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Multiples
To c-section or not?
My doctor said it's up to me (at this point) if I want to do a c-section or not. She actually sort of recommended it and described how even if both babies are doing great, you just never know what will happen with the second once the first one is delivered (if you do vaginal). This is my first pregnancy and I don't really care about the "ultimate birth experience" or anything like that. I just want them here happy and healthy. It sounds appealing to just walk into the hospital and have some babies with no labor. I get that the recovery process is different, but all my friends with c-sections don't have anything bad to say about it. Wondering what thoughts you all have on this subject?
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Re: To c-section or not?
I was glad not to have a c-section because it's a major surgery with a higher risk of infection. There's also the risk that the babies can be born with fluid in their lungs because it's not squeezed out like it would be in the birth canal. You can't hold the babies or try to nurse right away (if you're planning to BF). Then there are the risks of complications having to do with your incision (infection), and the risks on possible future deliveries (VBAC).
If you're okay with all of that, and you don't want to labor, then maybe a C is for you! I must say though... a vaginal delivery is a wonderful experience, and all the pain of labor ends in you feeling like Superwoman for pushing 2 babies out : )
The main risks in going vaginal are the babies having trouble coming out, and complications with Baby B. Our Baby B's heartrate dropped after A came out, but B ended up being delivered in 4 more pushes and everything was fine!
I guess you have to weigh the risks and benefits of each and go with what makes you feel the most comfortable.
I'm surprised you even have a choice, my doctor said there is no way I would be able to have a vaginal birth, for the reasons you sited. I don't understand the previous poster, the most important thing is to get the babies out safely, quickly, and for you to be in as little pain as possible. Do you really want to go through labor just to have an emergency C-section for the second baby? Not worth it in my opinion. You can still breastfeed withing 2-3 hours of giving birth, and you will still have the ultimate bonding experience as mothers who delivered vaginally.
Do what is safe and what is recommended.
We must have same doc.
I had my 1st, a singleton, vaginally and all natural (not by choice).
Mine did say the same that If I wanted to choose a C-section it was ok for him as well as the fact that there can be other complications with vaginal, esp if one is breeched and then I can be rushed to a c-section anyways. He also did state that Im a good candidate for vaginal delivery for twins and really was letting it be my decision.
I know im taking a risk on that, for me. I intend on going that route. I also will be having my tubes tied since DH and I are done having children. That will happen the same day so I feel Im taking care of that without having to go back again.
As much as its surgery and Im nervous/scared...I feel it will be ok, all around.
This is why I said "if you're planning to BF". If bf'ing is a high priority for someone, it is recommended that the baby nurse as soon after delivery as possible. As someone who has had my fair share of nursing issues with babies, it was a top priority for me to nurse soon after delivery. (Which my girls did wonderfully!) : )
But I agree, the best way to deliver your babies is the way that makes you feel the most comfortable. Although many doctors push MoM's into c-sections, I really don't think they should be pushed as often as they are. My doctor was actually the one who convinced me to go vaginal after a few other doctors just gave me the protocol c-section info. After delivery she told me she was so glad I didn't end up choosing the section because everything went great.
Was you first baby delivered vaginally? If so, you have a greater chance of delivering the twins vaginally (without problems). I would go for it, if I were you! The recovery is much worse with a c/s- such horrible pain! I would rather have labor pains for a little while than c/s recovery pains for a long time! But it is up to you! Don't feel guilty for any choice you make. You are right in that you never know what can happen. I am a twin and when my mom had us, we were both head-down but when my sister came out, she sorta turned me around so I was born footling breech! We were my mom's second and she said the labor was SO much easier, even though we were twins. GL!
Brady Phoenix, 8.29.09
Claire Zoe, 10.26.10
Yes, you most likely can nurse right after a c/s, however- your milk takes much longer to come in with a c/s than with a vag birth. I think 4-5 days as opposed to 1-3 days? I forget but definitely longer.
