VBACing twins

Replies to This Discussion

Permalink Reply by liz creditor on May 10, 2009 at 6:49pm

Hi Kimberly


Congrats on the twins? My sister had twins at 32 weeks. Her third pregnancy and first cesarean. The twins were both breech and her doc did not want to risk a vaginal birth at 32 weeks. They are doing great!

Firstly, I think you should think about midwifery care. Midwives are often misunderstood and are mostly really supportive of vbacs. If you doc is a no go with a vbac you need to dump him NOW. Dont even feel bad about it or look back.

In order to be considered for a vbac, most docs want moms to be at least 34 weeks prego before a doc will let you vbac, given that the babies need to be ready for contractions, labor, and vaginal birth. Also, it would be great if at least one of the babies was head down when you went into labor. So, my advice is get a midwife if you can.


Good Luck!!!

Liz Creditor
MS Ed LCCE,
MOm of three amazing kids, 1 c/s and 2 vbacs!

Permalink Reply by Kimberly James on May 10, 2009 at 7:03pm

Liz, thanks for the feedback. I'm planning on having a HB midwife serve as my labor support at home and doula at the hospital. She's the MW I'd have homebirthed with if HB midwives were "allowed" to attend twin homebirths. But they're not.

I see no benefit to having a CNM at the hospital. (1) Our sole freestanding birth center with OB support has since closed (bought out by the local hospital) leaving the CNMs without OB backup; (2) Only 2 CNMs are associated with OB practices at the moment therefore having priviledges at the hospital - 1 is with my OB, and the other is with an OB group I left a while back; (3) a CNMs back-up OB must be continuously available to the VBACing woman, so I'd rather have 1 less CP hovering over me while I do this. Plus, my history of recurrently loss has made OB care a necessessity; and finally, (4) a CNMs intervention in my last birth may have played a significant role in leading to the emergent c/s. Ultimately, CNMs still provide care under the medical-management model. Not to say that there aren't awesome CNMs, but there are also awesome OB who are much better "midwives" than some midwives.

The babies have been persistently breech & transverse. I'm only 24 weeks and know that a lot could change. I'm doing everything I can to encourage vertex presentation, at least for baby A (who seems to prefer lying at the bottom of my uterus blocking my cervix from baby B! ;p ).

Anyway, the short of the long of it is that I *have* to choose obstetric care - I'm at McDonalds trying to fashion a hamburger into a steak!

Permalink Reply by Elizabeth Sjoblom on May 10, 2009 at 9:28pm

Hi Kimberly,

I practice as a labor and delivery nurse and a childbirth educator. Being that you are twins does make it a little more risky with the extra stretching of the uterus. Positioning will also be a factor, as most OB's don't do breech deliveries anymore with the first twin. How long ago was your c-section and what was the reason for it?
I think that by sharing your birth wishes with your OB is the best thing that you can do. Is your OB open to a VBAC? In any pregnancy, you never know how things will go as far as when/how you will delivery, so being open to all possibilities is important. Educating yourself and having support with your choices is ideal and it seems that is what you are doing. Let some more weeks go by and see how things progress....

Enjoy!

Liz Sjoblom
L&D RN, CBE, breastfeeding counselor

Mom of one son, c/s & hopes to VBAC

Permalink Reply by Diane C. Nicholson on May 11, 2009 at 1:15pm

Hi Kimberly,

I've posted my story on a couple of other threads, but basically, I had a VBAC with twins in 1983. I worked hard to get it, but no one (except me) knew it was twins. We did know, however, that the "baby" was breech. Therefore, I had to find an OB who would deliver a breech babe. He said he would, as long as the presentation was frank or complete. I agreed, not wanting to push out a footling.

I pushed out a footling-- sort of. My babies were born with bilateral renal agenesis (no kidneys), so there was no fluid. Therefore, the presentaion ended up being interlocking.

It was difficult to say the least, but I had my vaginal birth! I was glad we didn't know in advance because no one, including me, would have wanted me to push them out.

I was 37 weeks; term.

So what I'm saying is-- it can be done. And I have no regrets. Several years later, I pushed out a 9 12 lb. healthy boy.

Best of luck. I looked far and wide for a supportive OB and found him the day before I went into labour.

