Birth plan, natural out the window with twins?

JennMarie1 · October 2014

My OB (whom I trust implicitly) told me that with a twin birth she recommends an epidural due to concern that baby B will get into trouble after baby A is born and they'll need to do an emergency c-section. She said without an epidural already in place they'd have to put me to sleep which has greater risk for both myself and the baby. I was hoping to avoid an epidural, of course I came to that conclusion through googling for all of 5 minutes and she came to hers by delivering a ton of babies so her opinion > mine.

So I'm set on placing the epidural, but I'm wondering if it's an idiotic question to ask whether it can be placed and not used. Could they place the epidural and just not give me the actual medicine? I was hoping to be more mobile during the birthing process but I understand that's a pipe dream too as they'll want to connect me to a bunch of monitors most likely, but at least maybe I could avoid the drugs themselves. Also I'm fully aware that I have no conception of how much labor hurts and it's entirely possible that I'll be changing my tune when I'm actually feeling it

Any advice from ladies who have tried to go this route or who have discussed this with their doctors? I don't have another appointment for almost a month so I'll check with my OB then but I wanted to see if this is a common practice or something born of my ridiculous mind. Thanks ladies!!

RayRay007 · October 2014

I have heard of ppl getting epis placed but no meds. I haven't talked to my doc about this yet so I don't know if it's actually an option. My doc recommends one as well in case of cs for baby b or in case they need to do a version or extraction- these are quite uncomfortable I guess. I understand that, but I also know from experience that they can have a spinal up and running in a matter of minutes. I think I would rather have mobility than have an epi JIC.

ktibbits1 · October 2014

Obviously the decision is going to have to come after talking to your doctor, but I'll give my two cents as far as I understand (as I haven't delivered yet). You can have the epidural catheter placed but delay administration of the actual medication, but I'm guessing that you'd need to have the medication delivered before you're actually ready for delivery as it takes anywhere from 5-20 minutes for the medication to take effect. That wouldn't be fast enough if there's a true emergency. Hopefully your doctor will be supportive of your wanting to be mobile as the labor process progresses and you can delay the epidural as long as your doctor sees fit.

It's great to have a plan, but I think it's important to be flexible as there's no way of knowing whether or not your twins will be vertex, breach, transverse, or any combo of those that would favor a vaginal birth. Personally, I'm planning on having the epidural (I don't recover well from general anesthesia and I'd like to be aware of when my babies enter the world!) but I'd also like to wait a bit and let labor progress naturally. At least I'm saying that now, we'll see if I'm changing my tune too when it's actually happening! Best of luck to you!

lupineaura · October 2014

I had an unmedicated vaginal birth with my daughter and I really want that for this pregnancy as well. Following; I hope to hear some success stories!

carrotcake06 · October 2014

Yes, you can have the epi placed and then not use it. Had I been a candidate for a vag birth, I would have gone this way.

Also know that many many hospitals require you to labor in the OR regardless.

I had a c/s under general anesthesia due to baby a's prolapsed cord. I really wanted a vag birth, but never got the opportunity.

SeattleKrista · October 2014

Just found out we are expecting twins. Was going to see the midwives at Swedish Ballard, but they dumped me as soon as the first ultrasound revealed that there is more then one little one in there. Our first daughter was born vaginally with no pain meds. Now it looks like it's going to be hard to find a hospital that will let me even deliver in a normal room! And now seeing this post with so many doctors wanting to start epidurals. Feeling overwhelmed and frustrated.

KDR1979 · October 2014

I had a great vaginal delivery (with an epidural in the hospital OR suite). Baby A was born in 4 pushes, Baby B (much larger) was born 60 minutes later. I did have increased bleeding after they were born and was thankful to have the epidural.

I think if you have an epidural catheter placed w/o meds, it would still be hard for them to dose you adequately for an emergency c/s and may just put you to sleep anyway. Once you have an epidural, you won't be able to get out of bed...even if it is a "light"epidural.

If your OB has lots of experience with twin vaginal deliveries, you are in good hands. There are so many OB docs that section all twins these days.

Good luck!

Rynleigh · October 2014

One step at a time. Yes, most hospitals can place the line without starting the drip until necessary - however, in the event of an emergency cesarean, they may not be able to get that drip started fast enough to kick in and still end up putting you under if they have to.

But, right now, the best option is to understand that a multiples pregnancy comes along with a lot of potential for complications - and being unmedicated should be something that you consider a "bonus" - not a "plan"... there are so many other far more important things that will be on your radar this pregnancy - and planning to know all of the possible options and ways things can go so that you can be informed regardless of what happens and know that you are still going in educated, prepared, and willing to advocate for what you need, is much more important than spending a trimester or two wondering about whether or not you get to go unmedicated. Get yourself to 35 weeks, first, and then start talking birth plans

JessaPrimate · October 2014

I had a med-free birth with my singleton. Honestly, with all the odds stacked against you, I think the bigger battle is just having a vaginal delivery with multiples.

