Natural Birth

Going natural with a breech extraction - twin birth

Hi ladies,

I am currently 38 weeks with di/di twin boys.  Baby A is posterior but is head down.  Baby B is still transverse, even though I've tried multiple sessions with the Webster technique at the chiropractor.  My ob has been pretty open-minded, and she is not making us induce and is willing to try a vaginal birth.  Although 7/8 on-call doctors will go right to c-section if they're not both head down.  I really want to do everything naturally (using the Bradley method), but my ob is somewhat pushing me to get an epidural in case Baby B needs a breech extraction or if we need to do an emergency c-section.  I really want to go natural, but I'm a little worried about having to be put under general anesthesia if we need to do a c-section.  Also, my ob keeps telling me that a breech extraction without an epidural will be too painful, that I won't be able to handle it, and that I'll have to be put under.  I've read that it is extremely painful, but I've been practicing my relaxation techniques and I really believe I can handle it.  How many of you have done a breech extraction without meds?  Also, what is your opinion on just going ahead and getting the epidural "in case?"  Thanks so much for any input you can give!
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Re: Going natural with a breech extraction - twin birth

  • Could you have the epidural catheter placed but not dosed? That would speed things up if you need a c-section, but you would still be able to cope with labour with the Bradley Method techniques.

    I don't really see why a breech birth would be more painful. It has more risks, but the baby isn't magically bigger backwards.

  • I hope things go well, but just in case, they don't put women under general anesthesia for csections any more.
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  • redaeroredaero
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    I work in a maternity center, and I know of a lady who had twins vaginally with an manual extraction of twin B... it was done without an epidural, but not exactly on purpose, because things developed into an emergency situation.

    Here's the thing that's potentially scary with twins. Once the first baby delivers, the uterus is decompressed, and this is one of the normal mechanisms that triggers delivery of the placenta. The problem is that sometimes this rapid decompression of the uterus (following delivery of twin A) will cause twin B's placenta to detach from the uterine wall BEFORE twin B has had a chance to be born. This means twin B needs to come out NOW, because he/she is no longer getting any blood flow or oxygen. If twin B isn't head down, or flips into a poor position for delivery at the last minute, you have an emergency situation on your hands. Either you need a c-section RIGHT NOW (which is the reason they often deliver twins vaginally in the OR), or the doctor has to reach up into your uterus, grab hold of the baby, and physically pull him/her out.

    That's what happened with this lady I mentioned. Twin A delivered vaginally with no problem, but then both babies' placentas detached. Twin B suddenly flipped transverse at the last minute, and wouldn't descend. The mother didn't have an epidural in place, and apparently the anesthesiologist hadn't even made it to the OR yet (things were happening that fast!), so the OB had no choice but to manually extract the baby. She had to shove her entire ARM up the mother's vagina, I'm talking all the way up to the elbow, grab the baby and pull him out. 

    It's not just that it was painful for the mother. The problem was that it was SO painful, it was actually making the situation more dangerous, because the poor lady wasn't able to remain still or relax her pelvis, which made the baby even more difficult to get out. (And this mama was no wimp, either, she had delivered a few babies before, all completely naturally!)

    I had a natural, med-free birth with my first child, loved it, and absolutely understand the reasons for wanting that kind of experience. That said, if I were having twins, I would get that epidural "just in case," not because I didn't think I could handle it, but because there are just special considerations with twins, and it would seem like the better safety option to me. If there were an emergency with twin B, I think I'd rather have an epidural in place that made manual extraction quicker, as opposed to emergency general anesthesia for a c-section.

    Discuss things a bit more with your OB, though, and see if he/she has another perspective or more info to share with you. Good luck!

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  • image bleusimp:
    I hope things go well, but just in case, they don't put women under general anesthesia for csections any more.


    In general, they will only use GA of there's an IMMEDIATE threat to mother or baby. If its an unplanned c section you can get an epi, but as far as I can tell they will sometimes use GA for a truly emergency c section.

    That's the impression I get from my pregnancy books which should be pretty recent
  • With my first son, I started bleeding heavily during labor. They did get the bleeding to stop, but were worried about placenta's abrubtion and the need for an emergency c section. I got the epidural "just in case". Turns out I didn't need it, but I would much rather be "attending" my sons birth than go under during an emergency.
    I was a little sad that I didn't get my natural birth, but all things considered, it was a beautiful birthing.
    My 2nd son is 2 weeks old and I was able to have my natural birth experience with him instead.
  • I had an epi with my twins and I had a really wonderful birth experience. Even with a relatively uncomplicated birth it will feel kind of frantic toward the end - I was in an OR, in stirrups, with about 10 people in the room (it's usually protocol to have NICU team for each baby just in case). I wanted everyone (including myself) to be able to focus on getting my babies out safely rather than managing my pain. 

    That said, I did wait until I was almost 8cm to get the epi - up until that point I definitely used some of my hypnobirthing techniques to get through contractions. I feel like it was the best of both worlds.

     Good luck and congrats on making it to 38 weeks! 

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  • image bleusimp:
    I hope things go well, but just in case, they don't put women under general anesthesia for csections any more.


    For an emergency c section, they can put you under especially if you don't already have an epi or block on board.

    Average time from incision to birth via c section is 15 min. In an emergency, it is 2 min. A general allows them to get to work much faster if you aren't already numbed.

    I'm torn on this topic too. At least the epi doesn't cross the placenta. It can slow labor, but it can also help labor progress too... All depends
  • image Shoecrazysarah:
    image bleusimp:
    I hope things go well, but just in case, they don't put women under general anesthesia for csections any more.
    For an emergency c section, they can put you under especially if you don't already have an epi or block on board. Average time from incision to birth via c section is 15 min. In an emergency, it is 2 min. A general allows them to get to work much faster if you aren't already numbed. I'm torn on this topic too. At least the epi doesn't cross the placenta. It can slow labor, but it can also help labor progress too... All depends

     

    i know I'm a special snowflake but I had an epidural two actually, and the planned c section didn't go as planned so I had to be put under. They do it. It's just not the first choice.  

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  • image bleusimp:
    I hope things go well, but just in case, they don't put women under general anesthesia for csections any more.

    I had a GA for my c/s as did a friend of mine.  So yes they do.  I had an epi that wasn't working and while she wasn't a crash section like my friend's was she needed to come out, and they didn't have time to try a new epi.  My friend was a crash section with a natural birth with cord prolapse she went from delivery room to baby born in 11 minutes.

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  • image bleusimp:
    I hope things go well, but just in case, they don't put women under general anesthesia for csections any more.

    My BFF had general anesthesia for an emergency C-section involving a surprise footling breech baby 5 months ago, so yes they do.

    Her recovery was terrible and she was completely out of it for a good 24 hours. I would see if they can do what tokenhoser suggested and if not, get the epidural. I know it is disappointing, but I also know my friend hates that she doesn't remember anything about her son's first day of life.



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