No Birth Plan for You!!

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Categories Ask the Readers, Birth Stories, Pregnancy

I’ve seen a midwife for my gynecological care for the last 12 years or so. I have preferred their approach of treating the health of the woman, over the potential sickness. The different women I’ve seen have always taken their time to answer my questions, never rushing out of the room and have made me feel comfortable. When I envisioned myself someday giving birth, I pictured a hospital, but having a midwife coach me through. This vision was thoroughly reinforced after seeing “The Business of Being Born” and having several friends deliver healthy babies, in uneventful births with midwives by their sides.

When we found out we were having twins, we went to see a midwife I’d seen a handful of times and who had helped me through my miscarriage. Her recommendation was to see both the OBs in the office, as well as the midwives throughout my pregnancy and that I’d be “shared” by them, most likely resulting in a birth attended (in the OR for certain) by both a CNM and OB. Last week I saw one of the OBs, and while I did feel comfortable, the difference between a midwife and OB approach is notable. I was thrown for a loop when this OB was strongly recommending that I see only the OBs in their practice. Her rationalization was that most likely, I’d end up with one of them delivering my babies, anyways, so why not start with them. She explained that a variety of scenarios are likely to arise that would require them to step in: if I had a vaginal birth and the second baby was breech, if I needed a planned or emergency c-section, or need to use forceps to avoid a c-section. Essentially, she was saying that things would have to be picture perfect for a midwife to deliver both twins start to finish.

On the one hand, I’m trying to let go of the visions I’ve had in the past of a particular kind of pregnancy, labor and child-rearing. In a way, I feel silly to not just work with the doctor who has delivered FAR more sets of twins than my midwife, and feel that I should work toward accepting the doctors will do whatever is safest for my babies and me on D-day. The other, more stubborn, feminist part of me gets upset at the idea of having a pregnancy that could be pathologized from this point forward: labeled as “high-risk” and having the OB drive the train that she desires. I’m terrified of ending up with a c-section because I went with an OB who wanted to get things over with (which, admittedly, may be an unfair judgment of all OBs), when I could have had a vaginal birth if I went with a midwife.

I’m curious to hear from others who may have been faced with this dilemma. How did you decide whether to see a midwife or an OB? Did you end up just scheduling a c-section, to avoid all the potential ups and downs of a vaginal twin delivery? Did you try for a vaginal birth with your multiples, but end up with a c-section anyways, after complications got in the way? I’d love to hear any thoughts, advice or perspectives I’m missing.

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25 thoughts on “No Birth Plan for You!!”

  1. I started out with a midwife but as soon as we found out it was twins, the practice switched you to an OB. When we further found out it was identicals, we were switched to a Perinatologist for the pregnancy. I found a Perinate that was very supportive of vaginal twin deliveries (had actually had her own twins that way) and that was my plan/hope. At delivery, my first little boy was born all natural but 5 hours and 2 epidurals later, the second one came by C-section. I don’t regret for a second that I tried the vaginal- I just wish both the boys had cooperated! I have many friends who delivered twins vaginally and not one regretted it- the recovery was just sooo much easier than woman who had C-Sections. I would say the most important thing is that you connect with whomever you choose- and that you feel supported in whatever decision you make! Good luck :)

  2. I started seeing a midwife with my pregnancy. When I found out I was having twins, she risked me out of her care. I had to search for an OB practice at 19 weeks pregnant (when I found out I was having twins). I talked to 3 practices before I found one that I liked and that I felt would include me in decision making. We talked through all kids of scenarios. They gave me options. Ultimately, I had to have a c-section, at 38 weeks 4 days, because the girls were both transverse. And, boy, did I try to get Baby A to move vertex! (The practice I chose would have delivered Baby B breech had Baby A been born vaginally.) But my docs did a great job. They new I’d wanted a natural, vaginal birth and did everything they could to make me comfortable. They even bent the rules and let my doula, along with my husband, back in the OR. They each held a baby while I was getting stitched back up.

