vag birth or c sect...both twins head down

hi...up til now, for the longest time the twins have been in a 69 position, baby a head down, baby b breech...for the last month they have been both head down and i have had two ob's tell me they won't flip and change positions now.

My ob had prev told me that he wouldn't let me go past 36 weeks (when one was breech) and that he recommneded a c sect, as the risk of a vag birth after 36 weeks hold s lots of risks.

Now he telss me that they are both head down, he said a vag del would be fine and could induce me at 36 weeks, though we wouldnt be making the actual date til i reached about 35 weeks.

I am a but torn...

My prev two del were vag, both induced, first one with pg gel lasting 9hours, and the second with pitocin lasting 2 hours with ecruciating back to back cx.

I had really wanted to try to have the twins vaginally, but after having the first talk with my dr i agreed for the less risky option for the twins, to deliver them by c section. Now i am just confused....should i have them naturally as they are in a perfect position for this, or opt for the c sect still????I dread the thought of surgery and recovery, but i just want to take home two healthy babies.

The dr is totally leaving it up to me, but now that they are both head down he sees no need for a c sect. What should i do????

DH is happy about the prospect of no surgery ( haha)

1) Does anyone have any exp and can help me make an informed decision,

2) and also what is it like being induced with twins for a vag del

3) and if both are head down , after the first baby is born , can the second baby still have trouble decending into the birth canal. Can they turn the wrong way.

4) If there are complications in a vag birth i am assuming a emergency c sect will be preformed. Has anyone had exp with this. Should i have an epidural (havent had one b4) and would avoid one wjere possible, incase i need to be prepped for an emergency sect, i am scared that if i have no drugs (had no drugs with last birth) and need an emergency sect, they will put me under general an.? I don't want to miss the birth of one of my babies.....any help please?

I know the main thing is i am open to change in my birth plan, which i am....i just don't know what my birth plan should be. I want to make the safest chioce for my babies.

Thanks in advance tash

 

I have had a c-section, and then two VBACs, and in my opinion, I would always choose to deliver vaginally. The recovery time is so much faster and easier, and giving birth is an experience I would not trade for the world. I am personally very excited to push out 2 babies. What an amazing experience that most women will never have.

 

You're SO lucky both babies are in the head down position! I'm only 11 weeks preggo, but if I were you, I'd soooo give it a shot for a vaginal birth! Good luck, I hope all goes well for you!

 

my doc gave me a choice too...i have quite awhile to decide but c-section seems safer...sure i could push one baby out and then all of a sudden baby 2 has been stressed longer and hr drops, i dunno...i could be very wrong. seems like alot could happen if i chose vaginal. and also, my mom has has 8 c-sections and im the oldest, so ive seen the recovery process, and its familar to me, it doesnt scare me in a way. i dunno. i told the doc whatever is BEST for the babies, and then me, NOT whatever is easiest for them. he said if i go into labor middle of the night and first baby comes out fine and then second baby wont come and they have to do an emergency c-section, the whatever doc to numb me or whatever it is they do, has 20 min to get there. and ALOT can happen in 20 min...not something i wanna risk

 

Keep in mind that I had my babies in a 69 position (as you put it ) when I went into labor and that baby b was in serious jeopardy (and actually almost died) due to complications during his attempted vaginal delivery.

1. I had the "full birth experience" aka one vaginal and one cesarean. The recovery was rougher than a vaginal delivery for sure, but not unmanageable.

2. I'm sorry, I don't know. I've never been induced.

3. Yes, but it's pretty unlikely they would turn. Quite a few doctors know how to turn a breach baby as well. Usually there's not trouble descending, but sometimes your body just gets pooped out and doctors can remove the baby via c/s or with forceps.

4. Me! I've had experience with it. Do get an epidural if you are able. You can always ask for them to put in the IV but not start the meds unless they need to. That way you'll be prepped just in case. I wasn't able to get an epidural because my labor progressed so incredibly fast. They put me under general anesthesia for Sean's c/s. I did miss his birth and I miss having that memory but he is alive now because of it so I've come to peace with it.

 

There is always a chance that a c-section might have to happen if something goes wrong during the vaginal delivery, but I think trying for a vaginal delivery would be great! The babies might still change around, so you never really know until you go in.....

