vaginal delivery

We are 37 weeks along and both babies (mono-di boys) are vertex. They are planning a vaginal delivery and I'm thankful, but I"m VERY nervous that after baby A is delivered that baby B will turn w/ all of the room in there. I have a friend here whose dr. had the nurses clamp down on baby B w/ their hands so that B wouldn't turn. My dr. said he won't/doesn't do that. He said that the cervix can close up and you might have to basically "start labor all over again" and he plans to do an US to determine how B is positioned and proceed from there.

My question is....1. how many of you have delivered baby A vaginally and then had to have a c-section b/c B turns breech (my dr. won't do breech delivery)
and 2. Do any of your drs "clamp" down on B to make sure they don't turn (or do they use other techniques.

I think my greatest fear is having to recover from a vaginal AND c-section delivery....YIKES!!!

If you have any advice for me or something for me to ask my dr. to do etc. I would appreciate it!!!!

 

I had a vertex - breech presentation and was hoping for baby B to turn to vertex but he did not, so I ended up with a breech extraction. I haven't heard of many last minute turns but I am sure it's possible and I am sure it has happened. It's a shame your doctor won't or can't perform a breech extraction because it's a safe, easy and quick way to get a breech baby B out. What's his reasoning behind this? No experience / proper training or any other reason?

 

My dr. said that he wouldn't do it b/c it's too easy for the baby to tilt it's head back (I think that's the direction he said) and then get stuck in the birth canal. I don't know....that's just what he said. I don't want him to do it if he's not comfortable w/ the option, but I am going to be really frustrated if B turns and there was some way to prevent it from happening. That's why I was hoping that others may have had experiences with this.

Thanks for responding.

 

QUOTE(mindyd @ Sep 4 2008, 11:35 AM) [snapback]962960[/snapback]
My dr. said that he wouldn't do it b/c it's too easy for the baby to tilt it's head back (I think that's the direction he said) and then get stuck in the birth canal. I don't know....that's just what he said. I don't want him to do it if he's not comfortable w/ the option, but I am going to be really frustrated if B turns and there was some way to prevent it from happening. That's why I was hoping that others may have had experiences with this.

Thanks for responding.


I've never heard of that tilting the head back. My doctor would do breech extractions, and he also said if Baby B shifted to breech, he could also do either an external or internal version (I think that's what it was called - basically pushing on my stomach from the outside, or reaching up inside and turning the baby to head down). Your doctor has to be comfortable and have experience. I agree with the PP, breech deliveries can be easy and no issues, but you want someone with experience. For what it's worth, my doctor told me that many breech babies turn to head down once the first twin is out. Something with the weight of the head and all that space. So if that's the case, a baby that's already vertex probably wouldn't turn to breech because they'd be fighting gravity and the weight of their head.

 

my dr said he would do a breech extraction if he needed to with baby b.
thankfully he did not need to.

 

My baby B tried to turn after her sister came out but another Dr was sort of keeping her in position from the outside. They were applying pressure to my stomach and she only ended up turning face up. He used the vaccum to turn her back face down and I delivered within a few minutes. It happened so fast I didn't have time to even notice the vaccum.

 

There is a way to prevent baby B from turning and it is what my Dr did. He went in (practically elbow deep) vaginally and grabed baby B's head and held it in place until my contractions started back up and he could guide him into the birth canal. He said he almost always does this with twins delivering vaginally. I did not feel it and I was working with no pain meds except a numbing shot in my perineum (sp?). I have heard of other OB's doing the same thing, so it's not just mine. He has tons of experience delivering twins and would also do a breech extraction, but he prefers head down it he can help it. My boys were also mono/di, and we had no complications at all. If your OB is not comfortable or experienced delivering Mono/di twins or twins in general, I would not attempt a vaginal delivery and I am all about a vaginal delivery! I just think there are too many things that can go wrong and if he isn't comfortable or experienced, he may rush you to emergency surgery before trying something a more experienced Dr would do. Baby B needs to come out fairly quickly once A is out, so you may need pitocin (I did, but I was induced) to start contractions again. My cervix did not close down, but there was an arm in the way. I hope everything goes well for you and your delivery. I also hope you have wonderfully healthy babies!

Kelly

 

My baby B was transverse and the Doctor and nurse and intern and everyone else in the room it felt like, put their hands on the outside of my belly and pushed and guided her down into head first position.

