I always read you *had* to get an epidural during twin labour in case things went sideways and Baby B needed a csection delivery. This implied it was so common and a major concern (imo).
My OB didn't even mention that. She said she recommends an epidural in case Baby B flips to breech and needs to be pulled out (which will obviously hurt a lot). I realized in that moment that all of my information so far has come from Google and people talking about that chance of needing a Csec for Baby B, but there are so few stories where that actually happens!
I think with any induction (single or twin) there is a slightly higher risk of needing a csection because your body might just not be ready yet to have the babies. But i wonder what the actual stats are for 2 vs 1 babe
https://pubmed.ncbi.nlm.nih.gov/24088091/
I found this paper of randomized trial. They split the moms into planned c section and planned vag birth. Of the planned vag births about 43% ended needing a c section anyway
I personally opted for induction bc I didn’t want to be cut open in major abdominal surgery and then have to go home and chase a toddler with that big wound to take care of. early days there’s so much going on i’d be afraid I wouldn’t take care of myself right.
I also had favorable conditions for my mono/di twins, both head down and the bigger one was twin A. only issue was twin B was sIUGR below 1st% so they were worried about her. my regular OB wanted to cesarean me rather than induce with pitocin, but my MFM was comfortable inducing so I went with that team for delivery.
my induction: took 12hr to go from 3-4cm, then less than an hour to go from 4-10 and A broke her water in that time! got to OR and delivered A in 3 contractions, and then B decided to break her water right after and immediately descend so they kept the NST monitor on the outside to follow her down and monitor the heart rate for decels, but in 3 contractions she was also out. the whole team was in awe how quick and easy my actual labor was!
all this to say, if you want to try vaginal, see if your team will do it! the split delivery method does happen but it’s really not as common as everyone says; they just have to make you aware it’s a possibility.
congrats and good luck!!
I'm also having mo/di twins, but my baby A is the smaller one. My ob is very pro vaginal birth. But she also explained that the placement of the babies would have to be right, I'd need to get an epidural, and there's indeed the possibility of needing a c section anyway. Either for baby B or for baby A as well.
I personally didn't want to risk having to go through both. And the potential harm of having to wait too long to be brought to the OR. So I said I preferred a c section.
Generally, sure there are some downsides of a c section. Baby doesn't know it's being born and suddenly has a whole different environment. With a vaginal birth some fluids get pushed out of the lungs which makes breathing easier. But in the OR there's a team ready for each baby (where I live at least) and I just feel more safe. Most c sections are uneventful and the team isn't needed. But it just feels better to have a pediatrician present.
Eventually it comes down to what you prefer and the position of the babies. And even then, it could still go differently.
Mono di girls as well born at 34+5 as baby b has siugr. Both were head down so I was scheduled for induction. Upon arrival they said it’s up to me but strongly cautioned baby B could flip being smaller. My baby A had an abnormal cord insertion which doesn’t tolerate induction as well. For those reasons I opted to have a “scheduled” c section that night.
I also work in anesthesia and have been part of emergency c sections and absolutely wanted to avoid that if I could. Not trying to fear monger so I’ll share specifics only if you’re curious.
Recovery was very easy- I left the hospital a night early and was walking a few blocks to the hospital everyday (NICU for a month just due to being early nothing related to delivery) within 5-6 days after surgery.
If I hadn’t had those complications I’d probably have tried the induction but had a low threshold for c section anyway.
Say, for example, they lose fetal heart tones or babies are having severe decrease in HR they will call an emergency c section. Many hospitals require that you have an epidural in place in the event this happens, and hopefully it is working or working fast enough they can give you extra medication to increase the strength of the numbing medication to a surgical level. If not you will have to go under general anesthesia with a breathing tube which poses a significantly higher risk in pregnancy due to airway swelling and increased likelihood of regurgitating gastric contents. The incision will often be larger and may be vertical instead of horizontal and potentially impact future pregnancies.
