Vaginal v CSection Birth

[ntlfr8]

FTM & 31 weeks: will be scheduling my c section today for 37 weeks. My obgyn unexpectedly retired (????) at the end of August and I met my new obgyn this morning. My new DR said that she’ll allow a vaginal birth if both babies are head down, otherwise it will have to be a c section. My old DR seemed more open to trying for vaginal. I was under the impression that as long as one was head down we could give it a try. I’m not against a c section, and have been preparing myself that it will most likely not even be an option. Not sure if I should be advocating for myself more here or just let it be

Question: Did you have vaginal/C-section/both and what were the circumstances around that decision being made? If vaginal how far along were you?

 

[marriedwiththescotts]

@ntlfr8 Vaginal birth at 35+4. Modi twin girls. Both head down. It was a fairly straightforward birth! I wanted to avoid a c section. My doctors were willing to do vaginal even if baby B was breech, as long as A was head down. Thankfully both were head down. It’s a personal decision!

 

[perhaps2day]

@ntlfr8 I'm 33 weeks and recently had this conversation with my OB. I had a vaginal delivery at 38 weeks with my first.

The hospital policy where I'm delivering is first time moms with twins must have both babies head down. Second time+ moms with twins can do a breech delivery but only if one is head down. I guess it's easier to predict complications if you've done it before? I don't really know.

Personally I'm opting for a csection if they both aren't head down. The last thing I want is for there to be complications, need an emergency csection, and have to recovery from a csection and vaginal birth.

 

[terry2xx]

@perhaps2day Having to recover from both a vaginal birth and a cesarian is my nightmare scenario! I'm scheduled for my cesarian next week and both babies are currently breech - so moot point. But I've been nervous about it all pregnancy.

 

[monsour]

@terry2xx I had vaginal for A and emergency c-section for B. It wasn’t easy but I can promise it’s not nightmare inducing. I’m 8 weeks out and healed wonderfully. Not recommended but I can promise it’s not that bad.

 

[icemodeled]

@ntlfr8 I think most OBs want a head down baby A- so the idea of just needing one baby to be head down does not work. The presenting baby aka “first to the exit” baby needs to be head down. Here is a good summary of practice guidelines.

IME— My baby A was breech and baby B was head down. My OB was ok with the possibility of head down A and breech B but since we had the opposite (breech A, head down B).. my OB was not comfortable with a vaginal delivery (which would have meant delivering the first baby/baby A breech and then the second baby/baby B head down). My OB was ok with the idea of delivering the second baby breech but not the first. The reason for a c section was because of a breech baby A. Also- my baby A was IUGR, VCI, not ideal NST performances, and was diagnosed early vasa previa/thought thought to be resolved… sooooo honestly those reasons complimented the c section decision anyway. My older kid was a vaginal birth so I was bummed to be cornered by the circumstances into a c section but I feel thankful I knew in advance/it felt very objective (breech baby A = c section) and there was no decision needing made. Like yeah I could have declined and attempted a vaginal support but it would have meant going against what is basically universally recommended .

 

[oak1683]

@ntlfr8 I thought my whole pregnancy I would be having a C-section. But once my water broke at 35 weeks every single doctor I had during my labor all said I could do vaginal and breach extraction for baby B.

I'm thankful I got to have that option.

 

[nirajrana]

@ntlfr8 C section at 36 weeks.

Both of my babies were head down 3 days before my water broke…..so planning on a vaginal birth…..got to the hospital and Baby B had flipped. Doctor made the choice for a c section and an hour later I was in the OR.

I had complications with my c section…..nothing terrible but not fun….but turns out Baby A had her cord in front of her head (if we tried for vaginal it would have been a cord prolapse cutting off her oxygen) so I was destined for a c section regardless.

 

[yorkiegal]

@nirajrana Similar situation here. My water broke and I had an emergency C-section. I had always planned to have one, even though baby A was head down. All the doctors told me I could do either, it was my choice. I still chose c-section. The OB who delivered told me after that the cord was wrapped around baby A's neck twice, so C-section was the right choice because I would have ended up there regardless. So glad that everything ended up alright!