 

Don't want to make you concerned...but there is still time for your babies to flip. My baby A went from vertex to transverse at 34 weeks!!!
Aside from that with your history of successfully induced vag births I would totally go for vaginal birth! Especially if your cervix is already beginning to dilate and thin out!! I'm not quite sure about why your doc would want to induce at 36 weeks...that seems like 1 week too early unless you plan on getting an amnio to check their lungs. Not all babies are ready at 36weeks.

 

I had no choice but i wanted the section anyway... Mine came at 35 weeks 4 days and were small buthealthy and both came home with me... I was scared of vaginal and then section for the second... The recovery was not that bad for me... I had been through back surgery, 3 lapos and IVF and doing at least 2 if not more shots for 11 months... So it was not a huge thing to me... Best of luck!

 

VAGINALLY, if possible. I delivered first dd vaginally and it was very hard (back labor, 24 hrs of labor, tearing), but when I had the twins by emergency c-section that was WAY HARDER, in my opinion. It is so painful afterwards and your body is never quite the same once you have a surgery. It may be easier the day of, but recover is terrible, you can't hold the babies easily, it is hard to get up and down, really if I had the choice (which I did not) I would have tried for vaginal. Of course, you will accept and deal with whatever comes, to get the babies out healthy and safe, but if you can and have the choice do what nature intended. You did it twice already and can do it again! Good luck!

 

I had a vaginal birth and would do it again in a heartbeat. Both babies were head down, after Baby A was born, Baby B flipped transverse, but they were able to flip her back and she was born 7 minutes later. I don't have anything to compare it to, but it was a pretty easy birth IMO. I'm a little bit leary that your doc wants to induce you at 36 weeks, 37 is considered full term for twins, and my doc wouldn't even talk about induction unless there was a medical reason until after 38 weeks (I ended up being induced at 37weeks5days b/c of increased bp).

As far as the induction process, it went really smooth, I had been 3 cm dilated for weeks, so they started the pitocin at 4:00 p.m., my water broke on it's own at 10:30 p, and the babies were born at 4:30 a.m. I wanted the epidural anyway, but the MD really encouraged it as well just incase they ended up having to do an emergency c-section. I have heard of before that they will place the catheder but not put any meds in so that just in case, all they had to do was put in the meds real quick.

I also remember it being in my favor that Baby B was smaller than Baby A, the doc said even if she flipped breech at the last minute, they could do a breech extraction b/c the path was cleared so to speak by Baby A. I did have to push for about 45 minutes with DS, he came out with a cone head and scrapes on his head, DD just slipped right out with a perfectly round head!!

 

Everyone says I am crazy but I have had two vaginal deliveries and I am begging for a c-sec, I was induced with my first two which to me was horrible but that's not why I am doing it I am doing it so I can get my tubes tied, now I know I can go back and have it done but I don't want to go back 6 to 8 weeks after delivering twins, I want to be enjoying my twins and getting into some sort of routine so while I am open let's get it done and be done!

 

Why does he want to induce you at 36 weeks? That's still early.

I would go for vaginal - that's what I'm doing. Both mine are head down right now. But my doctor also said if A is head down and B is breech, I could try vaginal - which I most likely will. I'm all for doing this as naturally as possible. My doctor also will not induce early, unless at 38 weeks I want to.

 

36 weeks is probably early unless you have an amnio to check lung maturity. My Drs wouldn't consider a scheduled C or induction until 38 weeks.

My babies were in the 69 position when they induced me at 34w6d for pre-e and HELLP syndrome. I had had a vaginal delivery for my DD and I really wanted one for the twins. Baby A was born with 3 pushes. Baby B decided to hang out for a while and enjoy the space. Eventually the Dr broker her water and she was born soon after - 1.5 hours after her sister but happy and healthy.

I've never had a C but my friends looked aweful after them. I didn't have a stitch and was up and running a few hours after birth.

My Dr is comfortable with a breech birth so I didn't worry - just left it up to him. He gave me a 5% chance of having a c after Baby A was born which was an acceptable risk to me.

My hospital strongly suggests and Epidural for twin moms - at least to place the catheter. With an induction, I can tell you it really hurts without one - mine quit working after an hour and no one could replace it for the next 8 hours. OUCH!

Best of luck with what ever you decide.

 

From my personal experience, I would definitely hands down choose the vaginal delivery. I had a c-section with the twins if I had the choice, I would have opted for the vag. birth. My first DD was a vag. birth and it was a breeze. The section was a much longer recovery and much more painful for me. Good Luck with your delivery, I'm sure you will make the right choice for you!

