If your Baby B was Transverse when you Delivered.....Come in

[requiressnacks]

Hi Ladies! It's question time....

My baby B is transverse and has been my entire pregnancy. Actually, she's about as transverse as they get and is literally straight across. She and her brother are in a very solid "T" formation. Let's assume that baby B stays this way and is transverse upon delivery.  I have questions on how you delivered and how you ended up delivering that way.

1. How did you deliver your twins? Vaginal for both? Vaginal for A, C-Section for B, C-Section for both?

2. How did you arrive at this type of delivery? Planned? Unexpected?

3. How did you and your doctor decide the best course of action?

4. Any other details you care to share?



I'm just looking for some general anecdotes from internet strangers who seem to be more helpful than my OB group.....They are literally telling me that my decision may come down to who is on-call that day. That doesn't seem very medically fact-based, honestly.

[schmella]

Oct 7, 2016 10:17:41 GMT -5 requiressnacks said:

I'm just looking for some general anecdotes from internet strangers who seem to be more helpful than my OB group.....They are literally telling me that my decision may come down to who is on-call that day. That doesn't seem very medically fact-based, honestly.

It's a pretty standard response, although most OBs do a piss poor job of explaining why- the reality is after A comes out, B could drop into the birth canal head down, easy easy. Or not, and then you're faced with a breech extraction or a c/s. A less experienced OB would likely recommend a c/s for both. One who is comfortable/experienced with breech extraction will give you options. And it will be partly up to you- I had no interest in recovering from the double whammy ( I didn't have to decide, baby A was breech from 2nd tri on), so if there was any chance of a c/s, that's what we were gonna do.

[requiressnacks]

Oct 7, 2016 11:04:50 GMT -5 schmella said:

Oct 7, 2016 10:17:41 GMT -5 requiressnacks said:

I'm just looking for some general anecdotes from internet strangers who seem to be more helpful than my OB group.....They are literally telling me that my decision may come down to who is on-call that day. That doesn't seem very medically fact-based, honestly.

It's a pretty standard response, although most OBs do a piss poor job of explaining why- the reality is after A comes out, B could drop into the birth canal head down, easy easy. Or not, and then you're faced with a breech extraction or a c/s. A less experienced OB would likely recommend a c/s for both. One who is comfortable/experienced with breech extraction will give you options. And it will be partly up to you- I had no interest in recovering from the double whammy ( I didn't have to decide, baby A was breech from 2nd tri on), so if there was any chance of a c/s, that's what we were gonna do.

I really don't want the double whammy either. Ugh, this is such a hard decision!

[requiressnacks]

And also - I thought they'd at least be able to give me some hard facts on how many transverse babies do end up head down.

[mc13]

Like schmella said it's all up to you and your doctor. If I had a transverse or breech baby B I was still going for the vaginal birth because my doctor was confident that she could maneuver baby b into a position that would get her head or feet into the birth canal. But if my doctor wouldn't have flat out said she was confident in doing that, then I would have gone with a scheduled c section.

[piccyami]

My doctor and I decided early on that a c-section was the best option for me because W was transverse the entire pregnancy at that point (this was before he started getting gigantic).

By the time we went to the hospital, he was head down, but flipped to breech sometime between the ultrasound and when he was born. My OBs office doesn't deal with a while lot of multiples, so she wasn't as comfortable with a transverse baby B.

[twobananas]

Oct 7, 2016 12:28:45 GMT -5 requiressnacks said:

And also - I thought they'd at least be able to give me some hard facts on how many transverse babies do end up head down.

I'd imagine that's a hard study to come by, but if you google something like - 'transverse twin delivery nih' you can do some of your own research. 'Nih' stands for national institute of health and whenever I google anything I want real stats about I add those three letters. You can read up on some studies for twin b deliveries. Good luck!

[requiressnacks]

Oct 7, 2016 15:22:28 GMT -5 @wineandcupcakes said:

Yeah I read this was all about the comfort/experience level of the OB on call. It's a gamble.

My only "birth plan" is that my vagina and abdomen can't get destroyed. There needs to be one exit only.

haha! This made me laugh.  I totally agree with you though. 