 

[valorwoman4jesus]

@ntlfr8 I had an unplanned c section but my doctor said as long as baby A was down, it was fine to go vaginal because once baby A is out, there’s more space and baby B tends to flip into place with all the extra space there now.

 

[deacondrew]

@ntlfr8 I spontaneously gave birth to A at home at 32 weeks. She was breech.

Then I got to the hospital and had to have a C-section for B, who was also breech. It was a little annoying they wouldn’t let me try for another vaginal birth (it would have been my 3rd vaginal), especially at that small size.

But it wasn’t the end of the world.

 

[investigate]

@ntlfr8 Same as everyone here, guidance was A had to be head down for vaginal, B could be any way. In the end I went into spontaneous labor at 34+1 and baby A was breech, so there was no choice in the matter - c-section it was. But it went great all around and babies did wonderfully.

 

[golden77b]

@ntlfr8 Our hospital requires all vaginal twin births to happen in a c section operation room because more often than not it’s necessary for the second baby. Go for the C section otherwise you might be recovering from a vaginal and c section!

 

[newlyrestoredgospel777]

@ntlfr8 My wife had our boys at 37 weeks via c section. But our singleton (first pregnancy) was breach and a scheduled c section. Her OB said she would not do a VBAC for twins.

 

[allthatisgood]

@ntlfr8 I’m with you. IMO , if baby A is head down, I will be fighting for vaginal birth. I have 5 prior natural vaginal births under my belt, and I’m not about to cave to a C and ruin my future chances for home birth if I have more kids (all my other babies except my first were born at home, Homebirth mw in my state cant attend twins or VBAC at home).

If baby A is breech, then of course I want what is safest and I believe that is probably a C.

Idk how far I’ll make it. I’m 19 weeks now. All my babies are born after 40. But EVERYONE tells me I can’t/won’t make it that far …

I’m also opposed to induction. Unless absolutely medically necessary … sigh.

Sorry, this probably isn’t helpful. Just felt like I can relate .. I don’t even know if OBs will fight me on wanting vaginal birth. I have switched practices a bunch and haven’t seen OBs yet.

 

[stosa]

@allthatisgood The reason that doctors usually induce twins at 37/38 weeks instead of letting it go to 40 weeks is because there is a much higher chance of stillbirth in twins the longer you let it go on. Studies have shown that 37 or 38 weeks is the sweet spot for twins where they have been cooking long enough to minimize the risk of neonatal complications while still decreasing the risk of stillbirth. It isn't about whether you can manage with the pregnancy. I'd be nervous about taking a hard line about induction knowing that.

 

[allthatisgood]

@stosa Right, which is why I said induction when medically necessary.

 

[stosa]

@allthatisgood No, you said absolutely medically necessary and implied that you wanted to make it to 40 weeks like your other kids. You mentioned that other people keep telling you you won't "make it" that far, implying that it is something you hope you might "make it" to. And stillbirth preventative measures for twins might not count to some people as absolutely medically necessary, as they are precautionary rather than reactionary.

 

[allthatisgood]

@stosa I’m saying the people around me act like it is CERTAIN I will have dangerous preterm labor, and I’m not talking 35-37 weeks. They’re fear mongering me that I’ll deliver at 32 weeks with guaranteed NICU, and I don’t appreciate that. I’m totally fine if I go into labor before 40 weeks. I will accept early induction if it is the safest option.

OBVIOUSLY if my doctors find risks indicating stillbirth is a likely outcome and they therefore want to induce, I would not argue it …

 

[stosa]

@allthatisgood The risks for stillborn birth for twins are 5fold a singleton pregnancy regardless of complications. This isn't something you find out and make a decision at 37 weeks about because something is wrong. There might be no indicators at all. The risk is increased even in a perfect di/di twin pregnancy.

Look, I'm not trying to argue with you. I absolutely believe that it is totally your right to make whatever choice you want. I am only telling you this because it seemed like you had some misconceptions, and I wanted to let you know so you are able to think about it and whatever decision you make is well informed.