My main concerns with getting an epi were stalled labor and drugs in the babies' systems. Well, I showed up at the hospital at 6am at a 6, got the epi at 7am, and delivered at 8am.

Also, the OR is of course not as pleasant as the birthing suite, but just like people's concerns about modesty, you stop caring in the moment. I have read a lot of complaints about the hard, narrow table. Personally, I didn't even notice it.

cls78 · October 2014

I plan on getting the epi for sure if I deliver my twins vaginally. I think like previous poster said the bigger battle is being lucky enough to deliver vaginally. My OB said it is based on how the babies are positioned, so 50/50 chance.

rachelkongsore@hotmail.com · October 2014

I HAD A VAGINAL DELIVERY WITHOUT AN EPI! I had a wonderful delivery. I had an iv running because I was induced so my mobility was hooked to the IV pole but I was able to move around and even with the added pain associated with pitocin, I delivered without any pain meds. I am hoping to deliver vaginally again and have an hep lock in place even though my baby b is in breech position and may require a breech extraction. Just wanted to chime in that it is possible and not to give up hope on a natural birth, or at least as natural as possible!

TREDgirl · October 2014

My main advice would be to become knowledgeable of all options. Do not focus solely on the plan you want. Talk and be very open with your OB. Will they deliver vaginally if baby A is breech. Most likely no matter what you'll deliver in the OR.

Also ask if your actual dr will be delivering you no matter when you go in. Many practices will share dr's and what your dr allows may not be what another one does. And honestly when the time comes it's all about what is going to keep you and the babies safest.

pillowass · October 2014

My babies were both head down and I was about 10 hours shy of 37 weeks when I went into labor, so my MFM and hospital were very open to whatever pain relief options I wanted.

Even though I love the idea of drug-free birth, I opted for the epi because I wanted everyone in the room (including mysefl) to concentrate on getting my babies out safely - not managing my pain. My birth was near-textbook, but even so it was very tense and a little scary in between the 2 births. My MFM told me that when things go south with a vaginal twin delivery, it's usually with Baby B, and I can't imagine any way an epi could be placed/dosed in an emergency between births. You'd almost certainly be looking at general anesthesia.

I did have several hours of labor in a normal hospital room prior to delivery. I was about 7cm when I had the epi placed. I took a glorious nap (had not been that comfortable in months!) and then gave birth a few hours later. They wheeled me back to the normal room afterwards. The OR was not a big deal at all.

Good luck! And I agree with the PP. It doesn't make much sense to stress about the birth until you are 35 weeks or so and have more information to make your decision.

Rynleigh · October 2014

I've had epis with all four of my kids. I wasn't able to walk right away after the twins because I nearly bled to death from pre-e - BUT with BOTH of my singletons, I was able to walk within minutes of the line being removed. None of my children have ever seemed "drugged up" - they all had 9s on their APGAR scores at birth and 10s at the 5min check. My labor with my girls didn't progress *until* I got my epis. I was stuck at about 3cm with each until I got the lines set - then I fell asleep and woke up ready to push. With my first, however, they did a better job and kept the epi on low so that I could feel my legs completely when it came time to push. With my second and with my twins, it was up so high that I had to have help moving my legs - that would be the only downside, for me.

JBoundy · October 2014

RayRay007 said:

that they can have a spinal up and running in a matter of minutes.

that may be the case in ordinary circumstances, but my epi with my son took over an hour for the line to be put in -- the doctor missed the first time and then they had to try a different technique.

carrotcake06 · October 2014

I had an epi w my singleton. All it did was take the edge off, I could still feel everything - the urge to push, the ring of fire as he crowned, and the stitches afterward. They made me get up to pee almost immediately. I nursed within 15 min of him being born (he had trouble latching, but that wasn't the epi - he was a 37w, so I attribute it to being near-term).

As someone who had a traumatic twin birth, it sucks but it's not the end of the world. I'm still really emotional about how it all went down, but I was able to take home two babies.

And the good things: We nursed successfully for 14 months. They are hitting all of their milestones and are happy, inquisitive, and loving toddlers.

JennMarie1 · October 2014

Thanks so much for all the advice ladies, I agree completely that there's no sense in having a "plan" per say because I'll do whatever my OB recommends. I think if she told me to hang upside-down by my feet and whistle Dixie during labor I wouldn't even find it odd, on account of this being my first pregnancy and knowing literally nothing. My new plan-ish is to let the OB administer the epi whenever she wants but I'll let her know that I'm comfortable laboring without it for as long as she thinks is safe for the babies. Which might be not at all and that's ok too

I don't have any romanticized notions about labor, whatever happens between the start and finish won't matter to me as long as my kiddos come out safe. Of course I say that now...thanks again!!

CNYBride05 · October 2014

I didn't read anyone else's response so apologies if I repeat. I was given the same talk and has the same desires as you. I ended up laboring unmedicated from 8a-6p at which point I got the epi. I'm glad I waited and glad I got it. I delivered vaginally at 3a the following day. True, planning labor, singleton or multiples, is not possible, but it's good to have ideas of what you want.

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