Vaginal Delivery with Identicals

I FINALLY remembered to ask my doctor her thoughts on vaginal or c section with my identical twins. I thought that they would be c section, just because its too risky. I have had one vaginal birth already, to an almost 8 pound baby boy, 2 years ago. While it was a very long, traumatic process (for me...not the baby), the delivery went fine. After we get passed the blood clots I had, and the blood transfusion, but all in all, my body "can" deliver a child.

So my doctor said "Oh no, we will definitly go for vaginal, as long as baby A is head down (breech is the term correct), and no other issues evolved, they would attempt vaginal.

I thought great...I mean yeah its scary to push 2 babies out, compared to the one I pushed for two hours, but then again, chances are the twins would be considerable smaller then my 8 pound chunker!

My concern is, when baby A comes out, they cut the Umb. Cord, the placenta is still inside, isnt that scary for baby B to come out with that cord dangling??

I am sure my doctor will explain the pros and cons to vaginal once that time comes (she said 34 weeks we would discuss the situation), but I am just curious what you all experienced.
TIA - Sarah

 

I was not a candidate for a vaginal birth because my ob does not do VBAC's (which ended up being a moot point because both babies were breech) but my ob told me she would have recommended a c section regardless because they shared a placenta. She said the risk (though small) of the placenta being delivered before the second baby, to her, was not worth taking. My ob is pretty conservative, but I trust her so whatever got them here safely was fine by me. Good luck!

 

My twins were being watched for TTTS. If they develop TTTS it can be VERY dangerous to have a vaginal delivery as blood can be pushed through the placenta into the baby still in the womb. I'm not sure of other complications, but I demanded a csection b/c I didn't want to take the risk. Okay, I was scared of a vaginal birth though too. I'd had several abdominal surgeries already so I knew what to expect with that.

It turned out that the boys had their own placentas, but they were fused and looked like one on the u/s. A vaginal delivery would have been fine for us, but I'm glad I made the choice I did.

 

I had a vaginal delivery with my Mono/Di twins.It was actually easier than my previous 2 vaginal deliveries with my singeltons.Mine were both head down,but after I delivered Baby A, Baby B started moving around with all the extra room she had.My Dr decided to do a breech extraction(which is where the Dr Manually sticks his arm into your uterus and pulls the breech baby out by their feet).It was either that or get a c-section.But after doing an ultrasound between the two being born he decided that was the best way.He had to hurry and do it because my placenta was starting to seperate from the wall and it would have been a danger to baby B if it were delivered first.I only pushed 2 times with Baby A and not at all with B.They were born 21 min apart.You will almost likely deliver in an OR due to things like what happened to me happening.Good Luck!

 

My boys had ttts and there was no way the doctors, or me would have risked a vaginal delivery. There is also something called acute ttts that can occur suddenly during a vaginal delivery, but I think it's pretty rare. Mommymeg described what can happen in her post. IMO mono-di should be c-section, but again that is just my opinion.

 

Mine we both head down [vertex/vertex] so my ob suggested a vaginal delivery. We delivered in the OR just 'in case' cause she said there was a 20% chance that after baby A was delivered, that baby B would turn [with all the room] and we'd have to do an emergency C-section. Everything went very smoothly and my girls were born exactly 20 mins apart ^_^

 

wow great question! i never would have even thought to ask about this. i'm expecting mono/di boys and my OB is going to schedule a c-section. she hasn't done it yet because i am not far enough along but the plan, from day 1 (well 8 weeks 5 days when we found out) was a c-section. of course if i can make it the full 37 weeks they are doing a tubal so i don't think i'll be risking the vaginal birth. in truth it scares me FAR MORE than an operation. i prefer the "painless" or as close to painless as possible route....lol, i'm a wussy.

but great question. i'm glad all of you ladies had successful vaginal births!

i DID get a letter in the mail from the OB/GYN (they send updates when they do tests and what not with the results) that i am considered and set for a "high risk" vaginal delivery. so i am pretty sure that if they want to ATTEMPT to get them out of my vagina they will be doing so on the operating table, just in case.

