Is it really dangerous to deliver twins past 38 weeks?

JNoelleE

My Dr was doing the typical- scare me into going against what they recommend-type of approach by not really answering my question if I'd be 'allowed' to deliver at 39-40 weeks (if I happened to even make it that far) by just saying that the chances of one of the babies dying, happens after 38 weeks. I am having di/di twin girls (they were wrong about one being a boy previously, found out at anatomy scan!) and I know that they will be doing lots of monitoring at the end, so I guess I'm not sure why its so dangerous? I know the placentas can start to deteriorate sooner, but couldn't an ultrasound pick up on that? Along with low amniotic fluid? Would it be horrible to try and push for 39, 39.5 weeks, if I wasn't in labor by then and we were all healthy?

 I'm just kind of sensitive to this topic because I was induced with my first at 38 weeks (for health reasons) and I could really tell he was not ready to come out. His ears were not all the way formed and the bottoms of his feet were purple and he had an umbilical hernia, due to the inner stomach lining not closing all the way. He was in great shape and condition but I felt that he was really a 36.5-37 weeker and my due date was wrong. I'm sure of my due date this time, so that makes me feel better, I just really want to make sure I can bake these girls for as long as they need.  

ks3pink

If it makes you feel any better my doctor continually reminded me that twins seem to be ready a little earlier. She always said it was mother natures way of taking care of them.

Rachel Goldstein

ks3pink:

If it makes you feel any better my doctor continually reminded me that twins seem to be ready a little earlier. She always said it was mother natures way of taking care of them.

Agreed. My di/di boys were 5lbs at 33w when they were born. We spent two weeks in the nicu but overall they were healthy. I expect your body will have the final say when they're done.

icedcoffeeluv

I delivered my girls at 38w1d via csection. I'm not sure they would have ever decided to come on their own!

They were 6.6 and 6.10 and perfectly healthy. I personally wouldn't go against doctors orders and my doctor said 38 weeks was the latest we would go. Even though there is a lot of monitoring at the end I still think that things can change in an instant and it just wouldn't be a risk I am willing to take.

mirnb

I would follow your dr recommendation....you can't be monitored 24/7 and things can change quickly....my boys were born at 38 weeks (water broke 2 days before I was to be induced) at 6lbs1oz and 6lbs11oz...they had no complications...your body will let you know before it gets to that point anyways most likely!

JodiAriel

I have di/di girls. I really did not want a c-section or to be even induced.  My docs agreed to monitor me more closely.  I had NSTs twice a week.  I was finally induced at 39w5d when I had not gone into labor on my own.  They were born 3 days later at 40w0d.   There was some aging of the placentas when they were born but nothing concerning.  They were born at 6lbs 13oz and 6lbs 9oz and came home with us 18 hrs after they were born.

E&RMommy

JNoelleE:

My Dr was doing the typical- scare me into going against what they recommend-type of approach by not really answering my question if I'd be 'allowed' to deliver at 39-40 weeks (if I happened to even make it that far) by just saying that the chances of one of the babies dying, happens after 38 weeks. I am having di/di twin girls (they were wrong about one being a boy previously, found out at anatomy scan!) and I know that they will be doing lots of monitoring at the end, so I guess I'm not sure why its so dangerous? I know the placentas can start to deteriorate sooner, but couldn't an ultrasound pick up on that? Along with low amniotic fluid? Would it be horrible to try and push for 39, 39.5 weeks, if I wasn't in labor by then and we were all healthy?

 I'm just kind of sensitive to this topic because I was induced with my first at 38 weeks (for health reasons) and I could really tell he was not ready to come out. His ears were not all the way formed and the bottoms of his feet were purple and he had an umbilical hernia, due to the inner stomach lining not closing all the way. He was in great shape and condition but I felt that he was really a 36.5-37 weeker and my due date was wrong. I'm sure of my due date this time, so that makes me feel better, I just really want to make sure I can bake these girls for as long as they need.  

Ears are made of cartilage.  A vast majority of babies have peripheral cyanosis where their feet and hands are purple.  Umbilical hernia happens at all gestational ages.

None of those are because of when your baby delivered.

38 weeks is the NADIR of morbidity and mortality for twins.  Does it means badness will happen afterwards?  Not necessarily.  But the risks for both babies and moms are lowest at 38 weeks. 

You just need to sit down and talk with your doctor about what is best for you.

carrotcake06

I had my singleton at 37w1d when my water broke spontaneously. He was 6lbs and had no NICU time.

This time, I was told the longest I would go would be between 38 and 39 weeks. There are still a million outstanding variables, so while I would like to go into labor spontaneously, I'm mentally preparing myself for the alternatives.

