Twin delivery

vegetablegardens · December 2013

Before learning that I was having twins, I was very much set on an intervention-free natural birth. I'm delivering with an OB, who is very supportive of this in general. With twins, the issue is always the delivery of Baby B. He is 100% comfortable with a vaginal delivery, as long as Baby A has a vertex presentation. However, it is not uncommon for Baby B to have "issues" once Baby A has been delivered, due to any number of things (e.g., closing of the cervix, quick change in presentation, etc). Because of this it is quite possible to have to deliver Baby B by cesarean after a vaginal delivery of Baby A.

Now. I've been very impressed my my OB's model of care. I was working with a midwife for my first pregnancy (which, unfortunately ended in miscarriage), and I was very much looking forward to the midwifery model of antepartum care and childbirth. My OBs answers have all been "right". I can have delayed cord clamping and immediate skin to skin. There is no "time limit" for labor. There is no time limit for Baby B after Baby A has been delivered (so I can labor for as long as necessary for Baby B after Baby A's delivery, provided that there are no significant signs of distress). I can use a shower or whirlpool or all sorts of other types of labor "gear" to aid in pain relief and labor progression if I want. Lights are low and the rooms resemble my bedroom at home. They will happily do intermittent monitoring, etc.

But. He highly recommends an epidural anesthetic with twins because of the higher likelihood of needing an emergency cesarean for Baby B (or of needing him to reach into my uterus to pull Baby B out to avoid a cesarean if possible).

Ultimately, this is about the healthy delivery of my babies and not about what I necessarily want out of a birth experience. What I don't want is to have to have general anesthesia for an emergency cesarean and for my husband and I to miss their birth. And I don't want to expose the babies to the risks of general anesthesia.

One option is to have the epidural placed but to not administer the anesthetic until late in labor, just before the pushing stage. That way is it there "in case," for the part where the risks are greater for twin deliveries, but I can still mostly labor without it. I just hate that I have to push with an epidural in. But again, it isn't about me.

I'm not sure what I'm asking of you all, but I just wanted to put my current labor thoughts out there for some validation, support, and/or suggestions. I've never been through labor and delivery before (much less twin delivery!), so I wanted to see if my idea of the "late" epidural is a reasonable one. Or if there are any other mothers of multiples who have had or desired to have a natural delivery.

Thanks, guys!

wintersong · December 2013

It sounds like your OB is someone you have a great deal of trust in, who wants to help you gave as close to your ideal birth as possible. Does he think a late epidural is a reasonable idea?

julyjennifer · December 2013

Yes, this sounds reasonable to me. There is a birth story on the Birth Without Fear blog about just this situation. Check it out.

https://birthwithoutfearblog.com

jennybean80 · December 2013

I've had a similar talk with my OB and I'm still not sure what I'm planning to do. I think having the epidural placed but infusing only for the end is a reasonable compromise. They might be willing to run it very low dose so you still feel the urge to push, and then top up for a possible c-section (which they would have to do even with a regular strength epidural). Still not sure if I'll get one anyway…

I was also warned that even if both babies are in good positions, the incidence of a c-section for B goes up quite a bit if babies come preterm. Since my DS came at 27 weeks, if I go into labour really early I might go for the late epidural just to be safer for babies.

pillowass · December 2013

I wrestled with these issues during my twin pregnancy. I had 2 head-down, nearly full term babies and a very accommodating MFM who would support whatever pain relief options I wanted. I decided to get the epidural. As I am sure you know, twin deliveries have a whole different set of risks than a singleton, particularly for Baby B. I wanted the care team to be 100% focused on getting the babies out safely, and I did not want anyone (including myself and DH) to have to worry about managing my pain during what would be a complicated delivery even under the best circumstances.

The other thing that contributed to my decision was the incredible physical discomfort of being 37 weeks pregnant with 13 pounds of baby. By that time any illusions of freedom of movement and changing positions during labor was pretty much out the window since I could barely change positions on my couch at home. The epidural was pure heaven. I have not been that comfortable in months. I still fantasize about it!

Good luck and congratulations on your twins!

ehighlan · January 2014

I am usually a lurker on this board, but I wanted to say that I delivered my twins vaginally and had to have an epidural because of the chance of c-section. Both babies were head down and then when my son was born my daughter flipped. My Dr reached in and turned her and she was delivered without issue 9 minutes later. Even though I wanted a natural delivery the low dosage epidural kept me from having to have the c-sec (if that makes sense). I was still completely "with it" and did not miss a beat. It sounds like your Dr. is very supportive and will be willing to do what you both believe is best for your babies. GL!

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