Hi everyone!

I was hoping to pick everyone's brains again and get some advice!

Had my first Doctor visit today I am 22 weeks. We are having identical twin boys monochorionic/diamniotic sort, and the Doctor informed me today that we have no choice but to have a c-section!
I am freaking out a bit and was hoping to know if anyone else had found themselves in the same situation, and/or had any advice for me.
I have read a bit on the net and all I have seen so far is bad stuff.
I have a two year old and with twins and the recover time I am worried about how I will cope after!

Thanks for your time Sammy-rai

Hi there! My boys were also monochorionic diamniotic.

There are some obstetricians who will assist at vaginal deliveries of MC/DA twins, but your obby is quite within his rights to refuse to (he should refer you on if it's something you really want). My obs wouldn't do it because of the risk of detachment of the placenta, prior to twin 2's birth (which would be fatal, or seriously damaging). That sounded like a pretty damn good reason to me! (as it happened, the boys were prem anyway, and a VB was never going to be an option)

I know mums who have safely delivered MC/DA twins vaginally- it's definitely possible- it's just that looking at the research, it's a bit riskier. It's all a matter of weighing up your options.

It occurred to me that even if you opt for a vaginal birth, realistically there's always a fair chance you might end up with a caesar anyway. So before the birth, give some serious thought to what resources you can draw on to help you out at home if you need it- at least for the first few weeks. If there's someone with you, they could help with your toddler. My hubby took a full 6 weeks of leave (annual leave plus leave without pay) when the boys were born- it was the best thing he could have done. Some people have mums, sisters, friends etc. who can help.

Good luck!

(And FWIW, I've recently had a repeat caesar for our little girl. If I'd had to, I could have coped on my own with the boys- both in nappies- and the baby from about 3 weeks, but before then I probably couldn't have managed it physically.)

Hi I had a cesaer with my identical girls. I had mine due to the fact that they were both breech and therefore wasn't given an option. They were breech from about 20 weeks and i knew they wouldn't change.

I too read all the info out there and as i had an uneven placenta it was considered too dangerous for the little one.

I had heard plenty of horror stories about c-sections but to be honest i didn't have any issues. I used virtually no pain killers ( not because i was a hero but i just didn't feel i needed them ). It was sore for a few days afterwards but by the time i went home a week later i felt fine. Just don't do anything stupid and you'll be fine. I also had my mum here for 3 weeks but apart from no heavy lifting i was fine.

I also didn't have a young one at home i had a 7 year old which was a great help but also came with it's own set of problems - like school runs.

I would just say be prepared for a stay in Scbu some sleepless nights and a messy house otherwise i am sure you'll be fine.

I have fraternal twins, and my ob still gave me no choice but a C/S. I was so disappointed initially because I had delivered DS vaginally with little drugs, so just assumed it could be the same with my twins.

He was very straight with me, and said he had lost a twin 3 years earlier, because the second twin turned after the first was born and got into trouble and subsequently died. He said that after this he just didn't like to risk it. After hearing his story, I became more amenable to the idea of a C/S. I just wanted my babies to arrive safely. If this meant having them cut out, that's what I would do.

In the end, like PP, both my girls were presenting breech, so I would never have been allowed to deliver two breech babies vaginally! So for me, lucky I was fully prepared and accepting of the C/S delivery!

Please do not pay much attention to the horror stories of c-sections.

I too was worried about ending up with a c-section with my twins (after hoping to have a natural delivery after labouring for 9 hours).

However, my ob may the decision that my boys had been in a labouring utereus for too long. And thank goodness he made that decision. Twin B was stuck and even with my c-section it took alot of pulling, twisting and tugging to have him safely delivered.

Safety of the bubs beiig delivered really is the only thing that mattered to me.

I am a vaginally-delivered twin, as are the vast majority of twins of our generation. I was breech as well, but predictably turned to face down once there was room to move, after my twin brother was born.

I'm guessing that your ob is not qualified to vaginally birth twins. I would be finding one who is. Ask your current ob exactly what his objections are to vaginally birthing twins. He/she will no doubt give you a list of what he/she perceives to be all the risks. Then take that list of objections to an ob who is willing to birth the twins vaginally, and see what he/she has to say to counteract the concerns of the first ob.

Oh, and don't forget to ask both obs what the risks are for c/section births!!!