    I’ve had all different kinds of birth: medicated, vaginal, with forcepts; all natural; and c-section. The natural birth was the easiest to recover from, by far. My personal opinion is, that if you want to try for a vaginal birth, you should, just knowing that twin births can get more complicated. :) Good luck with your decision!

  3. I started out seeing a midwife at my hospital, but once we found out I was having twins, that plus my age (35) got me in the “high-risk” category and I was switched to the OB side. I had a great OB, who actually encouraged me to deliver the boys instead of opting for a c-section. I was induced at 37 weeks due to increasing BP and pre-E risk, and I delivered the boys even though things ended up getting a little complicated. Baby A was no sweat, but Baby B dropped into footling breech and was delivered that way. I had some tearing but nothing major. The funniest part was looking out over my knees at the 20+ student doctors- footling breech deliveries are apparently something to behold!

  4. I think we can all relate! I was patching myself up for a no drug birth until I found out we were having twins. In the me, I chose a c-section to avoid the possibility of the double whammy. My ob (also a mother of twins) was so laid back, but I didn’t even want to try for a vaginal birth (I mean, I did but I didn’t, you know?). The section was not fun, and I don’t remember much about that day, sadly, but I don’t think I would do it differently. For me it’s just one of the things that goes along with a multiples pregnancy, although I know of plenty I MoMs with successful vaginal (but not drug free that I know of) births.

  5. I started out with a midwife group, but had to switch to the ob group that backs them up when I found out at 20 weeks I was pregnant with identical twins. The ob group was good, there were obviously some doctors I didn’t prefer. I ended up delivering both vaginally without drugs–it just went so fast. There were no complications. Could have gone to another midwife, but didn’t want to do a home birth. No other midwives delivered at my hospital at the time. Since then, I’ve had 2 more kids, both delivered by midwives. Definitely different experience. Just make sure you stand your ground with the doctor, or maybe get a doula to help advocate for you.

  6. I was with the midwifery practice where I delivered my first singleton child (vaginal, no drugs, at hospital, episiotomy). Luckily, I was able to continue with them through my twin pregnancy; however, since I was considered high risk with the multiples, I also saw the OB practice at the hospital where the midwifery practice had privileges ( and where I delivered my first).

    I only ever met a doctor at the OB practice once, for 10 minutes when they where referring me for further testing. I generally saw the nurses/technicians that did the periodic ultrasound, non-stress tests required by the OB practice. I felt in general all the testing was a waste of time (for my completely normal in all respects except for multiple pregnancy), but it was non-invasive, so I didn’t complain too much.

    Unfortunately, Baby A (my very determined little guy) was breech and never turned after about 30 weeks. I tried yoga and moxibustion to get him to move head down – vertex – but I think he ran out of room by the time I really started to worry about it. Since Baby B ( my mellow little lady) was wedge in my side with her head down, they were worried that the babies would lock chins if I tried to deliver vaginally.

    So I was scheduled for a c-section about 3 days before my due date. I never actually went into labor – I guess that can cause complications for the c-section – but I always wonder what might have happened if we tried. However, with one healthy vaginal birth and now two healthy twins by c-section, I don’t regret the decision. But I do think people that want “elective” c-sections are very uninformed about the difficulty of recovering from a c-section. I’d take an unmediated vaginal delivery anyday over abdominal surgery.

    Also, due to scheduling issues, I never did see an OB from the hospital practice. The midwifery practice referred me to another OB that delivered at the same hospital who I met just before the procedure ( and she was great). One of the midwives was in the OR with me until me husband was admitted, and I felt very reassured by her presence. So all in all, I felt that my twin pregnancy was overly “pathologized,” but with the midwifery practice in the picture, I was able to keep it from being intrusively so.

  7. I had a plan. I was going to give birth vaginally, without any sort of painkiller, in the hospital of my choosing, with the OB we’d chosen.