 

My girls are mono/di with TTTS and my high risk ob is fully intending on a vaginal delivery as long as everything is looking good. Baby A is cephalic, Baby B is breech but he said as long as A is head down and there are no concerns to get them out in a big hurry that vaginal delivery is the way to go. Either way we'll be in the OR so if something happens he can do a section but I feel very comfortable with him and know that he'll do what's right.

 

My OB cautioned me against delivering my Mono-Di twins (shared a placenta) vaginally. They never were diagnosed with "chronic TTTS", but she cited the risk, albeit small, of "Acute TTTS" during delivery. The risk is that once twin A is delivered, the placenta will start to detach leaving twin B with no source of oxygen until delivery, the speed of which could not be guaranteed. I researched it vigorously because I really really really wanted to deliver vaginally. Althought the risk was very small, I knew I couldn't live with myself if my personal preference caused death or brain damage to one of my babies, so we went with C/S. It was still sad because the day I went into labor, I was dialating fast and they were both head-down, so I probably could have done it vaginally, but I have to believe it was the right decision, because they both came out screaming and healthy!

 

I believe you will get such a mix of answers we may not help you decide. Understanding that there are risks with ANY birth, vaginal or c-section, my opinion is to go with what your OB is comfortable doing the most. He or she will be more comfortable delivering a certain way and that is what is best, honestly.

I delivered my mono-di boys vaginally, 10 minutes apart with zero complications. Their birth was WAY easier and faster than my first, singleton son. My OB held baby b's head in place after I delivered baby A so he would not turn. My OB's were very confident given my previous vaginal birth and weekly scans, that I was a good candidate for a vaginal delivery and the risks were no higher than a standard vaginal birth for me or my babiesThe tend to do more vaginal twin births than c-sections, so they have tons of experience doing just that. Acute TTTS is very rare, though it is a risk. Little known fact, the placenta can detatch between deliveries with a c-section as well, so that particular risk is still there, although the risk to the baby is less because they can get baby b out faster. Personally, the very temporary pain of a vaginal birth was much less scary to me than the week or more of pain/discomfort from a c-section. I couldn't imagine caring for 2 infants and a then 2 year old and recovering from major surgery. I was happy my boys were head-down and ready to go when the time came. I was induced due to preeclampsia, but that was no big deal either. I delivered exactly 5 hours after the start of induction as opposed to 22 hours with my first baby!

Good luck with your decision. I know it is a difficult one. The best thing for you and your babies has to be what you and your doctor are comfortable with. I wish you much luck and health during the rest of your pregnancy!

Kelly

 

i delivered my mono-di girls vaginally, about 8 minutes apart. baby B had no issues with the umbilical cord being in the way (although, this was something that i was worried about too - i couldn't figure out how it would work, but my doc said it wouldn't be a problem). my OB was against a vag delivery even though both my girls were head down & i had no pre-existing medical conditions that would warrant a c-section. i chose to fight her on it because i wasn't comfortable with a pre-emptive c-section (for a whole list of reasons), but as a previous poster said, it really does need to be a decision you and your doc are comfortable with. that being said, in our case, there was very little chance our OB would be doing the actual delivery anyway, so i wasn't too worried about her opinion. it turned out that the OB who WAS at our birth didn't have any issues with a vag delivery at all, so it all worked out. at the end of the day, i had to trust my instinct & that said that a vag delivery would be fine.

 

My peri does csecs with mono di identicals. She would have let me attempt one but I figured, "what's the pt? I know I'll end up w a csection anyway!" LOL.

A good friend just delivered mono di girls 3 weeks ago and the EXACT thing you're describing led her to deliver A vaginally (with episiotomoy and forceps) and B emergency C section! OY! Oh and labor of 24 hours first!

 

I know my reply here is "late", but I just wanted to throw my hat into this ring. . .

