Denied a C section with twins?

[stoppingbywoods]

For a friend. From her understanding of the risks involved, she wants a C section for the welfare of the twins.

We all thought a section would be standard in these circs. But the consultant has basically said no and indicated she would need to provide some kind of argument in order to get one.

Isn't she supposed to be able to just say 'I want a section?'. What can she possibly say to persuade a consultant, who is presumably already aware of all the risks already?

Other than saving money, I cannot see the reasoning behind this at all.

What is the reason for needing a cesarean section apart from 2 babies in there are there any other risks form prev pregnancies etc?why would she wish for major surgery when she has two babies to care for and she could be back on her feet after a vaginally birth rather quickly? I may be missing something and would be happy for someone with more experience to explain also so watching

Ask to see another consultant. If they won't do it, they have to refer to someone who will.

I asked for a c section for my baby, I got one with no arguments. It really boils my piss that some people try to deny women the birth they want.

Tell her to make a list of the pros and cons and go in armed, also she needs to say the thought of a natural delivery is frightening her and causing her distress!

NICE guidelines are that she should be able to request a c section. The consultant should refer her to another consultant if they personally won't provide it. She may need to fight for it but it is her body her babies her choice.

Spangles I was on my feet quicker after a section than most people who've had VBs, I was out the house in my pre pregnancy clothes on day 6. Easiest recovery ever.

I know people who've had a VB who still can't sit down -shudder-

She would have been happy to deliver naturally if it had been only one baby. The problem with a natural delivery is that the second baby would have a better chance if she had a section, apparently.

First delivery

Most of the second babies end up transverse - first baby leaves the womb and second baby goes 'wahey, space' and starfishes in there. Resulting in an emergency c section.

Imagine a vaginal birth AND a c section shudder Consultant is being ridiculous. Ask to see another.

What sort of twins?

I had twins 6 years ago now, in London.
Strongly talked out of a section- I was tired , and conceded eventually.
Induced for 24 hours, up all night, then natural delivery twin 1 with episiotomy, then, exactly as suggested, twin 2 spun around , and v traumatic emergency section.
Please insist on a section :(

AnLean We have a lot of twins in our family and all 6 Mums were told the above by Consultants when discussing vaginal vs c section, vaginal was never an option for them. And that spans 20 odd years. So sorry that happened to you.

It is extremely common with a twin birth for the second to be born via emergency section. Your friend needs to insist if that is what she wants

Luckily in my situation DT1 was transverse so there was no choice but a caesarean.

I'm a big believer in doing your research and treating the doctors as though you are two professionals trying to decide the best option together.

So things that I would find out.....

Risk to mother of:-
Vaginal childbirth
Planned C Section
Emergency C section

Risk to babies of:-
V childbirth
Planned C section
Emergency C section

Likelihood of twin birth becoming emergency C section if vaginal birth is planned.

I don't know about twins but with one baby I think that a C section is quite a bit more dangerous for the mother but very slightly safer for the baby. However breastfeeding rates post section (esp planned section) are quite a bit lower if I remember correctly as the hormones are not right. Which obviously has an impact on the baby's health.

If your friend is able to explain why she's willing to take the downsides of a c section as it works logically for her then that may help.

As a vague musing..... - is she Catholic. Traditionally Catholics are supposed to prioritise life of baby over life of mother. If Jehovah's witnesses are allowed to refuse blood products could a catholic insist on a c section?

There will be reasoning in that for a low risk mother, a straightforward vaginal delivery without interventions has fewer risks, shorter recovery time etc. So she should ask about her specific situation. C-sections are never automatic but for clinical reasons which may include birthing twins. She needs to discuss this with her consultant.

I don't want to give more details of her situation to protect her privacy.

Does it seem like she is right in thinking that the second twin is at more risk in a section?

Could she also make a case that a planned section would be safer than a natural delivery with one baby and emergency section with the other? She's already tried to put this point across to the consultant, who responded by talking breezily about all the interventions that would be used to avoid an emergency section. She quite simply doesn't want this.

Does it seem like she is right in thinking that the second twin is at more risk in a NATURAL delivery, sorry - not a section

If you have an experienced MW team (& doula?) there is no reason a natural birth should not go as planned, even with twins.
In the long term it is healthier for both mum and baby.
However if she can articulate the reasons for and against then the Cons should refer her to another Cons to discuss her options.
They may ask her to keep an open mind until week 30/32. No harm in that surely?
The actual problem is finding a suitably qualified and experienced team to support a natural birth. She should ask to meet the team so she can ask her questions of the actual people who might be involved. If they don't reassure her then yes full steam ahead with a CS request.

