Dr's issues with birth plan

wendylaine

So I went over my birth plan with the doctor at my last appointment. He has seemed very open to me doing things naturally so I didn't foresee any problems.

However when we talked about the IV vs. heplock he said he would want me to have an IV because emergencies are a little more likely with twins. I am not thrilled with this, but I guess if it is best I can make it work?!

He also said that even though he does not mind if I don't want an epidural he wants to have one placed and started just to see if it is in place correctly and then have it cut off. I am VERY nervous about this. For one having an epidural in place and NOT having pain meds does not sound fun to me. Plus I feel like it would be a HUGE temptation to have the meds so readily available. The reason he gave was that because if for some reason they had to do a c-section to get baby B out, who is breech right now, they will not have time to place one.

I wanted to hear thoughts and opinions from you ladies. Are his points valid? Can I refuse these things and should I?

JCWhitey

To me it kind of sounds like he really DOESN'T support your plan to go natural.  It sounds like he's already decided you're going to have to have a c/s and he's just humoring you.  I know it's a little late to switch OBs, so I wouldn't recommend that, but I would refuse some of these interventions.  For one I don't see how an IV versus heplock will really matter in the long run because if they need to get you fluids fast the heplock will allow that.

CLLDLL

JCWhitey:

To me it kind of sounds like he really DOESN'T support your plan to go natural.  It sounds like he's already decided you're going to have to have a c/s and he's just humoring you.  I know it's a little late to switch OBs, so I wouldn't recommend that, but I would refuse some of these interventions.  For one I don't see how an IV versus heplock will really matter in the long run because if they need to get you fluids fast the heplock will allow that.

I tend to agree with this, but I'm no Dr. and have no experience with twins.  I will say I had to have an IV for antibiotics (GBS+) and it really was NBD.  They unhooked the IV and just left the heplock in when I wanted/needed to get up to get through a contraction or use the restroom. 

The epi would bother me.  Again I don't know much about twin delieveries, but it sounds kind of fishy to me.  They can place an epi pretty quickly on someone who needs to have an emergency c/s.  Why can't they on someone who's been in labor for a while and even delivered one twin? But I haven't done any research to back that up, just my initial reaction.

1inzee

Did you ask your doc about a spinal block?  I'm not a big fan of putting anything into a person's spine unless absolutely necessary.  If you're not keen on the pain meds, then an epidural is unnecessary. 

 If you end up needing a c-section, then a spinal block can be done in the operating room.  They work pretty quickly, and are what's normally given to women having scheduled sections.  

sbevmc09

I can't see why an actual IV would be better JIC of emergency than a saline/hep lock would be.  The whole point of a saline/hep lock is to give them immediate access if they need it.  Artificially giving your body fluids JIC there's some sort of emergency which arises seems like a strange requirement to me.  I would definitely just go with the hep lock.

I also think the epidural thing is really odd.  I wouldn't be comfortable with that.  I think IF an emergency would arise where I would need a C/S I would rather them just put me under general anesthesia than have to labor with an epidural in place "JIC".  

Honestly, I don't know that I would be comfortable staying with this doctor.  Granted, I'm sure there is a greater chance that complications could happen with twins, but you wanting a natural birth doesn't seem to gel with your doctor's attitude about things.  It really seems like they're counting on needing to prepare for a C/S and their attitude is very important to your success.  JMO.

pepomntpat

I'm sorry. Both of those are BS. A heplock will allow quick emergency access. No reason to pump you full of fluids when they'd have to hook up meds anyway.

And the epidural is especially stupid if you do not want one. I had an unplanned c/s. Unless your baby is in serious trouble, there is plenty of time for a spinal. They went from decision to cut in under 30 minutes. That is the most overused and ridiculous excuse for undermining a natural birth that I hear. 

aylafsu88

I tend to agree with pp that the IV does not seem like a big deal.  I would still push for a Hep lock instead.  I have known several moms who went natural but had to have an IV due to being GBS+, it did not bother them.  The epi would bother me a bit.  I do not know much about twin deliveries but his point seems somewhat valid.  I would definitely discuss the epi with him again and suggest a spinal block instead.  Maybe if Baby B is no longer breech he would reconsider his stance on the epi?

