Am I Being Responsible?

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Categories Ask the Readers, Birth Stories, Medical, Pregnancy

I keep assuming that my experiences this pregnancy will be similar to the ones I had in my singleton pregnancies. I have been wrong over and over again. My first Ob appointment was no exception… totally different.

My Dr. started my first visit by saying ” I know since you’ve done this three times you feel like you’re an expert, but you’ve never been pregnant with twins”. He then went through a whole list of ways this pregnancy would be different: 2 gestational diabetes tests, more weight gain, more caloric demands, no more running, more appointments, more ultrasounds. None of those phased me. Then he hit me with “Now you know you’ll have to labor and deliver in the OR and you’ll have to have an epidural.”

What?

He then went on to explain that he understood how I felt about having natural births, but I needed to get comfortable with a very different experience “For the safety of the babies”. When I asked if I could try laboring without an epidural he said that it was my choice but “he’d just put me under when it was time for my C-section”

I literally didn’t know how to respond. So I didn’t.

With each of my births I have used less and less intervention. W’s  had the works: pitocin, epidural, the Dr. broke my water, and constant monitoring. G’s had a little less. O’s was intervention free: My water broke at home, no pain meds, no IV, and intermittent monitoring. I am proud of and happy with all of my births. They each resulted in a healthy baby. One of my friends asked me recently why I prefer natural birth. I explained to her that she competed in triathlons and I had babies. I love the challenge of getting through the pain and watching what my body can do. I am seriously weird in that I look forward to labor.

When I found out I was pregnant this time my husband and I decided that we’d like to use a midwife and deliver at a free standing birth center. He’s an ob/gyn so this decision didn’t come easily for us. We talked and talked and read and read. We felt confident in our decision. Then we found out it was twins and our plans changed.  We agreed that we both felt safer having the babies at a hospital. We felt better knowing that if something did happen we’d have experts on hand to help and  we wouldn’t have to waste time getting to a hospital.

So here’s my dilemma: How much intervention is needed in order to be responsible?  I had already happily come to terms with delivering in a hospital.  I’d also decided that I could deal with having  to labor and deliver in the O.R., but is having an epidural really necessary? Also, why is my Dr assuming I’ll have to have a C section?  And telling me he’ll “just put me under”? is he being flippant?

All I want is the CHANCE to have these babies vaginally without an epidural.  Is that being irresponsible?

I’ve had one more visit with Dr. Doom (my new name for him) since the awful first one.  I didn’t have the nerve to bring up our discussion.  I didn’t ask any questions and realized I was smiling and shaking my head a lot.  If you asked him I’m sure he’d say the visit went fine.  I left the appointment feeling like I either need to find a new Dr. or  have a very open conversation with him. Neither of those options sound particularly fun.

Per my usual I have launched into research mode. I’ve questioned other twin moms about their experiences, I’ve read all I can find on birthing multiples, and I have talked with my husband and a midwife friend about their approaches to delivering twins.  I’ve learned a lot and in the end I think I’ve realized that I still need to know more. So much of this decision to birth vaginally or by C section and with what interventions is dependent on my babies.

Right now my plan is to become comfortable with not knowing how I will give birth to these babies. This is very hard for my type A uber organized self.  I still want the chance to deliver naturally, but I won’t dig my heels in and refuse other options. I think being open is the only responsible choice.

Talk to me about your birth experiences. Anyone deliver their babies naturally? How much intervention did you find was truly necessary? Would you change anything about your birth?

 

Elizabeth lives in Central Texas with her husband and 3 sons.  She is 13 weeks pregnant with twins. 

 

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25 thoughts on “Am I Being Responsible?”

