Upset over OB visit. What would you do?

KayJayDee

I had my 28 week OB appt this morning.  He's the only doctor in the practice, which was one of the reasons I picked him.  I wanted to get to know one doctor, not see several doctors, get attached to one or two, and then have the doc I least cared for be the one on call when the time came to deliver.  Anyway... I didn't see him at my last appt, it was with the NP.  I wanted to start asking more specific labor/delivery questions now that I'm getting closer to the home stretch.  So I came armed with several specific questions regarding my desire for a vaginal birth.

Let me preface all of this by saying that my doc is very pro "natural" birth (I know, I know, unmedicated... his words, not mine).  When I originally met with him (8 weeks) we talked at length about my previous birth (unmedicated, birthing center, midwives) and about how I was really hoping to have as similar an experience as possible.  I know that twins are unpredictable and yes, obviously, my main concern is for their health and mine.  But I wanted to continue the conversation over the course of the pregnancy and make sure that he knew how strongly I felt about doing a vaginal delivery (preferably unmedicated).  I didn't want to just be told I was going to have a c-section because I was having twins.

 This is what I understood (until today) about how we would proceed:

If both babies were head down, I could go ahead with a vaginal birth.

If one or both babies was breech or transverse, I would have a c-section.

If, after Baby A was delivered, Baby B went breech, we would "assess the situation."  I asked about turning Baby B and was told, it would depend on different factors - size of Baby B, presentation, etc.

So here's where it gets upsetting for me.  As the only doctor in the practice, I get that he's busy.  All of my appointments with him have felt a little rushed and there's always a wait when I get there, so I hate to be the one taking up tons of his time and making someone else wait because of me.  So if I didn't see what was coming, it was my own fault, I know, because I haven't asked all the questions that maybe I should have.  Today, the office was really quiet and he seemed less rushed and more open to a longer conversation.  I point blank asked about breech deliveries and whether he'd let me push a breech Baby B or if he'd do a breech extraction.  His answer was, "I can't do breech deliveries.  The hospital won't let me.  I could lose my license."  

Ummm... that was NEVER mentioned before.  EVER.   So now I'm stuck knowing that if both babies are head down and we go for a vaginal delivery, there's a 50/50 chance I'm getting a c-section for Baby B.  The dreaded "double whammy."  

I'm upset.  There's still a huge part of me that wants a vaginal birth.  But now knowing that my doctor won't attempt a breech delivery, I'm tempted to just say screw it and tell him I want a c-section.  I'm emotionally drained about thinking about all the possibilities.  I want to be able to relax (as much as possible, anyway) and enjoy the rest of the this pregnancy without the anxiety of the what ifs.  But it totally feels like I'm giving up.  I have been so anti-c-section for so long that I'll feel like a bit of failure if I don't give a vaginal delivery a chance (if it's an option when the time comes).  

This was so long... sorry and thank you if read this far.  What would you do in my situation?  What did you do, if you were in a similar situation?   

tarajayne

I am sorry you are going through this.  My baby B went transverse in the last month and my docs like yours would not do breech extraction.  I could have done A vaginally and then hoped B flipped and not had to have a c, but I was not willing to do vaginal and c so just went C.  I was bummed, but in the end I know it was the safest way for all of us.  It was still an amazing birth though.  Whatever happens when you hear and see those babies for the first time, nothing else will matter.  Hugs!

JodiAriel

I understand your frustration. I am in a similar situation because I am seeing a midwifery group which around here gives me the best chance at a natural birth however since that is the case, whether or not I have a breech delivery of Baby B is dependent on which hospital OB is on rotation on the L&D floor when I come in.  Only 2 out of the 6 do breech deliveries.  I have struggled what to do since I love my midwives and know I could chose to change practices to an OB who will guarantee a breech delivery but that also means I lower my chances of a natural delivery in that case.  As of now I am sticking where I am and am going to risk it.  Baby A is currently a footling breech so it may be out of my hands anyway (although my chiropractor is doing Webster in hopes we can get her to turn).

mysteriousmommy

Will he attempt to turn a breech baby before making you have a c/s??  I'm sorry if you mentioned that and I missed it.  I read and reread and I'm still not clear.

 If he will attempt to turn the baby I would feel more comfortable.  At this point I don't know that I would change OBs, but my OB was willing to let me push a breech baby.  It was VERY important to me that I had a vaginal delivery and to have ended up with a double whammy especially would've made me upset.  I was pretty stressed out about that possibility throughout my entire pregnancy.  

Anyway, if he would attempt to turn the baby I would stick around if you are comfortable with everything else otherwise.  If not then you might want to look elsewhere...although it may be very difficult to find a practice that would take you this late in your pregnancy.

Edit: If a vaginal delivery means a lot to you I don't think I would say you should just say "eff it" and go for the c/s.  I briefly considered that, but when I delivered 2 beautifully healthy head down babies I was SO glad I didn't.   All that really matters is what you will feel comfortable and what you will have peace and acceptance with in the end.    Good luck!

caden

Why would you have a 50/50 chance of a c/s for Baby B if you go into L&D with both babies head down? My OBs had basically the same policy as what you described, and a double whammy was very rare for them, even though they didn't do breech extractions.

