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Discussion Starter · #1 ·
Hi

I was wondering if anyone could help? I'm currently 27 weeks pregnant with twins and every time I try to speak to my consultant about the birth he says he won't discuss it at all until I'm 36 weeks pregnant. This is really upsetting me as I've read that on average twins are born at 36.5 weeks so I can't believe I'm expected to be completely in the dark about what's going to happen until about 3 days before I give birth if I'm lucky enough to make it that long! One of the midwives told me I could forget active births, water births etc as I'd definitely be having an epidural but that's all the information I've managed to get hold of.

Please could anyone tell me if I have any rights about the way I give birth? Ideally I would like an elective c-section as I just want to get them out as quickly and safely as possible especially as I have a lot of pre-eclampsia history in my family - if I request this will they pay any attention to me at all? Similarly if I have a vaginal birth can I say no to an epidural? Also what happens if I go into labour at say 35 weeks - will I have any chance of a c-section or will they say well you've started a vaginal birth now so get on with it unless something goes wrong?

I'd be really grateful for any advice on this :)

Thank you

Sarah x
 

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I asked my midwife today at my 28 wks scan, they said they let me go to 37 wks then I can have the option of being started off but if baby 1 is head down they will let me go naturally, they said if I want an elec section I would have to have good reasons why as if they are in right position they would rather it was natural, obv if there is a problem before that they might need emergency section.  They said by 36 wks they have a better idea of the positions as up until then they can still move about alot.

I am going to try natural if possible, just so that the healing after wont take so long.

good luck with the rest of your pg
 

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Hi

They usually discuss it later on as the position of the babies will usually determine the mothod of delivery and that can change right up to term. From what I understand if one or both babies are head down vaginal is an option, however if they are breach or transverse it may not be safe for a vaginal delivery or to even let you labour/contract. In this case the decision is out of your hands and they'll opt for a section.

I was also told by my Consultant that we'd discuss it later but pushed it and said I needed to talk now as I was really concerned. I then told her I wanted and elective section and why and she totally agreed with me. I thought I was going to have a real fight on my hands but it was the opposite. She would have supported me if I'd wanted to try naturally but said if there was a sniff of a problem I'd be in theatre. I know there are risks with an elective to both me and the twins but I feel that with my history it's by far the safer option and the benefits far outweigh the risks. The plan for me is an elective at 39 weeks to help reduce the risks of respiratory problems with the twins which can be a problem with electives (because the hormones produced in labour help mature the lungs and the contractions help clear the lungs of fluid). The nearer to term you get the less chance there is of this problem occuring. However if I go into pre term labour and the twins aren't showing any signs of distress I'll be left to labour to help mature their lungs and then I'll have a section.
As for the epidural, you do have a say but as the chance of needing an emergency section with twins is 70% and 40% for needing a section with the second twin (UK statistics given to me by my Consultant) most Consultants understandably like to play for safety.
What ever you decide it's your body and they can't force you to do anything you don't want to do.  ^hugme^

Please don't get me wrong with this post. I know there are plenty of ladies out there who've sucessfully given birth to twins natrually and if that's what you want and it's safe for the babies, then that's what you should do. I'm not saying that sections are the right thing for everyone expecting twins!
 

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Hi Sarah,

I think it's standard practice that they won't really discuss the birth before 36 weeks.  I went to hospital at my 36 week check and eventually had a discission with a lovely doctor who agreed to induce me the following week....I had been moaning ro midwife/hospital every week from about 28 weeks about the birth but no one took any notice.  Depending on the position of the babies you will of course have choices but if you want a c-section there's no reason why you can't have one. 

Good luck.
Julie
 

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My consultant didn't discuss my birth till very late, despite me bringing it up at every opportunity!! ;D  But OF COURSE you have choices - it's your body and your babies.  If you feel you're not being listened to, try to take someone else along to your appt to give you some support. 

Incidentally, my first twin birth was vaginal with no pain relief, so an epidural isn't always given :)

xx Clare
 

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that's strange as it's possible you'll deliver early so I'd have thought they should discuss it before then...especially if you're keen to

I had the following choices (although as both were breech I didn't have any choice but a section)

If 1st twin head down then natural delivery but I would have had to have an epidural.

