UPDATED IN OP! Question for moms of twins re:delivery

[MSWR0319]

update: Well, she didn't get a choice! She went in yesterday for her checkup and her BP was slightly high and she was starting to show other signs of preeclampsia, so they did a c-section last night. Mom and babies are both doing great! One weighed over 5 lbs and the other just just under. I think she's right at 35 weeks.


My sister is pregnant with twins and is getting close to making a call on delivery. Baby B was breech, but has flipped so her doctor told her it's up to her if she has a c-section or tries a vaginal birth. She'd really like to try to deliver vaginally, but doesn't want to end up delivering one just to have the other flip and end up with a c-section. Her doctor told her most doctors at the hospital are trained in delivering a breech baby after the first comes out fine but it obviously could still end up in an emergency c. To top it off, unless she delivers by 38 weeks her dr. wants to induce. I'm not really into that idea, but it's not my pregnancy so I can only share information. So I was just wondering if any twin moms could share their delivery stories or recommendations on going natural vs. a scheduled c-section.

[JBaxter]

Not me but my cousin had twins Baby A was head down engaged babyB was breech but curled slightly over baby A feet. She chose to go to 39 weeks and went into natural labor Delivered in the OR they ended up turning baby B somewhat after baby A was born. Her doctor gave her the choice after Baby A engaged she said most often they can turn baby B unless it goes into distress.

[randomkid]

If she wants to deliver vaginally, then that's what she should try for if the doctor is in agreement. I did not have twins, but have a friend who did. Her problem was that she kept going into early labor and was on bedrest and meds forever, so she didn't have to be induced. She delivered both vaginally without a problem. I think if the doctor plans for a possible c to deliver one or both, but goes with vaginal first, then it's not truly an emergency situation. They may have to move quickly, but with advanced planning, it should all be fine. I guess I can understand him wanting to induce. I think a little more planning has to go into delivering twins, so an induction doesn't seem that crazy to me. Maybe it's his way of trying to avoid a c? I was induced at 38 weeks due to medical reasons and had no problems with the induction at all. My OB was very gentle with the induction and did not try to push things along too quickly. She should have a very open conversation with her OB and make sure he induces slowly, then she will likely be fine.

[Katigre]

I know multiple people who had vagina twin deliveries. Inducing by 38 wks is something I would fight - there is no reason for it if mom and babies are fine!

As long as baby a is head down and engaged, then the position of baby b doesn't matter since there will be a lot of room in the uterus after baby a is born, plus the cervix will be fully dilated and the doctor can manually turn the baby if needed (though a breech birth of baby b should be fine since the first baby fully opened everything).

She should also know that it is normal to have a delay between pushing out baby a and baby b. This is not a problem and actually allows for the first baby to have its cord finish pulsing, get some skin to skin with mama, and be checked over and breathing well established before doing it again with the second. The "wait to push until you feel the urge" skulls be followed for both babies as long as there is no distress. Ten or fifteen minutes is very normal and allows baby b to get into a good position naturally too. There should be no rush to "emergency c section" if mom and baby b are both doing fine.

If she really wants to encourage herself, she should Google "homebirth twins" videos. Those will help her see how it can go.

Sent from my Android phone using Swype

[TxCat]

At my hospital we do a lot of vaginal twin deliveries. Usually the only reason for going to c-section at that point is if Twin B goes into distress, same as for any mom/baby on L&D. The entire delivery usually will take place in the OR regardless (that way if there is a problem, the time to surgical delivery is that much quicker). Has your sister's OB explained why she/he wants to induce at 38 weeks? The why would be most important to me, rather than the induction itself. The other thing to consider is that most of the twin vaginal deliveries are encouraged to get epidurals for the following reasons: 1) if the OB needs to try and turn Baby B for delivery, it is much more comfortable for mom with an epidural in place, 2) it allows for more controlled pushing / time to deliver, which is important if attempting either a breech delivery of Baby B or turning of Baby B, 3) the epidural can be used for an emergency c-section, rather than general anesthesia, which is usually better for mom and baby.