I hope you can find the support to do what feels right for you. Good luck!

firstly congrats on your twin pg.

i have mc/da girls - they were a vb - the only time a c-sec was mentioned was 2 days before inducement at 37+3 and that was a matter of protocol to ensure that i knew and understood the potential risks of placental abruption.

i was told if they were mc/ma there would be no choice (risk of cord entanglement) but with mc/da as long as the leading twin was in the 'textbook' (aka head down bum up) position it would be all systems go for a VB - i was more than prepared for a c/s if that was the road we had to go down to make sure all were safe.

i birthed in a public hospital - it seems to be from what i hear that a lot of private ob's actively push (for want of a better term) c/s for multiples - ask questions as PP have said, do your research - i had to have an epi inplace during my labour with constant foetal monitoring (hospital protocol) which was a god send considering t1 got herself into foetal distress with her sister pushing her through the canal.

i hope you get the birth experience you want.

Hi,

My girls were di/di (not sure if it makes a difference) I delivered vaginally, with forceps assist.

I think if it is really something you want i don't see why you can't (all going well). I was just doing the wait and see, my girls were head down and one transverse and my ob was happy as long as twin 1 was head down.

It is possiable (again all going well) and i really don't like the whole "you don't have a choice" thing.

HI!
my twins were mono/di also and we chose to have a caesarian due to the risks to the second twin...we just figured it wasnt worth the risk!
Our second twin was delievered 45 seconds after the first and still went into breathing distress and was in special care for 3 days so we were so thnkful we went with the caesar!!!

My ob did not push for a c-section with my id girls. We didn't really discuss how they were going to arrive until about 30 weeks. He gave me some articles to read out of some obstetrics journal.

Pretty much in the end we decided that it wasn't worth the smallest chance that something could go wrong. Having done all that hard work I wanted them both here. Also I'm not sure I would have had the energy for a labour by the time I got to 36 weeks - I was flat out getting out of my chair!

In the end we had to do it anyway regardless of my choice for medical reasons.

I had a 2.5 year old and was also concerned about recovery. Its not fun but its not as bad as I imagined and you can do things to prepare your toddler like teaching them that you can't lift them and that you need to sit down etc. The thing that worried me the most was the thought of the needle in the back but when the spinal block was done it didn't worry me at all.

I am happy with how it all worked out and I have two happy and healthy little girls.

Thanks everyone so much for all your advice!

I do want them to be safe and healthy more then anything!

Did anyone get told they had to go on steroids to build the Twins lungs? I am really not happy about taking steroids of any kind or the effect they will have on my unborn boys!

Also skippy121 I am not very good at all the abbriviations yet, what is a scbu?

Thanks again Sammyrai

I didn't take any steroids. But then my girls are fraternal, so the risk of pre-term labour was less for me than it probably is for you. When are they asking you to take them? Now, or towards the end of your pregnancy?

It would be very unusual in Australia to give steroids "routinely", if there was no indication the babies were likely to come early. Are you in another country?

Yea the doc said that there is a good chance they will come early, they have booked the c-section for 35 weeks and want me to take the steroids from 30 weeks to ensure that their lungs hurry up and develop so they don't have breathing problems.
I have two nephews both on opposite sides of the family who have been given steroids due to asthma, one is only 2 the other 12 and they are both very stunted in growth, very short for their ages. I just don't think I want to give my boys that sort of start to life, or me taking them for that matter! But I am torn between having them born alive and complications that arise.
I know we are suposed to listen to the Doctors who are trained but sometimes I feel that they treat us all as a law of adverages and not as individuals.
Also I do live in Australia, Perth.

Is there an already identified medical issue with your twins? It seems a bit over the top / interventionist for a doctor to decide at 22 weeks that these things will be necessary unless there is already a medical reason. Was he / she saying you would have to do these things or outlining some of the possibilities?

We were given the steroids at 30 weeks because it became necessary - the ob was getting ready to deliver as one of the twin's growth was slowing and the gap widening between the two. He was prepared to let me go as far as 38 weeks before doing the c-section but at 36 weeks we had to do it. 35 weeks if there is no medical reason seems early to me. What do others think?

I think the problem about stunted growth and steroids is more about longer term use. My girls are developing completely normally in this regard and the steroids have caused no problem so far.

