C-Section or Natural Birth with single placenta Twins?

[SophiasTwins]

hi Guys,

I'd REALLY appreciate your insight on this. I'm 24 weeks with monochronic diamniotic identical twin boys. As they share a placenta we've been told we HAVE to have a C section.

This has raised several questions for my partner and I:

1. is it true we have to have a C section, and why? Has any one had a natural birth? We don't really understand the risk either way so any info would be Awesome.

2. Is recovering from a C section a real nightmare and immense amounts of pain?! esp with two little nippers and an inexperienced first time mum?

Any thoughts at all would be REALLY APPRECIATED !

Thanks so so Much,

Sophia.

Hi there
Have you asked your consultant to explain? How much do you want to know?! I think it would mainly be to do with something called TTTS (twin-to-twin-transfusion syndrome) and the risks of it happening during a natural delivery - so it seems to be recommended for all MCDA deliveries now. If you want to know all about TTTS, which can be quite alarming, I'd recommend the Tamba website. But go there when you're feeling nice and calm and philosophical or it might make you freak out a bit. Are you being scanned frequently? For the same syndrome, fortnightly scans seem to also be recommended.
There is lots of anecdotal stuff about natural MCDA twin deliveries but as with any delivery it's all down to you to look at the risks and talk to your consultant and then make up your own mind.
Can't help on c-sections though I might be able to in a few weeks!
Good luck...

And congratulations, by the way, how rude of me!

Thanks Hun!

Yep am being scanned every 3 weeks or so and quite familiar with TTTS basics. Consultant is recommending C section, but my other half is very against it, so promised him i'd try and canvas some further opnions/ and other peoples experience.

Good luck with yours in a few weeks!

Hi, I have ID boys who were monochorionic/diamniotic and I had TTTS. I was desperate not to have c section and was not told these were reasons I could not have a natural birth. I was induced at 37 weeks having been told I probably wouldnt reach 30. The first twin was forceps delivery. The second twin didnt want to come out and I thought oh no c section here I come. However 20 minutes later he emerged with the help of ventouse. He was blue and needed oxygen but has been absolutely fine. This was 6 years ago, I dont know if recommendations have changed since then HTH. xx

Hiya, I have ID girls (now 14mo) wo were MCDA. Both were head down from about 30 weeks and TBH no-one ever even mentioned c-section to me, so a completely different experince from you. I had mentioned at one of my many, many scans that I was hoping to have a natural birth so maybe they didn't mention a section as they knew my thoughts and the babies were in the right positions. Although, even when one was breech for a week or so, they still said I could have a natural birth. I would def go back and question your consultant about this, if I were you.

In the end, they arrived at 35 weeks and I had forceps with the first and no help with the second.

Where are you having them? FWIW, I was at St. Thomas' in London...

I should add that they were diagnosed with a very slight case of TTTS at birth which required a blood transfusion and 10 days in SCBU, but none of this was evident in any of my scans. Maybe if it had been, I would have been told that a c-section was the only way?

And apologies for my typos!

Hi,

I also have monchorionc/diamniotic girls.

I actually asked my consultant if the fact "it was twins" meant I would automatically have to have a csection. I was categorically told no, although if the first twin was in an awkward position at term then I would have to have a c section...this is no different to a singleton; but the chances are slightly higher with twins.

Most consultants recommend an automatic c section for mon-amniotic twins as they can apparently "get tangled" during delivery.

I have never heard of TTTS causing problems/arising suring delivery....I thought it was something that affected the pregnancy; not the delivery. Although if you need to delivery early as a result of TTTS then I think that would be a c section. I think that delivery pre-term for medical reasons usually is (e.g. for pre-eclampsia...). Again TTTS is apparenly more likely to present in mono-chorionic/diamniotic twins than mono-mono twins.

So as you can see there are a number of factors which make it more likely that you will have a c-section...but the fact that they are mono/di does not directly cause you to have a c section.

Incidentaly my twins were born vaginally, 1 vertex; 1 breech. Both were abosultely fine (albeit 3m premature).

Hi Sophia,
I can't help you with why you're being advised to have a section, but I had one with my dd (first baby) 18 months ago and have been told that I will have to have a section this time (expecting non-id twins in the new year), mainly because I've had a section before and partly because with twins there is a small risk that twin no2 will need to be delivered by section anyway.

So in response to your second question, I did find recovery after the section took longer than I expected - took me about 4 weeks before I could move about freely - and was glad to have help of dh and my mum, who stayed with us for a week after I got out of hospital. The main problem I had was frustration at being quite restricted in what I could do. The hospital will ensure you get good strong, regular pain relief and encourage you to get up and about 24 hours or so after surgery, to stop you getting too stiff and sore. A friend who had a vaginal delivery but tore badly needed 40 odd stitches and was in the wars for some time too!

