Vaginal delivery and epidaural question

As I prepare for these babies, I'm in discussion w/my OB about a birth plan. Although she has personal experience doing breech extractions, I'm getting a lot of resistance to her saying she would actually do one - basically she's saying that from a legal perspective, if anything is wrong w/Baby B, it's a liability issue. The fact that we live in Washington, DC, the most litigious city in the country, does not help!

So, presuming that the babies cooperate with my daily exhortation to get vertex (I'm 28 w. 3 days, so they still have lots of time to move,it seems); I'm wondering how many of you who delivered vaginally had an epidaural.

She's telling me that they like to do one proactively, in case we end up needing an emergency section. But - if possible,i would like to do a med-free birth both for the babies' sake and my recovery sake.

My understanding is that the number of emergency sections is low, so I'm wondering how far to push the epidaural issue. Obviously I want the safest delivery for the babies, but i'm struggling w/how to weigh the issue of what IS really safest and best.

Tks for your input!

 

My OB recommended an epidural, not because of the chance of a c-section--if you don't have the epidural and they need to do a section, then they will have to knock you out, but in case she needed to reach in to grab the second baby. She put it as "you really don't want to have to feel that!" I ended up having a c-section anyway, so it was a moot point.

 

My doc didn't really tell me an epidural was a must. I had no intention of going with out, but about the 3rd contraction I was begging for the meds. When it came down to it, I was glad I am it, because we had a little scare and we thought for a minute after Gracie was born we were going to need a c-section and I really wanted to be awake for it. It turned out I didn't need a section, but I was glad I was prepared had I needed one. I wouldn't have wanted to miss that experience for the world.

 

I wasn't told to have an epi either, just reccommend. I was induced & after they broke my water the contrx were pretty intense so I opted for an epi. I ended up getting an epi and something a little stronger because the epi alone wasn't cutting the terrible pain I was having in my right hip area.

I was happy to have the epi...it made things more enjoyable after the delivery.

 

I am in No. VA - what ob practice do you go to? During my pregnancy my ob told me that if both babies were vertex they would like me to do a vaginal delivery but they recommended I get an epidural just in case they need to wheel me back for a c section. By the end both babies were in fact vertex but the head of the practice changed his position and said I should do a scheduled c section because Baby B was bigger, and they saw a high risk of me needing a c section anyway after delivering Baby A. Who knows if this is actually what would have happened - Baby B was 6 lbs 14 ozs and I probably could have managed it - but I listened to my doctors and did the scheduled c section. But I just wanted to let you know what my ob's position was about the epi.

 

My doc told me that I needed to get an epi for all of the reasons the PP's have mentioned. I don't know how flexible she would have been because I had no intention of not getting one.
Both babies were head-down for my entire pregnancy and my OB kept telling me that I would most likely have a vaginal delivery. Well, I ended up being in labor for 18 hours because neither baby could drop enough to press on my cervix. They both wanted to come out I never dilated past 6 cm and finally I opted for the section because I was soooo tired and wanted the babies out. Who knows how long it would have gone on for?
We kept waiting for one to back off and let the other pass but they never did. I will say that neither baby was in distress, I had just had it by then and asked for the section. The doc on call agreed but didn't want to pressure me into one so she was waiting for me to either ask for one or until she couldn't wait any longer.

 

For me, baby A was vertex and B was breech. My doctor had no problem with doing a breech extraction for B. I had an epidural and delivered in the OR. Baby A was vaginal with no problems. Then she tried to get Baby B. She could not get him out no matter what. She said in the 20 years she had been doing this, it was the first time she couldn't get the second baby out. This was also a perinatologist.

She decided to do a C-section. Then his heart rate dropped to the 80s. It became a VERY emergent C-section. They kept pinching my belly and asked if I could feel it and I could. Even though I had the epidural, I still had quite a bit of feeling and they needed to knock me out completely so I ended up with general anesthesia as well.

I would most definitely get an epidural if it meant reducing the chance of having general anesthesia. I couldn't breastfeed or even hold my babies until the next morning. I completely missed Nicholas' birth. I didn't even know if he was alive when I finally woke up.

I didn't inted to have a med-free birth in the first place, so take this for what it's worth. I know you don't want the epidural because of the recovery and for the babies' health, but it's much harder for all of you to recover from general anesthesia.