Could you get a second opinion about these things?

Seems very odd the C/S is booked for 35 weeks- that's quite pre-term. I know many twins will deliver pre-term anyway, but what if your pregnancy was able to go till 37 weeks with no problems? Surely this is better than forcing an early delivery?

You're almost guarenteed a long stay in special care nursery with the associated risks of infection etc, which could be avoided if the C/S is booked for later and done earlier if needed.

Your OB seems very interventionalist, remember you're not obliged to stay with them. If you'd like to explore other options go see other health care providers. I'm a midwife in public hospitals and have seen many lovely twin v births, both id and fraternal. If you've had a previous easy VB it'd be such a pity to miss out on welcoming your twins the same way.

Of course if a c/s is what your after I'd discuss exactly why it's being booked so early.

Sorry Scbu is the special care unit. Yes steriods are common with id twins due to the fact that they routinely come ealy. I had two bouts of steriods one at 28 weeks and one at 30 weeks. When i first found out about this i was not impressed and did not want to do it. I asked around and realised that it is actually a good thing.

The steriods develop the lungs so that if they do come early the baby doesn't need as much intervention which means less time in Scbu. The actual steriod only lasts in the babies system for two weeks and has no lasting side effects ( according to the research anyway ).

IN the end I'm glad i took them as even though i went to 37 weeks because my girls were so small if i hadn't they would have been in Scbu for a lot longer than 10 days. I got to take them home so early (Haylee was ony 1.95kg) because they didn't have any breathing difficulties and had been given nothing by the hospital bar top up formula.

As for 35weeks planned C-section that does seem a bit odd, unless you have Twin- Twin or growth restriction. If you don't have either of these i would speak to your doc again as if they take them out at 35 without you going into labour you will be in Scbu for at least a month.

HOpe this is of any help

35w is definently early - the sucking reflex doesn't really develop until after 36w.

i was never offered steroids until i went into pre-term labour at 31+3, otherwise i would never have had them (i also had gestational diabetes requiring minute amts of insulin for the last 3 and a bit weeks) - i can assure at this stage (they are 25mths) there seems no lasting effects of the steroids and they are far from short for their age (currently around 93cm - but dad is 6ft 1 and i'm 5ft 9 so not surprised they're tall).

honestly - i'd be getting a second opinion, unless there is something else going on (and i was told mc/da twins have a low risk of TTTS due to the dividing membrane but happy to stand corrected) it's to early in my non-medical opinion - makes me really value the care i received at my public hospital now where the drs there would listen to a patient whereas sounds like this dr is like you said treating you like a number and not a person.

hi there

I had a c/s with DD so when I saw OB for first time I asked would this be a c/s and she said yes definitely. To be honest it didn't bother me because I want my babies to be born safely and without any drama but I remember the fear of my c/s with DD because its all unknown.

I will have a 2 y.o at home and my DH at home for 2 weeks and some help from SIL and MIL off and on during the week. I'm planning to keep everything downstairs for the daytime and feel confident enough to call MIL if I really get stuck or DH to come home.

ALl the stories do make it out to be hard to recover but I was fine and the only thing I couldn't do was hang out washing or drive a car but I was ok with that too and heh with twins I don't think you'll be wanting to drive anywhere too soon

oh and my c/s is booked for 37 weeks which my OB said is standard....
good luck
Corrie:)

I got pre-eclamsia with my first and had to be induced at 36 weeks. She was very small but we got to go home after a week.
The doctor didn't even know that when he first suggested a 35 week c-section. He told me that M/D twins always need to be a c-section and that often one twin dies after 35 weeks if they are not out???
That's what he has told me anyway

seriously - get a second opinion, i've never heard anything like that.

IUGR is a real risk for you, especially since it sounds like you've been through it before (it was a massive concern for me with DD3 and DD1 had early onset IUGR otherwise i would have been left to go until 39w).

is this a private dr? i really want to know where they're getting their info from - the only thing i heard is there *may* be placental issues after 38/39w due to the additional stress placed on it by multiple babies but nothing about one dying after 35w.

I think you want a second opinion or at least to check this doctor's credentials and how many multiple births they have delivered.

I had pre-eclampsia with my first daughter but with my i.d twins it did not get to the same levels at all.