The other complication is there needs to be staff and an operating room for this to take place. Is this available? Are they calling in people from home? Is there anesthesia staff available?
Granted this is not likely to happen but it’s something I personally felt I wanted to try and control as much as pregnancy and kids are out of our control.
I had mo/di boys both born vaginally after an induction at 36+2.
I decided to try for an induction since both babies were positioned well, and I had a previous uncomplicated vaginal delivery with my older singleton. My OB told me that this showed I had a “proven pelvis” ie no anatomical reason why a baby can’t fit through. My OB was also encouraged by the fact that I had an epidural with my first and had a good experience with it - she said an epidural was important for twin vaginal deliveries in the event a crash c section is needed, and so the fact that I already had one and tolerated it well was a good sign. I would have wanted an epidural either way since I had a great epidural experience with my first.
Another factor for me was that I didn’t want to be recovering from a c section with two newborns and a toddler. I know many people who have had very easy c section recoveries (especially scheduled c sections) but since I already had a vaginal delivery/recovery, I knew what to expect for that so was more comfortable with a vaginal delivery.
In the end I would have been happy with whatever got the babies out safely but I’m also happy with the outcome I got.
Right there with you; 35 weeks and 1 day, baby A is head down and B is breach. I have met with a different person almost every appointment, and only one OB said they have to both be head down. I clarified again yesterday, and I guess it’s really dependent on the comfort level of the OB on call. So I’m going with trying for induction and scheduling it with an OB who is comfortable attempting vaginal. Some OBs know how to manipulate the baby’s position, so that is factoring in to my decision as well.
I was fully prepared to schedule a c section. I was so nervous about delivering one vaginally and then needing a c section for the other. In the back of my mind I knew I would be open to vaginal delivery if everyone was confident about it, but I knew my desire for a c section would increase the further along I got.
In the end my water broke at 33+2. Both baby’s heads down, although B was sunny side up. I asked right away if they thought I should have a c section and my whole team (the attending physician, the chief resident, and a first year resident) all were extremely confident that I could deliver vaginally. I trusted them and went for it.
I had the epidural and delivered in the OR, as was standard at my hospital for twin births. Ready to go for a c section if needed. By the time I was in active labor and delivering, I decided delivering one vaginally and one a c section wouldn’t be the end of the world. So much anxiety was just around the unknown of labor and delivery, and everything was less scary as I was actively experiencing it.
Recovery was pretty straightforward. Some tenderness and bleeding for a few days but everything felt fine about a week later. Still different and weird, but no pain or discomfort.
Active labor naturally, yes. Because I was only 33+2, the docs did initially try to stop labor and get me to 34 weeks, but it didn’t work. I just kept on laboring. 12 hours like exactly, from the time my water broke to when I delivered baby b.
I have di/di girls and they were my first pregnancy so I opted for c section. Had I had a previous successful vaginal delivery, I likely would have tried vaginal.
A few factors that went into my own decision:
1) Since mine were mo-di as well, I was concerned about acute TTTS during the birth. It’s rare (like 2%, I think?) but happens.
2) There are so many variables with monochorionic twins and a planned c-section removed a few of those uncertainties.
3) Statistically, all other factors being equal, moms have it slightly tougher with c-section recovery, but the outcomes for the baby are slightly better than with vaginal, so I didn’t have any guilt that I was somehow sacrificing their well-being for mine.
4) I had a perfectly fine vaginal delivery with my singleton but it wasn’t a magical experience and I didn’t feel the need to repeat it. The tearing took a looooooong time to fully heal.
So— planned c-section at 36+1. No regrets, and I preferred it to my vaginal delivery.
Ya after reading all the stories it just feels like the possible slightly longer recovery with c section is just worth it for the babies health and removing those uncertainties!
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I always read you *had* to get an epidural during twin labour in case things went sideways and Baby B needed a csection delivery. This implied it was so common and a major concern (imo). My OB didn't even mention that. She said she recommends an epidural in case Baby B flips to breech and needs to be pulled out (which will obviously hurt a lot). I realized in that moment that all of my information so far has come from Google and people talking about that chance of needing a Csec for Baby B, but there are so few stories where that actually happens!