[JBaxter]

My induction with Jack ( 10.5lbs) started the night before He was a single but large.

[MSWR0319]

At my hospital we do a lot of vaginal twin deliveries. Usually the only reason for going to c-section at that point is if Twin B goes into distress, same as for any mom/baby on L&D. The entire delivery usually will take place in the OR regardless (that way if there is a problem, the time to surgical delivery is that much quicker). Has your sister's OB explained why she/he wants to induce at 38 weeks? The why would be most important to me, rather than the induction itself. The other thing to consider is that most of the twin vaginal deliveries are encouraged to get epidurals for the following reasons: 1) if the OB needs to try and turn Baby B for delivery, it is much more comfortable for mom with an epidural in place, 2) it allows for more controlled pushing / time to deliver, which is important if attempting either a breech delivery of Baby B or turning of Baby B, 3) the epidural can be used for an emergency c-section, rather than general anesthesia, which is usually better for mom and baby.

I believe he wants to induce because the babies are "supposedly" measuring huge. We all know how accurate that can be though. Other than that I haven't heard her say anything else that would tell me why he wants to induce. Her husband was an 11 pound baby with a HUGE head, and the dr said it looks like the twins are following in their dads footsteps.

I can guarantee she will have an epidural. The girl has no pain tolerance ;) She's even afraid of the pain from getting an epidural. Those are all very valid reasons though for getting one and hopefully will help her get through the initial poke.

[TxCat]

I believe he wants to induce because the babies are "supposedly" measuring huge. We all know how accurate that can be though. Other than that I haven't heard her say anything else that would tell me why he wants to induce. Her husband was an 11 pound baby with a HUGE head, and the dr said it looks like the twins are following in their dads footsteps.

I can guarantee she will have an epidural. The girl has no pain tolerance ;) She's even afraid of the pain from getting an epidural. Those are all very valid reasons though for getting one and hopefully will help her get through the initial poke.

So, this will admittedly be an unpopular opinion in these boards, but I'll say it anyways. If your sister wants to try for a vaginal delivery with twins, I think she probably needs to have some faith in the estimated fetal weights from ultrasound. Yes, it's an imperfect measurement, but she has a much better chance at success with delivering vaginally if the babies are smaller (assuming Baby B stays breech). Baby B may very likely turn head-down after the baby A delivers, but if he/she doesn't, size is a very real risk factor for severe birth trauma to the baby or need to immediately convert to c-section. I am admittedly biased because I work with a large percentage of high-risk pregnancies and my field is all about risk reduction, so I've seen many worst case scenarios that fortunately just stay as hypothetical situations for the vast majority of families. Hopefully your sister won't need to be induced, but it sounds like its being discussed as a safety concern, especially in the setting of achieving a successful vaginal delivery, which makes a lot of sense.

[AnnieW625]

So, this will admittedly be an unpopular opinion in these boards, but I'll say it anyways. If your sister wants to try for a vaginal delivery with twins, I think she probably needs to have some faith in the estimated fetal weights from ultrasound. Yes, it's an imperfect measurement, but she has a much better chance at success with delivering vaginally if the babies are smaller (assuming Baby B stays breech). Baby B may very likely turn head-down after the baby A delivers, but if he/she doesn't, size is a very real risk factor for severe birth trauma to the baby or need to immediately convert to c-section. I am admittedly biased because I work with a large percentage of high-risk pregnancies and my field is all about risk reduction, so I've seen many worst case scenarios that fortunately just stay as hypothetical situations for the vast majority of families. Hopefully your sister won't need to be induced, but it sounds like its being discussed as a safety concern, especially in the setting of achieving a successful vaginal delivery, which makes a lot of sense.