  1. I would say to definitely find a new OB! He doesn’t sound at all supportive and that just isn’t a good mix. My OB was completely supportive of whatever I wanted- and in her words- “no doctor is going to tell you you can’t elect for a C-section with twins, but none of them should tell you that can’t have them vaginally either”. I had no problems with the OR delivery for safety- and what we planned in advance was as long as positioning was good, I would try for vaginal. We agreed to set the epidural port but not use it unless a C-section became necessary- this was because I did not want full anesthesia if a C-section became needed quickly. I had my first baby vaginally with no epidural/meds used (again- the port was in place though). Baby B had other plans and was born by Csection (with epidural) ~5 hours later. I wouldn’t change anything about the approach- but I certainly would have liked the second little guy to be born vaginally also :)

  2. I wanted a unmedicated, natural birth with the twins, but while Bridget was head down, Christopher was traverse in my rib cage. Even my doula was less than enthusiastic (and she’s a very enthusiastic unmedicated advocate) about the twins going unmedicated.

    I think you have a good chance going all the way b/c your uterus is already stretched and can make room for twinnies. Follow Dr. Luke’s dietary advice (get the book, it is worth the money) and gain a boatload of weight eating dairy, fruit and protein. ((I’m a PhD and my colleagues researched her and said she is the ONLY person adequately studying twin pg nutrition))

    We had some complications and some NICU time, but did end up bfing for 2.5 years. Twins are different than singletons, but you have some good experience under your belt, so enjoy this and don’t let the negative energy in!!!

    I wish with everything I had that I’d let Bridget be born vaginally and Christopher a c-section if he didn’t come out. But overall, they are both here and both healthy.

    now go fix yourself a banana protein shake. 😉

  3. I’d consider looking for a new OB, too! I had to talk to 3 practices before I found one I liked.

    I’ve had similar birth experiences as you. I had two children before my twins. Each birth I wanted less interventions. I’d been planning a homebirth when I found out I was pregnant with twins; I switched to an OB right away. They all knew what I wanted and they were so great about presenting me with research and evidence and allowing me to make the decisions.

    However, both babies were transverse. I could have tried for a vaginal birth if Baby A was head down, but she wasn’t. I ended up with a c-section at 38 weeks and 4 days. Now, I would have loved to try to have those babies vaginally, but that would have been way too dangerous with transverse babies and I don’t regret anything. They arrived very healthy (no NICU time) and latched on almost right away. I nursed them for 14 months.

    My doctors were fabulous. They knew I wanted skin to skin right away and to breastfeed. They even allowed my doula back in the OR after the babies were born. The staff was truly wonderful.

  4. I had my twins without any interference until the very end. I did have to deliver in the OR as a precaution. The second baby was head up so they were afraid of c-section. After the first baby came, they got the second turned. I had them both no problem only three hours after my water broke. They were both almost six pounds and made it her a day before 34 weeks:-) I know I was extremely blessed and my experience isn’t the norm, but make sure your doctor is on board. Mine was great. She only stepped in when I asked her opinion. She went along with all my wishes. That is the key.

  5. Definitely get a new doctor! I looked around my city when choosing a provider for my singleton pregnancy because I wanted to do a VBAC after my twins c-section, and I’m very happy with the practice I found – midwives who work with a hospital and have OBs should the need arise. It was a completely different, and better, experience than i had with my OBs for my twin pregnancy.

    I went to a fairly large OB practice for my twin pregnancy (6 doctors!) and always just felt like a number. It was stupid. While I did end up having a c-section since both my girls were breech, I would have loved to deliver them vaginally if I could have. Assuming that you have great pregancies and are healthy, you should plan on a vaginal deliver. The only thing that was truly “high risk” for my pregnancy was that there were two in there. If they would have been head down (or even just the first one) I would have loved to have them naturally. But, they weren’t and I didn’t. Good luck!

  6. I didn’t have time for an epidural…my boys were born 3 hours after my water broke. Both were head down and one of the nurses held baby B’s butt (since he was sticking it up) so he wouldn’t turn and guided him down. It was easy. Strange, being in the OR with so many people there, but I didn’t know any different and I was comfortable with it, just in case something went wrong.
    I’d say, no epidural is necessary. I would find a new doctor–sounds like yours is already planning a c-section.