ETA: I had a vaginal delivery; baby B did everything "right"

ougrad1

I went with my regular OBGYN and there are 19 docs in the practice.  With both of my pregnancies I never saw another doctor until I delivered the babies.  It was fine.  More than fine, really.  I never had a single complaint.

Your post gives me the impression that something happened and he was told that he had less freedom than he thought he had as far as what he could and could not do.  Is he a new(ish) practitioner?

You can run yourself ragged trying to imagine all the possibilities or get with a practice that will take the time to listen, understand and be honest as to what is realistic with multiples.

GL....being a MoM is full of the highs and lows.   

 

Temp6313048411121614

Definitely ask your doc if he's open to an internal or external version (manually flipping the baby).  If both are head down then personally I would try for a vaginal delivery.  If 1 is breech then I'd schedule the c/s.  GL.

jalaiaa

I'm not saying you should do this but if your doc is comfortable doing breech delivery and it is the hospital that is limiting his freedom you could just refuse the c-section. I mean no one can MAKE you have surgery. If baby A is delivered and baby B is breech and you refuse a c-section your doc can't make you go to the OR, you have to consent. And he for sure won't just leave you to fend for yourself because you don't want surgery. I'd be sure that he had done plenty of breech deliveries and felt comfortable though. My doc had said that if A was head down and B was breech she would do a breech extraction as long as B was smaller than A. As it turns out mine were both transverse and I ended up with a c-section anyway. 

leapgirl8

I'm sure you have done a lot of research and don't need for me to tell you this, but breech extractions are difficult and dangerous. Our MFM is considered an expert in the area (he presents at conferences on it, etc.), and he strongly encouraged us to consider a c-section rather than risk it because Baby B was larger than Baby A. He left it up to us, but I trusted him and felt that if he wasn't comfortable we shouldn't do it. It doesn't sound like your doctor has much, if any, experience in that area, and shouldn't do it even if he is allowed to. 

I also wanted to reassure you that having a c-section is not the worst thing. DW was dreading it and did everything she could to avoid it and to prepare for unmedicated vaginal birth, but in the end she was so happy with how it turned out and didn't feel like she missed out on anything by not going through labor. Her recovery was fast and pretty comfortable with the (nursing-safe) meds, she was mentally prepared and had already 'mourned' the loss of the chance at a vaginal birth, and you can't even see her scar since he cut below the pubic line. Her milk came in at the expected time and bonding was great. Needing a c-section doesn't make you a failure!  

tarajayne

leapgirl8:

I also wanted to reassure you that having a c-section is not the worst thing. DW was dreading it and did everything she could to avoid it and to prepare for unmedicated vaginal birth, but in the end she was so happy with how it turned out and didn't feel like she missed out on anything by not going through labor. Her recovery was fast and pretty comfortable with the (nursing-safe) meds, she was mentally prepared and had already 'mourned' the loss of the chance at a vaginal birth, and you can't even see her scar since he cut below the pubic line. Her milk came in at the expected time and bonding was great. Needing a c-section doesn't make you a failure!  

 

CER+MEL

My baby B was breech at 37 weeks and smaller than baby A.  My OB told me she was willing to do a breech extraction in that case, or I could schedule a c/s.  I went with a c/s.  I guess you can take comfort that it's one choice you don't have to make.  It was a tough one for me.

If I were you I would move forward with the plan to deliver vaginally if both are head down (which was my plan). You don't sound like someone who should schedule a c/s just to prevent an unlikely double whammy. Definitely ask your doctor if he'll try to flip baby B if necessary to prevent one, just so you know. 

hunt2005

I'd talk to him and see what the plan would be if they are both head down. Would he have an attending help to keep baby B in place? Would he attempt a version if it turned?

For me, I was given the option of it if they were all head down or if at least the first one was and I said no. Breech extraction scared me and I didn't want to risk it.

macchiatto

Breech extractions are actually safer than a manual version of a breech second twin, and very similar safety-wise to a C-section ... but only if the dr is experienced with and comfortable with breech extractions. My Baby B kept flipping back and forth so I researched this (and I'm talking in medical journals and high-risk OB textbooks, not random websites) and discussed it with my OB  and he agreed. So did my MFM, who was the director of perinatology at the USC School of Medicine. (He also told me that in all his years of delivering twins, he'd never had to do a vaginal delivery for baby A followed by a C-section for Baby B.)

I'm not sure why your dr thought he would lose his license for doing a breech extraction, unless it's just that he's inexperienced in breech extractions? I have heard several OBs say it's a shame that drs aren't being trained as much in them these days because they ARE a good and safe option but only if the dr knows what s/he is doing. My Baby B was delivered by breech extraction and my dr certainly did not lose his license.

Here is my blog post about breech births with a few links (which hopefully still work? my twins are 3.5 so it's been a few years since I researched this):

https://rootbeertwins.blogspot.com/2010/04/what-if-baby-b-is-breech.html

I can understand being disappointed in your situation though, OP. But to make you feel better, the "double whammy" only happens in about 5% of twin births, so it's definitely not a 50/50 chance for you.