Brady Phoenix, 8.29.09
Claire Zoe, 10.26.10
Ditto jacobandcrystal. There are risks with both vaginal deliveries and C-sections; when there are no complications, vaginal deliveries are safer and healthier for the moms and the babies. Some OBs prefer C-sections b/c they're scheduled, easier to control, and just more straightforward. But jacobandcrystal is absolutely right that C-sections are major surgery and have risks for the mom and that it increases the risks of the babies having lung problems. I have a friend whose LO was born a month before my guys, and her full-term singleton was in the NICU for 19 days because of breathing issues that were a direct result of his C-section! So yes, the risks of a C-section are real as well.
Only 5% of twin moms vaginally deliver the first and have to have a C-section for the second. So it's a real possibility but the odds are low. Some OBs--based on my own experience and what I've heard from others--urge MoMs to get a C-section because of that risk, often without sharing how low the odds actually are. In many cases a breech extraction is a better option than an emergency C-section for Baby B but not all OBs are trained in and comfortable with that. I switched OBs in the third tri to find one who was, and that turned out to be a very good thing because my Baby B did flip from vertex back to breech during delivery.
I'm still surprised it even is an option. I'm delivering at one of the best hospitals in the Northeast, Hackensack University and the 4 Obs I see won't give you an option. Too risky and frankly not worth it in their opinion. From the day we found out we were having twins it was decided. I do know of another patient that was adament about delivering naturally and had to change Dr's and hospitals. The first twin came out no problem the second one was deprieved of oxygen and has brain damage. All could have been avoided.
I'm sure there are success stories with natural birth too, but the risks are just too great in my mind and in the mind of the doctors in my case.
Ditto to macchiatto.
I get so mad at Dr's who try to scare women into c-sections when their bodies are perfectly able to handle a vaginal delivery, it's what it was designed to do.
I have nothing against a medically necessary c-section, or even people who choose one just because. After all, the ONLY thing that matters is that your babies are born and are healthy.
But, if my Dr. said to me, "it's your choice," you bet I'd opt for a vaginal delivery. It really is healthier for everyone involved. And the chances of the "double whammy" are so slim. Though, FWIW--I was scared of that too.
I delivered my twins vaginally. And it is true that anything can happen w/ Baby B once Baby A is delivered. For me, my labor progressed so fast that I had no choice in the delivery of A--it was vaginal, no time for an epi or anything. But Baby B was breech going into delivery. As soon as her brother was born, she flipped vertex and was able to be delivered vaginally as well. It went so well (aside from being slightly freaked out by it all going so fast
, which wasn't really bad!).
GL with your choice! There's no "wrong" answer here
.
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There are many top hospitals, peris, OBs, etc., who are pro vaginal delivery for twins as long as the circumstances are right, no complications, etc. I understand there are doctors who are not comfortable with that, but please understand this idea that C-sections are always safer is not something the whole medical community agrees with. There is plenty of research and literature supporting vaginal delivery for twins as well. In the US, 50% of twins are born vaginally so it's obviously something many OBs/peris are comfortable with.
For example, here are a few articles specifically on options even when Baby B is breech (which is what I researched since my B kept flipping back and forth), from high-risk OB textbooks and similar reliable sources:
https://books.google.com/books?id=YXcCmcrUk...2&ct=result
https://books.google.com/books?id=zOfIHEqig...5&ct=result
https://cat.inist.fr/?aModele=afficheN&cpsidt=2911192
I really really really do NOT want a c-section. I want to be able to carry my babies, get around easily, and not be so dependent on my husband in the beginning since I'm recovering from major surgery.
I should maybe add that a big reason I considered a C was because I had 3rd and 4th degree tearing with my singleton boys (who were both about 9 lbs.), and I was afraid of making my scars even worse.
However, delivering the girls was SO much easier than the boys! They were much smaller babies (6.3 and 6.13), so I had minimal tearing this time. I am not exaggerating when I say that I hardly had any pain after delivering them. I only took Motrin after for back pain... I really wouldn't have needed anything for vaginal pain. I was in shock that delivering twins was easier than delivering my big boys! : ) (I was in pain for weeks after the boys) With the girls I said to my hubby "So this is what it's supposed to feel like after you give birth!"