[bocaburger]

I had the exact same situation. We planned for a vaginal delivery but ended up with a c-section - not because of baby B's position, but because I just wasn't dilating. My MFM believes that my uterus was just so stretched out that it couldn't contract effectively.

My MFM said she often sees this - people are so worried they will have a c/s because of B's position, but they end up getting it anyway because A won't come out.

She also mentioned that based on the way B flipped when they took A out, it would have been a breech delivery. And B turned out to be much bigger than expected (and bigger than A by 10oz!) so a breech extraction would have been difficult and we may have ended up with a double whammy.

[jd]

Oct 7, 2016 11:04:50 GMT -5 schmella said:

Oct 7, 2016 10:17:41 GMT -5 requiressnacks said:

I'm just looking for some general anecdotes from internet strangers who seem to be more helpful than my OB group.....They are literally telling me that my decision may come down to who is on-call that day. That doesn't seem very medically fact-based, honestly.

It's a pretty standard response, although most OBs do a piss poor job of explaining why- the reality is after A comes out, B could drop into the birth canal head down, easy easy. Or not, and then you're faced with a breech extraction or a c/s. A less experienced OB would likely recommend a c/s for both. One who is comfortable/experienced with breech extraction will give you options. And it will be partly up to you- I had no interest in recovering from the double whammy ( I didn't have to decide, baby A was breech from 2nd tri on), so if there was any chance of a c/s, that's what we were gonna do.

This. I think your doctors' response is fairly standard, and it makes sense if you think about it. A breech extraction is a somewhat complicated procedure, and less experienced (but still awesome) doctors may just not want to risk it. I was told the same thing even though both of my babies were head-down. They said they had seen babies flip during labor, and I could (and actually should) aim for a vaginal birth, but I should be prepared for the double whammy if I do because the doctor on call may not be comfortable with the breech extraction if baby B were to flip mid-labor.

I delivered both of mine vaginally, but I think if one were breech until really late, I would have opted for a C-section because the double whammy possibility was terrifying to me. Plus, delivering twins is daunting enough without worrying about which doctor is going to be on call. But I'm a planner, and rolling the dice on something like that would have just stressed me out.

[DVMmomma]

I cant help but think about the generations before us that had twins with no problems and no c sections. I realize there was a lot more fetal and maternal death that is simply not acceptable by today's medical standards. It's still somewhat frustrating that we face a...what? 50/50 shot of 'needing' a c section. And yet it's not quite reasonable to just gamble and trust your body either because you'd never be able to forgive yourself if you let something happen to baby B. Ugh.

[housecarder]

Is your OB comfortable doing a breech extraction? Could you talk to the other doctors in the practice who would be on call to see what their comfort level is too? That way maybe you would know ahead of time that say 4/5 would be comfortable or if you OB is one of the few. To me that would be a big determining factor. Thankfully I knew I was getting a RCS from day one so none of this made a difference and Finn (B) flipped positions almost daily even near the end.

[schmella]

Oct 7, 2016 21:51:35 GMT -5 DVMmomma said:

I cant help but think about the generations before us that had twins with no problems and no c sections. I realize there was a lot more fetal and maternal death that is simply not acceptable by today's medical standards. It's still somewhat frustrating that we face a...what? 50/50 shot of 'needing' a c section. And yet it's not quite reasonable to just gamble and trust your body either because you'd never be able to forgive yourself if you let something happen to baby B. Ugh.

Enh, I disagree. My mom was born in 1956 and her twin did not survive birth, it's not like these concerns are completely unfounded.

With higher instances of twins, especially in cases where the mother might not have been previously able to conceive, let alone carry to term but medical advancements have made it possible, I don't think it's unreasonable to expect more frequent c/s.

And many women carry far longer and birth larger babies than ever before- when your uterus has stretched to accommodate 2 8lb babies, it may not be physically capable of a vaginal delivery.

And then there's the reality that my MFM presented- if you've gone through years of fertility treatments and finally managed to conceive, some women just want to remove as much risk as possible to make sure they get their take home babies.

So I figure when my MFM had a 50/50 track record of twin vaginal delivery, a good portion of those c/s were chosen, so e probably had better odds (and then A refused to budge and pre-e kicked my ass).

