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What questions to ask consultant at 1st appt? 15+4 non-ID twins; 1st pg

15 replies

1stMrsF · 23/11/2008 20:58

I've got my first appointment with the consultant tommorrow afternoon, since being referred for consultant care after finding out we're expecting DCDA twins at 12 week scan. Our local hospital (East Surrey) has very high incidence of c-section overall (and doesn't seem to have published any separate figures for multiple births) and I'm keen to have a VB unless there are clear contra-indications. I'd also like to exlusively breastfeed so I want to find out what sort of support I can expect (or be forewarned and forearmed if it's not forthcoming). I know that it's early days yet and there will be other opportunities to push forward my preferences, but I'd be very grateful for any advice on the questions to ask at this stage in order to identify any conflicts and/or what additional support I might be able to get from other sources.

Thanks for any and all suggestions!

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dsrplus8 · 24/11/2008 13:42

hi, congratulations.you should ask as much as you can about delivery options, most twins that are vd are with epidural, but its better if you have the option of a mobile epidural.if you do have a c-section it would be done in the best intrests of your babies so dont worry to much about it.It is possible to exclusivly breastfeed ,although its advisable to bank some milk incase of emergencies. my twins were in scubu and i expressed so that they could still benefit, request that they are not bottle fed ,use a baby beak instead as this will help with latching if u have to be apart .its easier to go breast to bottle than bottle to breast.ASK about private rooms, some hospitals give twins mothers them without charge as you will need more room in hospital, also as about rooming in at the scubu department if its possible?please dont be alarmed at me bring up scubu, most twins are smaller than singletons and just need a wee bit extra help for the first few days as there will be a policy on reaching a certain weight before the babies can go home.contact tamba , they can help with ideas for nursing cushions that would make it much easier. there is a brilliant book called " twins and multiple births "by dr carol cooper ,its got diagrams on feeding positions.hope this helps ,good luck and keep us posted!!!!

1stMrsF · 24/11/2008 17:14

Thanks dsrplus8 - this is really helpful.

We discussed delivery options and although the doctor basically said it was too early to do too much planning he did explain some of the factors involved and he did say that if everything had gone well in the pregnancy and they were both in a good position they would go for VB so that has reassured me somewhat. Also saw both heartbeats on ultrasound today so that was brilliant!

I will use some of your suggestions for more questions at follow up appointments and also to start planning. I'm going to book a tour of the maternity ward, and some of those questions I can ask then.

I'd still be grateful for others' ideas too - I don't know what I don't know at this stage, particularly having not had any other children!

Thanks

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pollyblue · 24/11/2008 22:54

Hello,
does your hospital have a 'twins' midwife or offer a short course on having twins? I'm 28 weeks along with non-id twins and tbh have found the midwives I've seen more helpful than my consultant - he's planning a section for the twins as I had a section with my dd 20 months ago and I've got placenta previa - so although I'm strictly speaking under consultant care, until he has to get his scapel out there's not really much to discuss!

The midwife-led unit near me has a midwife who specialises in the care and delivery of twins, she's already made a point of introducing herself and hopefully I will transfer to the midwife-led unit after the twins are born. She also runs one day twin courses for parents-to-be at the main hospital, well worth attending if your hospital runs anything similar.

magnummum · 25/11/2008 09:52

Hi 1stMrsF, I'm also having non id twins at East Surrey (due June 09)so am watching your progress with interest. Waiting for consultant appointment to come through but expect I'll have much the same inital as you!
Had my first baby there in 2006 with no intervention so this is all a bit more daunting.

Neenztwinz · 25/11/2008 21:53

Hi there, I had non-id twins in May this year. Had VB with just gas and air. Both twins were head down. My consultant wanted me to have an epidural but I said no cos was worried it would increase chances of c-section.

My birth was an amazing experience. This is my birth plan (long!!) - it will give you loads of ideas about the sort of birth you want and how to get it.

My top tip is talk to as many different midwives, obstetricians and consultants at your hospital as you can (go on a ward tour as well as regualr appts), tell them all what you want, then when you go into labour you have a chance of being attended by someone you have already met and spoken to about your preferences. I was adament I didn;t want an epi, didn;t want continuous monitoring and didn't want to have to go for C-section if twin 2 turned breech (some obs won't deliver breech at all). Speak to as many people as you can. Get the hospital's twins birth protocol too. Good luck!

