C-Section V's Natural Birth in 1st time pregnancy with twins

[VictoriaSecrets]

Hi everyone,
It's very early days for me as I'm only just 12 weeks, but I'm looking at options for the birth. I have twins which look to be Fraternal, 2 sacs, 2 placenta's etc.

Assuming that both birth options are available (I'm aware that the decision may be taken out of my hands if they are in the wrong position or if there are complications)I'm trying to work out which route to go for.

From what i've discovered so far i've got some secific areas of concern...

With C-section i'm particulary concerned about the length of time for full recovery and the impact on the babies respiratory systems of not passing through the birth canal...

With VB i'm concerned about labour taking so long that one or more of the babies get into difficulties then having and emergency C-section (particulalry as this will be my first labour). I'm also worried about the long term effects of things like incontinence, tearing, feeling 'looser' (sorry for TMI) etc.

Does anyone have any real life info around either option - hopefully from a 1st time labour with twins perspective so that I can feel a bit more informed? Please be as honest/graphic as possible as I'm struggling to find real accounts that aren't either embellished for effect or played down to promote one option over another!!!

Thanks so much for your help

Victoria

x

P.S. - I've copied this over from a thread I set up under Ante-Natal Clubs on the recommendation of someone there :)

Hi,

i have no personal experience of this ut a good friend of mine was ecently in the exact same situation (1st pregnancy, fraternal twins) and her consultant gave her all the options for birth but pointed out that in a lot of twin births the second twin may become distressed due to the amount of time in labour and that she may have ended up having an emergency section anyway so she went for an elective section. this was 3 weeks ago now and she is doing just fine, babies are healthy and growing well and no problems so far.

by the way, she had never considered section up until right at the end and was convinced that she wanted VB but then thought what is the point of going through all the pain for one baby when she would likely (maybe) end up with a section anyway!

hope this helps!

Hi Choccyfiend

Thanks for your reply - that is the thing I would dread more than anything, struggling through a VB and then having to have a C-section in a less planned way anyway!!

I know i'm getting ahead of myself, but I can't stop thinking about the birth and which would be best and swinging from one to the other! Glad to hear that she is feeling better and that the babies are doing well. I suspect it will be taken out of my hands a bit, but just want to be as informed as possible in case I get a say in it!

Thanks again,

Victoria

Hi Loopymumsy

You're absolutely right - i think the hard part is that it's all so variable and can be influenced by all sorts of different factors. I'd like someone to just have some kind of spreadsheet and go through all the factors and put a tick against each that applies and come up with a definitive answer about what's best!! lol

The thing that worries me about the twin mum accounts i've read where they've had a VB at home or hosp and it all looks peaceful and nice is that when you read a bit further down they tend to be on babies 4&5+ and i've heard that even with singletons it gets a bit better the more you've had... not sure whether that's a physical reason or psychological or both! :)

Gah!!

Can someone else do it for me?!!

x

I had a normal twin birth, but it was my second labour. It was fantastic though :)

AFAIK, there is no greater risk of tearing etc because it's twins (possibly less as twins tend to be smaller?). Incontinence is increased in risk just by being pregnant, I think (sorry). If both babies are head down, then I don't think C section is more likely with twins either, but in my case twin 2 was transverse, and I was warned that if he didn't turn after twin 1 was born, or remained high, I would need a section. In fact, he turned during early labour and I had two head down babies. I do tI negotiated a normal birth with a hhink you're more likely to have a medical birth with twins unless you negotiate early to get the birth you want (if you don;t want a medical one, of course).

I'm happy to say more about my labour and negotiating a birth plan if you're interested, but I can't compare with sections, as I haven't had one.

Also, you might get more info about twin birth posting in the multiple births topic.

Good luck :)

I had a VB with my twins after a CS with my daughter.

I cannot overemphasise how much easier it is to recover from a vaginal birth. Yes, first time VBs can be a struggle, but when it's done it's done (more or less) and you can get on with the hard work of dealing with twins. Breastfeeding after a CS I found to be very difficult and I knew I would struggle to do it with two babies which was my primary reason for going 'natural'.

Honestly, you have to do so much lifting and carrying when you have 2 babies to care for and you just can't do that after a CS.