It hurt like heck but it was worth it to not need a breech extraction or C Section!

 

Mmm, very interesting. For some reason I get the impression that it is harder to keep the baby in the same position (head down) than just simply get out by breech extraction IF the baby actually does end up turning. Especially if there is already a arm in your birth canal .

My breech extraction was so quick and painless, I have trouble seeing the problem of this procedure EXCEPT when you have a doctor who is not willing / capable of doing it.

That said, I would still try vaginal ... I think the % of babies (B) staying in the same position is higher than the ones who flip. If you choose c/s you'll have a c/s for sure. If you go for vaginal, you still have a chance to avoid c/s.

 

I wouldn't worry too much about it -- when I went in to be induced, baby B was full-out breech. My doctor wasn't worried; he said once baby A is born, Baby B would likely turn, but if not, he could reach up and deliver baby B feet-first. Luckily, Baby B turned perfectly and was born without incident. I'm sure there are times (and people here have been through them) when the second baby is born via C-section, but it doesn't happen often. Good luck with your delivery!

 

I had a vag. and a c-sec delievery with my twins. I wasn't expecting the c-sec for the second one, since my doc is an expert in them and said "she loved breech extrations". After a was out b was still transverse, she went and tried to grab feet but could only get a foot. There was a ledge or lip if you wanan call it that and couldn't get him out,so I got the c-sec. The only bad part was durnig the pulling was awful, even all doped up. But I got up and around 12 hours after and went back to work pt 16 days later. Good luck whatever happens, ya never know!!

 

I've had 2 sets of twins, both born vag. and both births (two different Dr's) did the same as a pp said - he went in and pulled baby B down to my birth canal and then had me push the baby out.

 

My peri never said anything about the head tilting back. My peri was very comfortable with a breech delivery. My A was vertex and B was breech and after A was born, the 2nd doctor reached in to guide my B down the canal, she was born 3 pushes after her sister , took 3 mins between them. My peri said he preferred a breech delivery instead of trying to turn her around due to prolapsed cord.

I have never heard of B turning around from vertex to breech after delivering A. Maybe they could simply guide the baby down the canal so that its born vertex.

Good luck

 

I had a vaginal delivery with my girls. Baby B was born bum first. She was born 1.5 hours after her sister because the Mag I was on for pre-e stopped labor. She had a ton of time to turn but she didn't. The Dr just delivered her the way she presented when labor finally started again.

I'm glad my Dr was experienced delivering twins vaginally, especially with one breech. At our hospital, not many of them are anymore. I had a room full of nurses looking up my $%$# as they had not seen a breech birth lately, let alone a breech twin. It's a bit of a shame - there are way too many c-sections.

 

My Dr. told me the same thing. He tried to stay away from breech vaginal deliveries for the safety of the baby. Both my girls were head down, after the first was born, they did an ultrasound to make sure the other was still head down, she was so I was fine. Something to think about....They gave me an epidural b/c if the second would turn they would need to do an emergency c-section. The epidural would allow me to remain awake for the C. If I did not have an epidural they would have to put me to sleep,because we wouldnot have the time to wait for the medication to take affect. They also wheeled me in the OR to deliver just to be on the safe side. None of it was needed b/c she didnt turn, but it was nice to have all the bases covered just in case.

 

QUOTE(beg4books.com @ Sep 7 2008, 04:29 AM) [snapback]967340[/snapback]
My Dr. told me the same thing. He tried to stay away from breech vaginal deliveries for the safety of the baby. Both my girls were head down, after the first was born, they did an ultrasound to make sure the other was still head down, she was so I was fine. Something to think about....They gave me an epidural b/c if the second would turn they would need to do an emergency c-section. The epidural would allow me to remain awake for the C. If I did not have an epidural they would have to put me to sleep,because we wouldnot have the time to wait for the medication to take affect. They also wheeled me in the OR to deliver just to be on the safe side. None of it was needed b/c she didnt turn, but it was nice to have all the bases covered just in case.

I had an epidural as well, just for the possibility of an emergency c/s but B turning to breech (in my case he was breech already) is not an emergency in my doc's book (or mine). Breech extractions are considered a safe way to deliver a second twin. Unfortunately a lot of docs are not well trained these days.

http://findarticles.com/p/articles/mi_m0CY..._38/ai_98830104

http://www.ncbi.nlm.nih.gov/pubmed/7485286 (difference between external turning and breech extraction)