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Multiples
reillyroowho
member
Vaginal Birth with mo/di twins?
reillyroowho
member
in Multiples
I seem to bring this up a lot so I thought I might just share. My babies are mo/di are are being monitored for TTTS because they are just hovering within the range of normal. One has a fluid pocket usually between 2.3 and 4.0 while the other ranges between 11-12 so they definitely have a huge pocket discrepancy but the MFM says they are still okay. The MFM that I work with has clients coming to him from all over the country and beyond (I met someone in the UK last week in the waiting room!) so he is the real deal. I feel very lucky that he has agreed to take me on as a private client so he can deliver them. Anyways, we discussed very early on what my options were for birth. If I chose to deliver vaginally I would be putting them at risk for acute TTTS which happens very suddenly during labor and needs to be taken very seriously. The chances are somewhat small but he let me know that the if I was to choose a vaginal birth that their hearts would need to be monitored very closely and that if there were any signs that things weren't going well that they would preform an emergency C-section. I asked him what he thought and he told me that he believes that delivering mo/di twins through scheduled c-section is the safest option even if they haven't shown any previous signs of TTTS. We chose to do the scheduled C/S. I am now wondering if people who chose to deliver mo/di twins vaginally don't really know of this risk or if my specialist is just being overly careful because of his line of work. What have your OBs told you about this? I don't think I will change my mind about the C/S because TTTS is too scary to risk in any shape or form but I am just wondering if he has me a little too concerned about it
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Re: Vaginal Birth with mo/di twins?
Peanut Butter and Jelly!
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I know we've already talked about this, OP, but my OBs say the same. They are very pro-vaginal. I feel really lucky and am excited to try if all keeps going well. But my babes have been w/in an ounce of each other the whole time, same fluid levels, etc. I haven't heard about acute TTTS yet from my docs, by name, but my regular OB has mentioned the possibility of the placenta not working etc during labor/delivery. I am confident they will be monitoring the babies aggressively -- both continuing through pregnancy, and during labor.
I think my OBs haven't mentioned it by name b/c chronic TTTS is much more common than acute (acute is around 1%, chronic is about 20%). I've been monitored regularly through this pregnancy from the get-go -- ultrasounds every two weeks, and as I get closer to my due date, I'll be going every week.
Personally I think your doctor is trying to avoid a liability case. Have you talked with other doctors about vaginal birth w mono-di twins? I think I remember you saying he scheduled it pretty early, too, 36 or 37 weeks? Most doctors want the babies to stay as long as possible up to 38/39 weeks, so their lungs can mature and they can grow as much as possible. (OR -- he could be suggesting it b/c of your babies' fluid discrepancies, which is a valid concern, and could put them at more risk for acute TTTS. ) If I were you I'd talk to more doctors about what he's talking about, but that's just me.
My OB talked to us about the increased risk of being mono/di the minute we found out there were two babies, yet he is still supportive of me trying a vaginal birth as long as Baby A is head down and Baby B is either head down or measuring a little smaller (for a breech extraction).
I had a complicated pregnancy with DS and was monitored constantly through delivery, I have no doubt both of these babies will be monitored super closely as well, and should Baby B start showing distress, I'm sure they will go the emergency c-section route.
I have a call in to another dr. for Tuesday. I think it is so hard because every dr. has different opinions on delivery times and what is best. At the Boston hospital I go to the they usually deliver mono-di twins either before or right at 37 weeks.
Interesting -- I'm at BIDMC and they will, with aggressive monitoring and if everything is perfect, go until 39.
My MFM was supportive of a vaginal birth only if both were head down. It's interesting she never mentioned the TTTS angle. By the time they were born we had no TTTS concerns but there were some about 20 weeks. I had a c/s scheduled b/c baby b was transverse but she turned at the last minute and I had pretty uncomplicated vaginal delivery.
Yeah I plan on telling them I don't see why I should be induced so early If they don't find anything on the u/s then I don't see why I should be induced.
My mo/di girls were both head down, but my MFM and OB didn't want to deliver them vaginally.
Like blondek8 said, each doctor is going to have a different take. One of the risks in delivering mo/di twins vaginally is that after Baby A comes out, if B doesn't follow shortly, you risk the placenta separating from the uterine wall and eliminating B's supply, thus an emergency c-section.
But everyone has their own comfort levels. Personally, I LOVED my c-section. I originally wanted a vaginal birth, but after weighing things out, we made the decision at 36 weeks 0 days, to schedule my c-section 3 days later.
I do plan on having a c-section if they want to come out before 36 weeks, for that very reason -- to hopefully reduce the strain on them.