For an unplanned pregnancy, we were certainly surprised when we discovered two little beings on the first ultrasound. We had initially planned a homebirth, with our midwife who had supported us at our daughter's birth at home one year ago. However due to the increased risks associated with twins, we decided to opt for a hospital birth. Having birthed my first two children in hospital I held many reservations around birthing in this environment.
I also had the privilege of attending a friend’s twin delivery several years ago. Although my friend was essentially happy with the outcome of her birth, I wanted to avoid what I came to discover as “standard hospital procedure” for a vaginal twin delivery. I did not want to be given an ultimatum between an epidural and a caesarean; I wanted neither. I did not want the room full of unnecessary hospital staff eager to witness the unfortunately rare vaginal delivery of twins. I did not want to be confined to the bed, unnecessarily monitored, or have the second twin extracted by the doctor immediately after the first twin’s delivery. I needed to ensure that any intervention was ABSOLUTELY necessary, and not in the same context that hospital staff can portray as necessary, when in fact they are acting in their own best interests, not that of myself and my children.
To achieve my desired birth outcome, would require much planning, discussion and negotiation. In fact the most important part of my birth was the preparation. My midwife had an excellent working relationship with an Obstetrician who had significant experience in vaginal twin births. My midwife recommended we seek the obstetrician's joint care for the birth. I hoped the obstetrician would be open to our views and requests and help us achieve our desired outcome. However we needed to do our research and with our midwife’s assistance my husband and I became well educated in the finer details of vaginal twin birth and all its possible variants. Unfortunately there was a lack of research in the area and therefore no research to support the standard procedure adopted within the hospital system.
My midwife, obstetrician and I had several meetings to discuss the birth, which I felt challenged his comfort zones somewhat, requiring some negotiation and compromise, but in the end I was happy with his assistance and the birth plan we had agreed on. However, to complicate things, one or both twins remained in a breech position towards the end of the pregnancy. This created further reading, discussion, negotiation and revising of our plan. Fortunately our obstetrician also had extensive experience with breech births and was heading a Breech Clinic within Westmead Hospital.
Although I knew women are designed to give birth to babies in a breech presentation, and had witnessed the naturalness of this myself during my friend’s twins birth, I still held some fear of my impending birth. I felt this was preventing me from going into labour, so flicked through a book my midwife had loaned me on Breech birth. The visual imagery of women birthing breech babies helped me face my fear of delivering a bottom or two, and several hours later I was on my way to hospital.
After much discussion, planning and negotiating, Molly and Claire arrived at 3:10am and 3:37am respectively on 17th Dec 2011 – both breech!! Molly arrived shortly after our arrival, too fast for the obstetrician, but gratefully caught by my midwife. Molly’s speedy arrival definitely contributed to the ease of her birth. However, I believe our extensive preparation contributed to the success of Claire’s birth. Being the second twin, we had many concerns about the extent of intervention that could occur during her birth. I had previously agreed to having my membranes ruptured in order to determine her presenting part. This was to assist obstetrician to minimise any risks that may be associated with potential presentations. Fortunately Claire’s bottom presented and I was left to give birth to her unimpeded, in a standing position. Our preparation had paid off and with the help of my midwife and obstetrician, I had achieved a natural, vaginal birth, with minimal intervention and maximum safety to my children.
The breech book said that a full term baby’s bottom and head were an equal size, however at 37 wks I felt that Molly’s head was bigger than her bottom and it seemed my easiest delivery yet. So I paid close attention to Claire’s delivery which felt the same, confirming for me that in my experience, the breech position was far easier to birth than vertex. Two of my three previous children were a very similar size to the twins.
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I also gave birth to breech twins back in 1974 but I would not put my babies through that again and would opt for the caesarean that the doctors wanted. My first delivered feet first & almost died and my second, who delivered with one leg out straight & one behind his head, had hip problems. I look back now and realise how stupid I was to risk their lives just because I wanted to deliver naturally.
Diane - you have come to believe that c sections are safer than a vaginal twin birth but One of your twins still could have almost died if they had of been born via c section. Think of the life long health problems you have avoided for your children by having a vaginal birth. I will always suffer the consequences of a c section birth, it annoys me that people think they are safer despite the Australian numbers clearly telling us that the mortality rate for c sections is double that of vaginal births.
Carla, since you have raised the issue of data and evidence, I have to challenge you to provide the Australian evidence for an excess mortality rate for scheduled elective caesarean section versus planned vaginal birth for twins. There is no doubt that the mortality rate for second twins is higher in vaginal birth than elective caesarean delivery: overall mortality rate for twin pregnancy is 2.5 times higher than single pregnancy see http://www.nice.org.uk/nicemedia/live/13571/56497/56497.pdf
If you are talking about maternal mortality, there are no Australian data comparing maternal mortality of elective caesarean delivery versus maternal mortality of planned vaginal birth, twin or otherwise. Much of the maternal mortality of caesarean section is due to the underlying condition leading to the need for caesarean delivery, and often includes mortality for caesarean required for complications of vaginal birth. The lost time any significant analysis of this was done that I am aware of was published in the UK, "Why mother die 1997-99" This found that the maternal mortality rate for scheduled caesarean sections was 20% lower than for planned vaginal birth. The finding was obviously unplalatable to the Maternity System planners, and none of the subsequent reports have included similar comparisons with this subgroup of scheduled elective caesarean delivery lumped in with other elective caesareans, many of which will be for signigicant maternal illness (pre-eclampsia, major grade placenta praevia, diabetes etc).
It is clear the mother did not just 'want a natural delivery'. As she explains, she did a lot of researching, planing and discussing with her OB. The end of the first paragraph she even states that she only wanted the interventions if they were 'absolutely necessary' and in the 'best interests of her and her babies'. Doctors and midwives do know a lot about potential complications and how interventions can increase the chance of a good outcome for mum and baby, but for women to discard their professional advice, just because they want a 'natural delivery' is stupid. You do need to read up and educate yourself if you want to make your own decisions.
Hi. Id love to know, was your doctor at Westmead, Dr Pesce? I currently have breech twins and hope to be delivered by him too. What was your experience with the rest of the midwives/consultants during the labour?
I delivered my twins at 30 weeks 1 day they both were breech.. The plan was to have a csection at 37 weeks bit they had different plans. On September 11 2015 I was at Dr's I saw the nurse practitioner I wasn't feelings ng right and had complications earlier in month but she insisted I was fine didn't think in needed to be monitored and said "its not like you are going to have two babies hanging out by their feet" well the next day Saturday September 12 2015 I had a spontaneous delivery at home alone!! My husband was working.. My contractions came so quick and so hard I called Dr who thought I had time then called EMTs cause I knew otherwise.. My son who was baby b. Water broke and he literally pushed his sister out.. She was delivered in amniotic sac en cail as they call it.. I took her out and tried rescue breathing she was not crying at all.. Then he came about three minutes later EMTs walked in as he made his debut.. He also was not crying.. This was the scariest moment in my life.. I didn't know if they were ijay until I arrived at hospital.. They are true miracles so strong so amazing. They stayed in nicu for a little over two months which was their due date.. He was born at 3lbs 8oz and she was 2 lbs 10oz.. Today two days shy of seven months he is almost 15 and she is 11. They are doing wonderfully.. I never imagined I would be able to do something like this but we are Mothers.. When it comes down to it when our babies need us we step up to the plate no matter what...
Im have reached 35 weeks now and my presenting twin is breech i am hoping to discuss delivery with specialist at westmead to find out the risks as i dont want to be limited to one option.