 

QUOTE
1) Does anyone have any exp and can help me make an informed decision,

2) and also what is it like being induced with twins for a vag del

3) and if both are head down , after the first baby is born , can the second baby still have trouble decending into the birth canal. Can they turn the wrong way.

4) If there are complications in a vag birth i am assuming a emergency c sect will be preformed. Has anyone had exp with this. Should i have an epidural (havent had one b4) and would avoid one wjere possible, incase i need to be prepped for an emergency sect, i am scared that if i have no drugs (had no drugs with last birth) and need an emergency sect, they will put me under general an.? I don't want to miss the birth of one of my babies.....any help please?


1) I've had a C-section after induction (baby A failed to descend in spite of full dilation)
2) I don't have anything to compare against but it went fine until the end
3) When A is out, B will move and it's not always in the direction you like but typically a vertex B will follow and if they don't, the doctor can either turn B or deliver breech in many cases (this happened to my SIL and she was glad she had an epidural when it happened)
4) In most emergency situations, they still have time to give a spinal. General anesthesia for birth is unusual and the cases I've heard about were when the epi/spinal didn't work. I had my epi placed early and they gave a test dose but then the pump was left off until I wanted it on. The anesthesia prep for a section was just them giving me a push dose.

My section recovery was much harder than any of my friends' vaginal delivery recoveries so I'd go vaginal if I were you.

 

I would go vaginal as well. I've had both and the vaginal delivery was much easier to recover from (even though it was a 2 day induction) and it's also better for the babies because it helps get their lungs cleaned out. Because of complications, I was induced with the twins and it wasn't successful. Honestly, it wasn't difficult at all but I never progressed because my body wasn't ready to have the babies yet. My 2 day induction with Dax was hard but still way better than the c-section totally worth the wait. If you can hold off until 37 weeks I'd do that though to give your body a little more of a chance to get ready for birth. That will increase your chances of a successful vaginal delivery.

 

Both of my girls were head down and I opted for a C-section. I had my first son vaginally and both "birthing experiences" were memorable. The recovery was longer with a C and it is more painful, but manageable as long as you don't skip your pain meds (mine was only a stronger version of Aleve). I was too afraid of something happening to baby B (my Allison) and I thought the risk was great enough to choose the C-section. My girls were no worse off for having gone through a C. As a matter of fact, they had less issues than my son and were three weeks earlier than him.

You have to keep in mind that a C is a major surgery, unlike having a vaginal delivery. And there is recovery time involved. When you have a C you can't do any heavy lifting or pulling and you do have to have help getting up and down for a while. This is not so with a vaginal. You also can't exercise for a while, but I had no more trouble getting in shape afterwards with a C.

Both C-section and vaginal has its pros and cons.

 

QUOTE(HinSD @ Jan 22 2008, 11:49 AM) [snapback]583960[/snapback]
Why does he want to induce you at 36 weeks? That's still early.

I would go for vaginal - that's what I'm doing. Both mine are head down right now. But my doctor also said if A is head down and B is breech, I could try vaginal - which I most likely will. I'm all for doing this as naturally as possible. My doctor also will not induce early, unless at 38 weeks I want to.



I agree that 36 weeks is early.
I'm going vaginal, without a doubt, unless there is a definite medical reason for me not to do so. I'm not interested in major abdominal surgery, and the complications it involves.

 

I had my girls vaginaly. The hospital where I had them required me to be in the c-section room just in case. My doctor had me get the epidural pretty early on. My water broke at 3 o'clock in the morning. At 11ish the next night they started the Pictoin(spelling) . When the doctor came to check on my, i said i was uncomfortable he was like why don't i have the epidural. I said I was not in pain, but he made me get it then. I had my girls at 7 oclock the next morning. Dani (my twin B) was transverse and they tried to turn her when I was delivering Sydney . Didn't work and she was pulled out by her feet.

 

I agree with your thought of doing what is best for you and the babies. Things can change so quickly that even the best laid plans have to be altered.

I had a vaginal delivery with epidural. Both babies were vertex. Baby B descended right after his brother was born.
Maybe I had a strange doctor, but she would NOT schedule a c-section as long as Baby A was vertex. She would not attend a selective c-section. Her thinking was that a vaginal delivery, when at all possible, was better for mommy and babies. Her confidence made me confident and I just went with the flow.

 

My peri will not give the option. He says unless a baby is in distress or the first baby is not head down he always goes for a vaginal delivery, which I am thrilled about!! I am hoping to be able to deliver vaginally!