    My children didn’t agree with the plan. Twin A’s water broke at 33 weeks, and both babies were breech. We showed up at our hospital of choice, and I was quickly thrown in an ambulance with a magnesium sulfate drip to keep me from giving birth before we arrived at a hospital equipped to deal with premature neonates. Baby A began to go into distress.

    3 hours after my water broke, both my daughters were delivered by C section by a doctor I’d never met before and would never see again. I think I spent as much time grieving the birth I’d dreamed of as I did the big bouncy babies I’d expected to bring home when I was released from the hospital. My girls are now healthy, happy and whole, but the birth itself was traumatic, and Baby B came home at 16 days, Baby A at 21 days. It took me years to be able to look in the mirror and see my C-section scar without bursting into tears.

    I wish now that I’d planned for more to be unknown and unexpected. I still feel a pang of guilt at not having given my girls the start I’d wanted for them, even though they couldn’t be healthier today.

  8. Everyone else’s stories sound very similar to mine.

    I considered using a birthing center under the care of a midwife until I discovered I was pregnant with twins. No independent midwives in the area will touch a twin pregnancy; they all consider them high-risk.

    I deliberately chose an OB/GYN practice made up of both doctors and midwives to minimize my risk of having to have a c-section. Generally speaking, I don’t feel like they pathologized my twin pregnancy. I did have more ultrasounds than are typical, but I saw midwives for a majority of my visits, never met a MFM until around 28 weeks or later, never had a moment of bedrest, and the jerks wouldn’t even get me off work before my delivery date. 😉

    By about 28 weeks, my twins were both positioned breech, and they never turned head-down after that, so I was mentally prepared for a c-section when I had mine at 37 weeks. I was prepared for the fact that I would have to be flexible about my birth plans; I think that comes with the territory in a twin pregnancy.

    My c-section wasn’t my ideal birth, by any means, but it wasn’t terrible, either. I was kind of woozy for the delivery itself, and my memories of it are fuzzy now, 16 months out. My recovery wasn’t horrible; I took everyone’s advice and got out of bed and moving around as soon as they let me. I kept up with my pain meds, and I was functional within a few days.

  9. Not exactly the same situation, but after my original OB (who had delivered my 1st two kids) gave her spiel about “everything would have to be picture perfect” to deliver both vaginally, I shopped around and switched to a more confident & capable OB, one who would not automatically choose c/s if baby B was breech (or turned breech after A delivered). I switched at 20wks, way before I could know how my babies would present when the time came. Sure enough, B was breech, and I couldn’t have asked for a more positive Breech-Baby-B extraction. I don’t fault my 1st OB for not being willing to perform a procedure she wasn’t comfortable with, but I am very thankful to have found a practitioner who was confident and experienced enough to give it a try. Without a doubt, I knew I wanted to to have every possible (safe, reasonable) opportunity to try for a vaginal birth, even if it meant the possibility of a “double-whammy” with vaginal for A and c/s for B.

  10. The best advice I can give you is to take the time to find a practice with a handful of OBs that you truly like and trust as a group, because they are out there! I was lucky to find an OB practice comprised of many amazing OBs, and it’s a good thing too because I saw my primary OB throughout my pregnancy (who was very supportive of me wanting to try to deliver both vaginally) but she was unable to deliver my babies because she had her own surgical procedure scheduled at the time. I made it to 38 weeks, way longer than we both assumed I’d go! But 2 or 3 of her colleagues were with me that day, tag teaming throughout my 26 hour birth experience, and they were all phenomenal. Baby A (vertex) was extracted with vacuum assistance after 4 hours of pushing, and then Baby B (also vertex) got all cozy in my extra roomy uterus and after a 1 hour break and 3 more hours of pushing he was just not advancing, and I was exhausted so we did the c-section. I was very upset that I worked so hard for so long and in the end had to have the c-section anyway, but I don’t regret my choice to try for the double vaginal because I would have always wondered, “What if?” But that is just me and I don’t blame anyone for a second for wanting only the c-section. I should also mention I opted to also see the specialists in the Maternal Fetal Medicine unit at the hospital who worked in tandem with my OB. It was there that I got frequent ultrasounds, non-stress tests, and general monitoring for what they dubbed my “medium-risk” pregnancy.