Very well said and I am not a medical professional. IRL I have never met a mom who has carried twins to 40 weeks, I think one friend got close, but she had scheduled a c section for 40 weeks, but delivered on her own at 38 or 39 weeks. IMHO if I had twins I would be extra cautious about carrying them too long and would probably really take the doctor's advice to heart and potentially schedule an induction, however I would also have the doctor sweep my membranes. With DD2 I had mine sweeped at 4 pm and my water broke on it's own at 11:30 pm. I wonder if it would be faster with twins too.

I didn't have a fetal measurement with DD2, but I had one with DD1 and the doctor had said if she went full term or over 40 weeks then she'd be about 8lbs. She was 6lbs., 6oz. and was 12 days early. Had I been told the same thing with DD2 who was born at 6lbs., 3oz. I might have been a little bit more skeptical. BILW scheduled an induction with my nephew as he was estimated to be about 8lbs at 36 weeks, she was induced at 39 weeks and he was almost 9lbs. Same thing with our niece.

[JBaxter]

A girl I went to highschool with had her twins our senior year. Vaginally ( in 1985) 7 &1/2lbs & 8 1/2 Lbs those boys were huge.

But it is not unheard of to induce twins at 38weeks. Your sister could also ask for biophysical profiles done weekly after 36 weeks to track the babies.

[fivi2]

My water broke at 32 weeks but I didn't go into labor. I was on hospital bed rest for 10 days. My ob said I was delivering vaginally unless there was an emergency. I did deliver vaginally in an OR with an epidural (and a million docs just in case babies needed care. Not really a million but it felt like a crowd. The anesthesiologist was nice enough to take pictures :) )

My girls were 18 minutes apart. It felt like forever. And I forgot to keep pushing the stupid button for pain meds during the wait, so number 2 was more difficult (and she didn't want to come out - her sac was still intact. I think I had more back labor with her)

The induction at 38 weeks - honestly I would save that worry for if /when it becomes an issue. Not to be negative but the odds are against her making it that far. I feel like I remember reading that things can go badly more suddenly in a multiple pregnancy that goes long but I might be misremembering. I would wat and see what happens. If she goes that long and if her doc still recommends it she can evaluate then. She will likely have multiple ultrasounds so they should have a good idea of growth.

Jmo of course. Good luck to her!

[JBaxter]

Curious how many weeks is she now?

[JBaxter]

Curious how many weeks is she now?

[Kindra178]

This is a topic that is near and dear to me. Thanks TxCat for providing a solid medical perspective based on training and experience. Ds3 (Baby B) was breach. Although he did some flipping around, he was breach for most of my pregnancy. My obs, both the regular ob and the MFMs I switched to, were very confident that that Baby B's delivery would be "textbook" as he would be pulled down by his foot. Neither set of doctors I saw demanded I have a c section. Both sets were extremely confident that a vaginal delivery would be successful. I knew I would deliver in the OR with an epidural. Based on my experience with epis as well as my comfort with the research on safety, neither requirement bothered me in the least. I did not want to have a c section because I had a young two year old at home.

38 weeks or slightly before is a very good time to deliver twins. This is supported by significant well done research, spearheaded in part by Barbara Luke. 38 weeks is also ACOG's rec. I had zero problems throughout my pregnancy. I never had a contraction. I was induced at 37 weeks 4 days, in part because I had a pre-nephrotic syndrome and spilling protein due to 13 pounds of baby blocking a kidney. My inductions are slow and are encouraged by an epidural.

Baby A's delivery was generally fine. Baby B's delivery was difficult. I was exhausted by Baby A's delivery. Skin to skin between deliveries was not presented to me as option, getting Baby B out was important. Pushing for a second go around kind of sucked. In short, the doctors (MFM and fellow) couldn't get Baby B out. He ultimately was delivered with forceps. We were about 5 minutes away from a csection for him.

I am very glad I had a vaginal delivery for my twins. I would suggest that she trust her docs, talk to an MFM if she would like to and rest, rest, rest.