One of my twins was stuck a bit on the other's shoulder so delivery was a struggle, esp as I had never had a VB before, but even though I went to 38 weeks, as they were twins they were a bit smaller than a singleton so I guess that will always make delivery a bit easier.

Also, you may not be given the choice of an elective CS (but I reckon that if you decide to go down that route you could just find a pro CS consultant and switch to them).

Lots of luck to you, you must be very excited!

argh. last sentence of 2nd para should be "I do think you're more likely to have a medical birth with twins unless you negotiate early to get the birth you want (if you don;t want a medical one, of course)."

My twins were my first pregnancy, and I had an assisted VB (first one forceps, second ventouse).
I was adamant that I didn't want a CS if at all possible, and this was respected by the staff at the hospital, although I did have an epidural at 3cms, and slept through the 17 hour labour!
I was lucky in that they were both head-down by the time I went into labour at 36 weeks, as one had been breech until 34 weeks - I don't know where he found the space to turn round!
I recovered from the delivery much faster than my friends who had CS with their singletons, and I admire people who've had a section and have to care for 2 tiny babies - I don't know how they do it!

Hi everyone- thanks so much for taking the time to come back to me - it's much appreciated. I think from what i've read i'm swaying towards hoping for a VB, but I would be interested to hear how likely it is that i'd end up with a c-section for the second one.. I think that would be so scary and disappointing.

If you have an assisted VB does that cause any other problems for you or the babies? Or is everything fairly straight forward? Terrified of the thought of forceps and someone said about hands going in (TMI) etc... and I just can't see at the mo how that is physically possible without causing all sorts of problems (again too much info, but I even find sex painful sometimes!) Am I being naive/daft?!!

Thanks so much... I think i'm probably a bit OTT in terms of how scared I am about this.. the babies weren't planned (after 10 years on the pill without event) and i'm still trying to get over the shock. To be honest I wasn't sure i'd ever be having children as I am so worried about the process and particularly the birth in whatever format. The strange thing is i'm not normally a wuss, i've had operations and broken bones and things before but not sure where this gut-wrenching fear is coming from!!

To be honest I haven't even seen the midwife yet, although I have booked an appointment for 16th, so I'm hoping i'll feel a bit better after that. I might look into an independant midwife... i've also heard mention of a 'doula' but not too sure what the difference is!

I'm so worried about the birth that at one point I was thinking about general anaesthetic, but i've discounted that now because of the risks etc associated with it.

Just feel a bit sad because I can't get excited as I feel too worried about everything, scans, anomalies, birth...

need to snap out of it as got a long way to go and know I shoud be grateful that I can have babies etc!! :(

First congratulations victoria I'm not surprised you are still in shock - most people who find out they are pg with twins have that feeling.

I had twins by c-section. I had misgivings all the way through about having a VB, mainly because I really didn't want to end up giving birth both ways (ie VB for one and then EMCS for the other). In the end it was taken out of my hands as I developed pre-eclampsia at 35 weeks which got worse and the consultant said they were better out than in at that point. Induction was highly unlikely to work so he said just go straight for a cs which I was entirely happy with.

Re recovery - I didn't find it as bad as I thought. I had my appendix out 18 months earlier and the recovery from that was a lot worse. I was mobile as soon as the spinal block wore off and never really in a lot of pain (they give you lots of painkillers).

You may well find that the decision is taken out of your hands nearer the time, but if it isn't, and the babies are head down, then you are a prime candidate for a VB as your twins are in separate sacs.

As loopy says, if you do decide to go for a VB, be aware that the hospital are likely to want you to be monitored throughout and to have an epidural in case they need to get in quick and get either twin out by c-section. Hospitals also tend to have protocols as to how long they will let you labour after twin 1 is born before they will try intervention to get twin 2 out. Your hospital should be able to tell you what their protocol is. This doesn't mean that you have to stick to it, but be aware that you will have to be fairly robust in saying what you do/don't want.

I'm not sure of the stats on c-section for the 2nd one - I would suggest you go onto the Tamba website as they have all the stats on there and lots people will be able to answer from their experience.

Don't assume that a VB means an easy recovery - it may do for some but I know an awful lot of my friends who have taken a long time to recover from a VB, including one who had a c-section 1st time and VBAC second time and wished she hadn't. However, your twins are likely to be smaller than average singletons so hopefully the risk of tears etc is less.

