Vaginal birth with twin one/ both twins breech?

[Methenyouplus4]

Has anybody? 32 week scan and both breech but can't make peace with having a c section. Really hard to find research/ data in this area. Would love to hear from anyone who delivered vaginally.

[BrassicaBabe]

I had an elcs. One twin was head down, the second twin was breech. My reading and research suggested that there was a 50% higher chance of problems with twin 2 as 1 causing life long problems.
I loved by elcs by the way. All pain well managed. Back driving and having sex within a fortnight

[lauraw1987]

Yes i delivered vaginaly with my twins the second was double breech so i had to have a spinal anesthetic to get him turned around hope that helped any more questions just ask

[lamprey42]

Are you on the facebook group 'Naturally parenting twins'? People on there may well have experience on this. No personal experience - Mine were both breech from 32 weeks and I developed pre-eclampsia from 30 weeks so ended up having an emergency c-section after a month in hospital. I'd done a lot of reading on vaginal births before and was really keen to have them this way but wasn't to be - our hospital would not agree to a vaginal delivery if twin A was breech (well maybe they would have if I forced it but I wouldn't have counted on them having the experience). Sounds like you've got a great consultant though who talked it all over with you.
There are quite a lot of papers on this on pubmed e.g. www.ncbi.nlm.nih.gov/pubmed/15576266.

[slightlyinsane]

Hi mrsextraordinary, congrats on your pregnancy, I have 5 los the last 2 were id twins. like you I was massive from very very early on and joked about it being twins, won't be doing that again. The only advice I can give you is to wait and see what your scan shows up before you make any plans. If you are carrying twins antenatal care is very different and if they are id very full on and rightly so. If it turns out to be twins I would say that a home birth really shouldn't be an option as there is so much more that could go wrong, especially with twin 2. If it was id twins I would advise anyone to have a section.
I had had 3 natural easy labours and the hospital I was at decided natural would be fine again aslong as twin 1 was head down. I wouldn't say I was pushed down that route but was never advised to go for a section. What I have learnt since having my girls has angered me, my girls were so very very very lucky to have survived, they had undiagnoised TAPS and im grateful every day that fate decided they would arrive when they did the what ifs are horrible to think about. I think the hospital failed me and my girls and didn't give us the care that we should of had to ensure they did survive, I should not be in the position of having the daily thoughts of the what ifs everytime I look at them.

Good luck with your pregnancy and if it is twins double congrats, they are hard but amazing. x

[MrsExtraOrdinary]

Does the study include twin deliveries after successful previous vaginal births with spontaneous onset? I've had 5 vaginal births and have just found out I'm pg again. I'm absolutely huge and for the first time had a positive pregnancy test before af was due. Which I know can happen but just got me wondering about twins. The only birth I had trouble with was one where I'd had an epidural. There was foetal distress. Which was my first birth. All other births I managed naturally. I too like the op would absolutely struggle to have a c section this time round, with 5 older dc.

I'm interested to see what you decide op. I'm hoping to instruct an independent midwife this time to archive my 3rd home birth. I've been fortunate enough never to experience breech but I'm not sure id opt for a c section if I did have a breach baby. Good luck with your decision.

[Lezprechaun]

I don't know about specifics for twins but breech births are becoming more common, there is also no reason why a breech baby should automatically mean c-sec also as it's perfectly possible to have a normal vaginal delivery.

Sadly midwives are losing the skills needed due to so many people opting for a c-sec which is proven to be WAY more risky than a singleton breech birth but with the new training being given hopefully more people will opt to have their breech baby vaginally and this myth of a c-sec being safest will stop being spread.

Well done for looking at research and making an informed choice (whatever that choice may be) rather than blindly listening to the medical staff and scare stories. I hope all goes well for you.