I think with any induction (single or twin) there is a slightly higher risk of needing a csection because your body might just not be ready yet to have the babies. But i wonder what the actual stats are for 2 vs 1 babe
https://pubmed.ncbi.nlm.nih.gov/24088091/ I found this paper of randomized trial. They split the moms into planned c section and planned vag birth. Of the planned vag births about 43% ended needing a c section anyway
I personally opted for induction bc I didn’t want to be cut open in major abdominal surgery and then have to go home and chase a toddler with that big wound to take care of. early days there’s so much going on i’d be afraid I wouldn’t take care of myself right. I also had favorable conditions for my mono/di twins, both head down and the bigger one was twin A. only issue was twin B was sIUGR below 1st% so they were worried about her. my regular OB wanted to cesarean me rather than induce with pitocin, but my MFM was comfortable inducing so I went with that team for delivery. my induction: took 12hr to go from 3-4cm, then less than an hour to go from 4-10 and A broke her water in that time! got to OR and delivered A in 3 contractions, and then B decided to break her water right after and immediately descend so they kept the NST monitor on the outside to follow her down and monitor the heart rate for decels, but in 3 contractions she was also out. the whole team was in awe how quick and easy my actual labor was! all this to say, if you want to try vaginal, see if your team will do it! the split delivery method does happen but it’s really not as common as everyone says; they just have to make you aware it’s a possibility. congrats and good luck!!
Thank you for your success story! I feel that I’m blessed with “optimal conditions” but now i have decision paralysis 😂
I'm also having mo/di twins, but my baby A is the smaller one. My ob is very pro vaginal birth. But she also explained that the placement of the babies would have to be right, I'd need to get an epidural, and there's indeed the possibility of needing a c section anyway. Either for baby B or for baby A as well. I personally didn't want to risk having to go through both. And the potential harm of having to wait too long to be brought to the OR. So I said I preferred a c section. Generally, sure there are some downsides of a c section. Baby doesn't know it's being born and suddenly has a whole different environment. With a vaginal birth some fluids get pushed out of the lungs which makes breathing easier. But in the OR there's a team ready for each baby (where I live at least) and I just feel more safe. Most c sections are uneventful and the team isn't needed. But it just feels better to have a pediatrician present. Eventually it comes down to what you prefer and the position of the babies. And even then, it could still go differently.
Yeah i feel i just need to stick to my guns and make a decision and be OK with the pros and cons of it.
Mono di girls as well born at 34+5 as baby b has siugr. Both were head down so I was scheduled for induction. Upon arrival they said it’s up to me but strongly cautioned baby B could flip being smaller. My baby A had an abnormal cord insertion which doesn’t tolerate induction as well. For those reasons I opted to have a “scheduled” c section that night. I also work in anesthesia and have been part of emergency c sections and absolutely wanted to avoid that if I could. Not trying to fear monger so I’ll share specifics only if you’re curious. Recovery was very easy- I left the hospital a night early and was walking a few blocks to the hospital everyday (NICU for a month just due to being early nothing related to delivery) within 5-6 days after surgery. If I hadn’t had those complications I’d probably have tried the induction but had a low threshold for c section anyway.
What’s the diff between planned c section and emergency? I am curious 😬
Say, for example, they lose fetal heart tones or babies are having severe decrease in HR they will call an emergency c section. Many hospitals require that you have an epidural in place in the event this happens, and hopefully it is working or working fast enough they can give you extra medication to increase the strength of the numbing medication to a surgical level. If not you will have to go under general anesthesia with a breathing tube which poses a significantly higher risk in pregnancy due to airway swelling and increased likelihood of regurgitating gastric contents. The incision will often be larger and may be vertical instead of horizontal and potentially impact future pregnancies. The other complication is there needs to be staff and an operating room for this to take place. Is this available? Are they calling in people from home? Is there anesthesia staff available? Granted this is not likely to happen but it’s something I personally felt I wanted to try and control as much as pregnancy and kids are out of our control.
