VB with Twins - terrified!!

[willow3006]

Hi there

I'm 22 weeks with first pregnancy and they're non-id twins. I've always had a fear of birth but when they told me I was having twins the sonographer said I'd be able to choose to have a c-section because it's twins. I felt calmer instantly! I've read up on c-section extensively and even with the risks involved I'd still prefer it over that much pain, tearing, etc.

It seems he was wrong. Today I had my 1st appointment with a consultant and I made sure I asked just in case and she said I can't have one and that they want me to have a normal birth. I'm even more worried because of the 3 Mums I know who had twins all 3 had to go through their whole labour only for an emergency c-section at the end so they had to have one anyway! If I had the money I'd definitely just go private and have an elective because I'm that scared and my pain threshold is so low but can't afford it!

I did ask the consultant about the likeliness of me labouring then needing a c-section and she said it is quite a high likeliness for twin 2 to get stuck or turn but that it was still worth trying vb because of the needless operation otherwise. I was totally calm about a c-section and now I'm going to spend the whole pregnancy terrified!

She did say there may be a medical reason like breech nearer the time which will mean I will be able to have a c-section but we won't know until nearer. Does anyone know how likely this is with twins???

Willow

you sound genuinely scared

perhaps you could try the natal hypnotherapy for twins

I have found the programme amazing for reducing my 'fear'

also being scared is not a good starting point, so it would be good to either manage to reduce your fear OR speak to a more understanding consultant about a C section.

Good Luck

The voice of reason re twins (and all things midwifery) is Mary Cronk. These are her guidelines for dealing with twins.

I did ask about speaking to someone else but she said all consultants there would be the same and would want me to have a vb. I wish I could just go private and have an elective!

Are you somewhere particularly remote or is there another hospital you could transfer to?

I'd talk to your MW and see if she knows of any consultants in the area are more likely to be sympathetic to your request. You could also call an Independent MW and ask the same question (most will be very happy to give a bit of support for no fee - although they'll not be able to offer case specific advice as they do not have your full history). You cannot be denied a 2nd opinion if you make a formal request for one.

You might also want to have a look at/print the NICE Draft Guidance for Multiple Pregnancy, which states:
"Offer women with uncomplicated twin pregnancies elective birth (by induction of labour or caesarean section) from 37 weeks 0 days."
(recommendations - pg 260).

Note that this is a draft (if they keep to schedule it should be published in September) and this is one point where the current advice has changed - the existing advice (covered under Intrapartum Care and Caesarian Section) is consistent with what your consultant stated. That said, there is also CS due to maternal request - the Caesarian Section Guidance states on P38:

^"RECOMMENDATIONS
Maternal request is not on its own an indication for CS and specific reasons for the request should be explored, discussed and recorded.
When a woman requests a CS in the absence of an identifiable reason, the overall benefits and risks of CS compared with vaginal birth should be discussed and recorded.
When a woman requests a CS because she has a fear of childbirth, she should be offered counseling (such as cognitive behavioural therapy) to help her to address her fears in a supportive manner, because this results in reduced fear of pain in labour and shorter labour.
An individual clinician has the right to decline a request for CS in the absence of an identifiable reason. However the woman?s decision should be respected and she should be offered referral for a second opinion."^

So whilst what your consultant stated may have been consistent in an absolute sense, she shouldn't have left you feeling as though you have no involvement in the decision - and she shouldn't have told you there was no point in having a 2nd opinion (even though that may be true).

I do think it might be worth you asking for counseling (as per the guidelines) and seeing what comes of that - you may come to terms with the idea of VB, and if you don't then your counselor should then be in a position to support your request for a CS.

Fingers crossed your pregnancy is otherwise straightforward, and you have a type of birth you are at peace with when the time comes :)

I've been going through this too. My dts are nos. 2 & 3 and ds was an emcs for failure to progress after I was induced early for type 1 diabetes. After 5 obs told me I'd be having an elcs and I had no choice in the matter (after I'd asked about possibility of vbac) they suddenly switched tune to you'll be having vbac and we'll induce which I was less happy about.

I've now seen the head obs consultant and he's booked me an elcs with the proviso that if they come before then of their own accord and dt1 is headdown then we'll see what happens.

He told me that success rate for vb of twins in this hospital was 60% which was the same success rate for vb of type 1 diabetic mothers. That means 40% end in an emcs. Not great but if it did happen naturally I am prepared to give it a go on the grounds that my recovery was awful last time and will be even harder with an older one and dts.

If it really bothers you then take someone to appts with you and start quizzing them on success rates of vb with twins in the hospital, trained staff, amount who have episiotomy and section (my nightmare) and safety of babies.

The people that I know who have had a VB for twins have been very happy about it, one point that seems to have been important to them is avoiding having to recover from the abdominal surgery while looking after twins.

If an elective CS is what you really want then it might be worth speaking to a different consultant. Even though you have been told that another one wouldnt agree, your current consultant cant really know that for sure.

I had a VB with twins and it all went very well - found it much easier than my first birth so it can (obviously) be fine. Both twins were breech until sometime between my 32 and 36 week scan when the first twin turned head down. On the morning of their birth both were head down. I had an epidural quite early on (advised by obstetrican) because that makes things easier if emergency intervention is needed. I also wasn't allowed to eat during labour in case I needed a c-section (wasn't told this in advance so was starving!). Both babies heartrates were monitored throughout. I really felt like everything was under control.
I'm not in the UK and here VB are recommended if the first twin is head down. From what I remember the likelihood of that is around 60%.

I had VB twins and it was a good experience and no cs meant I bounced back faster.

Please try not to worry. You have a big medical team present at a multiple birth. They will monitor you very very carefully and do the right thing for you and the babies.

My mum had my sister and I by VB (she didn't know we were twins until my sisters feet popped out when they were expecting afterbirth). I was arrived bottom first and my sister was feet first - this was 30 years ago, but she tore far worse with my older brother and had no stitches with us twins.

I'm now expecting ID twins and was given a choice, but we'd actually already investigated cs as dd1's birth was not good. Once I knew it was twins I knew cs was the only option as the thought of stitches in 2 places from VB for twin1 and CS for twin2 was too horrific, especially with a toddler too.

Can you change consultant / hospital?

It might help to join Tamba and talk to mum's who've gone the VB route so it's not so scary.