is it possible to have a breech birth (not extraction) of twin B?

[MamaChris]

I am 34 weeks with twins. The first baby (A) is head down, but the second (B) has just turned breech. If he stays this way, will it be possible for me to birth him normally, or will it necessitate a breech extraction? I hadn't really paid attention to this scenario until my consultant mentioned when we last met "oh, we wouldn't have you in stirrups if they're both head down". Which suggests if B is not head down, I would be in stirrups = breech extraction? I know they won't do internal versions at this hospital, as they are not experienced with them, but don't know if that affects whether they do breech extractions.

Am trying to read up on extraction, but can't find out if it involves forceps, episiotomy, or what the risks of injury to the baby actually are. I am not seeing consultant for another two weeks, so would really appreciate some pointers where to look for info in the meantime.

I don't have personal experience but a lady I worked with had the same situation and she pushed second twin out 10 mins after the first one, she said she was told the first one makes was for the second one even if it is breech but her twins are 10 now so perhaps things have changed in that time? Hope someone else comes along and can give you some better advice soon, just letting you know it can be done.

Thanks cinnamon. I do think it's possible technically - a breech birth is what would happen if I was at home, for example. I guess I need to know whether it's possible in a hospital setting, and it sounds like it could be, at least for your friend. Which is good news :)

Are these your first babies?
My twin client had it agreed she could birth on the midwife led unit without intervention, even if twin two was breech. Both were head down at birth so this wasn't an issue, but it can be done.
Selina

No, 2nd and 3rd babies. I can't do the MLU here, but am negotiating a good low intervention plan of care for the delivery unit. I hadn't really appreciated the difference it made if twin B was breech before, thinking the only important thing was that twin A was head down.

There is a thread here www.mumsnet.com/Talk/childbirth/930699-Home-birth-for-twins-yes-no-too-dangerous-to-even
Where I posted her birth plan.
HTH.
S x

MamaChris - being in lithotomy for delivery does not equal a breech extraction, the obstetrician would only apply forceps to the after coming head if there were concerns about the fetal heart rate otherwise it would be a spontaneous breech delivery conducted by a midwife. Although most upright positions allow for natural descent of the breech, being in lithomy allows the body to descend and means the midwife is hands off until the nape of the neck is visible, at this point most midwives would gently flex the head using their fingers.

An internal or ECV is pointless once the first twin is delivered as long as the second twin is longitudinal (it would only be rotated to cephalic or breech if it was transverse) as you risk fetal heart rate anomalies and rotating only part way to transverse and cord prolapses etc.

You are right that it is only really the presentation of the first twin that makes a difference. I know that there will be plenty of posts on MN stating that midwives are no longer skilled in breech deliveries - but take heart, this is definately not the case across the board.

my brother was born right way round i was born breech it was always long standing joke that i kicked him out so i could have 10 mins extra inside and have lots of space lol

malteser, that's very good to know. I've been worrying myself about this!

So it would be possible to birth the baby with no forceps (ie no episiotomy), assuming heart rate ok, rather than have him pulled out (which sounds quite scary to me)?

bubblagirl, maybe that is my babies' plan too :)

MamaChris - no reason why you shouldn't achieve a spontaneous breech delivery if all goes smoothly. Episiotomies and forceps are not routinely performed for breech deliveries, fingers crossed for well behaved babies!
Good luck - and remember to update us when you have your buddles of joy!

Thanks malteser, feel much more relaxed now :)

I have twin brothers, the first was born head first second was born breech 11 mins later that was 33 years ago. :)