[DVMmomma]

Oct 8, 2016 0:26:55 GMT -5 schmella said:

Oct 7, 2016 21:51:35 GMT -5 DVMmomma said:

I cant help but think about the generations before us that had twins with no problems and no c sections. I realize there was a lot more fetal and maternal death that is simply not acceptable by today's medical standards. It's still somewhat frustrating that we face a...what? 50/50 shot of 'needing' a c section. And yet it's not quite reasonable to just gamble and trust your body either because you'd never be able to forgive yourself if you let something happen to baby B. Ugh.

Enh, I disagree. My mom was born in 1956 and her twin did not survive birth, it's not like these concerns are completely unfounded.

With higher instances of twins, especially in cases where the mother might not have been previously able to conceive, let alone carry to term but medical advancements have made it possible, I don't think it's unreasonable to expect more frequent c/s.

And many women carry far longer and birth larger babies than ever before- when your uterus has stretched to accommodate 2 8lb babies, it may not be physically capable of a vaginal delivery.

And then there's the reality that my MFM presented- if you've gone through years of fertility treatments and finally managed to conceive, some women just want to remove as much risk as possible to make sure they get their take home babies.

So I figure when my MFM had a 50/50 track record of twin vaginal delivery, a good portion of those c/s were chosen, so e probably had better odds (and then A refused to budge and pre-e kicked my ass).

schmella I think you're absolutely right. My point was intended to be more along the lines that I think we have created a world (with so much frivolous suing and threats of suing) where doctors are afraid for negative outcomes and push more for perhaps not actually necessary medical intervention. In the end it's entirely on the mother to be educated and make decisions and I get that. Sometimes it just makes me question things I guess. In the end, taking home a baby (or two or three!) is by far the most important thing though.

[requiressnacks]

Oct 8, 2016 0:16:36 GMT -5 housecarder said:

Is your OB comfortable doing a breech extraction? Could you talk to the other doctors in the practice who would be on call to see what their comfort level is too? That way maybe you would know ahead of time that say 4/5 would be comfortable or if you OB is one of the few. To me that would be a big determining factor. Thankfully I knew I was getting a RCS from day one so none of this made a difference and Finn (B) flipped positions almost daily even near the end.

It sounds like 2 of 6 doctors would even consider doing the breech extraction.

[mc13]

Oct 8, 2016 0:55:10 GMT -5 requiressnacks said:

Oct 8, 2016 0:16:36 GMT -5 housecarder said:

Is your OB comfortable doing a breech extraction? Could you talk to the other doctors in the practice who would be on call to see what their comfort level is too? That way maybe you would know ahead of time that say 4/5 would be comfortable or if you OB is one of the few. To me that would be a big determining factor. Thankfully I knew I was getting a RCS from day one so none of this made a difference and Finn (B) flipped positions almost daily even near the end.

It sounds like 2 of 6 doctors would even consider doing the breech extraction.

If you make it far along enough to need an induction, would it be possible to make sure you are scheduled with one of those two doctors? It may be because my doctor has her own practice but we scheduled my induction for 37 weeks (the latest recommended date for mono-di twins) about 1.5 weeks in advance and my doctor guaranteed me she would be there. That is something else that I would take into consideration. If it's a toss up of what doctor you have then I'd go with the safe bet of c section but if you can guarantee a specific doctor then I'd try vaginal.

[housecarder]

Oct 8, 2016 4:59:41 GMT -5 mc13 said:

Oct 8, 2016 0:55:10 GMT -5 requiressnacks said:

It sounds like 2 of 6 doctors would even consider doing the breech extraction.

If you make it far along enough to need an induction, would it be possible to make sure you are scheduled with one of those two doctors? It may be because my doctor has her own practice but we scheduled my induction for 37 weeks (the latest recommended date for mono-di twins) about 1.5 weeks in advance and my doctor guaranteed me she would be there. That is something else that I would take into consideration. If it's a toss up of what doctor you have then I'd go with the safe bet of c section but if you can guarantee a specific doctor then I'd try vaginal.

+1 to all this.

But I will also say that my c section recovery was a breeze compared to how uncomfortable I was at the end. It was so nice to be able to breathe and eat and walk with out 13+ lbs of baby on my cervix.