With close monitoring of id twins this really should not be the case. Mine were monitored fortnightly from 28 weeks and we had growth discordance which the doctors think was a result of a very mild TTTS late in the pregnancy. The monitoring allowed us to pick the optimum time for delivery. My Ob was of the opinion that they were better off out than in if there was at least some growth happening. We didn't deliver until there were signs of distress.

Hi again

I don't want to make you doubt your obstetrician, but I agree with the other girls- you should definitely be looking for a second opinion. Routine steroids from 30 weeks is unusual to say the least (and repeated doses of antenatal steroids have been shown to be associated with an increased risk of vision problems), and a caesar at 35 weeks in a MC/DA pregnancy that is uncomplicated is a bit bizarre. They don't "often" die after 35 weeks!

I wonder if he is experienced with twin pregnancy care? Is he very junior? I would want to know how many MC/DA twins he has delivered in the past. If the answer is "none", then you wouldn't see me for dust- you really need someone on the ball to monitor you closely for possible complications.

(If you DO need steroids, don't worry about damaging your babies. Growth issues in asthmatic children are a completely separate kettle of fish- in fact it's often hard to tell whether those kids are short because of the steroids, or because of their severe asthma, for which they're TAKING the steroids).

Good luck looking around for a second opinion.

Sorry girls i just wanted to claify things, in my previous post i said that steroids are routinly given for id twins what i neglected to put in there was id twins which show signs or either TTTS or IUGR.

I would tink if there is no issue there should be no reason to take them.

Hi, I'm in Perth too and have had a lot of involvement with expectant parents over the years through my work with AMBA. I can honestly say that I have never heard of anyone being told that a CS will be booked for 35wks as standard practice. Although, I do recall that there was an OB (can't remember which one) who was pushing for delivering twins early.

Even my OB, who is considered quite conservative by many, did not raise the issue of a CS for my MC/DA twins until 35 weeks and that was due to Twin 2 being tranverse breech. Even then, he gave me the option of delivering twin 1 vaginally and seeing if twin 2 turned (if not, then CS). He explained that it was his preference not to turn second twins manually as he felt that it was a traumatic experience for the mother and presented too many risks for the baby, however he also informed me that other OBs may attempt it and he would be happy to refer me to one of them if I was very keen on a vaginal delivery. I later met someone with exactly the same presentation. Her OB did turn twin 2 and she she delivered both of them vaginally at 36 weeks.

I ended up in labour the very next day after that conversation and I decided on the CS. My girls were born at 35wks, and although they did well, they were born with no sucking reflex and were in SCN for 2 weeks and tube fed. I recovered well from my CS and was pretty much fully recovered by 2 weeks - but I did not have other children at home, had the luxury of staying in hospital for 2 weeks and got a lot of rest.

I would be happy to PM you the name of my OB if you are interested in seeking a second opinion.

Just thought I would share my experience

My twins were ID (mc/da). I was told that I COULD have a vaginal birth, but there were conditions. The condition was that I had an epidural in. It was there in case after the 1st twin was born the 2nd got into distress or got stuck. They told me that if I wanted a vaginal birth this was the best option, at least then IF something went wrong they wouldn't have to waste time getting me ready. The first baby had to be head down as well.

I asked about steroids when I was still PG & they didn't give them unless they thought you might have an early birth. I was not given them. From 30 weeks I was to have a scan fortnightly to check for TTS. Then from 34 weeks scans weekly for the same reason.

I ended up having my girls at 30 weeks (spontaneous labour). I had no choice & had an emergency c-section (both were breach & they were both head down days before). So I didn't get a vaginal birth, but there are lots of woman here that have done it. There are lots of twin mum here that have had their twins 36-38 weeks as well.

Good luck

Belinda

Thanks everyone for all your advice everyone, it has certainly given me a few things to think about!

I sure do have a few questions for the doctor when I go back for a visit!

Thanks again Sammyrai

Hi

I delivered my MCDA twins 4 weeks ago vaginally and all of us are doing well. It CAN be done!!! My ob was all for me trying a vaginal birth.... maybe you need to seek an alternative ob if you are keen on trying for a vaginal birth.

Good luck

My story is the same as BusyB - I was going to have a vaginal birth on the condition that i had an epidural in. Ended up we had a c-section at 38 weeks as they had to come out..both were head down but docs didnt want to risk induction in case of distress to second twin.