  7. At the risk of sounding callous, it sounds like you’re being a whole lot more responsible about your pregnancy and birth planning than your ob. I would think that listening to the mother and doing one’s research would be the responsible thing for a doctor to do in this case. I think I may have already mentioned this to you, but the Houston program for multiples would probably be covered by your insurance. It’s kind of a drive, but perhaps even a phone call to them could clarify what your options are/should be.

  8. After reading your post, two things come immediately to mind:
    1. find a doctor you trust and feel comfortable with. Even if they end up telling you things about the birth that are different than what you had in mind, if you trust them, the information will be easier to swallow. You clearly do not trust this doctor implicitly so find one with more twins experience or one that has the same outlook on childbirth that you do.
    2. As you stated, twin births come with their own dangers and hurdles, above and beyond singleton births. Accepting and respecting that is part of the process. I am a healthy person who was pregnant with natural twins who planned on a natural birth. I made it until 38 weeks until labor but my twins were breach so a c-section was a must and I hemorrhaged after delivery and ended up getting 3 units of blood. Not what I planned and not what I expected but I was happy the precautions were there for my safety and the safety of my children.

  9. I too would be upset at “when it is time for your c-section”, and would be looking for a new doctor or planning a conversation with Dr. Doom.

    My twins were my first labor and delivery. I was comfortable with birthing in a hospital and in the OR. My labor was 6 hours, halfway through I asked for an epidural. Twin A was vaginal straightforward delivery. During the delivery, Twin B’s heartrate tracing was troubling, and he was born via emergency C-section because of placental abruption. Since I had the epidural I did not need general anesthesia for the C-section.

  10. Another vote here to ditch that OB. I had my twins with a midwife at the tiny local hospital with no medication And twin B breech. No reason not to aim for the birth you want and adjust if and when things change.

  11. I vote for ditching the doc. My perinatologist told me all the way through that we wouldn’t be making the final decision until the very last moment. My daughter was head up and my son had some complications that she felt would not be good for vaginal birth and we ended up with a planned c/s.

  12. Another vote for OB-shopping. I had a very similar experience, same time in my pregnancy. I didn’t mind the OR and the epidural, but I hated when my OB said that if either baby was breech, or switched to breech mid-delivery (sometimes happens with baby B) or if B was bigger than A, all of these would result in C-section, end of story. I did NOT like those odds. It took me a few weeks and a lot of asking around, but I found an OB that had experience delivering breech baby B’s by week 20. And good thing I did! My Baby B was breech, born vaginally by breech extraction, and everything worked out beautifully. I had such confidence in my OB that I didn’t realize until after the fact what an unusual and exciting delivery that was for all the nurses and techs and doctors in the OR… for everyone except my OB, I guess! Also, I labored in a regular L&D room, and they wheeled me to the OR just before it was time to push. There would never have been enough room for all the PEOPLE in the regular room that were present at delivery. Two of everyone, or more.

    So, given that you’re in “Central Texas” and I am too, I’d be happy to share the name of my OB and her practice, if you have a way to email me (don’t the moderators have access to the email address we list in order to post here?)

  13. OR birth seems to be pretty standard for multiples. “Just in case.” I’m not going to comment on whether or not that’s a good idea though.

    Our twins were born five years ago now, and my wife was really looking for a natural birth similar to you (though it was her first l&d). We got a similar comment about ‘just putting you under for a c-section’. As best I recall they explained it as being because if you have an epidural you already have the spinal tap in place so it’s easy to give you a pain block for your lower body, but if you’re trying to do a natural L&D and suddenly need a C-section they don’t have time to do the tap and have to put you under.

    So it sounds like a completely rational statement to make, but you need to be really comfortable with your doctor in a situation like this. So if it put you off then I’d definitely recommend either a new doctor or a serious heart to heart with Dr. Doom. Find a doc several other mothers of multiples recommend or you may burn through several before you get to one you like.

    We actually found a good doc my wife was comfortable with and who seemed okay with her natural childbirth plan and doulla, but one of his partners who was less friendly to natural birth was on call when our time came. He let her do it how she wanted, but he made his opinion pretty clear so it was an uncomfortable situation. But she was in severe pre-eclampsia and it was an ‘urgent but not emergency’ situation so your milage may vary.