Twin pregnancies and deliveries are nothing like a singleton version. Everything is more complicated by the fact that there are two babies. Information or truths known for singleton pregnancies do not necessarily apply to twins.

[AngB]

So, this will admittedly be an unpopular opinion in these boards, but I'll say it anyways. If your sister wants to try for a vaginal delivery with twins, I think she probably needs to have some faith in the estimated fetal weights from ultrasound. Yes, it's an imperfect measurement, but she has a much better chance at success with delivering vaginally if the babies are smaller (assuming Baby B stays breech).

I was high risk and had regular growth ultrasounds for all 3 pregnancies. For each one, they were only off by a few ounces.

Plus with twins I would be really concerned with how the placenta and uterus everything was holding up if they are indeed both large.

[Tanya]

My OB kept insisting that he wouldn't let me go past 38 weeks either and I was determined to go as long as possible in order to have bigger babies, etc. I had had midwives with my first two singletons and had them without pain meds, etc. I wanted the same for my twins, but the state law was that I had to have an OB and had to deliver in an OR.

Anyway, I ended up with cholestasis and once it was diagnosed, I was immediately induced. At that point, I was so miserable, I don't think I could have kept going...due to the cholestasis, although being pregnant with twins wasn't very comfortable either. So, Baby A was head down, but Baby B was breech, then transverse. The OB wanted me to have a C-Section. I had hoped to go vaginal with no drugs. The OB said I'd have to sign going against medical advice if I didn't at least have an epidural, so I went ahead with that. Had Baby A and then Baby B did turn head down. She was in some distress, so OB used forceps. Honestly, I think I would have done so much better if I hadn't been confined on my back and forced to push on their count.

Twins are scary. Sure women have them all the time, but it is higher risk. I still wish I could have carried mine longer and delivered them in a different position and not had that horrible epidural, but they did arrive safely at 37 weeks 1 day and were 6 lb 3 oz and 6 lb 1 oz. My second singleton was 6 lb 5 oz at about 39 weeks.

I am glad we fought for the vaginal delivery over the OB pushing for the c-section. I wish I'd been able to go longer, but the cholestasis made it risky for my twins. My son also had a 2 vessel cord instead of 3 vessels, so he was monitored closely throughout my pregnancy, but it ended up never being an issue and their weights were very close to each other. I had a lot of ultrasounds and non-stress tests.

[MSWR0319]

So, this will admittedly be an unpopular opinion in these boards, but I'll say it anyways. If your sister wants to try for a vaginal delivery with twins, I think she probably needs to have some faith in the estimated fetal weights from ultrasound. Yes, it's an imperfect measurement, but she has a much better chance at success with delivering vaginally if the babies are smaller (assuming Baby B stays breech). Baby B may very likely turn head-down after the baby A delivers, but if he/she doesn't, size is a very real risk factor for severe birth trauma to the baby or need to immediately convert to c-section. I am admittedly biased because I work with a large percentage of high-risk pregnancies and my field is all about risk reduction, so I've seen many worst case scenarios that fortunately just stay as hypothetical situations for the vast majority of families. Hopefully your sister won't need to be induced, but it sounds like its being discussed as a safety concern, especially in the setting of achieving a successful vaginal delivery, which makes a lot of sense.
Thank you for this. It's very helpful. I have no experience with twins so I don't know what to tell her or how to guide her.


Curious how many weeks is she now?

She's 32 weeks and the babies were estimated to weigh almost 4 lbs a week and a half ago.


This is a topic that is near and dear to me. Thanks TxCat for providing a solid medical perspective based on training and experience. Ds3 (Baby B) was breach. Although he did some flipping around, he was breach for most of my pregnancy. My obs, both the regular ob and the MFMs I switched to, were very confident that that Baby B's delivery would be "textbook" as he would be pulled down by his foot. Neither set of doctors I saw demanded I have a c section. Both sets were extremely confident that a vaginal delivery would be successful. I knew I would deliver in the OR with an epidural. Based on my experience with epis as well as my comfort with the research on safety, neither requirement bothered me in the least. I did not want to have a c section because I had a young two year old at home.