Ruthie04

My OB and MFM were not comfortable with me going past 38w, which was a good thing for us. The placentas were rapidly calcifying (they looked horrible!) and the boys had IUGR. We knew the condition of the placentas before delivery, as I was having 1-2 level II ultrasounds every week. My water broke at 36w1d and they were delivered four hours later. Thank goodness, as the boys hadn't had much growth in several weeks and were both under five pounds. I don't know if the placental age issue was related to multiple gestation or some unknown factor with me, but my boys needed to get out early. They had some issues with breastfeeding and temperature, but did not do any NICU time and we were all discharged together. 

I would rely on your doctor's recommendation, but I don't think there is anything wrong with questioning his or her reasoning and asking that a plan be developed based on your particular case. There are many women with healthy twins born after 38w, but it was not a good idea in my case. 

Best of luck with the rest of your pregnancy!  

atorrrres

My doctor said she tries to push for 40 weeks, even if it's twins, but they are considered full term at 36 weeks. She told me it honestly depends on how long my body can sustain them and how early they decide to come out, but there is no doubt they'll be healthy babies either way.

JNoelleE

E&RMommy:

JNoelleE:

My Dr was doing the typical- scare me into going against what they recommend-type of approach by not really answering my question if I'd be 'allowed' to deliver at 39-40 weeks (if I happened to even make it that far) by just saying that the chances of one of the babies dying, happens after 38 weeks. I am having di/di twin girls (they were wrong about one being a boy previously, found out at anatomy scan!) and I know that they will be doing lots of monitoring at the end, so I guess I'm not sure why its so dangerous? I know the placentas can start to deteriorate sooner, but couldn't an ultrasound pick up on that? Along with low amniotic fluid? Would it be horrible to try and push for 39, 39.5 weeks, if I wasn't in labor by then and we were all healthy?

 I'm just kind of sensitive to this topic because I was induced with my first at 38 weeks (for health reasons) and I could really tell he was not ready to come out. His ears were not all the way formed and the bottoms of his feet were purple and he had an umbilical hernia, due to the inner stomach lining not closing all the way. He was in great shape and condition but I felt that he was really a 36.5-37 weeker and my due date was wrong. I'm sure of my due date this time, so that makes me feel better, I just really want to make sure I can bake these girls for as long as they need.  

Ears are made of cartilage.  A vast majority of babies have peripheral cyanosis where their feet and hands are purple.  Umbilical hernia happens at all gestational ages.

None of those are because of when your baby delivered.

38 weeks is the NADIR of morbidity and mortality for twins.  Does it means badness will happen afterwards?  Not necessarily.  But the risks for both babies and moms are lowest at 38 weeks. 

You just need to sit down and talk with your doctor about what is best for you.

I know what ears are made out of. You could tell he was a little premature because of his ears, and his feet. The drs even said so, not just me speculating. And umbilical hernias are a little more common in babies that are early, even though they can happen at all ages. 

 

My Dr. didn't go over risks with me when I asked, just scared me by saying one of the babies could die if I went past then. That's why I decided to check with you guys who have gone through it, but I have another appt with another dr, ( it will be one of 5 at their office) so I hopefully I get more helpful advice and recommendations then.

JNoelleE

Thanks for the suggestions guys. It's kind of difficult because there are 5 different Drs and 4 MW's at the practice I go to, and they all seem to give me a little different kind of perspective when I go in. So I'm not sure what is the 'best' thing for me to do, as all of their recommendations are a little different. I was taken back by the way the last Dr. just mentioned that one of the babies could die if I went past then, without really going over stuff with me and answering my questions, so I was interested in hearing your opinions.

Also I was googling and found all these other forums on Circle of Moms and they were all talking about how it's not that dangerous and how lots of them were 40 weeks when they delivered and it put more doubt in my mind like maybe I wasn't getting the correct information. 

 I will just make sure to get more info at my next appt with one of the other Dr's.  

DandT1206

icedcoffeeluv:

I delivered my girls at 38w1d via csection. I'm not sure they would have ever decided to come on their own!

They were 6.6 and 6.10 and perfectly healthy. I personally wouldn't go against doctors orders and my doctor said 38 weeks was the latest we would go. Even though there is a lot of monitoring at the end I still think that things can change in an instant and it just wouldn't be a risk I am willing to take.

 

this, except mine were born at 38w3d via scheduled c-section.  I was told as long as everything was fine, 38.5 weeks was the furthest they'd push it.  All depends on your situation and how well the babies are growing.

Lil Kate

ks3pink:

If it makes you feel any better my doctor continually reminded me that twins seem to be ready a little earlier. She always said it was mother natures way of taking care of them.