 

Both my babies had been head down since week 27 and they stayed that way. I did have a vaginal and needed the epidural as soon as my water broke. With the first epidural the guy put it in wrong and after 30minutes I was in pain again and they had to have a different guy come in and redo the epidural. I could still move my legs and toes, I her some people can't. After that I was much happier, until we went into the operating room to deliver. My DD came out just fine, very little pain. But my darling DS decided he liked it in there and didn't want to come down. So 2 hours later, (after my epidural wore off) my DS came out with his hand next to his head. The doctor also had to go and turn him around and with no more epidural in my system it HURT. So I recommend the epidural I just wish mine lasted longer or even better if DS would've come out sooner. I also had slight hemmoraging afterward and the dr had to go in with her hand and remove 2 huge clots - hurt worse than delivering. Hope I didn't scare. I would do all again. Good Luck

 

My ob highly suggested one but i already knew i wanted one. I would recomend them to anyone. I loved mine

 

My first priority when we found out about the twins was to find an OB who would put a priority on helping me do things naturally.

I had a vaginal delivery, no meds (both were vertex, but my OB was willing to do vaginal and no meds for a breech extraction of baby B if that's what I wanted). My OB did have to "reach in an grab" baby B and it was uncomfortable. But it was over quickly and certainly wouldn't have warranted an epi for me.

As I said, my OB was equally dedicated to natural childbirth -- she assured me that the chances of something happening that would require such a quick switch to a C-section that I would need a General were very very slim.

Also, some women go the route of having the epi put in but no meds administered -- that way, you are covered if they need to give you meds, but you can stay all natural if everything goes well.

I encountered lots of people who insisted that I would definitely want an epidural with twins and am very glad that I stuck with my goals and did things naturally. Feel free to PM me if you want more info on my experience!

Kim

 

My OB recommended an epi in case of emergency c-section or "reach and grab" for baby B. She is skilled at breech extractions and told me that the chance of an emergency c-section for baby B was very low (in addition, both of mine were vertex) but said that she'd have to knock me out in case that happened. She also said she'd prefer for me to be relaxed in case of a "reach and grab" or breech extraction. I delivered my son without an epi and didn't really want one this time, but was planning to get one just in case.

As it turned out, I didn't get an epi and everything went fine. My labor was very unique in that I was never in any pain and the delivery was quick and (relatively) easy. My baby B was sunny side up and there was a little bit of repositioning before he was delivered, but it was totally manageable for me. I intended to ask for an epi when I got uncomfortable, per my OB's suggestion, but that just never happened for me.

Good luck!

 

I just had my twin boys on Jan. 29th. Both were head down & I delivered both vaginally with an epidural. My ob suggested it also in case we needed a csection. Everything went perfect & didn't end up needing one. Baby B was bigger but still no problem, they did have to adjust his arms, they were over his head. The epidural made the experience so enjoyable, I had one with my first son & knew I wanted it again. I could relax & enjoy the experience with my husband. The actual epidural was easy, compared to the contractions & the recovery was quick. I didn't think there was any risk to the babies by having one. I would recommend it!!! I was in labor with my twins only about 4 hours, so it didn't slow it down at all. Good luck, it is the most amazing experience you will ever have.

 

quote:
Originally posted by NYCmom:
My first priority when we found out about the twins was to find an OB who would put a priority on helping me do things naturally.

I had a vaginal delivery, no meds (both were vertex, but my OB was willing to do vaginal and no meds for a breech extraction of baby B if that's what I wanted). My OB did have to "reach in an grab" baby B and it was uncomfortable. But it was over quickly and certainly wouldn't have warranted an epi for me.

As I said, my OB was equally dedicated to natural childbirth -- she assured me that the chances of something happening that would require such a quick switch to a C-section that I would need a General were very very slim.

Also, some women go the route of having the epi put in but no meds administered -- that way, you are covered if they need to give you meds, but you can stay all natural if everything goes well.

I encountered lots of people who insisted that I would definitely want an epidural with twins and am very glad that I stuck with my goals and did things naturally. Feel free to PM me if you want more info on my experience!

Kim

I'm really glad you posted that, Kim. It is proof positive that a med free birth is possible even though so many people look at you like you have two head to even suggest such a thing.

Like Kim said, you can have the epi put in place without medicating. It may be the "compromise" that will please your doc and still allow natural childbirth for you.

I personally encourage you to do natural. It was SOOOOO much better with Wesley to be med free than my previous experience where I could barely enjoy the time with my children because I was so drugged up. Even a "simple" epidural affects you.

And trust me, I would have MUCH rather pushed out a couple of normal vertex 5 or 6 pounders than one sunny side up 8 pounder.