38 weeks or slightly before is a very good time to deliver twins. This is supported by significant well done research, spearheaded in part by Barbara Luke. 38 weeks is also ACOG's rec. I had zero problems throughout my pregnancy. I never had a contraction. I was induced at 37 weeks 4 days, in part because I had a pre-nephrotic syndrome and spilling protein due to 13 pounds of baby blocking a kidney. My inductions are slow and are encouraged by an epidural.

Baby A's delivery was generally fine. Baby B's delivery was difficult. I was exhausted by Baby A's delivery. Skin to skin between deliveries was not presented to me as option, getting Baby B out was important. Pushing for a second go around kind of sucked. In short, the doctors (MFM and fellow) couldn't get Baby B out. He ultimately was delivered with forceps. We were about 5 minutes away from a csection for him.

I am very glad I had a vaginal delivery for my twins. I would suggest that she trust her docs, talk to an MFM if she would like to and rest, rest, rest.

Twin pregnancies and deliveries are nothing like a singleton version. Everything is more complicated by the fact that there are two babies. Information or truths known for singleton pregnancies do not necessarily apply to twins.

THanks for this perspective as well. I shared everyone's comments with her tonight. She's just so scared I think. A lady she works with had twins and had a c-section and it turns out it was a good thing she did because there was something that was wrong and the baby would have died if it was a vaginal delivery. I think that story is just scaring her to pieces, even though her dr said he things she'll be perfectly fine with a vaginal, but the choice is her.

[TxCat]

I was high risk and had regular growth ultrasounds for all 3 pregnancies. For each one, they were only off by a few ounces.

Plus with twins I would be really concerned with how the placenta and uterus everything was holding up if they are indeed both large.

Any measure of estimated fetal weight is imperfect, limited by the skill of the person doing it, the body habitus/weight of the patient, and the position and size of the baby. As a pregnancy progresses to term, it actually can get more difficult to get an accurate ultrasound weight due to the increasing size of the head and/or descent of the baby lower into the pelvis. My personal experience has been all over the place on this, with two high-risk pregnancies each requiring regular ultrasounds. My first pregnancy, the final MFM ultrasound 2 days before delivery overestimated the weight by 12 ounces, but my OB's ultrasound 4 days prior was within 2 ounces. This pregnancy, my MFM ultrasound the morning I delivered overestimated by 7 ounces. So, all less than a pound difference, but if I had had really big babies, those half- pound differences might have made a big difference in decision-making.

As an aside, my "special" skill in life appears to be measuring fetal weight by hand, also known as a Leopold maneuver. When I was still an OB resident I would routinely get notes from patients marveling over how accurate my predictions were, and even now when friends ask me to "check" them, I'm still very accurate, usually under half a pound difference. Too bad this isn't a more useful skill!

[TwinFoxes]

Twin pregnancies are by definition high risk. Anecdotal stories of people going full term really don't mean a lot. My pregnancy was perfect, until it wasn't. I know dozens of multiples moms, and they are more reflective of the stats. FWIW, my high risk OB was totally fine with my planned vaginal birth. But it didn't work out for me.

Anyway good luck to your sister. Inducing is not the worst thing that can happen. But people don't usually post their bad outcome stories online so googling won't help.

[georgiegirl]

Any measure of estimated fetal weight is imperfect, limited by the skill of the person doing it, the body habitus/weight of the patient, and the position and size of the baby. As a pregnancy progresses to term, it actually can get more difficult to get an accurate ultrasound weight due to the increasing size of the head and/or descent of the baby lower into the pelvis. My personal experience has been all over the place on this, with two high-risk pregnancies each requiring regular ultrasounds. My first pregnancy, the final MFM ultrasound 2 days before delivery overestimated the weight by 12 ounces, but my OB's ultrasound 4 days prior was within 2 ounces. This pregnancy, my MFM ultrasound the morning I delivered overestimated by 7 ounces. So, all less than a pound difference, but if I had had really big babies, those half- pound differences might have made a big difference in decision-making.