  11. I should also mention that I learned during my birth experience that Baby B being head-down and vertex, while the safest position for the baby, is not the ideal position for Baby B to make a quick exit after Baby A. I was told that if Baby B was feet first it would have been much easier to get him out quickly after Baby A because they could have yanked him out by his feet. Since he was head down they couldn’t assist in getting him out and I had to do all the work. They tried really hard to get him to turn so he was feet first but he wouldn’t budge. I’m not sure if that’s just how my practice does it or if it’s the standard, but I didn’t know that until I was on the table, so I thought I’d pass that along if you wanted to ask about it.

  12. I was told all the way along, that I would need a C/S, but someone forgot to tell my twins. They were born vaginally. Both head down, although I did need an episiotomy & forceps to help with T2, as he was bigger than T1.

    I know of someone who birthed breach twins vaginally & another who birthed her first twin vaginally & needed a C/S for T2.

  13. I’d say hope for the best, but understand that a C-section is very likely. If you want a vaginal birth go for it. I only saw an Ob to start with. While I would have chosen a vaginal delivery of my twins, I wasn’t able to as both were breech. However, I am planning a vaginal delivery with my singleton baby here in a month, so if you do have section, you can try again the next time around for a different outcome.

    I have though, known several women who gave birth to twins vaginally… several in fact. My cousin’s wife and my sister-in-law among them.

  14. If I had it do over again, I would have a midwife/doula as well as an OB. After a healthy pregnancy, both my guys were vertex and I was 1 cm dilated at 38 weeks. My OB urged me to induce, so I agreed. Ideally, I wanted a drug-free vaginal delivery, and I honestly thought I would have the presence of mind to make decisions in the moment. In reality, I was huge, uncomfortable, and emotionally at the end of my tether. When the OB on call (not my dr) started making decisions that were meant to speed up the process (i.e., breaking my water, upping the pitocin), I felt I had no choice but to place my trust in her because I was already so exhausted, and focusing on the contractions was as much as I could do! Long story short, I ended up with an emergency c-section due to complications that I strongly suspect were a result of rushing the labor. Of course I’ll never know for sure, maybe if I wasn’t in a hospital the same complications would have arisen and my children’s lives would have been in serious danger. But I think that if I had a midwife there to advocate for me and guide me, things would have gone a lot differently and I would have been able to deliver vaginally. Just my 2 cents…I think it makes sense to have a midwife in your corner, as well as the safety of a hospital setting.

  15. I liked having all my appointments with the ob who would be at the delivery. After all those appointments, he knew what I wanted and I knew that if said I needed surgery then that was the best option for me and the babies. I ended up with one born vaginally and one emergency c-section. In an emergency situation, general anesthesia is usually given because it is the quickest. However, I had an epidural during labor (partly so I could avoid general anesthesia if necessary). I had always thought I would have a drug-free labor, but I am glad that I had the epidural.

  16. I too was transferred to a high-risk OB when I found out at 20 weeks I was having twins. My OB was awesome, she and I agreed that I would try for a vaginal delivery. Baby B flipped from transverse to head down at 33 weeks- causing preterm labor. I ended up on hospital bedrest. At 36 weeks my BP was too high, so we induced. Not the funnest thing ever.
    My OB wasn’t there, but the on-call OB was amazing – never seen her since though. After hours of pushing out big headed baby A, Baby B went into distress, and I got moved to the OR and drugged up for a C-section. I was given one last chance, and opted for forceps (Baby A), and vacuum (Baby B).
    It took me awhile to get over mourning the loss of the birth I wanted. It took until a friend had a perfect pregnancy, and a perfect natural childbirth and ended up with a (wonderful) baby with Down Syndrome that I realized that my non-ideal birth experience and 2 healthy boys was better.

