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.

Get the NICE guidelines for twins and the hospital twin birth policy (they should have one). Arrange for another meeting with consultant and tell him exactly which hits she is not happy with and quite the guidelines. Also ask for their statistics for 100% vaginal births for twins / vb and section/ planned section etc.

I had a planned section for my twins but T1 was breech which made it easy to get. Zero doctors want to have a go at breech twins! BF for a year, pretty mobile after a week.

I'm due to be induced with twins tomorrow, and I just want to correct some misconceptions on this thread. Statistically, only 6% of twin births result in the first born vaginally and the second requiring a c-section. So, that's by no means a majority. Additionally, research shows that c-section outcomes are no better than vaginal birth outcomes in twin births. C-sections might result in a greater chance of the babies requiring special care because their lungs won't go through the birth process which helps to remove the mucus.

This isn't to say that your friend shouldn't be able to have a c-section if that is what she prefers. I was offered one, but I've made the decision to be induced, partly because my body is already going in that direction. I may have very different feelings after tomorrow, but I do think it's important that people considering natural birth with twins aren't met with endless stories of doom and gloom.

Good luck for tomorrow Titus!

Will you come back and let us know how it all goes?

Thank you! I'll try to remember to come back. It all feels very surreal right now!

I have had identical twins naturally. As long as twin one is head down it is far safer than a c section. Also a lot easier to care for them when you haven't had surgery.
If there is a medical need for a c section she will be strongly advised to have one. Otherwise a vaginally birth really is the best thing.

There are risks associated with identical MCDA pregnancies eg TTTS that aren't there with DCDA and in my trust they prefer planned section for MCDA and vaginal for DCDA.

MOMO - def section.

Yes my twins had TTTS ( TAPS) they were MCDA.
I agree MOMO twins would need a c section. However I can 100% guarantee the ops friends twins are not MOMO twins. No consultant would then refuse a section.

I had twins normally, T1 was head first, T2 turned and came out head first. It was mostly without any interventions (except injection between births) because they came fast, and I knew what I was doing, having already had a singleton fast, and read up on as much as I could. From what I understood, the second twin being breach was not as bad as a single baby being breach, as T1 has already done all the hard work.

I also knew someone who had twins about the time I had my singleton, in 6 hours with no intervention.

Twin births are usually more monitored and they will intervene earlier and leave less to chance. They are pretty keen not to delay the arrival of T2. The majority of first time births in my twins group were like this. Personally, I would have gone for a caesarean if it was my first and I did not know what was going to happen. It is very worrying, and in my experience, I got no explanations on how they were going to manage things before the birth, so did not trust them an inch. A bit of communication from the health care professionals is essential.

The biggest risk is if there are shared blood vessels in the placenta, but scans are so much better at picking this up before birth.

I had MCDA twins and was straight away told it was hospital policy to have a C-section.

It seems to be increasingly common for women with perfectly understandable requests for c sections are being denied them. I think it's a disgrace, and I'm bloody glad I was allowed one six months ago.

A friend of mine wanted a section after experiencing major gynae issues after her first child. She was told no, and her mental health was suffering so much she went private. But not everyone can afford that, can they?

OP, I think your friend just needs to be very VERY firm that she wants a section. Jump through all hoops put in place. Ask to see another consultant if necessary. She shouldn't have to do this, but sadly I think she will.

They can't refuse in this instance and should be prepared to fully discuss risks/benefits of each, including all risks that are objectively likely to be significant and those that are particularly material to her for her to reach her decision. They can try to dissuade people who stand a good chance of vaginal delivery being possible as if all goes well, the complications are lower. However - elective birth should be offered to all multiple pregnancies (35 weeks triplets, 36-37 weeks twins) and if not in labour before this, the manner of the elective delivery should be your decision.

Pretty much everything in mindfulbear's post is, if not wrong, objectionable in some way.

Just thought I'd update after my induction with DCDA twins. I will be honest and say that it was a challenging experience. I was given a pessary on Tuesday morning and stayed in hospital for 24 hours. I hadn't progressed loads by the next day, but they were able to break my waters and then, after an hour, I had the syntocinon drip. I also had an epidural, but it wasn't very effective for me and I struggled with the pain. After several hours, I hadn't progressed beyond 4-5cm and the decision was made that I would have a c-section. However, the babies were happy and I was comfortable because I had the epidural re-cited, so it was a few hours before I got into theatre. I was fully prepped for a c-section, but when I was examined it was discovered that I was fully dilated. I delivered both babies with the help of a ventouse. It was strange to push without being able to feel what I was doing, but still do-able. Twin B was gently held in place and encouraged down into the birth canal, and he was able to stay head down.

I had an internal tear which has caused me very little discomfort. I also had very little blood loss and am recovering well. Given the demands of looking after twins, I am so grateful that my delivery ended the way it did. I am fully mobile, I can lift and move comfortably, and feeding is progressing. I'm currently in my hospital bed having skin to skin with my two gorgeous boys.

I totally appreciate that everyone has a different experience, but I am thankful I didn't go for a c-section in the end.

Thank you all for these very helpful replies.

Titus Congratulations on the safe arrival of your twins!! Thanks for letting us know how things went.

I had ELCS and twin 2 spun around anyway. Just a thought.

I managed to get my consultant to agree to a c section for my twins. I basically said that I felt the risks in a planned section were known and could be managed accordingly and this was preferable to me than the induction and forced epidural that was their policy for natural twin births.

They did try to sway me but I stuck to my guns and it turned out lucky that I did as I would of certainly lost at least one of my twins had I given birth naturally.

I'm so glad you insisted Cloudy, well done and congratulations on your twins.

Well done cloudy and congratulations.

I'm 34 weeks pregnant with DCDA twins and I've known since 24 weeks that I was having an ELCS. I had an EMCS with DC1 after I was induced and dilated only 3-4 cm in 2 days. So the consultant tentatively suggested I'd probably need a c-section this time. I agreed and had it booked by 29 weeks. I had one consultant try to convince me to try for a VBAC since twin 1 is head down but I just said no and we moved on.

OP, tell your friend to stand her ground and to do her research. There is no reason why she should t get the birth that she wants, especially considering the additional risks associated with twins.