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Vaginal birth with twin one/ both twins breech?

(33 Posts)
Methenyouplus4 Tue 26-Aug-14 22:40:53

Has anybody? 32 week scan and both breech but can't make peace with having a c section. Really hard to find research/ data in this area. Would love to hear from anyone who delivered vaginally.

SoonToBeSix Tue 26-Aug-14 22:43:52

I desperately wanted to avoided a cs to the point of being terrified of having one. I was lucky both twins were head down however if twin one was breech I would have had a CS. Please don't risk it it's too dangerous.

Methenyouplus4 Wed 27-Aug-14 08:53:03

Without being cheeky, how do you know it's too dangerous? I can't seem to find any information on it. Hospital said greater chance of needing a couple of days in SCBU for breathing but this is also given as one of the risks for a c/s?

I'm not at all scared of the operation but just want to feel fully informed.

slightlyinsane Wed 27-Aug-14 19:08:44

What type of twins are you having as this can play a part in the advice given.

Diamondsareagirls Wed 27-Aug-14 19:28:53

My first twin was born head first and my second breech. They had to take me to theatre for the second delivery in case of complications but it turned out fine!

Methenyouplus4 Wed 27-Aug-14 20:46:48

None identical in their own placenta. They don't mind what position twin 2 is in, it's twin 1 they are concerned about delivering breech.

slightlyinsane Wed 27-Aug-14 21:06:36

Id twins I would always advise a cs but not sure about dcda. I googled and the 1st thing I came across was a study on 500 & something twins, there was no evidence that they needed anymore help afterwards but after a death of 1 twin they concluded cs was the best option. It doesn't mention how many needed help to deliver.

SoonToBeSix Wed 27-Aug-14 21:06:53

My twins were identical sorry that may well make a difference. I was under a top consultant who refused to let me deliver vaginally if first twin was breech. I would not have gone against his advice.

parallax80 Wed 27-Aug-14 21:46:30

As I understand it there are general problems with vaginal breech delivery and specific problems with twins (twin1).

There has been a massive decline in the incidence of vaginal breech delivery since the publication of the Term Breech Trial. Its headline finding was improved neonatal outcomes (esp re mortality / significant morbidity) with c section vs vaginal delivery for term breech singletons. There are differences of opinion as to whether there are some flaws in the methodology but what is indisputable is that it has been a very influential study that has contributed to a big decline in experience (esp recent experience) in both medics and midwives of vaginal breech delivery.

Specific to twins, they are more likely to be premature than singletons, which is particularly risky for breech babies. The head is even more disproportionately large compared to body in prem babies, increasing the risk of delivery of body while head gets stuck and resultant hypoxia. There is also a rare complication of locked twins, where twin 2's head still in the uterus prevents twin 1's head from being delivered. (Rare, but real. Do not google.)

Of course there will always be people who have experienced a successful vaginal breech delivery and will be able to tell you all about it. I guess the trouble is that you can only know that yours will be successful in hindsight. My main concern would be a lack of experienced Obs / midwives.

familyfortunes Wed 27-Aug-14 22:24:10

Watching with interest...also just had 32 week scan DCDA, twin 1 head down twin 2 breech...I'm unsure about delivery. ..will see what happens at my 34 week scan.

chucklingbunny Wed 27-Aug-14 22:33:24

OP, I had twin 1 head down and twin 2 breech and was advised to go for vaginal delivery. I took the advice with an epidural in case of intervention needed (standard with a twin delivery anyway I believe). In the event it became clear after 8 hours my labour wasn't progressing fast enough for twin 2 to cope and she became distressed. I ended up with an EMCS which was the most terrifying and distressing experience for me and my DH. Twin 2 had to be resuscitated at birth and spent 5 days in NICU in spite of being 6lb 6oz and delivered at 38+5 full term for twins. I believe had I had an elective CS that she wouldn't have become distressed and may not have needed NICU - I could be wrong but an elective is a lot easier to recover from than and EMCS I can tell you. Oh and friends of mine with single babies in breech position have been medically advised to go for ELCS for the safety of the baby so I certainly wouldn't risk it with twins. Good luck!

TreadSoftlyOnMyDreams Wed 27-Aug-14 22:52:12

What's the issue with the C-Section?

Methenyouplus4 Wed 27-Aug-14 23:10:58

Thanks for all your responses, lots to consider. My main issue with a c section is that I have two other children, one starting a new school next week and one only 18 months, husband can't take more than two weeks off as he's a teacher. sad

I know the advice is very different if twin two is breech (room to move/ enough room to move them /birth canal already opened by twin one).

I know needed assistance with breathing is mentioned but it is also mentioned if a c section is needed. The study I found stated that, long term, there was no evidence to show vaginal breech anymore risky that c section... except still no mention of Twins in that research.