  17. I went with an OB from the get go- After my RE told me it was twins I called the hosp, and asked the nurse for the BEST one for twins. I wanted someone who had done this before. A lot of times before. And I couldn’t have been happier. He told me from day one to throw away my birth plan, as that was now his job.

    He let me deliver vaginally, with baby B breech. Read that again. Yep, I ran the risk of delivering one vaginally and C-sectioning the other. But he was awesome.

  18. Thank you SO much to everyone for your comments and stories! This helps me so much to make some decisions and also to further wrap my brain around surrendering some control in this area. I so appreciate the sharing!

  19. Please do let us know how you decide to approach this. It sounds as though the ob you spoke with may not be as supportive of your working with the midwives in her own practice as you might like. You could always talk to the midwives and have them help you advocate for your wishes for your prenatal and birth care, or find another practice that has more of a balanced approach. I completely understand your desire not to pathologize your pregnancy; a large part of our staying with our ob despite her noting that she didn’t have privileges at a hospital with a NICU was that she was extremely supportive of exercise and physical activity during pregnancy … and owned her own yoga studio!

  20. I had an OB who was asissted by a midwife in her practice but I also hired a Doula. Went for monthly scans with the perinatoloigist as well. They insisted on inducing me at 39 weeks for no good reason but it was natural and vaginal, albeit extremely long. I stalled at 9 cm. for 4 hours. So it was 24 hours of labor all together. I empahsized my extreme desire to avoid a c-section and they worked with me. I think having the Doula showed them that I was really serious too.

  21. I think the backlash against the traditional OB route has sometimes been too extreme and there is a place for both. Was planning to work with midwives but they didn’t work with twin births. They referred me to an OB who was great and who operated under the assumption that we would do a vaginal birth unless there was some sort of emergency. I did need to be induced because of pre-eclampsia. I was very concerned about going this route since I thought that this would be the first of many medical interventions and would end up with a C-section after a drawn out couple days of labor induction. Happily this was not the case. My babes were both born vaginally within 12 hours of the cervicil being inserted. I know every birth is different and I was very fortunate (and both babes were head down!) But twins are a high risk birth and there is a place for OBs as things can change quickly. That being said not all OBs are created equal and you need to find one who you feel listens to you and has similar assumptions about how the birth will proceed.

  22. I had the most amazing OB in a great practice. I switched to her at 7 months – yes 7 months after poor care during complications. I credit her for my full-term twins. I had a planned C-section because that’s what I wanted and for the same reasons other people have said – didn’t want an emergency C, one breach, etc. I would say don’t make this a control issue or dwell on the “high risk” label. That’s just medical terminology but upsets every mom, including me! :) A good doctor or midwife works with you. I haven’t always heard glowing experiences with midwives either – no outcome can be totally planned. Just speak up, really hear and value others’ insights and experience, then make good decisions for your twins as their mom.

  23. Just wanted to add another quick thought! I know every mom wants to avoid doing the vaginal delivery followed by a C-section, but that is what I ended up doing and the recovery really wasn’t that horrible! I can’t compare it to having only one or the other- but with all the pain meds available (that were perfectly fine to use while I nursed)- I was back on my feet within 2 weeks- and those 2 weeks were pretty much just spent in bed nursing anyways :). If I ever had another set of twins- I would absolutely try for the vaginal again- and that’s after first hand experience of the dreaded double delivery. If you want to try vaginal and things work out- please don’t let this fear hold you back!

  24. I see that someone sent you the link to the article about there being no statistical benefit to delivering twins by c- section over vaginally. I was lucky because my twins were born vaginally in an emergency delivery at 31 weeks. The doctor was a young female gyn in Hong Kong. She gave me the choice but pushed me to try natural birth. Twin A was very low. And a biting a risk in case of a c- section. Twin B was transverse. Luckily, twin B turned, with some help, when it was her turn to come out. There was no time really to have my bloodwork done really, so a c- section was risky for that as well. Good luck! I had no idea what would happen and couldn’t really plan it, it worked out well somehow.

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