.


Same here. I always wondered it I experienced both ways of delivering what I would say but I recovered fine from the c section.


QUOTE(akameme @ Nov 8 2008, 03:29 PM) [snapback]1062509[/snapback]
Honestly, I would do a c-section - but this is coming from someone who had a pretty easy recovery. I had one or two bad days in the hospital - but i was taking my "walks" at 2 weeks post partum. Maybe I have amnesia, but I really felt like my recovery wasn't that bad.

For me, I didn't want the stress of labor ( I had been on bedrest for 11 weeks for high bp and jakes' iugr) and an induction has its own issues. I had read stories here and heard from friends of labors that didn't progress and ended up with a c-section anyway.

The bottom line is everyone is different and it's impossible to know how it will go for you.


I always wonder if I had amnesia too because I dont remember it being bad. I just remember that I needed to be sure to take my pain meds and I was good.


My dr had said that once baby a comes out, baby b can turn and make things more difficult so I was always good with having a scheduled c section.

 

I would definitely do vaginal for the reasons you gave. I was induced with my twins right around the same point as you're at now and I had a great experience. Your OB will be prepared for a c-section if things don't progress as hoped. Good luck!

 

For what its worth, I am a veterinarian and my husband is a surgeon; and i opted and preferred to have a c section. It worked out great for me and I don't have any regrets.

kim

 

Tough decision. I'm actually a little glad that the decision has been removed for me. My OB has assured me I'll have a c/s as baby A is 45% smaller than baby B. Just too risky. However, I'm a bit intrigued at their epi/spinal cocktail they do here. I'm going to get more information, but all I know so far is that it's a half and half effort which helps eliminate those nasty spinal headaches.

Good luck with your decision and can't wait to hear your good news on Monday. Congratulations!

 

I planned to have a vaginal delivery- both babies were vertex, and ended up weighing 5# 10 oz at birth. I was induced at 36 wks 4 days, and DS was born vaginally after 10 minutes of pushing- good boy! DD, however, decided to be dramatic and prolapsed her cord, requiring an emergency c-section- they booted my partner from the surgery suite, knocked me out and had her out in just a couple of minutes.

C-section recovery wasn't too bad, but the tear I had from DS's vag bith was uncomfortable.

I'd do it the same way, planning for vaginal, even knowing what I know now.

Good luck! Can't wait to hear how it goes, my thoughts are with all of you. :hug:

 

I had a c/s with my girls, only because baby "a" was breech. I would have LOVED to have had them vaginally but it didn't happen. The operation went well, it was the easy part. Brooke who was baby "b" inhaled some amniotic fluids and had to be in the nicu for 18 hours. That might not have happened if she was born vaginally, not that I could have changed the situation. Also the recovery was really hard for me. I'm really hoping for a vbac next time. I can understand that it is a hard decision to make, I would pray about it and then decide. Honestly if I had the choice I would prefer to deliver vaginally for all the same reasons that you listed. Do whatever you feel is safest for you and your babies Good luck!

 

I also had a c-section with the twins and then a VBAC with my 9lb9oz singleton. Having done a vaginal birth, I would do it again in a minute. It would have to take extraordinary circumstances to make me have another c-section.

While I had no complications, I wouldn't have called the c-section recovery easy. Especially compared to my vaginal birth. I was induced with both pregnancies and labored 18 hrs with the twins and 48 with my singleton. The only real problem that arised during my VBAC was directly related to my past c-section. When they broke the baby's water, the contractions started really irritating my c-section scar and it hurt bad. The 30 hours before that were fine. It took over a week to even begin to feel a little normal following my c-section whereas I was doing pretty well within a day of my vaginal birth.

One thing to consider when deciding to induce is your Bishop Score. It takes into account your dilation, effacement, etc. and predicts how successful an induction will be. You can look it up in google. If you have a low Bishop score, your chances of a successful vaginal birth are small. That was how I was with the twins. With my singleton, my bishop score was right at the bottom of the "acceptable" range.

Below, I've linked a study where they actually compared the outcomes of vaginal vs. planned c-section births for twins were Baby A was breech. Surprisingly, they didn't have more negative outcomes in vaginal births versus c-sections even in that situation.
http://cat.inist.fr/?aModele=afficheN&cpsidt=18430083

As for c-section risks, in addition to more short-term breathing problems, babies born by c-section are more likely to have asthma later in life. They could also be cut and have double the risk of a prolonged stay in intensive care. Hospitals are not somewhere you want your baby to be in for any more time than necessary because there are so many mistakes made and germs floating around. It is very easy for a relatively healthy person to get quite sick just due to a simple hospital stay. It's not the fault of the doctors or nurses, it's just a symptom of the place.

In your situation, there is no clear cut right and wrong. You just have to decide what is best for you. Good luck tomorrow!

 

I would have given anything to have a vaginal birth with the twins, but A was breech and B was transverse. Labors were hard for me, but recovery was much better than with a c-section. The c-section was great cause I avoided labor, but the recovery was hard. I had two infections and didn't start feeling way better until about 7 weeks postpartum. Let us know what you choose.