This....full term with twins is actually 36 or 37 weeks.  They develop faster than a singleton because they typically come sooner.  I persona;;y would not risk any complications with you or the babies. 

icedcoffeeluv

Also at 38w1d I was more than happy to evict them. I would not have pushed for another week to week and a half of dragging my huge self to daily monitoring appointments.

My husband was sick as a dog when I was about 37 weeks and he asked if I could stop at the drugstore and get him some medicine on my way home. I cried. Every little thing is a huge task to take on when you are that pregnant.

Rachiemoo

No, I don't believe it is, at least for fraternal twins.  My cousin delivered hers via a planned c section at 39 weeks.  I have read conflicting advice for identical twins though, because the placenta can supposedly give out earlier.  Some say for identical it is safer to go by 37/38 weeks.

lovepink519

Im carrying di/di twins and was also told I will not go past 38 weeks.

starrkitten89

My office will not let twins go past 38 weeks, even if twins is the only high risk factor. The placenta can degrade relatively quickly even with no or few signs beforehand. I am also a type 1 diabetic (also causes placental degradation and higher risk of stillbirth) so my c/s is scheduled at 36w2d. They told me if I was absolutely against it they would let me go one more week to 37.5 weeks (with 3NSTs that week), but after losing a child I am not comfortable risking it.

kgs0505

I really wouldn't worry about pushing your delivery date past 38 weeks.  A lot of twins come sooner for one reason or another.  If you get to 38 weeks, you are golden and those babies will be fully cooked!  Mine came at 35w 6d because I developed pre-eclampsia.  The Pre-e developed fast over about 3 days. And yes, I was being monitored those three days, but what if it had developed on days I wasn't being monitored?  the situation could have been much more complicated. 

My girls, although born early, and they were 5lbs 1oz and 4lbs 14oz, they only spent 1 week in NICU.  They had a little trouble breathing initially, but were off the oxygen in less than 24 hours and spent the rest of their time there as feeders and growers.  They are now a month old and extremely heathly!

BabyCarryingVessel

Di/di twin girls here, too! Congrats! My body was "done" at 36 weeks 5 days since I developed pre e and HELLP. It came on fast, I never had a single problem through the whole pregnancy. The girls had zero issues and came home with us 4 days after they were born. I hope this helps put your mind to ease. I think your girls will be perfectly fine, and exceptionally great if they're born between 36  and 38 weeks!

macchiatto

Lil Kate:

ks3pink:

If it makes you feel any better my doctor continually reminded me that twins seem to be ready a little earlier. She always said it was mother natures way of taking care of them.

This....full term with twins is actually 36 or 37 weeks.  They develop faster than a singleton because they typically come sooner.  I persona;;y would not risk any complications with you or the babies. 

37w is full-term for any pregnancy, singleton or multiples.

Also, the idea that they develop faster than singletons is controversial.

bunny731

MrsLee04:

As a blanket statement, no not true. I asked a former doctor of mine about this and he asked 4 different MFM friends about this. All 4 said there is no truth to this. There may be individual scenarios where this may be true, like sometimes with identical twins, but as a general rule no. This is why my hospital won't schedule twin deliveries before 39w unless there is medical necessity.

Ditto this. Void of course with the risks of identical twins, personal medical risks etc....

Plus there is a lot more research on the benefits of in-utero brain development between 37-40 weeks than there were years ago. Brain development and the size of the child are two very different measures. And I have never read anything that indicated the brain grows faster with twins. Though I am interested if there is information out there-regarding twin brain growth and gestation.

If you feel comfortable and your doctor feels comfortable with 38w go for it---but if you have doubt get a second opinion and see if you glean anymore information.

palm513

I didn't want a C-S and my doctor wouldn't induce me so I carried my twins until 39.6 and when I had to have a C-S because of pre-e. Both boys were healthy, other than a little water in the lungs from the C-S instead of vaginal birth. 

KDR1979

I definitely read an article when I was pregnant that said it does get risky after 38wks. My OB wouldn't have let me go past then. My pedi says twins actually act 1 week earlier than their gestation at birth (so my 36 weekers acted like 35 weekers). I delivered at 36wks 1 day, DD weighed 5lbs, Ds 6lbs 9.4oz. No NICU/SCN, but they would not latch. DD did have an umbilical hernia, but it closed on it's own. DS does need a circ revision (possibly related to being 36wks).

Mrs. Alice

This was not an issue for me as I wasn't allowed to pass 34 weeks due to complications.  I have read recent studies that suggest the safest week for delivery for mono/di twins is 36-37 weeks but not sure about di/di.  I would honestly follow you Dr.'s recommendation.  Ask for evidence based practice studies and articles.  Do your own research. TALK to your OB, it is their job to inform you of these things.   The chance that you will go past 38 weeks on your own is probably not likely but they will be fully mature at this gestational age.  You mentioned your son may have actually been earlier dates then what was estimated?  Did he have any preemie issues?

