In desperate need of advice re: delivery options

Re: In desperate need of advice re: delivery options

• macchiatto member

  December 2010

  I switched OBs (and hospitals) at 31w and that was part of my reason. I was really glad I did. My Baby B kept flipping back and forth between breech and vertex (while A was vertex the whole third tri). When I started my induction, both boys were vertex but B flipped again at some point during labor. If I'd stayed with my original practice I would've ended up with a double whammy, so I was very glad I had switched to someone who was comfortable and experienced with breech extractions.

  You may have come across these articles already since you said this is what your research has pointed you toward, but I have a blog post about this with some links to great resources on delivering breech second twins:

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

  fraternal twin boys born january 2009

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• Temp159135562506975 member

  December 2010

  ashleymarie123:

  I'm graduating with my bachelors in bio in May so I know how to research REAL facts and everything I've read keeps encouraging me towards the TOL with attempted breech extraction. TIA!

  I'm sure you find a lot of info out there encouraging a breech extraction -but I personally would listen to the person with the MD, who has been in practice for many years and experienced how things like that go vs. stuff you read online.

  You can certainly shop around for other doctors - but realize that you will always have a chance for a c/s no matter who you end up with and what they tell you they are willing to do.  A scheduled c/s is generally MUCH easier to heal from than an emergency one... and often, you are knocked out if you go in for an emergency c/s of baby B.  Keep all these things in mind as you make your decision.

  My c/s was cake to recover from compared to my vaginal birth, FWIW.

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• GiGi1221

  December 2010

  I would by all means look around.  Both my peri and ob were comfortable with breech extraction.  Baby A was head down and Baby B was transverse.  He switched to head down once A was out so I didn't need a breech extraction.

  Hope you get the labor and delivery you're hoping for!
  

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• macchiatto member

  December 2010

  Goldie, a lot of the stuff online--e.g. the resources I linked to--are medical journals and a high-risk medical textbook, not just random websites. The research does indeed point to a breech extraction being the best option in general for a breech Baby B--definitely preferable to an external cephalic version and at least as safe as a C-section (which, of course, has its own risks for both mom and babies, though as your experiences prove there are no guarantees either way). Many doctors are not adequately trained in breech extractions these days and consequently not comfortable with them--mainly because of convenience and avoidance of litigation, not evidence-based medicine-- but many top peris, etc., (including the MFM at my original practice, who was the director of perinatology at the USC School of Medicine) are trained in and comfortable with breech extractions. So I think it's worth shopping around, even though of course there are no guarantees in the world of L&D.
  

  fraternal twin boys born january 2009

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• Temp6313048411121614 member

  December 2010

  OUCH!  GL to you if you need a BE.  That sounds incredibly painful and terrifying.  My OB was not comfortable with it, but another OB in the practice was (though I didn't know this before delivery).  I absolutely love my OB and had a scheduled c/s.  I had 1 vaginal birth and was terrified of the c/s, it really wasn't any worse than my very easy vaginal, just different.  Hope you get a very routine, uncomplicated vaginal delivery.
  

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• babydontforget

  December 2010

  I agree with macchiatto. Often peris/OBs aren't comfortable with breech extraction on a second twin not because the patient's case makes them uncomfortable, but because they just don't have the training to feel comfortable. Thank god docs who don't have the training to do it will say to their patients that they don't feel comfortable...but that doesn't mean that there aren't other docs out there that DO have the training.

  OP, if I were you I'd ask your peri outright: Do you feel uncomfortable because of something having to do with me/my pregnancy? (For example, my peri group only does a breech extraction on a second twin if the second twin is smaller. Is your baby B smaller?) Or is it because you don't have experience with it? If he says the latter is true, why not just ask HIM to recommend another doctor who does feel comfortable? Honestly, if he's the only peri in your area, he's probably the most likely to know the skillsets of the other OBs around town.

  macchiatto:

  Goldie, a lot of the stuff online--e.g. the resources I linked to--are medical journals and a high-risk medical textbook, not just random websites. The research does indeed point to a breech extraction being the best option in general for a breech Baby B--definitely preferable to an external cephalic version and at least as safe as a C-section (which, of course, has its own risks for both mom and babies, though as your experiences prove there are no guarantees either way). Many doctors are not adequately trained in breech extractions these days and consequently not comfortable with them--mainly because of convenience and avoidance of litigation, not evidence-based medicine-- but many top peris, etc., (including the MFM at my original practice, who was the director of perinatology at the USC School of Medicine) are trained in and comfortable with breech extractions. So I think it's worth shopping around, even though of course there are no guarantees in the world of L&D.
  

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• anyalee

  December 2010

  I found that it was very hard to find anyone who would let me deliver vaginally with Baby B breech.  My OB would only if this 1 MFM who would assist was there.  Well, of course, that 1 MFM was on vaca.  I so did not want a c-section!  But at that point I was just like "whatever, take these babies out".  The c-section wasn't that bad.  Many of the younger OBs won't do it because these days they hardly ever deliver singletons breech so they don't have as much experience.  The only reason some will deliver B babies breech (as long as it isn't much bigger) is because once A comes out they know B will safely fit out breech.  The older docs delivered more breech babies so are more apt to do it.  I actually found that some men were more open to it too.  But in my case none of the Drs that covered would do it without that 1 MFM.  I really hope you're able to find someone who will let you deliver vaginally!

  

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• ashleymarie123

  December 2010

  Goldie_Locks_5:

  I'm sure you find a lot of info out there encouraging a breech extraction -but I personally would listen to the person with the MD, who has been in practice for many years and experienced how things like that go vs. stuff you read online.

  These are peer-reviewed medical journal articles written by doctors, most of whom are practicing physicians.

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• macchiatto member

  December 2010

  Aussie*s_Mom:

  OUCH!  GL to you if you need a BE.  That sounds incredibly painful and terrifying.
  

  I had an epidural so the breech extraction honestly wasn't bad. After 3 hrs of pushing just to get Baby A out, in a way it was nice not to have to do more pushing for the second baby. Besides, I had this amazing little Baby A on my chest that I was just getting to see for the first time, and that helped distract me from what my OB was doing.

  Even with taking the time to let DH cut Baby A's cord, then the OB did a u/s, discovered B had flipped to breech again, broke his water and then was maneuvering the u/s wand with one hand while his other hand reached up to pull Baby B out (which was tricky b/c he was way up in my rib cage). Even with all that, they were born just 7 minutes apart so it went pretty quickly.
  

  fraternal twin boys born january 2009

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• nikinikinine member

  December 2010

  our babies are vertex/vertex and have been since week 16. That said, I still grilled all of the delivering OB's at my practice on their delivery stances. I want a vaginal delivery and I want someone who will let me fight it out that way and not push me toward a c/s. Not all doctor's have experience doing twin deliveries and/or breech extractions.

  Feel free to ask your OB what is is about your situation that makes him/her uncomfortable. Is it something anatomically that is a concern, or is it just something that she/he isn't comfortable performing.

  I wouldn't hesitate to switch if you were backed into a corner with no medical reason for having to deliver via c. It's major surgery, there's recovery and pain killers and surgical site pain afterward. I understand that for some the c/s is easier (or a better option, or the only option) - but I get your reasoning for not wanting one.

  FWIW, I wanted as natural a delivery as possible and my OB said no way. I have to have an epidural placed at 4-5cm if they'll let me do a vaginal delivery just in case a breech extraction (or an emergency C) is needed. To me, it's worth it to get the epi if it means they'll let me deliver the way I want to.

  GL to you! 

  It's Always Something
  
  

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