Good luck - twins are fab

Hi and congratulations!

I had my ID twins (so more likely to have complications) vaginally without any pain relief 3 years ago and was worrying about the same thing at the time - i.e. having one vaginally and then the next as an emergency section. As it happened, both DTs were head down, although I seem to remember they were keen for me to try for a VB even when one DT was breech, as the presenting DT was in the right position and apparently there is a high likelihood of the second turning once there is more room. During labour the MWs were quite keen for me to have an epidural in case I ran into problems with DT2's delivery and so I did consent but then the anaesthetist got called onto a crash section and I was already fully dilated and ready to go, so didn't in the end.

I'd echo what people have said about the amount of lifting and general physical-ness of having newborn twin babies. I would have found it tricky with c-section recovery as well, but then again I am very independent and didn't want to have to reply on lots of help.

FWIW, I did tear (3b - so fairly extensive too) as DT1 had to come out quickly and forceps were used but the recovery was really really quick and I haven't suffered at all since then. DT2 was very straight forward. Mine were born at 35 weeks and so the reason for the tear was def the forceps rather than size, but tbh you could end up in the same situation with a singleton birth, and I was just glad that both babies were delivered healthy.

Another FWIW, I am currently almost term 39+4 with my next baby and also plan on delivering vaginally.

HTH - and good luck!

Oh and yes, I did have to be monitored throughout but could still sit on a birth ball, be relatively mobile - I didn't find it a problem really.

just to say that you can ask for intermittent monitoring (the mw listens every 15 minutes) rather than continuous (you have a couple of belts round your belly with monitors strapped to them, which does reduce your mobility a bit - eg you can't be in water which I found helped a lot). and you can say you don't want an epidural, as these are known to increase the risks of forceps delivery/sections. despite whatever's in your hospital twin protocol (which you should ask to see asap), you do have the right to make informed choices, and the hospital will need to respect them. I had intermittent monitoring, no epidural, was in the bath during the first stage, and requested that doctors only came in the room if the midwife asked them (they didn't). I'm not saying my choices are right for you, but do know that you have these choices, but you may need to ask to meet the consultant midwife to discuss what choices you have.

I also had a doula, who was fantastic not just during the birth, but in supporting me antenatally to find the information I needed to make these informed choices.

Don't worry about it all. Honestly, birth is a funny old thing, when you are in the midst of labour you don't worry about all this and something rather primal takes over. And when your twins are here you will look back and wonder what you were stressed about - seriously, there are threads on here where I am up in arms about my consultant being about me wanting a natural delivery of the placenta. When I had 2 babies on my chest they could have removed my placenta with a JCB and I wouldn't have noticed or cared less.

However you have your babies, make sure you have help enlisted for the days / weeks following their birth as it is exhausting looking after them even if the birth doesn't cause you any problems. Sort all the things you need as early as you can too as you never know when twins will appear, although fraternal twins do often hang on until full term. It is difficult to find time to get out and buy extra stuff once the babies are around.

Oh and even though I was VBAC with twins I laboured in the hospital pool and had intermittent monitoring so it need not be an overly medical birth.

Congratulations on your twin pregnancy Victoria! My first pregnancy was also fraternal twins, and although I'd been hoping for a vaginal delivery all along, I didn't set my heart on it and in the end they were born by planned C-section (because I developed pre-eclampsia at 35 weeks and they were both breech). It was a very calm, happy experience and all three of us were healthy and well at the end of it. The downsides for me were that they were both quite drowsy for a long time after the birth and it was so breastfeeding was difficult. It also took ages for my milk to come in as my body hadn't experienced the build-up of hormones it would have done in labour. I found it hard to pick up my babies and feed/change them in hospital, though it was fine during the day when my partner was around to help. Physical recover from the C-section was relatively quick, but then I didn't have other children to look after, and my partner was also at home for nearly a month as they were born shortly before Christmas. I had a VBAC with a singleton 2 years later and would choose it over a C-section any day, but C-section was the right decision first time around.

FWIW, my consultant reckoned that there's a 50:50 chance of a normal delivery with twins, and that that it was fairly rare for one twin to be born vaginally and the other by C-section. I know two people whose second twin was breech, but both turned spontaneously during the birth of the first twin and didn't cause any problems.