I had TTTS Stage I mono/di boys vaginally. . . successfully.

I had been on bedrest for 13 weeks (7 weeks in hospital) with close monitoring due to TTTS and cerclage in place due to early dilation related/possibly unrelated to the TTTS. My boys arrived at 34w1d. We were very fortunate that by delivery, our guys were doing well.

For weeks, we discussed with the doc and did lots of research on what to do concerning delivery. Initially, one of the MFM docs suggested we have a c-section and possibly not even allow me to go beyond 35 weeks (IF I made it that far). Then at about 32 weeks, another MFM doc (with more experience) said he did not see why I couldn't deliver vaginally since
(1) both babies were doing better and were miraculously stabilized
(2) I had three other children I'd delivered vaginally with no complications
(3) I'd be delivering in the OR with epidural and ready to go c-section if any complications came up
(4) both babies were head down

I discussed acute TTTS with them and was paranoid like crazy about it. It wasn't an easy decision. My OB docs kept telling me they felt comfortable doing the vaginal delivery and would be monitoring me and the babies closely the whole time. I finally consented to it, and I was fortunate it was successful. They were delivered 5 minutes first with the Donor baby being born first. I'm trying to remember. . . there is some question about whether it's safer or not with the smaller baby being first or last, it seems. Can't quite remember, so you might look that up or talk to the docs about research on that.

My guys were sent to NICU because they were preemies and were TTTS twins. They needed to be observed, but they never had breathing aid. The donor had an IV, but the recipient never had one. They were both home within two weeks.

Now, that all said, it is a very difficult decision. And I'd definitely lean on my docs and specialists for their opinions. I remember it being an excruciating decision for me. . . another reason I was encouraged to try to have them vaginally was because I had three small children at home, and my docs thought it would be easier for me to heal and care for them afterwards. In all honesty, however you choose to deliver. . . have help waiting at home!

Emily

 

I was at Stanford Hospital with my mono/di twins and, since my twins had TTTS, my pregnancy was watched only by a peri. She did all my appointments and weekly ultrasounds. Along with all the other top peris at the hospital who were watching our case, she believed that a vaginal delivery would be safe as long as Baby A was head down.

I didn't get to have my vaginal delivery because I came down with HELLP during labor and we had to do a c-section but I definitely would have preferred vaginal if things had gone right. I delivered my two 9 1/2 lb singletons by VBAC and the recovery is so much better. Within an hour of the vaginal birth, I felt better than I felt a week after the c-section. Vaginal births also help the babies' respiratory development both at birth and in the long run.

The chance of having Baby A vaginally and then Baby B by c-section is actually pretty small, it's less than 5% of births. Having an OB who is quick to jump to c-section would up that percentage though but your OB doesn't sound like that type.

 

Thank you for all of your help, and information ladies. Its nice to hear all of your stories! My Ob does think it would be more benificial to me to have a vaginal delivery, since I have a 2 year old at home, and recovery is easier.

I wonder how familiar they are with my situation and vaginal deliveries? How do I ask "Are you qualified to deliver "my" babies?" lol

I will ask my peri tomorrow what his thoughts are on the subject. He seems to know my doctors office well, but there are many doctors. Who knows who will be on call the day I deliver, while I may trust one doc to deliver vaginally my "special" twins, I may not have confidence in a different doctor. Such a tough decision??

Guess I will have to wait and see how things go. I may not have a choice in whether I can have a vaginal birth. So many things to think about!!
But I appreciate ALL of your stories and input ladies.

 

I'm delivering vaginally tomorrow at 34 weeks with my identical twin boys. I have IUGR. One baby will be 3 1/2 or more pounds the other close to 5. I asked my doctor why they just dont c-section since it could put stress on the babies and she told me they would have me hooked up to monitors to check for any signs of distress during labor, if there was then they would c-section. My advice is to trust the doctor, if they think its safe, or unsafe, they will let you know. All pregnancies are differenent, so the way the doctors deal with each delivery is different too.