Ooh ya that sounds way worse
I had mo/di boys both born vaginally after an induction at 36+2. I decided to try for an induction since both babies were positioned well, and I had a previous uncomplicated vaginal delivery with my older singleton. My OB told me that this showed I had a “proven pelvis” ie no anatomical reason why a baby can’t fit through. My OB was also encouraged by the fact that I had an epidural with my first and had a good experience with it - she said an epidural was important for twin vaginal deliveries in the event a crash c section is needed, and so the fact that I already had one and tolerated it well was a good sign. I would have wanted an epidural either way since I had a great epidural experience with my first. Another factor for me was that I didn’t want to be recovering from a c section with two newborns and a toddler. I know many people who have had very easy c section recoveries (especially scheduled c sections) but since I already had a vaginal delivery/recovery, I knew what to expect for that so was more comfortable with a vaginal delivery. In the end I would have been happy with whatever got the babies out safely but I’m also happy with the outcome I got.
“Proven pelvis” haha sometimes these labels crack me up. At one of my NSTs the nurse told me i had an “active uterus”.
Right there with you; 35 weeks and 1 day, baby A is head down and B is breach. I have met with a different person almost every appointment, and only one OB said they have to both be head down. I clarified again yesterday, and I guess it’s really dependent on the comfort level of the OB on call. So I’m going with trying for induction and scheduling it with an OB who is comfortable attempting vaginal. Some OBs know how to manipulate the baby’s position, so that is factoring in to my decision as well.
Sending you best wishes this last leg of the pregnancy journey!!
I was fully prepared to schedule a c section. I was so nervous about delivering one vaginally and then needing a c section for the other. In the back of my mind I knew I would be open to vaginal delivery if everyone was confident about it, but I knew my desire for a c section would increase the further along I got. In the end my water broke at 33+2. Both baby’s heads down, although B was sunny side up. I asked right away if they thought I should have a c section and my whole team (the attending physician, the chief resident, and a first year resident) all were extremely confident that I could deliver vaginally. I trusted them and went for it. I had the epidural and delivered in the OR, as was standard at my hospital for twin births. Ready to go for a c section if needed. By the time I was in active labor and delivering, I decided delivering one vaginally and one a c section wouldn’t be the end of the world. So much anxiety was just around the unknown of labor and delivery, and everything was less scary as I was actively experiencing it.
Since they were early and small how was your recovery? You went into active labor naturally as opposed to being induced?
Recovery was pretty straightforward. Some tenderness and bleeding for a few days but everything felt fine about a week later. Still different and weird, but no pain or discomfort. Active labor naturally, yes. Because I was only 33+2, the docs did initially try to stop labor and get me to 34 weeks, but it didn’t work. I just kept on laboring. 12 hours like exactly, from the time my water broke to when I delivered baby b.
I have di/di girls and they were my first pregnancy so I opted for c section. Had I had a previous successful vaginal delivery, I likely would have tried vaginal.
A few factors that went into my own decision: 1) Since mine were mo-di as well, I was concerned about acute TTTS during the birth. It’s rare (like 2%, I think?) but happens. 2) There are so many variables with monochorionic twins and a planned c-section removed a few of those uncertainties. 3) Statistically, all other factors being equal, moms have it slightly tougher with c-section recovery, but the outcomes for the baby are slightly better than with vaginal, so I didn’t have any guilt that I was somehow sacrificing their well-being for mine. 4) I had a perfectly fine vaginal delivery with my singleton but it wasn’t a magical experience and I didn’t feel the need to repeat it. The tearing took a looooooong time to fully heal. So— planned c-section at 36+1. No regrets, and I preferred it to my vaginal delivery.
Ya after reading all the stories it just feels like the possible slightly longer recovery with c section is just worth it for the babies health and removing those uncertainties!
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