37 weeks, twin girls, natural or section?

[lisajcoleman1]

Baby A is head down and ready to meet the world.

Baby B is transverse, laying on top of baby A.

Ob is insisting on a C section in 9 days.

There is a 50% chance baby B will be breech.

The doctor is adamant about the planned C section, because she wants to avoid the risk of baby B going into breech position after baby A comes out.

My wife and I are upset because we had a detailed natural birth plan.

Can someone weigh in with some wisdom on the risk of pushing for natural and declining the Doc’s recommendation for a planned C section?

Please and thank you

 

[bobfeed123]

@lisajcoleman1 I would trust the doctor’s recommendation. I did not have a birth plan with my twins because there are too many unknown factors.

 

[sussi]

@lisajcoleman1 First of all, going in with a detailed birth plan is a sure-fire way to make yourselves miserable and upset when anything/nothing goes "to plan".. you might want to open it up a bit. I've seen too many moms be upset instead of happy over their births because they didn't go according to plan. As long as everyone is safe and healthy, that's all that really matters. You can go in with some idea of what you want but I've found that babies (especially multiples!) are super unpredictable and you just have to go with the flow! Even if delivering vaginally, you will most likely be in the OR because they will be on standby for an emergency CS in case it is needed. This is common for a multiples birth!

I went in open to anything. A was head down, B was transverse basically up in my rib cage. We opted for a CS to make sure everyone, including me!, made it out healthy and safe (and the idea of the OB potentially having to "manually manipulate" B out made me nervous). I'm so glad we did the CS because after getting the twins + placentas out, my OB was able to see that my uterus wasn't properly contracting down and that I started hemorrhaging (the hemorrhaging was most likely due to the fact I had developed preeclampsia/HELLP and was on meds for that). They used a newly developed JADA device to help with my "boggy" uterus. I'm not sure what would've happened otherwise! I had a wonderful team and recovery wasn't bad at all.

My friend just had twins and she was able to have them vaginally! Her water broke at 36w. As soon as A was out, she had to push another 45 mins because B flipped and went up high.. once B was out, they were "stunned" because they had a cord wrapped around their neck. She only tore a tiny bit (the dr made a super tiny cut because they could tell B was stressed and needed to get out ASAP) but basically recovered super easy because of how well her birth went. She did have to go back into the hospital a few days after being discharged because she developed preeclampsia a few days later. She couldn't visit the babies in NICU while she was on the magnesium drip, but they did let her husband facetime them in. Life is so unpredictable and it sucks but you can't get too stuck in the details.

 

[abctradelinks]

@sussi Wanted to comment on this specific comment because the same thing happened to me after my C-section (with 1 baby breech and the other transverse). I lost half my blood and if I hadn't been in an OR, I would likely not have made it. OP, don't risk your partner or your baby's lives just because you have a 'detailed birth plan'. Most things you read about 'natural' birth (by which you mean 'vaginal' - a cesarean is not 'unnatural') are about singletons! Having multiples is a completely different story, physically. We're lucky to live in a time of so much medical advancement, if you trust your doctor I would listen to them

 

[matt97]

@lisajcoleman1 Echoing that having a detailed plan is setting yourself up for failure. Also, it’s vaginal (not natural) or c-section, there’s nothing “unnatural” about giving birth.

Having said that, if you are insistent about moving forward with a vaginal delivery, then there are some things to consider. Is there any signs of impending labor? Will there be an induction involved? If she needs to be induced to start labor, there’s a chance that she’ll never progress enough to attempt a vaginal delivery. Also induction meds put you at risk for hemorrhage, which is already higher for multiples given the weight the uterus has to bear.

Is she prepared to deliver one vaginally and the other c-section? Sometimes a spinal can not work correctly, so in an emergency situation, she may need general anesthesia- is that something she’s considered?

I had an induction at 37 weeks for rapid onset preeclampsia. I made zero progression in nearly two days. I had a c-section after that. Due to the induction meds and the big babies, I hemorrhaged a lot. I was fine because my team is great, but I was at higher risk because I attempted the induction. I wish I wouldn’t have. I really didn’t even care one way or the other but figured I’d give it a try since they were both head down.

 

[doodlum1]

@matt97 Thanks for the call out on the "natural" phrasing. So many multiple births are C-sections and most of them for reasons beyond our control so it's a little tone deaf especially here.

 

[matt97]

@doodlum1 So true. Also what used to be super “natural” was dying in childbirth and/or stillborns at much higher rates. Not really something I’d be interested in seeing return.

I’ve also been on the healthcare side of watching the outcome of some truly preventable fetal demises and maternal trauma that you can’t just wash from your mind ever. Some have given me nightmares for months after. Providers don’t want to see that outcome for patients.

