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Sure this has been asked lots before, but pros v cons of csection v vag birth for twins?

(28 Posts)
legallyblond Fri 05-Apr-13 10:56:09

Am yet to discus this with the consultant as its still early days (16 weeks)...

I have a 2.5yo DD who came out naturally. I was induced at 42 weeks, but only with the cervix softening thing, and labour was 8 hours. I had an episiotomy, but other than that, all fine.

I have heard horror stories of natural births (twin 1 fine then twin 2 spins and needs high forceps / c section) and c sections (bleeding, infections, terrible recovery, split muscles).... Helpful!

Any thoughts? A friend is further along than me with twins with the same consultant (she only ever seems to see registrars though) and she just keeps being told - whatever you want to do we'll support it (dependant on final positions of babies I suppose). Not ideal!

What are the pros/cons, especially as I've had one naturally....?

Bibblebo Mon 01-Jul-13 20:19:11

I was advised to expect that method of turning twin #2 if necessary if I end up having a VB with T1 in Oct.

Can I ask, how did you find this procedure?
I remember feeling awful after I had a manual removal of placenta with DS1, it gave me the creeps and felt very invasive - perhaps it couldn't have been helped.. I am sure that they needed me out of theatre ASAP after my forceps delivery and everything but I hated the very thought of it after the event for some reason.

Picklemom Mon 01-Jul-13 00:35:30

I'm wondering if anyone's doctor discussed performing, or actually performed, an internal podalic version on twin 2? This means reaching into the womb, grabbing and turning the second twin, and pulling it out by its feet. This is how my twin #2 was delivered (following a standard vaginal delivery of twin #1). All of the doctors I consulted leading up to the delivery described this technique to me as if it were standard procedure, but I've never read anyone on mumsnet discussing it.

For the curious, epidurals were also standard for twin deliveries at that hospital, and the hospital in question was in the U.S.

Bibblebo Sat 22-Jun-13 07:50:43

I am due DCDA twins in Oct/Nov. I have a three year olds who's natural labour ended in a forceps delivery which also always involves episiotomy. The recovery time was quite long for the stitches to completely heal and I always felt that they had sewn me up rather too tight.

I would really like to hear from somebody who has managed a vaginal birth having had a previous episiotomy. I have just been advised that if T1 is head down then vaginal delivery is the option to go for. He advised that they don't give you an episiotomy if you have had one already - I just wonder what they would do if you needed forceps? I supposes it might be a c section. Please let me know, anyone with experience of twins and previous episiotomy!

Ruby1080 Tue 28-May-13 22:43:37

I think it depends on the circumstances. I was induced at 37 weeks and ended up with an emergency c-section just a few hours later as my uterus hyperstimulated and one of the babies was in serious distress. I would never agree to being induced again in the future, and if a future pregnancy had to be induced prior to naturally going into labour then I would very firmly request an elective section.

However, if I were to naturally go into labour then I would try for a vaginal birth in future, I'm just very wary of inductions.

AprilFoolishness Wed 22-May-13 14:54:27

Without wanting to be the voice of doom, I would request from your hospital the protocol for multiple deliveries, ELCS and EMCS.

I had a full-on 'hit-the-red-button-and-get-as-many-staff-in-theatre-as-physically-possible' EMCS, but because I knew a reasonable amount about what was going on,and because the staff were great - and I suspect even better because they knew I was well informed and wanted to be kept that way right up to the GA - it was much less traumatic than it could've been, if that makes sense.

qwertymclate Wed 22-May-13 14:48:58

Make sure you get a consultant you trust. Mid way through the pregnancy I saw one who told that I would be having a vaginal birth and it wasn't up to me and I had no choice. This was after a c-section had been talked about from the start. Her attitude was disgusting. I got very upset and DH told her she was very rude and we put in a complaint. After that we had a lovely consultant and he very supportive. Found out afterwards they were trying to get the number of c-sections down due to cost and from a friend who works at that particular hospital that people had complained about her before. I understand that maybe c-sections are more costly but wasn't prepared to risk the safety of my babies.

legallyblond Wed 22-May-13 11:38:48

Qwerty, this is EXACTLY why I am making the choice too! Thanks for the post!

qwertymclate Wed 22-May-13 11:20:22

I had a c-section and choose to do so because I felt there was too much a risk of to twin 2. I remember reading when I was pregnant that the risk for CP is higher in T2 because they can get stuck and end up with a lack of oxygen so that was my personal reason. My consultant agreed, but said if I had wanted a vaginal delivery he would have let me have a go as T1 was head down.

I'm really glad I had the c-section. It was planned, lovely and calm, the babies were out safely and quickly and the staff were lovely. I had no problems with recovery. Stayed in hospital 3 days but it was really only the first 24 hours moving was a bit difficult. We were out and going for a lovely walk in the woods 4 days after having them.

WhatTheWhat Fri 17-May-13 10:16:39

I had a traumatic natural birth with my single older one and a completely stress-free EMCS (only 'emergency' in the most nominal sense and we were booked to have a CS anyway a few days later) with my twins.
85% recovery within about 2 1/2 weeks from the CS and by contrast this level of recovery took about 12 weeks from the natural, so you never can tell.
Go with your gut instinct and don't over-think it.
All the best.

legallyblond Sat 11-May-13 16:10:17

Just thought I'd update here (I'm the OP!)...

Met with the registrar last week (at 20 weeks) and asked LOADS of questions about the different risks of the different options. Funnily enough, she is 26 weeks preg herself, with her fourth!