As an aside, my "special" skill in life appears to be measuring fetal weight by hand, also known as a Leopold maneuver. When I was still an OB resident I would routinely get notes from patients marveling over how accurate my predictions were, and even now when friends ask me to "check" them, I'm still very accurate, usually under half a pound difference. Too bad this isn't a more useful skill!

My us the day before I delivered was only 2 oz. over. One of the OBs in my group also specialized in measuring fetal weight by hand. His guess 5 days before delivery was less than 8 oz. under the birth weight ( which is pretty darn close estimating an ounce per day weight gain at the end,). The u/s tech said that OB was notoriously accurate.

[Kindra178]

Twin pregnancies are by definition high risk. Anecdotal stories of people going full term really don't mean a lot. My pregnancy was perfect, until it wasn't. I know dozens of multiples moms, and they are more reflective of the stats. FWIW, my high risk OB was totally fine with my planned vaginal birth. But it didn't work out for me.

Anyway good luck to your sister. Inducing is not the worst thing that can happen. But people don't usually post their bad outcome stories online so googling won't help.

I wish I could like this post. A twin delivery is not about a birth plan or how you want things to go. It is about resting, getting the babies out safely and taking care of them once they are out.

[AnnieW625]

I wish I could like this post. A twin delivery is not about a birth plan or how you want things to go. It is about resting, getting the babies out safely and taking care of them once they are out.

I think this should be true for all births not just twins.

[MSWR0319]

I wish I could like this post. A twin delivery is not about a birth plan or how you want things to go. It is about resting, getting the babies out safely and taking care of them once they are out.

This is essentially what I told her. She needs to do what the doctor tells her is safe and if he gives her a choice, have him talk her through the choices to help he make a decision. She's had a super easy pregnancy, way easier than either of my single pregnancies. I really hope that continues for her.

[twowhat?]

On 38 weeks: that is considered term for twins. Because a twin pregnancy isn't "normal", stress levels are higher throughout the pregnancy. The babies' lungs develop faster and the placenta ages faster. For a normal twin pregnancy, it's fine to go over 38 weeks but inducing at 38 weeks doesn't ring any alarm bells to me. The high-risk docs are gonna keep a really close eye on you as you go over 38 weeks to make sure the placentas hold up. Risk of complications start going up after 38 weeks (assuming a normal, healthy twin pregnancy).

My c-section was scheduled for 38 weeks for the above reasons and because both twins were breech. I really wanted a vaginal delivery but with both being breech, first pregnancy, big babies, it just wasn't worth it to me to risk the "double whammy" of trying to deliver vaginally and ending up with a c-section.

So I think your friend should consider how much of a risk for the "double whammy" she's willing to take:)

Anyway, on natural vs scheduled c-section...I honestly think a scheduled c-section at 38 weeks is totally fine. There are some advantages to it, logistically. You can be sure you have help lined up, etc. Of course it's major surgery. But I'd rather have a scheduled major surgery with my doctor as the surgeon than an emergency one with the on-call doc...

Also, it's much harder to get accurate size measurements on twins on ultrasound at near term. They are SO packed in there and a good sonographer has to do a lot of manipulating in order to get good angles to measure. I had to turn this way and that and watch my stomach go all lumpy this way and that. I had a very skilled sonographer and she was 5 oz off on each twin.

[MSWR0319]

bump for update in OP. Thanks for all the insight from everyone!

[Melaine]

bump for update in OP. Thanks for all the insight from everyone!


Congrats! Glad all went well for her and the babies. You guys will have a lot of fun!!

[TxCat]

Congrats! Healthy mom and healthy babies - best outcome you can ask for. :)