 

[graceforyou]

@matt97 The double wammy

 

[overcoming1]

@matt97 Same. I was induced for almost 24 hours and barely progressed to a few centimeters. I then had an emergency CS where I lost too much blood and almost got a hysterectomy.

 

[xxmnbvcxx]

@lisajcoleman1 Our babies were presenting this way and I had a scheduled c-section for 37+1 that turned urgent at 36+5. No regrets! Our goal was all of us safe and healthy.

Also all birth is natural—vaginal and c-section.

 

[anna123]

@xxmnbvcxx I always thought a Natural delivery meant no meds?

 

[nirajrana]

@lisajcoleman1 So I had almost the same thing happen to me and I was very upset……..however one of the nurses said something that really rings true.

You don’t want to do anything that the doctor isn’t comfortable doing. Yes, maybe a different doctor WOULD be comfortable but unless you can find a different doctor who is comfortable with delivering the second twin breech in 9 days (unlikely but feel free to try)…..you don’t want someone who isn’t familiar with breech delivery trying it for the first time on you.

Yes, that’s upsetting, but just the truth. Also, unfortunately there’s not a lot of control with twin births.

In my case, turns out Baby A, who was head down, had her cord in front of her head. If I had attempted labor, her cord would have prolapsed cutting off her oxygen supply and resulting in an emergency c section. It’s good to listen to the doctors

 

[all]

@nirajrana This should be way higher!!! OP, It sounds like your OB will not deliver B breech. That means your chances of having one vaginal and one C-section are way higher (and it is already a high chance). To me that would be it.

We are told everywhere that c-sections are bad. But we have posted on this sub how much easier it is to recover from a C-section with two infants than the last couple of months of twin pregnancies. Forget what the world tells you about c-sections (being bad and unnatural!?) and follow the doctor you have.

 

[madria]

@lisajcoleman1 I personally chose to have a scheduled c-section solely because I didn’t want to have to recover from both which is the worst recovery. In the end, neither baby was head down so I would have had to have a c-section anyways.

 

[believer990]

@madria This right here. And having the c section scheduled makes for a much better experience and recovery

 

[catcox]

@madria Same here!

 

[christina1979]

@madria Same!

 

[imcatholic]

@lisajcoleman1 This is your one twin pregnancy. Your doctor has seen many and read the studies and wants to go with a csection at this is considered the best practice in this case. I didn't get an option because twin A was breech. I'm having a repeat csection with my singleton in a couple weeks. I'm a good candidate for a VBAC but I don't want to take the 1%risk of a rupture. I did ivf to concieve my children so to my mind the odds have been against me from the start so I'm not adding any unnecessary risk I can avoid.

Parenting is a lot of weighing risks. If you're ok with the 50% chance that you have to have an emergency csection for twin B, then by all means go for the vaginal birth. I know twin moms who have gone that route and have had both good and bad results. The odds are a coin flip and you could come out on the right side of it. You might get that picture perfect birth plan delivery. It could happen. It just also might not. This isn't going to be the last time you're faced with a choice to make about your kids where you have to weigh the risks vs rewards.

I know a lot of people are very invested in their birth plans and want very curated birthing experiences. The truth is that often giving birth is chaotic and full of unexpected experiences. What you plan for may not be possible in that moment. I do hope your twins arrive safely and your partner had a birthing experience that she feels good about whatever that might be.

 

[overcoming1]

@lisajcoleman1 You already set yourselves up for disappointment with a detailed birthplan. I would listen to the ob if I were you. They have seen way more twin pregnancies than you have experienced. I wouldn’t play with fire with my babies’ health and mine. They know what they are doing.

 

[amy15]

@lisajcoleman1 Not a woman who gave birth, but a dad who witnessed the births of our 4 kids (singleton and triplets). Our first was natural delivery and the triplets were C section. My wife says they both have there moments but would not be afraid to do either again. The scariest part about the cesarean for us was the operating room being an experience, but to the team doing the work it was another day in the office. They were cool as a cucumber and very experienced at what they were doing. Looking back now it was no biggie. Took about an hour all together, mainly time to inspect the babies since they were premies. They were dilvered about 2 minutes between the 3 of them.

From what I know about multiples, opting to deliver naturally will be going into a higher risk that you will start naturally and then have to move to cesarean and you get to experience both sides. There will be a much higher chance you will end up having a cesarean as the doctors will not hesitate to make the call to protect the lives of you and your babies. Our specialist OB told us she would not deliver our babies naturally due to the risks involved.

My suggestion of course would be just to go with the cesarean and eliminate a few risk factors to worry about. You have enough on your plate for that day so simplify if you can.

Also, take advantage of the nurses helping out and get some sleep. Your babies will be fine in their hands and you can get some rest while you recover, same with Dad tol. We learned this on our second go around and we honestly did better the second time around as far as sleeping in the hospital goes.