She needs to request to see another consultant.

I am currently pregnancy with DCDA twins and my consultant and midwife have both prepped me to expect a c section.

Wow at these replies I hope your friend gets the birth she wants and it has really opened my eyes to dangers of multiple births! Good luck to your friend op

In the long term it is healthier for both mum and baby.

How is it?

From what I understand the risks of childbirth are

1. uncomplicated easy VB
2. planned cesarean
3. emergency cesarean
4. assisted VB

number 1 can easily become 3 or 4, especially in twins. Very few people have an easy VB. so logically it makes sense to ask for a cesarean

Thanks for all these responses, they are really helpful.

I think the 'no reason it shouldn't go as planned' reasoning has already been put to her. It didn't help because she's concerned about what happens if things don't go as planned. From my own perspective (not that it matters), I suppose there's no reason any birth shouldn't go as planned but the risks still vary.

She is concerned that natural deliveries of both twins don't seem to happen that often so lack of experience might be an issue.

For personal reasons, she does need to reach an early decision about this.

I'd advise your friend to see a second consultant- in fact I'm sure that the original one should've referred her on.

It's her decision how she wishes to give birth. Personally I do not think it's helpful when people make statements like 'she'll be up and about more quicker with a VB'.

Really? Is that a guarantee? I know it's possible recovery will be quicker, but I've got friends who were still recovering from their instrumental births a long time after I'd had my ELCS.

Also I breastfed afterwards, not for long, but that was my decision and not because the 'hormones weren't right'.
A good friend gave birth naturally at a birth centre (unfortunately 3rd degree tear during the process), she was unable to BF as her milk simply never came in.

I have supported a twin birth in hospital. As others have said 1st was born naturally on all fours then 2nd spun round with the space and Mum in stirrups in theatre for forceps and episiotomy whilst feeding baby one. They sited the epidural after birth of baby 1. She was struggling with the trauma of it all at first but now 20 months on has recovered so well and pregnant again and preparing for HB of singleton :)

I fought for, and got, a CS for my twins. I then fought for, and got, a CS for my third (singleton) baby.

In my case, the consultant pushed for me to try for a vaginal delivery because baby 1 (the baby nearest the cervix) was head-down, despite baby 2 being breach. He said baby 2 would probably turn during labour with baby 1, and that failing that they would use external manipulation to turn her. Failing that, they'd use internal manipulation to turn her, and failing that, they'd deliver her breach (which would be easy because baby 1 would have stretched everything already).

My first and final thoughts were Fuck. That. No. Way.

I researched thoroughly and presented my case to the consultant. I talked about the risks of vaginal birth and CS. I talked about the risks of vaginal birth and CS with twins. I quoted NICE. He was pretty blasé about all of my reasons and said I should try vaginally and go for an emergency CS if it became necessary. At that point I cried. He scarpered and sent the midwife in to see me, and 10 minutes later I was outside with 'plan for a CS' written in my notes.

With my third baby, I asked for a CS from the start, but engaged with the midwives and discussed VBAC. I went to the VBAC session with a senior midwife and planned what I would want if I decided to try and labour. I asked for a new consultant when the first said he wouldn't do a CS. I agreed to book the CS for 40+2 (they were hoping I'd go in to labour and decide to give it a shot). I turned up at 7am on my planned section day and the midwife breezily said "so, we're going to try a sweep first?". No. Fuck That. I informed her I had turned up for my planned section, on the day that my planned section was booked for, and I did not want a sweep, thank you very much. I was taken to theatre and had a CS.

So, you're friend needs to step herself for a battle of wills. She may need to change consultant/midwife. She will almost certainly need to research, plan, and argue her case. She may need to cry (which isn't too hard once you're past 28 weeks with twins TBH). But they should agree to a CS, and once it's on her notes, she should be ready to fight for it all over again if she labours before the planned date. They should move straight to an emergency CS is she had been planning a planned CS, but they will more than likely suggest just seeing how this go ...

Good luck! And wish her well on the amazing twin mum journey :) I am almost envious of her just starting out with twin babies Almost ....

How disgusting, that they can bully someone like this and put babies' lives at risk.