 

sschwege

I'm not understanding his argument for not supporting a hep-lock, isn't that the whole point of doing a hep-lock, for emergencies?  Perhaps you could ask for clarification?

As far as the epi, I think that really just depends on what you are comfortable with.  If it were a true emergency and they didn't have time for an epi they would put you under general, not ideal of course, but that is always on the table.  I mean isn't that the risk all of us take when declining an epi?  Albeit it's more likely with twins, but still.  It's just one of those things you are going to have to weigh the pros and cons of.

And to answer your question, provided you are mentally capable of making decisions for yourself then you can decline any and all medical procedures.    

wendylaine

I guess an important factor that I did not mention before was that I am a VBAC momma. I successfully VBACed my second child almost 2 years ago. I think the risk of rupture is what makes him more inclined to have emergency anesthesia in place.

pepomntpat

Also, it takes at least 10 minutes for an epi to take effect. They will not wait until you are numb if it is an emergency. They will do general regardless. I would definitely decline the epi if you do not want pain meds.

pantherRN

I don't understand his point on the IV. Does he not understand that you'll have the IV placed, but just not connected to anything? 

As for the epidural placement, I've heard of this being done and I can sort of see where he is coming from. However, it would make me nervous too. I'd probably decline and take my chances. I'd also gauge his reaction to me declining the epi placement at my next appointment. 

sarahjulypsu

I find both issues strange. I can understand wanting the hep lock there just in case. Maybe there was a miscommunication? But I find having the epidural placed just in case crazy. If needed babies can be out in minutes with out the advanced placement of an epidural. Every medical intervention carries a risk so I don't understand why he would undergo one if not neccesarey. Also they are very expensive.

bdutton0005

I would opt for the hep lock becuase it is IV access just without beign hooked to anything. As far as the epidural goes I am with PP I was under the impression they put you under general because it does take 10-15 mins for an epi or spinal to take affect. My OB told me if he deems it an emegency they have 5 mins to have you from the room to the OR with him starting to cut but I don't know if that is his policy or hospital policy or if that is standard practice.

bripratt2

I would talk to a doula or lamaze instructor they would be able to tell you exactly what is and isnt necessary and what you could say to get what you want.

jellybeanjean

L&D RN here -- I can only speak for what happens in "my" hospital.

The IV vs. Heplock makes no sense.  It takes no time to connect to a needleless port.  That's absurd, and I'd fight that one.

Usually our OBs want an epidural in place for planned vaginal twin deliveries.  Again, if the patient doesn't want it, it's not dosed.  The reason is exactly as your OB said.  If baby B remains breech and they won't do a vaginal breech, or if baby B's heartrate tanks after baby A is delivered (I've seen it more than once, unfortunately), then they will jump right to general.  Recovery from general is a lot longer and rougher than recovery from a spinal dose in an already-placed epidural catheter.  I understand your concerns and I'd have the same ones (I'd probably cave to getting the meds if that catheter was already there during transition), but I've seen too many stat C/S for baby B's to say that it's outrageous.  It's not.  I have no documentation to back it up, but from the thousands of births I've witnessed, it seems like your chance of having a C/S with Baby B's vs. a standard, low-risk singleton is much higher.

 

Good luck!  I hope it goes really well for you and you're able to have them vaginally.  I love vaginal twins -- so awesome.

Runaway22

I was so troubled by your doctor fighting you on these issues I actually had a L&D nightmare last night involving some of these exact scenarios. You should feel special - your problems are in my dreams. lol

kkee08

The IV and heplock are basically the same thing.  Have them start your IV, but not run any saline or meds and this makes it a heplock so to speak.  I understand the need for the IV placement just in case they need to give something.  They can have all IV bags of saline and other supplies in room to hook up at the last minute if they need.  I would not get epidural unless I just needed it.  Even if they have to do a C/S they have options of doing epidural then, a spinal block, or just knocking you out completly.  They will probably have anesthesiologist standing by anyways with you having twins just in case need to do C/S.  All 3 of the above need the anesthesiologist to perform. Good luck.  Also,  don't come to hospital until the last minute if you can.