 

Like PP mentioned - you can have the epi put in as a precaution, w/out any meds unless a c-section is needed...

That being said - I am so very very happy I had the meds! Even w/my little guys it hurt! I needed an episiotomy and they had to reach in and pull baby B down...but that was part of my plan from the beginning. Do what you feel comfortable with.

 

Please explain to me what are the recovery factors that the epidural brings? I have no clue what they could be.

I had my girls vaginally, epi. Both were head down the entire pregnancy.

 

Hi,

My OB also recommended that I have an epidural. I had planned on trying to go naturally but after 6+ weeks of off and on contractions and then 2+ days of intense contractions I decided last minute to have the epidural. I was in excruciating pain and had I not had the epidural I think I would have literally gone nuts.

I had the epidural during labor and then it was turned off during the delivery because I was having difficulty pushing. So I did infact feel everything during the delivery and was completely aware after they were born. I think the epidural just gave me a little time to 'relax' during labor and save my energy for the actual pushing part.

BTW: This is coming from a person who was adamently against any pain medicine. I think you will have to make the final decision when the time comes.

 

I thought I'd add that if you plan to go meds free, I highly recommend using a hypnosis program as preparation. I'm a pretty skeptical person by nature, and was dubious about the elaborate claims of the hypnobirthing crowd, but I really had a good experience. It wasn't a pain free experience (like the programs tout), but the relaxation and self hypnosis techniques really helped. I bought both Hypbirth and Hypnobabies home kits. They are pretty similar, but I preferred Hypnobabies.

Kim

 

quote:
Originally posted by sharongl:
She put it as "you really don't want to have to feel that!"


I can definitely agree with Sharon... I had a c-section but I am glad I could not feel anything.. I can imagine an entire hand going up THERE would really hurt! Congrats on the upcoming birth of your twins!

 

I delivered my twins vaginally, with twin B (William) a breech extraction who weighed half a pound more than his brother. As some pp's have suggested, I had an epidural inserted early in labour, then kept it at a low level after the initial "test" dose of meds, then they cranked it up for the breech extraction. I had a VBAC, so I was worried that if I had a strong epi, I wouldn't be able to feel if anything was going wrong (like uterine rupture). In the event, everything went perfectly & I was very happy to avoid another c/s.

 

I wanted the same as u as natural as possible. The agreement I came to with my OB woz. They would put in the epidural Line!! without the medication and then if they needed to put in the medication they could do that for the the 2nd baby he said the same as above, I might have to reach right up inside. As it turns out I ened up with C section after trying to induce me for 48 hours with ZERO dilation.

Good luck



amanda (jessica and jorja 3)

 

Let me start by saying if I had a 5th pregnancy, I would get another epidural. But, an epidural is a procedure, and procedures all include a certain risk factor.

With my first dd, I was gung-ho to go med free, but since I was induced and had 24 hours of pitocin in me before my water broke, I had major pain and called for the epi. But, the epi ended up going up instead of down, didn't take away the pain but started shutting down my heart and breathing. My blood pressure was 40/10 at one point and they had to counter act it to shut it off. But, when it came time to push, I pushed through the pain and it didn't seem to hurt too awful bad.

My second dd I thought there was no way I was having one. But, as labor progressed (my water had already broken), I immediately changed my mind. This one was wonderful. I could feel the contractions, but they were so not painful. I could feel pushing, the babies, everything, it just took the pain off. I LOVED it. My third ds wouldn't drop and I had terrible back labor. I just got the epi. immediately and was glad I did. Eventually the nurse had to externally push my ds down to engage (which I heard was a painful procedure), but the epi. made that doable.

My 4th time with the twins, I had one immediately because baby A was head down, baby B head up. So, just incase we needed a section, I had the epi (although I would have done it anyway). We ended up fine with both babies, but I'm glad I had it again.

So, it's up to you. It's such a personal decision, but consider if you do end up with an emergency C-section- do you want to be out for it? Good luck with your decision and your birth!!!

 

As the PP just said, you can have the epi placed without the meds given to appease your OB and in case of emergency c-section. Most OB's will not willingly perform a vaginal multiple birth without the epi for previously stated reasons and litigation. Their malpractice insurance is the most expensive in the country and many OB's won't even deliver babies anymore because of it. It sucks.