  14. I had to have a C-section with my twins because baby A was breech (and stayed that way the whole pregnancy). If she had been head down I would have gone natural becuse I had a pretty good experience with my first pregnancy and being up and around 40 minutes after delivery. But for me C-section was good because at least I knew when it would be done….I was pretty miserable at the end because I am really short and all that baby put a lot of pressure on my body.

    Either talk to the doctor or find a new one. It’s good to have options and giving birth in the OR just in case is a good idea, but there are pleanty of mom’s in my twins club that have not had to have a C-section. Let him know that you want to keep your options open until further in the pregnancy.

    If you do have to have a C-section in the end, one piece of advice that I recommend is have the epidural before you get the catheter that way you won’t feel it.

  15. Find a new ob. Mine was a high risk/multiple specialist and amazing. Baby a was head down and B was breech. I delivered in the Or in the event of an emergency. My water broke at 33 wks, 3 hrs later baby a was born vaginally, they turned baby b and she was born vaginally also 8 min later. I had an epidural in case lf an emergency c section. Even though things worked out I was glad I did because baby b came close to needing it. Her heart rate dropped a lot and she was under a lot of stress.

    Good luck to you. Mkne are 3 now and its one crazy journey!

  16. I would look for a new Dr. They should be supportive of your desires. I had my twins vaginally at 38 weeks, after 24 hours of induced labor in a room adjacent to the OR and did not have an epidural until they forced me to after I stalled at 9 centimeters for 4 hours. They said I either had to have an epidural so they could give even more pitocen so I would just have one constant contraction to get rid of the remaining cm. or I had to have a c-section. Obviously I opted for the damn epidural but asked for the lowest dose possible. I also had a Doula and I think that helped let the hospital and my Dr. know thatI was really serious about not having an unnecessay c-section or a lot of interfereance. I pushed gfor 3 hours to get my daughter out 5lbs. 4 oz. and then my son was born 16 min. later 7lbs. 10 oz. Don’t be a sheep because it’s easier, stand firm and fight for the oportunity to have the birth you want! Good luck!

  17. I’d recommend a conversation with your OB (he can’t read your mind!) and if you’re not comfortable then move to someone else.

    My OB had horrible bedside manner & was often condescending, *but* I knew he was very experienced with twins, which was my main concern, so I just learned to deal with him. Where I live, the OB decides whether or not to deliver in the OR, and mine was fine with a regular room. Baby A was head down and B was transverse/ breech, so my OB’s plan was to do vaginal and to turn B after A was born. He said not all OBs are comfortable/ experienced enough to do this. He also didn’t feel that an epidural was necessary, although when I talked to the nurse in the delivery room, she thought that was kind of crazy because turning could be *extremely* uncomfortable.

    I had always decided that the epidural would be a “game time decision” and in the moment the contraction pain was manageable, but there was an anesthesiologist available (with my first delivery I had to wait a while, which was awfully b/c I had hideous back labour) and I didn’t want to be put under should a C-section be needed, and the odds of that were much higher than a single delivery. I only got a mild epidural so I still had the urge to push (my first they have me the max and I was totally numb) and A was delivered vag. The nurse wasn’t kidding about the turning hurting – I couldn’t imagine what that would have been like with no meds! In the end, B wouldn’t turn so he was delivered feet-first after a small episiotomy.

    I was pleased not to have a C-section b/c of the impact of the recovery on the whole family, but would have done it in a heartbeat if it was best for me and the babies. The delivery is just one day and healthy babies is what you want for the rest of their lives.

    Good luck!

  18. Forgot to mention that I actually had a near-miss of having to get put under for a C-section. I was induced at 36+2, which I was nervous about b/c I’d heard too many stories of induction leading to a very long labour and then a C-section, but I had identicals and my twin-expert OB recommended they were better out than at that point b/c the placenta breaks downs.