[lateatwork]

mine were both breach and smallest baby was presenting first. i asked lots of questions and ended up with cs on basis that neither my mw nor consultant had delivered the combo i had before. was told they had done it with biggest baby presenting first. i found recovery quite difficult- but mainly the hospital bit. i lost a lot of blood and so was on high dependancy first until i stabilised and then was moved and then moved again... if i was doing it again, i would recommend trying to get extra help immediately post delivery in hospital (would pay for a private room with more nursing support). it was hard to corale babies in their respective cribs and pick them up all night etc with two. also the beds arent quite wide enough so end up having to have one between legs to settle which tricky with cs stitches. was fine when i got home though... i have 1 older dd and had absolutely amazing mw support at home. it was fab. good luck!

[Methenyouplus4]

Sorry, in past 6 months.

[Methenyouplus4]

Also, she said if I went for vb, it would be best to go into labour naturally rather than being induced (as that comes with increased chance of needing intervention). However, down side of that is they wouldn't know who would be on hand to deliver. She said all staff will have experience of delivering breech I part 6 months but some who are less experienced may worry about breech plus twins element. I appreciated her honesty.

[Methenyouplus4]

Hi, had really beneficial, positive meeting. Consultant made it very clear that it was my choice and I would be supported whatever I decided, whether this be a cs or a vaginal delivery with no epidural / monitoring. She went through in detail why they recommend a cs when twin 1/ both twins are breech. She backed this up with the research it was based on but also told me about critics of that research.

In the end, I have decided to have a cs. This has been a tough and emotional decision but one that I am now focusing on making peace with and trying to think how I can make that a positive experience still (e.g dimmed lights, delayed cord clamping etc).

For me, the positives of a vb were quicker recovery and also benefits to baby of hormones/ journey through birth canal etc. She said there was a reasonable chance that I could have a vb and it would be fine. However risk with vb for breech is that is has to be 'hands off' meaning no instruments/ pulling baby as forces chin upwards so head is tilted and diameter is at is widest, so will be more stuck, and then comes risk of oxygen deprivation / brain damage etc. She said this risk was small, but as my previous two vb required ventouse, I just decided I didn't want to take that risk as ultimately most important outcome is two well babies.

Happy to answer any questions if I can.

[Yikesitshot]

Methenyou

Any update?

[Methenyouplus4]

I can feel both of their heads and defo still both breech, despite trying acupressure and spending a lot of time with my head on floor and bum in the air! Due to position they said both would have to turn for the bottom one to have enough room and unlikely now due to lack of space.

I'll keep you posted to let you all know what they say on Tuesday.

[AlpacaLypse]

Another whose slightly older daughter came out head first just as she was meant to but second daughter insisted on turning herself sideways.

Big cheese obstetrician came in and aligned her vertically again, although she was now feet first. Nevertheless out safely.

Both taller than me and in top sets for the GCSEs they'll be taking next June so clearly all went well.

Good luck with everything OP. Surely there's still time for the little sweeties to rearrange themselves again?

[Yikesitshot]

Methen - do keep us posted! Interested to hear the advice as I'm going through all this at the mo (although a bit behind you).

[Methenyouplus4]

Thanks for all the thoughts/ experiences. I have an appointment with big cheese consultant to go through things, I just want to feel fully informed as at the moment, all of the reasons they gave me against a vaginal birth are also risks for c sections with twins.

[Frec68]

I had a great labour with my identical twins T1 was head down and T2 was head down too. They were born vaginally 5 mins apart. You just have to do what feels right once you have taken all the advice on board x

[BackspaceEnter]

I wouldn't take the chance. Have a cs if possible, it's just not worth the risk. I choose a cs even though T1 was head down, my consultant also felt it was safer as cerebral palsy is more common in twins because T2 can get in trouble after T1 is already out.

You can recover quickly from a cs. I was out on country walks with them when they were 3 days old and had a quicker, easier recovery than some friends who had had vaginal birth.

An ELCS is much better than an emergency one.