Or a section.

My ideas of a mobile, natural birth in the birthing pool went to pot...!!

Ginny
 

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Hi

Not sure if this is applicable at all hospitals but towards the end of my pregnancy I found out there was a consultant midwife I could talk to. She was absolutely fantastic, took time out to talk me through birth options and even came to visit me when the twins were born. I completely understand why we have to see consultant doctors during a twin pregnancy but I found that I saw a different one each time and whilst they were very competent medically the human touch was a bit lacking (My consultant was almost outraged when I dared to ask to be tested for Strep B!!) With a problem free pregnancy I wished I'd been able to spend more time with the midwives who I think have a better understanding of the worries we all have.


Good luck

Smudge

 

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My consultant wouldn't discuss until 36 either.  I had come around to the idea of a section as they were back to back but then they moved back again so I was back on for a vaginal birth which is what I really wanted. 

I originally wanted the bath and a mobile birth but they wanted to use the epidural to control my blood pressure and so I was prepped for a section should I need it.  It all made sense when it came to it because I just wanted them to be safe.

As it was I was 5 cms dilated when they decided to induce me, they broke my waters (telling me I had 2 hours to get moving else they would give me drugs to speed things up because of my blood pressure), I went into full labour within 20 mins with no break between contractions, dilated a cm per hour and then spent 6 hours pushing.  I couldn't have done that without the epidural it was exhausting as it was.

HJG

HJG
 

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I find it quite shocking that women are talked to in terms of You can't.." "We won't let.." etc etc.

It's your body and your birth and noone can impose anything on you. If you want to discuss and plan for a CS, then this should be accommodated.

In my case, i was very concerned that i should have a natural birth with no un-necessary intervention, and I therefore sent my birthplan to the supervisor of midwives and discussed it with my consultant and also met with the manager of the labour ward.  My main concerns were about no unnecessary induction, being able to use the pool, letting the cord stop pulsing before cutting the cord, and letting twin II come naturally in their own time, plus DP taking twin I skin to skin while I delivered twin II. As well as no unnecessary staff in the room, paediatrician called in only if needed, etc etc.

There were some complications as I had pre-eclampsia and twin II was diagnosed with IUGR, so I did have my waters broken, but nothing happened that I did not agree to. Twin I was delivered by the midwife, after an hour of contractions and 15 mins pushing, no drugs. The doctor in charge was brilliant and even though he then wanted to scan me and put me on a drip as soon as twin I arrived, in the end we waited 2 hours. Twin II was indeed in a bad position, and I agreed to having her turned plus drip plus going into theatre to have my waters broken... but I know for sure that all this was needed rather than imposed on me willy nilly.

The doctor actually shed a tear at the end, I don't think he had ever been involved in a twin birth where things were pretty much left to happen naturally and intervention only happened when it was really necessary. For me, it was very quick - 6 hours, inc the 2 hour rest in the middle - and I had no stitches or anything and was on a real high afterwards and left the hospital within a few hours. I was so relieved to get the birth I wanted.

Whatever it is that you choose, you have the absolute right to your choice. The hospital cannot do anything without your consent.

I hope you can get it sorted out.

xx

 
G

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Of course you have a choice!  I always wanted natural (until I was fed up, few hours in and said 'just get 'em out, I don't care how!!) but one was always head down, the other turned about 24 weeks and then stayed head down.  My PCT says I can insist on C-Sect for twins but consultant said hat he'd prefer me to go natural unless very necessary and I went along with him as he has an excellent reputation.  I was induced at 38+2 and had them naturally after 13 hrs.  Up and moving within 2 days and going out on 3 miles walks within 7.
 

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You will get a choice and they should talk to you about it. I can see why in the general scheme it is pretty pointless to talk about birth pre 30 weeks unless a person is at high risk of very early labour as so much can change between then and term but they ought to consider each woman as an individual. I would have thought with a family history of pre-e (if your mother or sister had it then your risk is increased x3) plus twins (increases the risk x3) you are at a pretty high risk of pre-e in the first place so if you start having signs of it they ought to be considering at the very least inducing pre-term from probably around 36-38 weeks.