BIRTH PLAN
To all midwives and other health professionals who may attend my twins? birth,

I fully understand that a twin birth is different to a singleton birth and can throw up complications not encountered with just one baby. I have read the twins protocol for the hospital and have spoken to parents of multiples who have delivered naturally and to various professionals at the hospital about the various risks and options re. pain relief.

I am keen to have as little medical intervention as possible during labour and delivery and I would like to have skin to skin contact and to nurse the babies immediately after birth. I would also like to leave the hospital as soon as we are deemed fit to do so. My named birth partners will be at home with me and I am confident they can look after me there as well as I could be looked after in hospital where there may be many demands on the time of the midwives.

We will trust the medical judgement of all who attend the birth but ask please that any intervention or procedure is properly explained, including options for refusing.

I do not wish to be induced. As long as the babies and I are fit and well I want them to come in their own time.

I wish to be attended primarily by my husband Peter, and possibly also by my mum.
If all is going well with the labour I wish to be attended by midwives only, with at least one experienced in twin birth.
I wish for there to be as few people in the labour room as possible to give me privacy, but I understand that a twin birth is an excellent teaching opportunity for student midwives. I am happy to consider allowing students to attend the birth on the day on a case by case basis.
I would like there to be as little noise as possible in the room, I would like those attending the birth to speak in low voices and for the lights to be dimmed if possible at the time of delivery.
I do not wish my labour to be started or speeded up using drugs or rupture of membranes. If labour stops I wish for it to be allowed to restart naturally as long as the babies are not distressed.
I do not wish to have an IV drip or any other line put in ?just in case?.
I wish to be able to eat and drink during labour.
I am happy to use the EFM belts for 20 minutes or so to initially record a baseline of the babies? heartbeats when labour starts, but I want to be free to move around so I would like the heartbeats to be monitored using a hand-held device thereafter. I do not want a scalp electrode used to monitor the heartbeat of (twin 1).
I do not wish to be confined to the bed.
I do not wish to have an epidural just because this is a twin birth or just ?in case? there are complications with the second twin. However, if I do decide to have an epidural, I may request that the epidural be sited but that the drug is not administered unless necessary for the turning/delivery of (twin 2) (as agreed with Mr Jones). I understand that turning a baby or delivering a breech baby without an epidural can be very painful. If Esther is breech after Theo?s birth then I would like all options of pain relief discussed with me.
There must be somebody on the ward who can deliver a breech baby. If there is no one, I would like someone to be called well before the birth of the first twin. I do not want to have to have a ceasarean for the second twin just because there is no one there who is experienced in a breech delivery.
I wish to take up whatever position feels best during delivery, including squatting, kneeling, standing or being on all fours - for both babies.
When twin 1 is born, I want him to be handed straight to me for skin to skin contact and nursing and I do not wish the cord to be cut until it stops pulsating. If for any reason it is not possible for me to take the baby, I want him to be handed to Peter for skin to skin contact and for the cord to be cut after it stops pulsating. I do not want the baby to be cleaned in any way before being handed to us.
If twin 2 takes more than the guidelines of 30 minutes to deliver and her heart rate is normal, I want the labour to progress without intervention past 30 minutes. I do not wish to have drugs to restart labour unless medically necessary.
After the birth of twin 2 I would like her to be handed to me immediately for skin to skin contact and nursing and for the cord to stop pulsating before it is cut. I do not wish for her to be cleaned in any way.
I would like the third stage of labour to occur without drugs to speed it up - unless agreed by me.
If both twins are healthy I want them to stay with me and not taken to SCBU.
If an episiotomy is deemed necessary I want that to be discussed with me prior to it being performed.
In the event of a caesarean, I would like Peter to be in theatre with me and to for me and him to hold the babies immediately after their birth if possible.
If the babies have to go to special care, I want to hold or at least touch them before they go.
I want the babies to have breast milk that I pump, no formula, and I would like to nurse them as soon as they are able.
I would prefer vitamin K to be administered orally rather than by injection.