That said, I delivered my twins vaginally and without meds. However, I did try to get an epidural, it just doesn't work on me.They reomved the epi before we even went to the delivery OR. My twins were my second delivery and the epi didn't work right with my first son either! I felt every moment of it and it wasn't so terrible. I would actually forget about the epi if I were to have another child. I will caution you that if this is your first delivery, things can and usually do, go very slowly. My first labor and delivery was 22 hours long and I pushed for 2 1/2 hours of that. It was really, really difficult and I had wished the epi had actually worked! They tried 3 times to place the thing right and just when it did, my OB ordered it be turned off so I could feel to push. As for recovery. you can be up and walking around as soon as you can feel your legs, which is usually within an hour of the time they turn it off. Many OB's turn the meds off for pushing so you can feel some of what you are doing, so it may wear off before you're even done pushing them out.

Back to the twins' delivery, my OB had his hand up there after A was born to keep B from moving out of the head-down position and I did not even notice it. My contractions took a few minutes to pick back up after A was delivered and baby B's heart rate bottomed out when they did return. I feel that if I had a working epi, I may not have gotten baby B out fast enough because I may not have felt EVERYTHING like I did. Trust me, when you can feel everything, you push them out much faster than if you can't. Anyway, I got him out in one contraction and all was well. The twins' labor was only 5 hours from start to finish and I was induced due to pre-eclampsia in both pregnanies. All in all and natural birth is amazing and like I said, I would do it again. Just remember things never go exactly as planned in childbirth and be prepared for all possiblities. Don't be disappointed if you do indeed end up using medications. Enjoy the babies you give birth to no matter how they come in to the world. Your birth story will be all yours no matter what.

Good luck with everything!

Kelly

 

My advice is to ask for an epi "light". I could still feel and move my legs. I wasn't totally drugged up. But the epi took the edge off of the pain (allowing me to concentrate on effective pushing). And if the need for a C arose (which in my case, it didn't), then the anesthesiolgist could have quickly increased the meds because the catheter was already in place.

 

Our boys were yin-yang position and one with head down I insisted on an ob that would deliver a breech 2nd twin. I also went without drugs for all of the labor and was given an intrathecal at the last minute as
I was pushing so my ob could reach in and extract the 2nd twin by the feet. much more humane with painkillers, i'de say...

Both natural and vag. I say fire youR ob and find someone to do what you want. It's YOUR BODY, YOUR BABY AND YOUR PREGNANCY!

 

Most OBs will recommend an epidural for a twin delivery. You don't have to have drugs in it though. If you really don't want one, try to compromise and agree to get it when you are getting closer to full dilation, rather than at the beginning of labor. This way you won't be tied down to the tubes the entire labor. Stress in your birth plan that you don't want drugs flowing through the epidural and you may even want a sign for your door that you are doing a drug-free delivery so people aren't constantly offering the epidural.

 

I delivered vaginally with no epidural. It was against the doctor's advice but I was ok with the risks/benefits and knew that my situation was ideal for no epi. The doctors were not my doctors but those who were on call that I did not know (or like!). My twins were very small, both head down, Baby A was the bigger of the 2, 2 placentas, and I had already given birth to a much larger baby med-free in the past. They wanted me to get the line put in "just in case" but I'm not opposed to drugs, I'm just opposed to needles in my back, so that was not a compromise to me. If everything had not been ideal (and my original OB had promised me it was safe to deliver without the epi in my case), then I would have had consented to it, but I don't think "every" twin mom should have to have one against her wishes. The risks of a truly emergency c-section when everything has been looking perfect is really low.

 

quote:
Also, some women go the route of having the epi put in but no meds administered -- that way, you are covered if they need to give you meds, but you can stay all natural if everything goes well.


This sounds like a great solution!! I know that MOSKI just had to be knocked out for her 3rd and didn't get to experience her twins either, so you might like this option just in case. It might appease your OB and you might decide that you really do want the meds.

No one can tell you what you will decide! My advice is to keep an open mind to the options. Best wishes for the remainder of your pregnancy!

 

I actually asked my OB for 2 epidurals . . . one for each baby! I had a vaginal delivery with both babies. I felt the contractions, pushing, everything. I was glad I wasn't in intense pain because I wanted to enjoy the experience as well.

 

I took Bradley Method birth classes and really wanted to go med free. However at 37ish weeks, I went to a routine visit and was told that I had beg. preeclampsia and to go across the street and start induction. (DH and I had been hoping to to change docs mind about inducing me the following week.) I was very disappointed to not go into labor naturally, but followed doc's orders.