Anyway, just wanted to add my backstory. I'm really not pushing a vaginal delivery for you... I just happen to have a lot of info to share (after 4 babies!)and wanted to share it to give you some insight : )
I disagree with your assertation that one of the most important things is for you to be in as little pain as possible. Let me be the first to tell you that my vaginal delivery, while immensely painful, I'd be willing to repeat in a heartbeat in lieu of having my abdomen wall and uterus cut open.
I also disagree with the bonding experience thing. Every woman reacts to her birth experience differently, and it may not be the same as someone who delivered vaginally.
There must be something to delivering twins vaginally, as many of our OBs will allow it under certain circumstances. My OB would be happy to let me try if A were head down. That's the only restriction on my vaginal attempt. Unfortunately, A isn't head down and never has been. Hence, I have a scheduled c-section which I'm terrified about.
I had to have a scheduled c/s because both babies were breech. It was a really great experience too. We weren't rushed and everything went smoothly. We were in and out of the OR in an hour. My recovery was really easy (I listed to the doctor and didn't do too much too soon).
But, if one hadn't been necessary, I would have definitely tried a vaginal delivery first.
I don't know why she's making you decide now. My OB didn't ask me to make my decision (not that I really had one, but anyway) until I was 36w along. You have no idea what position those babies will be in when you deliver and you can't even be certain that you'd make it to your scheduled date anyway (although I hope you would).
I would tell her you prefer to make that decision closer to the time that it is necessary. 20-21 weeks just seems awfully early to be thinking about that yet.
I only had a spinal anesthetic so I could BF immediately after we were in recovery. Both boys did very well.
It might not be as bad as you think. My worst days were when I was in the hospital. Once I was home, I could carry the babies around and do things for myself as long as I didn't overexert. I just made sure I only did the stairs twice a day until I was more recovered and everything was fine.
I know everyone reacts differently to the healing process, but mine wasn't bad at all.
After 2 rounds of IVF & 2 rounds of FET, we were blessed with identical twin girls!
This is what I'm so concerned about with a c/s. I just want to be able to take care of myself and my babies as soon as possible after delivery. My dr. says I can go vag if baby A is head down but she isn't into delivering a breeched baby. I went online to find different ways to get babies to turn.
Personally, I am terrified of a C-section. While it might be nice to know when you are going in to have babies, the unknown factors of how your body react afterwards aren't worth it to me.
I had a semi-difficult labor with my singleton (24 hours, back labor, 3 hours of pushing), I would do it vaginally in a heart beat. I just don't know how recovery will be from a CS and I am scared of the added risks.
My doctor is comfortable with delivering B breech - so I am just really hoping A turns head down!
I saw a peri exclusively. Although I had the choice to a c-section, he was very pro-vaginal delivery because it is generally better for both babies and mother. Honestly, I wouldn't go to a doctor that said you *had* to have a c-section. That tells me that they either have very little experience with twins or are extremely worried about lawsuits. Possibly both.
I had a vaginal delivery and would do it again in a heartbeat.
i had a c/s as baby b was breech, and also i'm not sure if they really like doing vaginal births under a certain gest age... i think i remember that??
i did go into labor at 33 1/2 wks, and was at least 8cm when i finally got my spinal block (we were waiting on b/w to come back due to my clotting disorder). contractions are not fun, and when you start feeling like you want to PUSH, but can't... that's not fun. the actual c/s was bliss. no pain. the recovery was horribly painful. not sure if that was partly due to being on bedrest since 13wks. my body was a MESS, and i felt like the straw man from the wizard of oz... nothing was holding me up/together. anyway, i would've gladly taken the immediate pain of vaginal birth (though i was scared of the double whammy too) over the after pain of c/s. though many have had much much better experiences with c/s. not trying to scare you, just saying there are no guarantees.
there is a general trend toward c-sect in this country. we do more c/s than most, if not all, other developed nations. imo, choices by doctors and hospitals are made at least in part in fear of litigious patients. c/s is a major surgery, but puts more control in the hands of the docs. in vaginal birth (esp twins) there are more variables, and this makes many doctors uncomfortable. also, a planned c/s is an efficient way for hospitals to make $$.... much more so than long, drawn out vaginal births, esp that involve twins.
