No vaginal birth even if both head down?

Mrs.Paws · February 2013

While at this point I'm thrilled to still be pregnant after a per-term labor scare, something one of my doctors said really caught me off guard. So there are three doctors in the practice. They make you see all three while pregnant, but one is relatively new.

In talking with the other two, both said they would recommend a vaginal birth if both were head down and A was bigger than B. I delivered my nine pound daughter vaginally with no problems.

Today the new doctor said a c-section might be safer but we'll see. I didn't stop and ask questions. It was at the end of a long appointment dealing mostly with follow up from my hospital stay.

Any thoughts? Could it have anything to do with the per-term labor? I'm thinking I might try to avoid appointments with her and get notes in my chart on the other doctors' recommendations. Of course if there's some reason I'm totally fine with it. I'm just worried she is being overly conservative.

macchiatto · February 2013

That would annoy me if there was no medical reason for it and it wasn't something you wanted. Some docs in my original OB practice (which I ended up leaving, partly for this reason) were just very biased in favor of C-sections. Like one of them said, "Well, you can go vaginal if you want to if everything is going OK but I just don't see why you wouldn't want to get the babies out in 10 minutes if you can." NOT my philosophy at all and I think it's sad that an OB would just ignore all the health benefits to mom and babies that a vaginal delivery can have (if, of course, there aren't complications that would make one unsafe). One of my local friends had a healthy full-term singleton a month before my boys were born. He ended up in the NICU for 3 weeks, in part because of breathing problems resulting from the C-section (since it doesn't push the fluid out of baby's lungs like vaginal birth does). That was definitely on my mind when weighing the risks and benefits of vaginal deliveries and C-sections.

JocelynB0911 · February 2013

My doc told me that as long as baby a was head down that I could delover vaginally. He said even if baby b was breech he could reach up there and grab baby b and pull it out. Obviously, we'd do a section if medically necessary.

mrsjami · February 2013

My OB is pushing Csection too which is concerning me. Be just keeps saying its safest for twins and baby b can be unpredictable after delivering A....

ghl · February 2013

Prior to my placenta previa dx, my MFM was in full support of letting me VBAC if baby A was head down so if your previous delivery was vaginal, I really don't see why a C would be deemed medically necessary unless there's anything else going on. There are risks with either option, and my understanding from my MFM was that the challenge w/ vaginal delivery of twins is how baby B might move once A is delivered and B suddenly has space to turn. It is possible that an emergency C ends up being necessary and there is a higher chance of that happening w/ baby B, but that can also happen with any birth.

As a VBAC, he didn't feel the risk of uterine rupture was significantly greater w/ twins than a singleton so he supported it as a birth option as long as it was under controlled conditions - we would be in an OR with an epidural and prepared for a C if needed, not a regular L&D room. Unfortunately, now that I have complete placenta previa, these decisions are now moot anyway and it'll be a RCS but at least it truly is for a medical necessity.

Mayan2011 · February 2013

JocelynB0911:
My doc told me that as long as baby a was head down that I could delover vaginally. He said even if baby b was breech he could reach up there and grab baby b and pull it out. Obviously, we'd do a section if medically necessary.

This. I, however, developed HELLP Symdrome so it was an emergency c/s for me.

bluebonnetmeg · February 2013

My dr was fine with a vaginal birth even with pre term labor and a breech baby B. He did a manual version after A was born (reached in to flip him) and B turned right over. They were 9 minutes apart, even with the version. I really wanted to avoid a c-section if at all possible since DH and I do want more children. Good luck!

LadyNikon · February 2013

JocelynB0911:
My doc told me that as long as baby a was head down that I could delover vaginally. He said even if baby b was breech he could reach up there and grab baby b and pull it out. Obviously, we'd do a section if medically necessary.

This.

MuseumMaven · February 2013

macchiatto:
That would annoy me if there was no medical reason for it and it wasn't something you wanted. Some docs in my original OB practice which I ended up leaving, partly for this reason were just very biased in favor of Csections. Like one of them said, "Well, you can go vaginal if you want to if everything is going OK but I just don't see why you wouldn't want to get the babies out in 10 minutes if you can." NOT my philosophy at all and I think it's sad that an OB would just ignore all the health benefits to mom and babies that a vaginal delivery can have if, of course, there aren't complications that would make one unsafe. One of my local friends had a healthy fullterm singleton a month before my boys were born. He ended up in the NICU for 3 weeks, in part because of breathing problems resulting from the Csection since it doesn't push the fluid out of baby's lungs like vaginal birth does. That was definitely on my mind when weighing the risks and benefits of vaginal deliveries and Csections.

Well said. My boys were born vaginally as they were both head down. I would definitely ask for some clarification on your practice's policies.

keg · February 2013

I'd definitely be worried...It sounds like it's a doc that would much prefer to do a section and might not be comfortable dealing with a twin vaginal delivery. My group turned out to be like that and I really wished I switched providers, but hindsight is 20/20. Even if the other two doctors are supportive, I'd still be leery of the group since you can't control who is on call when you go into labor. At the very least, I'd try to get confirmation of what would happen if that doctor is on call.

yinyang124 · February 2013

My PTL started at 23w, and I delivered my boys vaginally at 34w. They were mono/di and both head down. I would advocate for the vaginal delivery!

missfire · February 2013

Do you know how much experience the doctors have delivering twins? So many doctors feel more comfortable with a c-section because they have more practice with it and have more control. I would want a more experienced doctor, if you have other options!

jcath · February 2013

I would talk to one of the other doctors that said you did have the option for a vaginal birth and explain what the new Dr said and what your wishes are.

ppants · February 2013

Mine were both head down and I delivered both vaginally. Two of the drs in the practice would have done a breech extraction of baby B if needed. The others would have done a c/s. A vaginal birth is better for baby because it helps get the fluid out of their lungs.

KDR1979 · February 2013

If you had a 9lb baby vaginally, you should definitely be able to deliver your twins vaginally!!! ESPECIALLY if they are both head down! I was a first time mom and we knew baby B was bigger (we expected him to be one pound bigger) and we knew his head was much bigger. Baby A's head was 10-15th percentile and Baby B's head was 90th percentile. I pushed 4x for my 5lb daughter and 45 minutes for my son, who was 6lbs 9oz! I was a 1st time mom & both babies were head down. I am so happy that I was able to avoid a c/s!

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