I feel a bit reading that now!!! Lights dimmed at time of delivery? ffs!! You will not care by that time I promise you In the end, I was induced and had a forceps delivery with twins 1 so had an episiotomy. It was all fine and they didn't need to go to scbu.

Neenztwinz · 25/11/2008 21:55

Also, I was continuously monitored in the later stages cos I didn't want to move around. The belt monitors didn't bother me in the slightest, but they did say I didn;t have to have them if I didn;t want. They didn;t use a scalp monitor.

jerin · 30/11/2008 21:52

Congrats 1stMrsF and Magnummum - will also be watching as expecting twins at Esat Surrey - March 09! Almost 24 weeks and so far only seen consultant at 15 weeks. Hoping to get some info soon tho as DS1 was born at 32 weeks and thats not far away.....

NeverEndingPileOfLaundry · 30/11/2008 22:04

I can't answer your questions, but perhaps can offer a little reassurance - the SIL of a good friend of mine had non id twins at East Surrey around 2 years ago. She had a VB, and breastfed them both until they were around a year old, so it can happen. I gather that she laboured in / near theatre in case a CS was needed, but thankfully it wasn't necessary.

I wish you all the very best.

magnummum · 02/12/2008 08:56

1stMrsF and Jerin would be interested in getting in touch with you both if you fancied it. Think some local twin support would be fab.

pophas2boybeans · 03/12/2008 09:39

1stMrsF, Jerin and Magnummum - I'm 31 weeks today with MCDA twin boys. I'm having a c-section at East Surrey on the 7th Jan at 34 weeks. I will let you know how I get on. I had a rough time there with DD so have loads of fears about the whole thing. Hopefully, I'll have a really positive experience this time. I also want to breastfeed but am worried as they were hopeless at get DD to latch. In the end my mum took over and manhandled my boobs until DD got the hang of it, it took 2 weeks after being discharged but we got there eventually.

I look forward to hearing from you 3. Would be nice if we could all keep in touch. My sis is also pregnant with twins (DCDA), due a week after me but having hers at Princess Royal - Haywards Heath.

jerin · 03/12/2008 21:25

Congrats pophas2boybeans. I found them pretty useless at ESH with the breast feeding. My DS started then stopped whilst in SCBU and then started again at around 16 weeks.
Have had consultant appointment but found it next to useless really -was offered hospital tour -I spent over 2 weeks there with DS. Asked about twin parenting classes or similar and got a blank look. Asked about policy on twin pregnancies and told I would be told what sort of birth to expect after my 34 week scan. Pointed out DS was born at 32 weeks and told these are likely to arrive around 30 weeks!! Had previously been told there was no reason for these to come early. I was told by my midwife that she couldnt tell the difference between the 2 heartbeats so I would be seen by consultant who would use mini scanner to listen & see that the heartbeats were from different twins. Doctor only used doppler as midwife would,and heard both heartbeats on the same side at first. Came away wishing I only had midwife care as it all seemed a waste of time and very impersonal.

1stMrsF · 04/12/2008 09:27

Thank you everyone for these really helpful suggestions and advice. So great to hear from other twin mums nearby! Magnummum yes I'd love to get in touch. You and jerin and pophas2boybeans are welcome to email me at adrienne.forster @ btinternet.com (without spaces, I'm assuming I won't be able to get the address to show if I type it all together) and let me know if you are happy to be in touch with the others and then I can circulate to each of the others - does that work? Alternatively (or as well!) we could start a little antenatal thread of our own - Twins & East Surrey? and chat on there - let me know what you think.

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pophas2boybeans · 07/12/2008 20:25

hiya - I reckon the twins and East Surrey thread is a great idea. My email can play up quite a bit.

xx

pophas2boybeans · 07/12/2008 20:27

Just noticed that I said my boys are coming out at 34 weeks. No such luck, 36 weeks!! 34 would be great as that's christmas eve and would mean I could get out of going to the MIL for christmas day!!

1stMrsF · 07/12/2008 22:06

I have created our new thread here

pop sorry you will have to survive the Christmas in law trial but the twins will have a birthday distinct from Christmas! Hang in there for the wait.

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