Opinions wanted re: convenience c-section

[DVMmomma]

Im an only child. DH has 2 brothers. One is in China and one is in Ohio (we're in MN). Both sets of our parents live in IL. So, basically, this means we have zero family living near us. We're started trying to plan for the impossible to plan- the birth of these twins. At 34 weeks, A is still breech (has never been head down). My perinatologist says 37 weeks is the max that I'm 'allowed' to keep these 2 in utero. So we have a c-section already scheduled for 37w2d (because I'm a rebel like that). 

Here is my current dilemma (perhaps influenced mostly by my discomfort these days): Do I schedule an earlier c-section? Maybe like 36 weeks? And then we can more easily plan when we need to have family up here? My worst case scenario is going into spontaneous labor in the middle of the night and having to wake DD1 and take her kicking and screaming to the hospital. I also dont want a ton of family on top of me in my house between this Sunday and the birth (which is what we currently have on tap). I never wanted to force evict (and I still really dont) but it kind of feels like c-section is where we're going anyway. They both seem pretty darn comfy in there and set in their improper positions. WWYD? Also, I'd like to breast feed so I worry about that too. Force eviction and my boobs taking a while to get the memo. 

[callmeKD]

Will your doc let you do an earlier csection? Do you have back up care for DD1? Is there someone who can help with her until family gets here? I was in the hospital for 4 days/3 nights with my c section. Would that give your family enough time to get here to then be able to help once you are home?

[DVMmomma]

Mar 22, 2017 22:44:21 GMT -5 callmeKD said:

Will your doc let you do an earlier csection? Do you have back up care for DD1? Is there someone who can help with her until family gets here? I was in the hospital for 4 days/3 nights with my c section. Would that give your family enough time to get here to then be able to help once you are home?

My doctor would prefer an earlier date. I think I'm giving him some anxiety pushing it as far as I am. Every appointment he reminds me that the perinatologists doing my ultrasounds recommend NO LATER than 37 weeks. I roll my eyes and we chuckle.

No real back up care for DD1. My dad can and will be up here within 6 hours of the call so at least there's that. I guess I'm just thinking If I knew the date of the c section and felt confident I wouldn't go into labor before that it would all be a bit easier I think. But I don't know. Again. Trying to plan the unplann-able. Maybe I should give it up and be grateful they're still cooking and just ride it out.

[richzep]

This is exactly what I did. I moved my date up to 36w2d because I was terrified I'd go into labor at a time when I couldn't get DS situated. I had no clue what I would do with him if I went into labor. So I scheduled it slightly earlier than my doctor wanted and it worked out perfectly. DS was taken care of. Wasn't woke up in the middle of the night. We went to the hospital calmly and comfortably. I'm all for the convenience. And convenience is key not just for when they're born but throughout your first year or two with twins.

[DVMmomma]

Mar 22, 2017 23:32:22 GMT -5 richzep said:

This is exactly what I did. I moved my date up to 36w2d because I was terrified I'd go into labor at a time when I couldn't get DS situated. I had no clue what I would do with him if I went into labor. So I scheduled it slightly earlier than my doctor wanted and it worked out perfectly. DS was taken care of. Wasn't woke up in the middle of the night. We went to the hospital calmly and comfortably. I'm all for the convenience. And convenience is key not just for when they're born but throughout your first year or two with twins.

Yay! Doesn't sound like you regret it either. DH is worried I'm risking them needing nicu time and that I'll regret kicking them out and having a longer hospital stay in exchange.

[richzep]

Mar 22, 2017 23:34:42 GMT -5 DVMmomma said:

Mar 22, 2017 23:32:22 GMT -5 richzep said:

This is exactly what I did. I moved my date up to 36w2d because I was terrified I'd go into labor at a time when I couldn't get DS situated. I had no clue what I would do with him if I went into labor. So I scheduled it slightly earlier than my doctor wanted and it worked out perfectly. DS was taken care of. Wasn't woke up in the middle of the night. We went to the hospital calmly and comfortably. I'm all for the convenience. And convenience is key not just for when they're born but throughout your first year or two with twins.

Yay! Doesn't sound like you regret it either. DH is worried I'm risking them needing nicu time and that I'll regret kicking them out and having a longer hospital stay in exchange.

This is probably not the best parenting advice but for me, those 5 days didn't make a difference. If they were going to need nicu time for those 5 days, well, I was in the hospital recovering for those 5 days anyway. I still would have gone home with my babies. Only difference is they wouldn't have been in my room with me. That's a horrible way to look at it but I just couldn't imagine juggling DS during that time.

[Deleted]

I'd sit with your doctor and let him know your dilemma. See when he is okay with taking early. I asked my OB to take at 36 weeks and she refused waiting to exactly 38 weeks to do my csection(sideways babes.)

Do you have any friends or neighbors that could watch DS for the 6/7 hours till family arrives? That's honestly not a long time they have especially if overnight while he's asleep.