Best wishes
Betty
 

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You very much have the right to the birth you want, it drives me mad when there is an assumption with multiple births you have no choice.  I went to visit the Head of Midwifery at my hospital and discussed my birth plan with her in detail and it gave me a great idea about what I could have.  My original plan was

1.To have no routine stimulants to start to speed up labour or rupture of membranes unless medically required

2.To be free to walk around during labour – no routine confinement to bed

3.To have to option to modify delivery positions – whatever position feels comfortable at the time – for the first and second baby

4.That any monitoring enables me to move around as outlined in point 6 and 7 above

5.To have no epidural unless required for c-section

6.To receive the first baby to say ‘hello’ immediately after s/he is born and if possible I would like to nurse one or both immediately (this is also applicable to second baby) – if possible cords to be left a little while before clamping

This was all agreed to....and then my presenting twin turned breech and they weren't prepared to deliver naturally so I had an elective section!!!  I'd still prefer natural over the section but at the end of the day it wasn't to be (maybe next time!) but my birth experince was very positive and I was able to influence that as well.  It is your 'right' to have the birth you want within the realms of what is safe for you all.

HTH
x
 
G

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My birth plan was I didn't really have one  :-[
I'd decided on entonox and epidural but that went straight to epidural.  I wanted the induction and natural but that was the extent of it.
I was passed both babies immediately too.
 

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i delivered in australia and delivery was discussed with me from the first appointment!  but i find it wierd that they won't discuss it 'till 36 weeks.

i reached compromises that i could live with with (for example having the epi in place, but no drugs to be administered unless necessary just in case twin II decided to do a last minute turn, (he didnt) or i wanted it for the pain (i didnt).  I did agree to being induced at almost 39 weeks - something i NEVER thought i would do - and i also agreed to continuous monitoring - not because i was concerned with anything, but because having been through labour before, i know i prefer to be sitting up, and quite still, so i figured it would make no difference to anything (it didnt!).  Plus i was having IV as i tested positive to Group B strep (routine testing here in australia).

In answer to going into labour at 35 weeks, if both babies are head down, they will probably go for a VB.  its better for babies (all other things being equal), as the labour/delivery process will help their lungs in a way that a C-sect won't.

If you want to breastfeed, your milk generally tends to come in quicker if you have a natural birth, so thats something to think about too.
 

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Funnily enough I saw an interesting article on birth choice yesterday (I start my midwifery training next year so get lots of publications!).  The RCM say that one of the reasons birth choices are left until later is that many women change their minds throughout their pregnancy.  A woman at 8 weeks pregnant will make different choices than a woman later in her pregnancy and feeling more confident about herself, pregnancy and giving birth.  It may be the reason that consultants delay these types of conversation - also twin birth is very reliant in many ways on positioning and twins usually settle into these around 36 weeks - that said you should be able to discuss the options available to you before this point so when it comes to make decisions you are well informed.

Just one note on the section/bf'ding thing....this can sometimes be the case but can also be like that with VB as well.  I had a section and my milk was in on day 3...i think this is more influenced by how you feed and your body.
 

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Discussion Starter · #16 ·
Hi everyone

Thank you so much for all the information. I think I'll be a lot more confident discussing the birth now that I know I can have a say in it.

I feel a lot better knowing that most people don't get to talk about the birth until 36 weeks as well and it's not just my consultant being awkward! Having said that I rang the other hospital in my area to ask what their policy was on discussing birth plans before 36 weeks and they guessed immediately which consultant I was talking about!!

Thanks again everyone  :)  :)  :)

Sarah xx



 

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do you see the same consultant every time?  i saw different ones, and their opinions on birthing twins ranged from "no, you can't labour like that"  to "whats the problem?  thats exactly what i would suggest!"
 

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Discussion Starter · #18 ·
Yes so far I've seen the same one each time. I think he might be the special twins guy as one of my friends had him too when she had her twins.
 

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my hospital had a 'twin clinic' and i saw different doctors (about 4 in total i think), all experienced in twin pregnancy and birth, and ALL with different opinions!  so i guess there is no 'one size fits all' approach.
 
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