This. If I felt pushed or scared into an unnecessary surgery, I'd be shopping for a new doctor. There are risks with both types of deliveries, but if I had the ability to try for a vaginal delivery, I'd choose it every time.
BTW, I had a vaginal delivery with a breech extraction for Baby B, and it was a breeze. (And I felt a little like Superwoman after it was over.)
I had a vaginal birth with DS1 and a c/s with twins (Baby A, Jacob was breech). Both have their ups and downs IMO.
My vaginal birth was great. I did need an episiotomy, but I had an epidural and didn't feel anything. My looloo was of course sensitive for a while. They had my mesh underwear filled with crushed ice in a NB diaper to help with swelling (so sitting in a chair was hard in the hospital, but in the bed was fine since the bed was soft). I delivered LATE Saturday night and went home on Monday morning. I was terrified of that first poop since I did have an episiotomy but it wasn't that bad, I just took stool softeners and took my time (wasn't near as bad as I thought it would be).
My c/s was pretty good too. It was nice to have everything planned (since we already have a toddler, we didn't have to worry about calling someone last minute to watch him). Even though there was a ton going on, it seemed very calm and structured since it was all planned. I was TERRIFIED of the c/s, I was so scared that I wouldn't be numb (which is rare but can actually happen). I don't remember much of the procedure because I was trying to block what was happening out until I heard our first baby's cry (Jacob). Two minutes later William started crying. It took them about 30 minutes or so to stitch me back up and DH was holding the babies while that was happening. I was then wheeled to my room and got to hold my babies (or maybe I held them on the way to my room, it's all such a blur). What's great is that I wasn't afraid to use the bathroom since nothing in my nether regions was touched, but I was scared to take a shower (again, not a big deal, I'm a huge worrier and nothing is ever as bad as I think it will be). It did hurt to laugh, cough, or sneeze but God was very good to me and I didn't have to do much coughing/sneezing for quite a while until I was healed. The worst part of the whole thing was how long I was there. I had my babies on Thursday morning and was there until late Monday morning. EVERY.SINGLE shift change the nurses would ask me to rate my pain from 1-10, how often/how long the babies were nursing, just aggravating me when all I wanted was some space. By Saturday I was so ready to walk myself and my babies out of the hospital because I was so ready to go home.
I know that was long, just figured I'd lay out the pro's and con's from my experience. Like you said in your OP, the most important thing is that everyone's happy and healthy.
ETA: One of my favorite things about my c/s is that it was MY doc there doing it. If I'd have gone into labor when he wasn't on call, I would've gotten one of the other OB's in the practice.
This. We don't have the highest rate--I've read that Brazil has a c-section rate of 80%! But our rate is over 30%, while the World Health Organization recommends the no country should have a national average greater than 15%.
Of course, twins are extraordinary. IMO, twin moms--and all moms--should feel comfortable choosing whatever feels right to them. But it might be difficult for them to feel comfortable choosing vaginal when their doctors are not properly informing them about the risks and benefits of each delivery method.
My MFM told me that I can choose a c-section if I want to, but that she recommends vaginal birth in all cases where the babies present in a way that means vaginal delivery is safe (baby A head down and bigger than or the same size as baby
. Unless an emergent situation suggests otherwise, vaginal is safest for both mom and baby, she says. And I agree. I'll be hoping for vaginal.
I wish you--and everybody--the best in your decision making, though. I'm all about supporting each woman in whatever she chooses for herself and her family.
Ditto this exactly.
Only 5% of twin moms have a double whammy.