Good luck with it all - and don't read too much!

My twins were elcs due to being breech and them needing to come out at 35 weeks. It was never really discussed and I was happy to go with the cs as advised by the consultant. Mine were ID. It was fine.

Hi everyone,

Sorry it's taken me a little while to get back to you, i've been in the office at work and lots of websites are blocked there so I haven't had my fix.

I have to say, I do actually feel calmer having read all of your replies - i'm not sure whether it's because of the level of meaningful info (which you don't seem to find anywhere else!) or because I'm starting to appreciate that i'm not the only person in the world to be pregnant with twins

I'm very tempted by the independant midwife idea... it's expensive, but I suppose the reassurance of having someone there consistently might help given how worried I am about it.

I think i'm going to see what the views are of the consultant and midwife and perhaps push (excuse the pun) for a VB but try and keep an open mind.

The other thing though, which might sound a bit rubbish, is that my OH seems very keen on me having a planned C-section. I think he's worried about the risks of VB and lack of planning etc. because he works in a hospital and has seen some very extreme cases of what can go wrong. I do appreciate that i'm lucky in some ways to have a partner with lot's of medical knowledge, but sometimes I just want to hear true life info from people who have actually experienced it and know how it feels to recover from each physically/feelings etc. When he puts his clinical hat on I almost switch off although I know what he says is usually right .

If you have a VB are you usually able to pick the babies up and feed them straight away? Was the reason it was difficult with the C-section because of the pain from the operation, or tired or a combination?

I've got so much to learn ... and from what you've all said I think it's best that we start planning our house move sooner rather than later!! gah, hassle!!

Thanks again

xx

I'm 37 weeks with breech twins and due to have a section next week...i'm terrified of the whole thing and also feel I was given no choices on birth....Its really not what i want but I dont feel i have any other option...:(

VS, I held twin 1 for a few minutes before twin 2 was born, then held and fed them both right after that. I had to stay in/near to the bed for 4 hours after the births as they give twin mums a drip of syntocinon to prevent any excessive bleeding. But I felt fine and we went home a few hours after that.

Jenz, please don't be terrified. I haven't had a section, but have friends who have had very positive experiences of planned sections (with twins). As I understand it, breech twin VBs are only safe if you have midwives experienced in this kind of birth, which few are in the UK today. So a section is probably safest. But I understand you still have choices with a section - whether you want to see the babies be born, hold them right away, have skin to skin, feed etc. I'm sure there are many on MN who could make suggestions. Perhaps thinking about making the choices you can will help you feel less fearful? I do hope it goes well for you.

I have B/G twins, now 3.3 and I can only second what posters have said previously, it's such a brief moment in the grand scheme of my children's life that I can honestly say I can hardly remember the details anymore, although I can vividly recall the constant deliberation and concern about birth plans pre the 'big event'. In the end I had a VB at 38.5 weeks, after being induced. Up to the birth itself I had been inclined towards a C-section as it just felt more controllable than a VB, however the hospital's twin policy was to have a VB where possible, although care was consultant led rather than mid-wife. I can echo 'Sinkingfeelings' comment above - my consultant advised that the instances of having a VB with the first and a C-Section with the second are pretty rare and something they make every effort to avoid - although it was a big concern of mine too.

Everyone obviously feels very differently about what is right for them, however having lost a baby at 20 weeks previously I was very anxious to have as controlled and supported (probably best to read 'medicalised') birth as possible. I was also very clear that I was happy to have an epidural. All thoughts of being able to move around were pretty academic as I was rather on the large size :) and could barely move anyway, regardless of any additional contraints.

My babies were 7lbs 2 & 7lbs 4, needed a little assistance with ventouse to be introduced into the world, but overall - although somewhat drawn out, the experience really was manageable. I had a small tear which required stitches, but again no real problems (the piles were another issue altogether )

I obviously have nothing to compare against in terms of my recovery post birth vs C-Section, but I think in either event be prepared to be absolutely bloody knackered and for your body to need some time to recuperate and make sure you have people around who can lend a hand. I had my mum with me for the first month after the birth, and it helped enormously...

Congrats - and good luck - I consider myself to be unbelievably fortunate (most of the time) to have twins, even with the unique challenges that they present.