JNoelleE

Mrs. Alice:

This was not an issue for me as I wasn't allowed to pass 34 weeks due to complications.  I have read recent studies that suggest the safest week for delivery for mono/di twins is 36-37 weeks but not sure about di/di.  I would honestly follow you Dr.'s recommendation.  Ask for evidence based practice studies and articles.  Do your own research. TALK to your OB, it is their job to inform you of these things.   The chance that you will go past 38 weeks on your own is probably not likely but they will be fully mature at this gestational age.  You mentioned your son may have actually been earlier dates then what was estimated?  Did he have any preemie issues?

My son didn't have anything major but he was a little lethargic, apgars were I think a 6 when he was born, he was a little jaundice and had the umbilical hernia and just looked like he wasn't ready. Like I said earlier by his feet and ears. But he did great and got big fast. 

 

If seems there is so much conflicting info out there! Even based off these answers. Does anyone know how and why the placentas can deteriorate sooner with di/di twins? Makes sense with twins that share a placenta, but not with di/di. 

JNoelleE

I've also read that the theory that twins developing sooner is a myth. That they can in the beginning but then are actually behind towards the end, or something. I had piece of mind when I first heard that theory but now I don't anymore.

GoMaltby18

My hospital's policy is to deliver twins just after 38 weeks but no sooner.  I had a c-section at 38w1day because my girls didn't come on their own before then.  They were 7 lb 1 oz and 6 lb 3 oz and both had apgars of 9 and 9.  (both also had purple feet...I have never heard that considered a preemie thing before)

I think you need to trust your doctor(s) on this one.  If you don't trust them, see about finding a different practice that is more in line with what you think. Mine said that was their policy and it made perfect sense to me.  Plus, by that point I would have paid someone to take them out anyway.  I also didn't have "constant monitoring" late on because they never saw any need for it.  I never had NSTs; just growth ultrasounds and frequent appointments where everything looked fine.  Have they already told you you will be followed that closely or are you speculating based on what ladies on here talk about?

kiwi443

macchiatto:

Lil Kate:

ks3pink:

If it makes you feel any better my doctor continually reminded me that twins seem to be ready a little earlier. She always said it was mother natures way of taking care of them.

This....full term with twins is actually 36 or 37 weeks.  They develop faster than a singleton because they typically come sooner.  I persona;;y would not risk any complications with you or the babies. 

37w is full-term for any pregnancy, singleton or multiples.

Also, the idea that they develop faster than singletons is controversial.

True.

My MFM told me mo/di twins are generally delivered by 37 weeks because of the increased risk of placental breakdown. Di/di twins do not necessarily have to be delivered earlier than 39 weeks.

117ict10

I'm being monitored and will ultimately delivery at one the best hospitals in the country for "specialty and high risk" pregnancies.  I go to the Antenatal testing center for BPP each week and see an MFM in addition to seeing my regularly scheduled OB on weekly sessions. 

Just today the MFM grilled me on when I was scheduled for delivery stressing that it had to be before 39 weeks for the health of everyone involved.  Since my OB delivers twins 36-38 weeks, I'm scheduled for delivery 37w 5d and the MFM was fine by this.   He said delaying delivery for twins - even absent other complications - introduce complications that can be disastrous for twins - even in our complication free, di/di situation as the placenta starts to break down at about 38 weeks with twins.

This isn't the first time I've heard this from an MFM at the center - they've been checking that I'm on the schedule for the last 3 weeks. 

Having both the doctor's in my OB group, and the MFMs at INOVA Fairfax concurring on the topic combined with a friend who lost a di/di twin at 39 weeks a day after having a good NST, is plenty enough for me to follow their advice. 

JNoelleE

GoMaltby18:

My hospital's policy is to deliver twins just after 38 weeks but no sooner.  I had a c-section at 38w1day because my girls didn't come on their own before then.  They were 7 lb 1 oz and 6 lb 3 oz and both had apgars of 9 and 9.  (both also had purple feet...I have never heard that considered a preemie thing before)

I think you need to trust your doctor(s) on this one.  If you don't trust them, see about finding a different practice that is more in line with what you think. Mine said that was their policy and it made perfect sense to me.  Plus, by that point I would have paid someone to take them out anyway.  I also didn't have "constant monitoring" late on because they never saw any need for it.  I never had NSTs; just growth ultrasounds and frequent appointments where everything looked fine.  Have they already told you you will be followed that closely or are you speculating based on what ladies on here talk about?

Yeah they said they will be doing close monitoring at the end to make sure things are going well