I waited until 7cm dialation before getting the epidural. I refused all other drugs which seem to only dope you and baby, but not really help with the pain. I am glad that I did have the epi looking back. The pain was doable, but I got scared that something might happen and how much worse would the pain get. When it came time to push, I asked them to turn down the epi so I could feel to push. I ended up tearing VERY BADLY after the episiotomy that I didn't want caused Baby A to fly out on the next push. Since Baby B stretched out with all the room, we had to wait almost 1 1/2 hours and up the pitocin (but not the epi)so I would dialate again, so I felt just about everything. I was very tired by the time we were ready for baby b and almost had an emergency c with her. I was just glad at that point to have 2 healthy babies. In the back of my head, I kept thinking about my father's twin (baby b) who didn't survive due to cord prolapse or entanglement, so I was very nervous.

As for recovery, it was very hard, but not because of the epidural. I had developed hemerroids from pushing, torn horribly, and become anemic from lots of blood loss, but I would do it all over again. I am proud that I had the girls vaginally though I wish that we'd had a smoother recovery since I felt that hindered our ablility to breastfeed. If anything, I would have refused the episiotomy, though I think that is the only way my doc felt comfortable letting me have my girls vaginally. Liability becomes a huge issue for docs and they don't like to take chances.

GL to you. You've heard some great ideas already. Just remember that the most important thing is healthy babies. Now that my girls are 2 1/2 no one cares or asks how they were born.

 

Thanks all for your insight and suggestions!

I really appreciate the notion of not having the line put in til I'm mostly dilated (although the thought of having to sit still through contractions as they put needles in my back is a bit disconcerting), and having the line in but no drugs running through automatically.

That seems like a good compromise -I will discuss w/my doc (whom I love by the way, it's a two person (woman) practice and they have been GREAT: responsive, they spend time w/me each visit answering all the questions I have, they respond quickly to email questions....i feel very fortunate.

I have no intention of being a martyr to drug-free birth; of course i I want the best for my babies; it's just that I don't like the notion of 'automatic' anything, just because they're twins. I know lots of women locally whose doctors won't even CONSIDER vaginal delivery for twins -regardless of their position!

Now - I keep singing to the babies: HEADS DOWN! LOL

 

I had an epi with my vaginal vertex, breech extraction delivery. Im SOOOOO glad I had that epi as well...seeing a hand at my belly button moving around wouldnt have been so pleasent without the epi and she spent a bit of time in their turning him so he could come out properly footling breech....
Mostly I did it incase of csection where i did not want to be knocked out and not see my babies.

 

quote:
Originally posted by Jordari:
I really appreciate the notion of not having the line put in til I'm mostly dilated (although the thought of having to sit still through contractions as they put needles in my back is a bit disconcerting), and having the line in but no drugs running through automatically.


I'd be careful about waiting too long: When I had my dd, I didn't get an epidural inserted until I was fully dilated and already pushing (she was posterior, and there was a 'lip' of cervix that she was caught on), and it was awful trying to hold still on my side while they inserted the needle - I had to have 2 nurses holding me down! Also, when I got my epi with the twins' birth, they had to put some meds through the tube to confirm that the epi was in the right place. It took about an hour for this dose to wear off

 

My babies were both positioned perfectly, head down, going into delivery. I, having delivered three babies with difficulty before, really wanted the epidural. This was going to be my last delivery & I wanted to enjoy it. My daughter was born no problem. Right before she delivered, however, my son turned breech. He was born by breech extraction (all 7 lbs 13 oz of him), and it was not comfortable even with the epidural. I really can't imagine what it would have been like without it. I think pain control is a personal decision, but with twins you need to be aware that a breech extraction or emergency c-section is a big possibility. If you still want to do it naturally, I say go for it!

 

My baby A was headdown and B was shown to be smaller than A, so my docs let me go ahead and try a vaginal delivery ... I was admitted at 11 AM and got an epidural at 2 in the morning since I was only dialated to a 2 and she thought the epi would relax me, plus we wanted one in place just in case a C was needed. Fast forward after 27 hours of labor and I ended up needing an emergency C-section, so good thing the epi was in place.

I was up and down on getting an epi and wanted to hold off on it, but I am very glad I did - with a twin delivery you just never know what would happen. Plus, baby B turned out to be a pound heavier than A, so I probably would have had to have a C with him anyways.

 

My boys were both head down and born vaginally, but after the first one was born the second started moving around and my doc had to reach in up to her elbow to turn him around so he could be delivered head first. I wanted an epidural anyway, but after that I was really glad I had one.