 

After having a c-section, if given the option, I would have done vaginally...

 

I had my first two vag and my twins C-sec.

I'd do vag or c-sec anyday!

 

Personally, I am terrified of a c-section. I was with my SIL when she had one, and saw how long the recovery was for her and also for my sister after hers. I pray that mine are both head down! My three daughters were all born vaginally, and all induced. None were easy labors, and I actually had a 4th degree tear with my first. BUT, I would take that any day. I would also take an epidural, especially with induction. These twins will be my last, but even if I have to have a c-section my husband is getting a vasectomy. After giving him 5 kids I feel it is the least he can do! lol

 

I delivered at 39wks 2 days the boys were both 6lbs. 10oz. I was scheduled to be induced but my water broke the day before at 6am, I went in and after a few hours I wasn't dialating past 2cm so they started pitocin. I was given my epidural around 3pm, the rest of the day was comfortable sitting with my family, watching TV, labor started for me at about 10pm that night, I got sick (happens sometimes with the onset of real labor) and was moved into the OR after 12pm ... I delivered Evan after yelling for them to just cut me because I could not push anymore I was too tired, out came Evan and Ian (who went transverse the day before) fell into position I remember the doctor asking if my contractions were coming fast and I said no so he told the nurse to up the pitocin and Ian came a few minutes later...they were 30 minutes apart born at 2:38am and 3:08am.


3) and if both are head down , after the first baby is born , can the second baby still have trouble decending into the birth canal. Can they turn the wrong way. Here is a link on Posterier position http://www.babycenter.com/0_posterior-position_1454005.bc
But with my delivery (and I think it is common with a multiple delivery) they had a U/S machine right there to see the positioning of the second baby.

4) If there are complications in a vag birth i am assuming a emergency c sect will be preformed. Has anyone had exp with this. Should i have an epidural (havent had one b4) and would avoid one wjere possible, incase i need to be prepped for an emergency sect, i am scared that if i have no drugs (had no drugs with last birth) and need an emergency sect, they will put me under general an.? I don't want to miss the birth of one of my babies.....any help please?
I did not have experience with this but their are some women on this site who have delivered this way so I'm sure they can be of more help.

 

QUOTE(Susanna+3 @ Jan 22 2008, 09:15 AM) [snapback]583685[/snapback]
Don't want to make you concerned...but there is still time for your babies to flip. My baby A went from vertex to transverse at 34 weeks!!!
Aside from that with your history of successfully induced vag births I would totally go for vaginal birth! Especially if your cervix is already beginning to dilate and thin out!! I'm not quite sure about why your doc would want to induce at 36 weeks...that seems like 1 week too early unless you plan on getting an amnio to check their lungs. Not all babies are ready at 36weeks.



should i ask for an amnio?

My ob says that 36 wks is the optimum time to deliver twins...I haven't questioned this as i have read this also???...but i will definately ask him about their lungs and the possibility of an amnio.

At this point in time i am going with the majority advice given- a vag delivery with epi in ...but i'll try it without meds first...i'd like to be in control and feel when to push(unless it hurts waaaayayyy to bad)

How long does it actually take once epi drugs are administered through the tubes, b4 pain relief?

Thanks girls for all your advice....will def ask dr about the 36 wks thing.

 

I went vaginal with the same scenerio. My doc never said that going past 36 weeks would be more risky if I went vaginal or because one was breech. Why would you deliver a premature baby if there is no medical reason to do so (position or vaginal delivery are not medical reasons, IMHO). I had a scheduled induction at 38w2d. Baby A was born 4 1/2 hours after they started the Pitocin. My boy was born 4 minutes later by breech extraction. I think too many doctors make us believe that c/s are safer for twins, but it doesn't have to be the case. Plenty of women can deliver twins vaginally without a single problem regardless of the position of B (assuming A is head down). A c/s is major surgery, and is not without risks either. You've been through vaginal birth before, so that's a major advantage. If you feel your doctor is qualified enough to perform a breech extraction (which unfortunately not all doctors are) I would go vaginal.

With regards to the optimum ... 36 weeks is not with regards to the studies I've seen. Take this one. There is a major difference in outcome between 36-37 week and 38 weeks, but the difference between 38 weeks and 39 weeks+ is minimal. My hospital won't deliver before 38 weeks (singletons and twins) unless medically necessary.

http://www.ispub.com/ostia/index.php?xmlFi...vol5n2/twin.xml