Yikesitshot Thu 28-Aug-14 10:11:59

Watching with interest. 29+2 DCDA twins. Twin 2 has just flipped to breech, twin 1 head-down. At the moment, I'm being strongly advised to go for a vaginal delivery. If twin 1 was breech, I would be having a C section for the reasons stated by Parallax80.

Chucklingbunny and Diamonds, would love to hear more about your experiences. Chucklingbunny, did you deliver Twin 1 vaginally?

chucklingbunny Thu 28-Aug-14 21:02:07

Yikes, no I didn't get the chance to deliver twin 1 vaginally as wasn't dilating properly sad and doctors and midwives were so worried they asked about a section and within 10 minutes I was in theatre and they were both out! It was that quick! Initially I was induced and I don't know if that had anything to do with labour not progressing. What I do know is that I'm so worried about something going wrong again that I'm having an ELCS this time round - I'm 33+3 with my third DD. I also strongly believe that my twin 2 would have been fine had I gone for an ELCS in the first place (I have no evidence for this, just a gut instinct given her weight and how well she bounced back - she's very robust now! grin)

mandy214 Sun 31-Aug-14 23:02:32

Slightly different here as it was a premature delivery (so smaller and probably less likelihood of them getting stuck) and as OP says, not really relevant as Twin 1 was head down. Twin 2 was breech, but I delivered them both naturally 16 mins apart.

BackspaceEnter Mon 01-Sep-14 16:39:20

I wouldn't take the chance. Have a cs if possible, it's just not worth the risk. I choose a cs even though T1 was head down, my consultant also felt it was safer as cerebral palsy is more common in twins because T2 can get in trouble after T1 is already out.

You can recover quickly from a cs. I was out on country walks with them when they were 3 days old and had a quicker, easier recovery than some friends who had had vaginal birth.

An ELCS is much better than an emergency one.

Frec68 Tue 02-Sep-14 21:50:19

I had a great labour with my identical twins smile T1 was head down and T2 was head down too. They were born vaginally 5 mins apart. You just have to do what feels right once you have taken all the advice on board x

Methenyouplus4 Thu 04-Sep-14 19:55:43

Thanks for all the thoughts/ experiences. I have an appointment with big cheese consultant to go through things, I just want to feel fully informed as at the moment, all of the reasons they gave me against a vaginal birth are also risks for c sections with twins.

Yikesitshot Fri 05-Sep-14 09:35:56

Methen - do keep us posted! Interested to hear the advice as I'm going through all this at the mo (although a bit behind you).

AlpacaLypse Fri 05-Sep-14 09:44:26

Another whose slightly older daughter came out head first just as she was meant to but second daughter insisted on turning herself sideways.

Big cheese obstetrician came in and aligned her vertically again, although she was now feet first. Nevertheless out safely.

Both taller than me and in top sets for the GCSEs they'll be taking next June so clearly all went well.

Good luck with everything OP. Surely there's still time for the little sweeties to rearrange themselves again?

Methenyouplus4 Fri 05-Sep-14 20:49:20

I can feel both of their heads and defo still both breech, despite trying acupressure and spending a lot of time with my head on floor and bum in the air! Due to position they said both would have to turn for the bottom one to have enough room and unlikely now due to lack of space.

I'll keep you posted to let you all know what they say on Tuesday.

Yikesitshot Fri 12-Sep-14 15:58:07

Methenyou

Any update?

Methenyouplus4 Fri 12-Sep-14 19:33:30

Hi, had really beneficial, positive meeting. Consultant made it very clear that it was my choice and I would be supported whatever I decided, whether this be a cs or a vaginal delivery with no epidural / monitoring. She went through in detail why they recommend a cs when twin 1/ both twins are breech. She backed this up with the research it was based on but also told me about critics of that research.

In the end, I have decided to have a cs. This has been a tough and emotional decision but one that I am now focusing on making peace with and trying to think how I can make that a positive experience still (e.g dimmed lights, delayed cord clamping etc).

For me, the positives of a vb were quicker recovery and also benefits to baby of hormones/ journey through birth canal etc. She said there was a reasonable chance that I could have a vb and it would be fine. However risk with vb for breech is that is has to be 'hands off' meaning no instruments/ pulling baby as forces chin upwards so head is tilted and diameter is at is widest, so will be more stuck, and then comes risk of oxygen deprivation / brain damage etc. She said this risk was small, but as my previous two vb required ventouse, I just decided I didn't want to take that risk as ultimately most important outcome is two well babies.

Happy to answer any questions if I can.

Methenyouplus4 Fri 12-Sep-14 19:37:57

Also, she said if I went for vb, it would be best to go into labour naturally rather than being induced (as that comes with increased chance of needing intervention). However, down side of that is they wouldn't know who would be on hand to deliver. She said all staff will have experience of delivering breech I part 6 months but some who are less experienced may worry about breech plus twins element. I appreciated her honesty.

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