[mandy214]

Slightly different here as it was a premature delivery (so smaller and probably less likelihood of them getting stuck) and as OP says, not really relevant as Twin 1 was head down. Twin 2 was breech, but I delivered them both naturally 16 mins apart.

[chucklingbunny]

Yikes, no I didn't get the chance to deliver twin 1 vaginally as wasn't dilating properly and doctors and midwives were so worried they asked about a section and within 10 minutes I was in theatre and they were both out! It was that quick! Initially I was induced and I don't know if that had anything to do with labour not progressing. What I do know is that I'm so worried about something going wrong again that I'm having an ELCS this time round - I'm 33+3 with my third DD. I also strongly believe that my twin 2 would have been fine had I gone for an ELCS in the first place (I have no evidence for this, just a gut instinct given her weight and how well she bounced back - she's very robust now! )

[Yikesitshot]

Watching with interest. 29+2 DCDA twins. Twin 2 has just flipped to breech, twin 1 head-down. At the moment, I'm being strongly advised to go for a vaginal delivery. If twin 1 was breech, I would be having a C section for the reasons stated by Parallax80.

Chucklingbunny and Diamonds, would love to hear more about your experiences. Chucklingbunny, did you deliver Twin 1 vaginally?

[Methenyouplus4]

Thanks for all your responses, lots to consider. My main issue with a c section is that I have two other children, one starting a new school next week and one only 18 months, husband can't take more than two weeks off as he's a teacher.

I know the advice is very different if twin two is breech (room to move/ enough room to move them /birth canal already opened by twin one).

I know needed assistance with breathing is mentioned but it is also mentioned if a c section is needed. The study I found stated that, long term, there was no evidence to show vaginal breech anymore risky that c section... except still no mention of Twins in that research.

[TreadSoftlyOnMyDreams]

What's the issue with the C-Section?

[chucklingbunny]

OP, I had twin 1 head down and twin 2 breech and was advised to go for vaginal delivery. I took the advice with an epidural in case of intervention needed (standard with a twin delivery anyway I believe). In the event it became clear after 8 hours my labour wasn't progressing fast enough for twin 2 to cope and she became distressed. I ended up with an EMCS which was the most terrifying and distressing experience for me and my DH. Twin 2 had to be resuscitated at birth and spent 5 days in NICU in spite of being 6lb 6oz and delivered at 38+5 full term for twins. I believe had I had an elective CS that she wouldn't have become distressed and may not have needed NICU - I could be wrong but an elective is a lot easier to recover from than and EMCS I can tell you. Oh and friends of mine with single babies in breech position have been medically advised to go for ELCS for the safety of the baby so I certainly wouldn't risk it with twins. Good luck!

[familyfortunes]

Watching with interest...also just had 32 week scan DCDA, twin 1 head down twin 2 breech...I'm unsure about delivery. ..will see what happens at my 34 week scan.

[parallax80]

As I understand it there are general problems with vaginal breech delivery and specific problems with twins (twin1).

There has been a massive decline in the incidence of vaginal breech delivery since the publication of the Term Breech Trial. Its headline finding was improved neonatal outcomes (esp re mortality / significant morbidity) with c section vs vaginal delivery for term breech singletons. There are differences of opinion as to whether there are some flaws in the methodology but what is indisputable is that it has been a very influential study that has contributed to a big decline in experience (esp recent experience) in both medics and midwives of vaginal breech delivery.

Specific to twins, they are more likely to be premature than singletons, which is particularly risky for breech babies. The head is even more disproportionately large compared to body in prem babies, increasing the risk of delivery of body while head gets stuck and resultant hypoxia. There is also a rare complication of locked twins, where twin 2's head still in the uterus prevents twin 1's head from being delivered. (Rare, but real. Do not google.)

Of course there will always be people who have experienced a successful vaginal breech delivery and will be able to tell you all about it. I guess the trouble is that you can only know that yours will be successful in hindsight. My main concern would be a lack of experienced Obs / midwives.