Anyway, the message I got loud and clear was that the risks of medical intervention re baby 2 with a natural delivery are relatively high. The risks are no 2 not progressing, high forceps, cord round it's neck (it spins because if suddenly has more space) and not uncommonly, emcs anyway, having delivered baby 1. I explained that as a lawyer, I think in risks and asked her as a mother what she would do. She said elcs. I said I agreed and she visibly sighed with relief! She said the consultant I am under would always respect the mother's wishes but believes elcs is safer for twins.

So..... I think I will be going down the elcs route!

I know that recovery from a totally perfect natural birth would be quicker for me (I had no medication at all with DD but had an episiotomy - that took 8 weeks to heal....), but I would prefer not to take the risk fir babies or me or emergency medical intervention for baby 2.

notnagging Sun 21-Apr-13 20:19:04

I had an induced twin birth. Second breech wouldn't turn but both born finesmile

DragonTwins Sun 21-Apr-13 20:16:59

I had emcs after very unsuccessful induction. I was booked in for one due to huge babies and risk of womb rupture. I was 39 weeks. They were pumping maximum dose for 15 hours, but nothing happened... Ended up in theatre, which was my biggest fear. But now looking back, it should have been CS planned when second twin turned breech at around 36 weeks . That would have saved me 19 hours in labour ward.
Twins weighed 3400g and 3600g, 57cm and 55.5cm length

jumblejam Sun 21-Apr-13 17:14:00

I had an El CS. I asked far too many questions of the consultants early on and came to the conclusion that CS was safer for the babies (other Mums might disagree with this conclusion)
As I was going for scans fortnightly I made sure that I kept asking about a CS. They were reluctant to book me in for one but I got my date in the end
The CS went well, boys were delivered safely and recovery wasn't at all bad.
I'm glad I opted for a CS

Linguaphile Sun 14-Apr-13 16:26:55

I'm 17+4 with DCDA twins and have been mulling over this very question, so I'm keen to hear dialogue on it. Sounds like it's best to plan/hope for natural but be open to c/s if necessary. With an elective section, when do they schedule it? 38 weeks?

rednellie Sat 06-Apr-13 10:51:10

I'm not sure you should always completely give yourself up - in some cases yes, but I had an awful ob originally who had the highest section rate in our area and wanted to booklet in when the twins hadn't turned by 32 weeks. Thankfully I changed doctor's and ended up being very supported and feeling very safe. In fact my new doc had a much better safety rate probably because she actually gave a shit about her patients.

Mandy21 Fri 05-Apr-13 22:31:02

I also think you have to keep an open mind and just give your body over to medical staff. My situation was different in that I went into premature labour so I just gave up any decision making to the medical staff and said they could do whatever they needed to do to deliver 2 healthy babies.

FWIW, both were head down right until Twin 1 was born at which point Twin 2 started celebrating how much room he had - he was a lazy boy though, he didn't want to come early, he was comfy smile. He was breech then and threatened a section but let me push for one contraction and he was born naturally.

Emphaticmaybe Fri 05-Apr-13 19:13:34

I was very lucky and had a straight-forward VB at 39 wks - twin 1 cephalic, twin 2 breech but I remember being advised to have an epi-spinal to cover the possibility of needing a CS if problems occurred which seemed reasonable.

If it's safe to try for a VB go for it but like others have said it makes sense to be open-minded about CS and focus more on delivering safely above all else as twin labours are notoriously difficult to predict.

gardenpixie32 Fri 05-Apr-13 18:56:05

My consultant wouldn't discuss birth options with me until I was 32 weeks. We then decided on a natural birth if presenting twin was head down, if not he booked an ELCS for 38 weeks exactly. He was great and I saw the same consultant each time.

rednellie Fri 05-Apr-13 18:55:01

Having said all that, with twins you do have to let go a little bit! Mine were both breech throughout my pregnancy right up until the 36th week and they then took turns going head down until I actually gave birth. I really really wanted a vaginal birth, but I also made my peace with a c-section. And there are lots of wonderful things you can do to make a section very special indeed. But it's good to look at some of the facts and to use them to help you relax.

I'm sure you'll be absolutely fine!

rednellie Fri 05-Apr-13 18:53:04

Recent studies (here) show that c-section births are no safer for Mum and baby in twin births as long as the pregnancy is healthy and twin 1 is head down.

There are quite a lot of reasons why vaginal birth is often thought to be better for a baby (and the mother), but obviously this is only when that mode of delivery is safe. Here's some more recent research that's come out about mode of delivery and the effect on infant health here

andadietcoke Fri 05-Apr-13 14:44:45

Yep. Di chorionic and di amniotic. Two of everything (and twice the anxiety!!)

legallyblond Fri 05-Apr-13 14:28:18

Are DCDA twins the kind with separate sacs and placentas...? If so, mine are the same! Separate everything.

andadietcoke Fri 05-Apr-13 14:14:07

I'm also early on (17w) so haven't discussed this with the consultant registrar yet. I have DCDA twins, first pregnancy. Am I likely to get a choice, or do most hospitals aim for natural first? Like legallyblond I'm erring towards an ELCS to reduce the risk of complications I think. At what point in the pregnancy do they discuss this with you?

legallyblond Fri 05-Apr-13 13:33:51

Good advice. Tbh, if it is even a tiny bit safer for the babies, I want a c section I think.... DD's birth was very natural (I mostly laboured in water) and totally drug free... So I sort of feel like I have that badge and quite want it to be easy this time round...!!!

I feel much, much more anxious now that I know it's twins. More do than I ever did with DD (I was not at all nervous about her birth!). My priority is their absolute safety.

MamaBlue4 Fri 05-Apr-13 12:59:16

I agree with garden things may not go as you planned so prepare yourself for having something totally different.

I was lucky.

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