[jd]

Oct 8, 2016 4:59:41 GMT -5 mc13 said:

Oct 8, 2016 0:55:10 GMT -5 requiressnacks said:

It sounds like 2 of 6 doctors would even consider doing the breech extraction.

If you make it far along enough to need an induction, would it be possible to make sure you are scheduled with one of those two doctors? It may be because my doctor has her own practice but we scheduled my induction for 37 weeks (the latest recommended date for mono-di twins) about 1.5 weeks in advance and my doctor guaranteed me she would be there. That is something else that I would take into consideration. If it's a toss up of what doctor you have then I'd go with the safe bet of c section but if you can guarantee a specific doctor then I'd try vaginal.

Yeah, my doctor also ensured that a doctor experienced with breech extraction was available on my induction date. I didn't make it to that date, but it took some of the gambling out of the question. I would definitely push for that at the very least!

[requiressnacks]

Thanks everyone! After talking more with MH, reading these insightful responses and speaking to some IRL twin moms, I'm just going to schedule the CS. If baby B turns and is head down, super. If not - we will just move forward.

I do think I had my heart set on a vaginal delivery, but I'm starting to let that go. I just want my babies here - happy and healthy- so I'm going to listen to the medical professionals. Also, I was fucking miserable this weekend with pelvic pain and I honestly I might feel reassured with a scheduled date as a goal.

[thesportsgal]

My A was head down and B transverse and I delivered vaginally. My OB was going to deliver my twins no matter what and she WANTED me to have a vaginal delivery. I'm not sure if she would have let me schedule a C section just because B was transverse. Our only caveat the whole pregnancy was that A remained head down and she was comfortable she could get B to flip. Which she did. She did have to hold B in place with the vacuum until I could push her out but like I said, it was all stuff she was comfortable with. What is your OB comfortable with?

Also, I have not heard many good breech extraction stories My friend ended up with 20+ stitches after hers amongst other problems.

[requiressnacks]

Oct 10, 2016 10:16:38 GMT -5 thesportsgal said:

My A was head down and B transverse and I delivered vaginally. My OB was going to deliver my twins no matter what and she WANTED me to have a vaginal delivery. I'm not sure if she would have let me schedule a C section just because B was transverse. Our only caveat the whole pregnancy was that A remained head down and she was comfortable she could get B to flip. Which she did. She did have to hold B in place with the vacuum until I could push her out but like I said, it was all stuff she was comfortable with. What is your OB comfortable with?

Also, I have not heard many good breech extraction stories My friend ended up with 20+ stitches after hers amongst other problems.

I think the problem is that my OB practice, in general, is not confident that they can get B to flip. So we'd be looking at a breech extraction or a C-section, if Baby B didn't go head down.  There are only a couple of the OBs who would even considering doing the extraction. So, it's just such a toss up. Baby B could totally go head down and it could be perfectly fine. Or, not.  I just don't know if I could forgive myself if anything happened to the Baby during an extraction.

[thesportsgal]

Oct 10, 2016 13:01:02 GMT -5 requiressnacks said:

Oct 10, 2016 10:16:38 GMT -5 thesportsgal said:

My A was head down and B transverse and I delivered vaginally. My OB was going to deliver my twins no matter what and she WANTED me to have a vaginal delivery. I'm not sure if she would have let me schedule a C section just because B was transverse. Our only caveat the whole pregnancy was that A remained head down and she was comfortable she could get B to flip. Which she did. She did have to hold B in place with the vacuum until I could push her out but like I said, it was all stuff she was comfortable with. What is your OB comfortable with?

Also, I have not heard many good breech extraction stories My friend ended up with 20+ stitches after hers amongst other problems.

I think the problem is that my OB practice, in general, is not confident that they can get B to flip. So we'd be looking at a breech extraction or a C-section, if Baby B didn't go head down.  There are only a couple of the OBs who would even considering doing the extraction. So, it's just such a toss up. Baby B could totally go head down and it could be perfectly fine. Or, not.  I just don't know if I could forgive myself if anything happened to the Baby during an extraction.

So you definitely have to go with what the practice says and if they're not comfortable with it then hey, on to plan B  I'm not sure WHY my OB was SO comfortable with it but there's definitely twin circumstances that are different doc to doc.  BEST of luck!!