    Anywho, when they broke A’s water the OB says “There’s a hand”! With all the water pressure A’s hand slipped out and was pawing at the Dr (this does not happen often)! They started calling down to the OR to prep for a C-section b/c they were concerned that the umbilical cord was being pinched. Thankfully within 30 seconds he slipped his arm back in and everything was fine. Having experienced that panic of knowing that I might be put under, also helped me with my decision to get an epidural. At least I could control something!

  19. I’m almost 21 weeks with twins right now and went through a similar debate at about your stage. I wrote about it on here, if you want to read it. Although my situation is somewhat different, as this is my first pregnancy and I wasn’t totally against the idea of an epidural, I can relate to being transferred to an OB when you’re used to working with a midwife. I also feel like my visions of a birth plan have been slowly shut down since I found out I was having twins. I went from midwife, to OB with a doula, to OB with no doula, after learning she wouldn’t be allowed in the OR, anyways.

    Since my blog post (It’s titled “No birth plan for you!” if you wanted to read it), I’ve changed my focus. I feel that I was fighting every recommendation the new OB made, and was researching every way to have the most natural birth possible. The fighting was making me crazy. I’ve since decided to change my focus to accepting that this is certainly an area in life in which I have little control. I’m working daily on accepting that the babies will know the way that they’re meant to enter the world, and that I live in a great city with excellent medical options, and have chosen a good doctor and a reputable hospital. Deciding not to fight this so hard has felt more calming to me. I’m still very terrified of needing a c-section, and don’t know how this will all shake out, but it’s certainly making the waiting period a little less stressful to trust that there is a plan larger than I am.

  20. Thanks for bringing this up. I’ve been starting to think about it more lately. I’m 22 weeks with twins. So far we like our OB a lot! She’s open to vaginal delivery as long as baby 1 is head down. Our OB said we will labor in a regular room, but for delivery we will move to an OR (just in case). This makes me a bit nervous. It sounds like an uncomfortable place for delivery. We do a birth center tour in a few weeks, not sure if we will get to see an OR.

    I’ll have to have an IV because I’ve already tested positive for Step-B. Do I still need a “just in case” epidural port too? I really don’t want one. Also, OB mentioned that we will have continual monitoring of babies heart beats. I really didn’t want that either because it restricts my movement so much.

    It is great to hear from other mom’s of multiples what their birth experience was like. Thanks everyone for sharing your stories!

  21. I had a vaginal birth at 34 weeks 1 day. That being said, NOTHING else about that birth went as planned. My water broke at 33 weeks 6 days, I had to take a 4 hour ambulance ride to a hospital with a better NICU, I was induced for 23.5 hours etc etc. I didn’t even know the doctor that delivered my babies. Couldn’t tell you what her name is.

    SO. What I learned from all that is- plan for the best and the worst. Know what your best case scenario is and where you’ll go and what you’ll do if something goes wrong. Your doctor sounds like the kind of doc whose all “Sure honey, you want an “intervention free” delivery with twins? Okay, I’ll pat your hand and tell you that’s what will happen but at the end of the day, you ARE getting a c-section.” I think doctor shopping is in order. Doing a c-section on all twins is the lazy way out. I couldn’t believe that I was allowed to go over 50 hours with my water broken with twins and have a vaginal birth. I thought they would be champing at the bit to section me and get me out of there. So I think it just proves that there is no one-size-fits-all situation.

    I apologize if my thought seem a bit scattered. Those twins are now two and a half and fighting bedtime!

  22. Elizabeth,
    Although it may be a political nightmare, don’t allow yourself to second-guess your desire to find a different OB. For my most recent baby, despite having a repeat cesarean, I felt good about it. This would not have happened without the support of my OB. I chose his services before ever becoming pregnant, because I knew I was considered “high-risk” and many others would have required me to induce early. Knowing that my doctor listened, supported, and sought to give me every chance at having the birth experience I wanted, allowed me to be at such peace with the cesarean when it did happen. You are strong and wise. Find a doctor who trusts that.

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