[hollyberry]

Ya thats a complicated situation. I didn't have a scheduled CS but I did choose it as opposed to labour. (I was afraid of the double wammie, and my anxiety problems) I agree that if the babies need to be in NICU it may not have made a difference weather they were born a week earlier or not. And a bonus of them being in the NICU aftet a section is a better rest after the birth and hence faster better healing. My 2 were born at 35.5 and DS needed a week in NICU and DD needed 2. I am sure DD would have needed it even if she made it a bit later.

Its a hard choice, but I would likely go with earlier. The babies are in a good place, if they need extra and you won't have the stress of hoping your DD1 is well taken care of. I wouldn't be able to realax during everything if I was unsure about her. Which won't help and you won't be able to enjoy the process as much. (babies arrival)

[dke2010]

Honestly, I would never choose to have a c-section. My babies flipped at 35 weeks and I delivered two days later. There's a good chance you won't make it to your scheduled c-section unless you move it up. I would try to find a friend that could take your daughter for a few hours until your dad arrives.

[DVMmomma]

Mar 23, 2017 7:59:42 GMT -5 dke2010 said:

Honestly, I would never choose to have a c-section. My babies flipped at 35 weeks and I delivered two days later. There's a good chance you won't make it to your scheduled c-section unless you move it up. I would try to find a friend that could take your daughter for a few hours until your dad arrives.

They did?! This gives me hope. That's the whole reason I pushed my c section longer out was to give them time because I'd prefer vaginal but having them be wrong way up for so long had me wondering if I should just accept it and then if I had to accept it, might as well make it convenient. Also no thanks to the double whammy like hollyberry said.

I'm off to the Ob here in an hour or so so I'll see what he says. Thanks everyone! You've all been really helpful.

[requiressnacks]

Personally, I wouldn't choose a C-Section at 36 weeks, DVMmomma,. I delivered at 36 weeks and I think my babies would have really benefited from an additional week or two in utero. That said, I have no idea if I had delivered at 37 weeks vs. 36 weeks if that would have eliminated DS's NICU time. You just never know.

But I guess if your doctor is on board, then that's good. Mine really wanted me to go to 38 weeks.

So, this wasn't helpful at all.

[piccyami]

I delivered at 36+5 and Z barely managed to stay out of the NICU. If I had called the doctor when I started having headaches and vision changes (3 days earlier), she would have had a minimum 5 day NICU stay. She might have gotten to go home with me, but I don't know. I'm glad I gave her the extra time inside because she nearly didn't go home with us as it was. I had a C-Section scheduled for 37+1 because of discordance.

[callmeKD]

IMO obviously the earlier they come the greater chance of needing the nicu, but there's always a chance they will need it even if they are full term. So it's a total gamble. Maybe focus on finding backup care for your DD1? LMK if I can help, in a super non creepy way. Haha there's actually some post partum doulas on the MPLS mom's of multiples FB group. I bet you could easily find some help.

[mustloveerica]

I don't think I would feel comfortable delivering that early. My girls came at 35+3 and although they skipped the nicu we are still struggling with eating, weight gain, jaundice, etc. I think an extra 2 weeks would have made a world of difference.

That said you have to do what makes the most sense for your family. Even if the babies need extra TLC you'll know that the hospital will take great care of them.

[DVMmomma]

Thanks again everyone. With Mo/Di twins there's a lot of research supporting taking them at 32 weeks if you can believe that ish. For the non extremists, the most supported range is 35-37 weeks. Any longer and apparently I risk a stillbirth or two. If that wasn't the case, I wouldn't even be considering taking them now-ish for my convenience. I'll copy and paste the reference if anyone is interested. It's actually all pretty interesting. My SIL is an MD so she sends me research all the time on the matter.

In other news, of course the one time I actually had questions for my Ob, he was called away to a delivery and I got the nurse practitioner (who I love, so whatever) and a student. Let the student go ahead and practice check my cervix for funsies. She also got the pleasure of swabbing me for Group B strep. What a fun day had by all.



...we suggest delivery at 36 to 37 weeks of gestation. Delivery at about this time provides a reasonable trade-off between the morbidity of preterm birth, which falls with advancing gestation age, and the risk of unanticipated subsequent fetal demise. In one study, the perinatal morbidity rate and the prospective risk of fetal death at 36 to 37 weeks were 9 and 1 percent, respectively, in closely monitored pregnancies [7]. We do not perform amniocentesis to document lung maturity prior to delivery at 36 to 37 weeks in monochorionic/diamniotic twins.

The American College of Obstetricians and Gynecologists suggests delivery of monochorionic twins at 34 to 37 and 6/7 weeks of gestation [2] and the North American Fetal Therapy Network suggests delivery at 36 to 37 and 6/7 weeks of gestation

[DVMmomma]

callmeKD, thanks! We do actually have a doula so as long as it's not a labor between 8p and 7a, I'll be fine. I'm the type that hates to inconvenience others and that will be my demise haha.

