OB's c/s vs. vaginal birth policy for twins?

lynnyrd80 · March 2014

Hi ladies. I finally had the birth talk with my OB at my last appointment. Her policy is that both babies have to be head down when I go into labor to attempt a vaginal birth. I will also set up a planned c-section date between 37-38 weeks. If I make it to that date, I will definitely be having a c-section because she won't induce with twins.

I'm comfortable with this because I really like and trust my OB, but I'm curious how this compares to everyone else. What is/ was your doctor's policy on c-sections vs. letting you try for a vaginal birth?

ajsweeton · March 2014

My MFM's policy is to go for a vaginal birth so long as: Baby A is head down and Baby B is smaller than A regardless of position they will "reach in and grab B's feet to deliver" if they are breech. If Baby B is larger than A they must both be head down to try for a vaginal birth. My MFM will induce if I make it to 38 weeks without going into labor on my own.

legaleagles · March 2014

My OB's practice is that a vaginal delivery is ideal and she will induce with twins. She requires a c-section when baby A is breech. She also tends to require a c/s if baby A is head down, but baby B is breech and measuring bigger. If baby A is head down and baby B is measuring smaller and breech, she is fine doing a breech extraction of Baby B.

Right now both babies are breech so I'm scheduled for a c/s at 38 weeks to the day. If A flips head down, it will be switched to an induction since baby B is measuring smaller (even if B is breech).

TheDairyQueenx3 · March 2014

My midwife would deliver vaginally regardless of position as long as it was not your first child(ren). Her husband my MFM, would induce at any point necessary. He would deliver vaginally over c/s as long as A was head down and B was allowed to be breech. My B was breech but after a was born followed him out head down.

macchiatto · March 2014

At the practice I was with for the first 31w of my pregnancy, the OBs and MFM all had different policies. I think 4 of them wanted both babies head down, one or two were willing to manually turn a breech baby B, and the MFM said a breech extraction for baby B would be no problem.

I did end up switching practices at 31w for various reasons. At the second practice, my OB was very willing and able to do a breech extraction for Baby B if necessary (which did end up happening even though both babies were head-down when my induction started). His partner was not comfortable with that, and the two doctors in their partner practice wanted both babies head-down, too. My OB though knew it was important to me so he gave me his cell phone number and even though he was on vacation (in town) when I was 36w-37w1d, he told me to call him if I went into labor and he would be there, regardless of who was on call or if it happened during his vacation. We very much appreciated that and that all went smoothly with the breech extraction. And I did make it to my scheduled induction at 37w6d so his vacation was uninterrupted.

whitehousem · March 2014

There are 20+ different OBs who could be on call if I go into labor, so it depends a little on who is on-call. But my OB will schedule me for an induction at 37 weeks (mo/di). There hasn't been much talk of c-section bc A has been head down for months and B moves between head down and transverse. If B flips breech, it will depend on the OB and what they are comfortable with. My OB did say I could opt for a c-section but I'd rather try to deliver vaginally. Either way I will deliver in the OR in card they need to do an emergency section at any point.

KatieGummow · March 2014

As long as baby A is head down my OB encourages a vaginal delivery. She will then try her best to flip B if he is breech after A is born. I will deliver in the OR in case of an emergency.

Rannndi · March 2014

Like PPs, my MFMs policy is that as long as Baby A is head down, and Baby B isn't "too big," we will try for a vaginal delivery. B can be bigger but just not too big. She can also be breech, and they will still attempt.

LittleLady77 · March 2014

Honestly, I would be concerned if my OB told me that OP. Vaginal deliveries are highly encouraged at my hospital. They will induce with twins (my induction date in next week) and only baby A has to be head down. They will also take the size of the twins into consideration but so far B is 1lb bigger than A and they don't see that as a problem.