Have you looked at the childbirth board? There are often postings on there about c-sections and could be worth a look.

Is your dh very opposed because he thinks sections are much riskier? There are risks in all births, and as I understand it, because many sections are performed in emergency circumstances - ie, something is already going wrong - the statitics can look frightening. However, a planned section is a completely different kettle of fish - ask your consultant to go through his reasoning with you more fully, so you understand his stance on sections in your circumstances.

Best of luck and congratulations!

Hi Sophia, I also have MC/DA twins. I had an unplanned cs with my ds1 and was at first told I would have to have a cs with the dts because I had already had one and because it was twins. I changed hospital and after long discussions it was agreed that I would be able to have a vb if I had a model pregnancy, reached 34 weeks and both twins were doing well, both head down etc....

At 36+4 everything looked perfect, 2 days later my waters broke and unfortunately during the 2 days somehow dt2 had managed to turn breech.

Ask the questions why you can't have a vb. My doctor told me every situation that I would have to have a cs and admitted that they didn't have the experience to do a vb twins in any of those cases. I accepted this. If all was well I would definitely not have accepted a cs.

Recovery with a cs depends. with ds1 I couldn't walk alone for 4 days afterwards and was in a lot of pain. with the dts it was much better. In the hospital you could pretty much guess which mums had have vbs and which css, the vb mums seemed to be back to normal very quickly (although I know this isn't true in every case), the cs mums were hobbling around bent over.

If you ask the same question on the Tamba message board (you need to be a member but I would say it's worth it if you want to get all the info on this you can), you will get a barrage of replies about why you should have a c-section with MCDA twins. I did this when I thought mine were MCDA, it scared the heck out of me at the time but I'd rather be informed then make a decision than just take my consultant's word for it. There is some research that's widely quoted about risks of natural delivery with MCDA twins.

Good luck!

Hi Ladies,

Thank you for your experiences on this. Having read through every one elses advice and done some more research I'm inclined towards following my hspitals advice of a planned C-Section, but only because I really want my Babies to be safe and i'm nervous of something going wrong.

My partner is still in favour of trying for a natural birth, as it's clearly the optimal route when everything goes fine. I just can't quite settle the niggling fear, "but what if everything doesn't go fine". I've worried about them for so long already it would just be so awful.

Really apprecaite your help and all insights shared! Thanks You,

Sophia

I think the research regarding TTTS in delivery is fairly recent. I was certainly allowed to try for a natural birth, though I ended up with an emergency c-section anyway! Check out TAMBA, it has loads of info on the message board.

Congrats sophia!

I had the same concerns as you, I have mcda twins due in apr. My consultant says I don't automatically have to have a c secn, alot of it depends on twin 1 (the lowest). If he/she is head down you have the option of natural birth.

There is a risk of TTTS during delivery as there is in pregnancy but it is lower.

I was reminded that there are many factors which affect the delivery decision, twins are still fairly rare and each case is unique so you can't apply a common solution to all.

Of course you (we all) want the safest option for our babies, but still want to be in a fit state to look after them when they finally make it into this world.

I am hoping to either go naturally into labour or be induced (BTW early induction isn't necessarily good if the womb isn't ready as it can prolong labour) and have a natural delivery; however, if there is a prob there is always the option of emergency c secn - which sounds scarey but is still quite routine for the doctors.

I would say, don't make a decision yet, wait and see how things go. Hope this has helped. Believe me, I'm not all hippy about natural births I'd just like the best for my beans - who doesn't!!!

I've just been booked in for the 11th Dec (36 weeks) for my id twin girls section - apparently the new research on TTTS has found that labour can bring on TTTS which is why more and more consultants are leaning towards sections rather than natural birth.

Also (sorry to be sarcastic, but I blame the hormones), if you partner really wants to try the natural birth route, tell them to get pregnant with twins!!!!!!

Congratulation sophia!
While i had non- id twins, I did have a planned C-section at 38 weeks. (sorry to any of you who have read about this before!)
DD was breech so had no choice.
It was great! Arrived in hosp at 7.30. Down to theatre with DH at 8.30, twins born born at 9.30 and 9.31. Hooray! Anaesthetists were lovely and cheerful and it was a very jolly atmosphere.
I breast fed with no problem (as I know that can be a worry).
I don't know how long it takes to recover naturally, but I think that people recover from C sections at different rates too. My SIL had a c-section at 35 weeks and really had problems recovering as she found the sudden loss of abdominal muscles really hard to cope with. The advantage (!) I had was being the size of a small planet meant I hadn't had any muscles for months anyway! The relief of not having a bump any more meant that little things were so much easier (going to the loo etc).
I'm sure you will make the decision that suits you and you will get support from MN here when you need it.
Good luck!