[piccyami]

DVMmomma, I didn't realize yours were mo/di. With the discordance (measured anywhere between 23% and 35%, born at 33%), they wanted no later than 37 weeks, so push it as far as possible to give the smaller baby time, but not too far because it would have risked similar complications.

[dke2010]

Mar 23, 2017 8:17:23 GMT -5 DVMmomma said:

Mar 23, 2017 7:59:42 GMT -5 dke2010 said:

Honestly, I would never choose to have a c-section. My babies flipped at 35 weeks and I delivered two days later. There's a good chance you won't make it to your scheduled c-section unless you move it up. I would try to find a friend that could take your daughter for a few hours until your dad arrives.

They did?! This gives me hope. That's the whole reason I pushed my c section longer out was to give them time because I'd prefer vaginal but having them be wrong way up for so long had me wondering if I should just accept it and then if I had to accept it, might as well make it convenient. Also no thanks to the double whammy like hollyberry said.

I'm off to the Ob here in an hour or so so I'll see what he says. Thanks everyone! You've all been really helpful.

Yes! I was absolutely convinced there was no way they would/could move, but they did. Also, at 35+2 my girls needed 10 days in the NICU. It was the hardest thing I've ever went through and I wish I could have kept them in longer even though I was miserable by that point in pregnancy.
At the same time, I completely understand your situation with your older kid. That really complicates things. I'm a planner so I know I'd be thinking of all the possibilities like you're trying to do. Good luck!

[piccyami]

Also, W (baby b) kept flipping vertex, breech, transverse, some combination of the three, all through the end. He had plenty of room to flip around. Z was head down from basically the beginning. I know there was some time in there toward the end where she was also flipping around, too, though.

[callmeKD]

Mar 23, 2017 12:07:56 GMT -5 DVMmomma said:

callmeKD, thanks! We do actually have a doula so as long as it's not a labor between 8p and 7a, I'll be fine. I'm the type that hates to inconvenience others and that will be my demise haha.

Sorry I meant a doula who will care for DD1 while you are at the hospital.

[DVMmomma]

Thank you everyone. I've decided to stick it out. I think A just flipped because I can't feel her head anymore. So I'm clinging to hope. And then I was reading old threads trying to remember what all you guys recommended to pack in the hospital bag and I told more than one of you to also hold out hope when you were in my position so I can't be a hypocrite!

[schmella]

I delivered at 36+ 3 or 4. DD was fine, but DS had trouble with suck, swallow, breathe and the nurses referred to it as "wimpy white boy syndrome." He stayed a few days longer but never technically ended up in NICU. I'd stick with 37 weeks (I was scheduled for 37+2), but I'd probably consider earlier with 2 girls!

[DVMmomma]

Mar 24, 2017 12:10:31 GMT -5 schmella said:

I delivered at 36+ 3 or 4. DD was fine, but DS had trouble with suck, swallow, breathe and the nurses referred to it as "wimpy white boy syndrome." He stayed a few days longer but never technically ended up in NICU. I'd stick with 37 weeks (I was scheduled for 37+2), but I'd probably consider earlier with 2 girls!

Wimpy white boy syndrome! Is that similar to a man cold I wonder? Interesting they come out that way right from the get go

[piccyami]

Mar 24, 2017 12:18:40 GMT -5 DVMmomma said:

Mar 24, 2017 12:10:31 GMT -5 schmella said:

I delivered at 36+ 3 or 4. DD was fine, but DS had trouble with suck, swallow, breathe and the nurses referred to it as "wimpy white boy syndrome." He stayed a few days longer but never technically ended up in NICU. I'd stick with 37 weeks (I was scheduled for 37+2), but I'd probably consider earlier with 2 girls!

Wimpy white boy syndrome! Is that similar to a man cold I wonder? Interesting they come out that way right from the get go

Our NICU talked about it. Apparently, in a NICU, if you're going to have problems with a baby, it'll be the white boy.

[callmeKD]

Mar 24, 2017 13:01:12 GMT -5 piccyami said:

Mar 24, 2017 12:18:40 GMT -5 DVMmomma said:

Wimpy white boy syndrome! Is that similar to a man cold I wonder? Interesting they come out that way right from the get go

Our NICU talked about it. Apparently, in a NICU, if you're going to have problems with a baby, it'll be the white boy.

Lol our nicu said something similar too

[requiressnacks]

Dying at wimpy white boy syndrome! DS definitely had that.

[nerdykitten]

Yes this was talked about at our NICU as well , but Damian actually did better than the girls.

[piccyami]

Mar 24, 2017 17:09:12 GMT -5 nerdykitten said:

Yes this was talked about at our NICU as well , but Damian actually did better than the girls.

W did better than his sister, but he was 2.5 pounds heavier and more developed, though I think he did need oxygen in the or.