Rachiemoo · March 2014

My MFM allowed vaginal delivery as long as Baby A was head down. Both of mine were head down so it wasn't an issue, but even if Baby B was breech I would have been able to attempt it. I find that you need to find a very experienced doctor if you really want to go for a vaginal birth. Many doctors just don't seem to be that open to vaginal twin deliveries, even if they don't come out and say it.

caden · March 2014

My OB did not do breech extractions, but she did do inductions. So I could only try for a vag delivery if both were head down. My babies were both head down so I didn't ask the other OBs in the practice if they would do a breech extraction.

Dena526 · March 2014

My doctor wouldn't do a breech extraction, which was fine with me. Baby A ended up staying breech so we set up a c section for exactly 38 weeks, but I did go into labor 4 days before my scheduled date. Everything worked out:)

steidla · March 2014

Mine was the same as most of these - as long as Baby A was head down, go for vaginal. This worked, and my OB yanked out Baby B by his feet. She was young, so I was a little surprised she was comfortable with breech, but their whole practice was fine with it. She had an older doctor in there to help coach her along. Also, I was induced at 39 weeks (although the doc preferred 38).

BeesKnees181 · March 2014

My OB's policy is that he would deliver vaginally as long as Baby A is head down. He said that not everyone in his practice will attempt a breech delivery, but that if baby B was breech he would do a breech delivery. (He said not many "new OBs" are comfortable doing that though.) My OB is pretty adamant about 37 weeks being go time. He has not mentioned inducing me, though.

LegalLadyBug · March 2014

My OB is the same, he wants both twins to be head down. He has done many breach deliveries but told me he doesn't see the point in taking that risk if we don't have to. He's been practicing a long time and is one of the best in the area so I trust him and after talking about it with him I'm at peace with the c section decision.

ppants · March 2014

My OB and two others in the practice would attempt a breech extraction of Baby B if needed. Thankfully, both were head down and stayed head down and I was able to have a vaginal delivery.

curlylocks3 · March 2014

My MFMs recommendation and my OBs policy is that we try for a vaginal delivery as long as A is head down and B is the same size or smaller. Every OB in the practice is comfortable with breech extractions. Induction prior to 39 weeks is only done for the same reasons as with a singleton (non-reassuring testing, etc)

The only warning I had about the increased likelihood of a csection actually came from a midwife I saw, who commented that with two of them the chances of something indicating need for earlier delivery, either while pregnant or in labor, is higher than with one. I'm not sure how true that is...but she just said it might factor into the decision.

maribelleNS · March 2014

My MFM recommended a vaginal delivery provided baby A is head down and larger than B. My baby B was breech but we went for an induction vs immediately going for c-section. I was given the option but persuaded to at least try for a vaginal delivery. Ended up with a c-sec anyway after induction didn't progress enough for delivery. If i had my time back i'd have gone straight for the c-section

JTA2426 · March 2014

OB was comfortable with letting me deliver on the same terms as yours until it was determined that mine shared a placenta. MFM said some research suggests that Twin B doesn't do as well under those circumstances when delivered vaginally so when I went into labor at 34 weeks, we did a c/s. I was comfortable with it!

Labyrinth3000 · March 2014

My doctor wants both of my babies head down in order to deliver vaginally but unfortunately at 31 weeks baby B has not turned. Since this is my first birth, my twins are Mono/Di, and they are exactly the same size my doctor is leaning towards a C-section at 37 weeks. I still have a bit of time for baby B to turn but they feel so tight in there already!

sarah_beth2005 · March 2014

Great thread! I asked my doctor about this at our appt. this morning. Baby A is smaller than Baby B, and so far, both babies have been breach at every ultrasound. He said that if both babies are head down when the time comes, and no other complications, we'll try for vaginal. If Baby B stays breach, then definitely a C-section. If Baby A is head down but Baby B is breach, then it'll be a C-section, since he doesn't want to get in a situation where Baby B (as the bigger baby) gets stuck when they try to pull him out as a breach baby.

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