Permalink Reply by Natalie Dominguez on May 12, 2009 at 10:15am

Hello Kimberly,

Big congratulations on the upcoming birth of twin babies. I would just like to share with you my experience more for a positive uplift to your situation and I pray my story would help you in some way. I have 5 wonderful children my first son being almost 10 yrs old. I had him naturally but almost didn't because he was in a breech position they did what is called a version and was able to turn him completely around and thank God natural delivery still with a great deal of intervention in the hospital. My second son was also breech but I was in active labor and at that point the hospital really scared me that trying to turn him would be very dangerous so I had my first c-section. My third a daughter was also in a breech position but I was determined to try a version again but was not a success this go around so there goes c-section number 2. My fourth daughter was head down which was wonderful news but because I had 2 previous c-sections it was out of the question to try for a vbac at that time. I was so disappointed and felt very unhappy that the only reason I was having another c-section wasn't for a breech baby there was no one in the hospital who would do it.

So here I am 4 years later and was so happy with the pregnancy of my 5th child. At this point I knew automatic c-section no question about it. So a dear friend of mine was in a similar situation and she did not want to get another c-section so she began looking into a home birth. She had a wonderful midwife and had a wonderful vbac at home after 2 c-sections in her past. I knew I had to do research and get a midwife who had experience and was beyond qualified to handle my particular situation which would be vbac after 3 c-sections.

My husband and I were at a complete peace that this was the right choice for our family. I had so much faith that I was making the right choice that my baby deserved to be brought into this world as it was intended to be I was so excited. My water broke at home my midwife came baby in a wonderful position to be born and I was in labor for a whole 48 hours but I had always mentally prepared myself in case I had to be transported to the hospital but I didn't dwell on that during my birth I only focused on the positive of the situation and believing in my body and my baby to be able to take this journey of childbirth together without any intervention that could potentially stall that from happening. After 48 hours my beautiful daughter was born 8 lbs 4 oz and no complications what so ever. My labor took a while but that is what my body naturally on its own had to do and by letting that happen I believe the outcome was better then I could have ever imagined. I know you are having twins and I have never been pregnant with twins but as far as determination and researching I was able to beat all the odds against me and had a natural home birth after 3 c-sections. So think positive and if you and your family want a vbac and you feel comfortable with that choice no that from a mother to a mother you have the support that you can do this and have a wonderful birth healthy baby and mother the way it should be. All the best truly.

Natalie
Mother of 5

Permalink Reply by Kimberly James on May 13, 2009 at 7:58pm

Thank you all for the advice and personal stories. I won't be doing a vaginal breech birth here in this community because none of the care providers do that, and therefore, they have all lost the art/skill of vaginal breech birth, our homebirth midwives included. Sure, there are a couple of surprise breechies that come out, but presentation will be a major factor.

I did tell my OB that I am planning a twin VBAC. I know he's supportive of VBAC and has delivered twins naturally. I've been told he's my best option in town. In his defense, since my c/s (2004) was performed by an OB in a different part of the country and I had a hysteroscopic myomectomy done this past summer (2008), I can understand his hesitance. He probably feels like he's assuming a lot of risk backing up invasive procedures that were not performed by him. I get that.

Yeah, I've done a lot of research. (I'm a University professor, so research is part of my life work!) And I can pull studies that support ACOG's CW and studies that completely refute that CW. What's frustrating about ACOG proclamations is that they are made by clinicians, not necessarily researchers. Evidence-based practice in any field is a challenge... questioning tradition is "prickly." Hope this makes sense.

So a large part of my "resistance" comes from knowing that (1) OBs, especially in my town, are clinical surgical specialists with a limited range of expertise and comfort; (2) clinical practice in obstetrics is not necessarily evidence-based (look at the use and abuse of Cytotec in obstetrics, for example); (3) VBAC moms are only at a slightly increased risk of rupture (all women, scarred or unscarred are at risk of uterine rupture); (4) my body can do this; (5) OBs make decisions that minimize their discomforts (i.e. medico-legal distress, insurance issues, etc.); (6) OBs do not always consider the damage that can be done to the mother-baby dyad from "routine" interventions; (7) that some women, like me, are well-versed on their rights and have sophistocated knowledge in the area of childbirth.

Etc. blah blah blah. I could rant all night.

Thanks again, everyone. And if anyone has anything to add or ask about what I've just posted, go for it!

Permalink Reply by Sarah Kent on May 15, 2009 at 12:05pm

Very different situation for me as I'm in the UK - but here's my HBAC twin story if you're interested :)

http://www.vbac.co.uk/stories/story.php?s=sarah2

Sarah x

Permalink Reply by Kimberly James on May 24, 2009 at 7:23pm

Thanks Sarah. I look forward to reading your story for inspiration! I see that you had two good-sized babies. Awesome!

Sarah Kent said:

Very different situation for me as I'm in the UK - but here's my HBAC twin story if you're interested :)

http://www.vbac.co.uk/stories/story.php?s=sarah2

Sarah x