birth plan for twins

[elmotaughtddtousethepotty]

hello ladies, MN has gone mad and won't let me use my normal name, claiming the name is already in use! so i'm flumpity really but seemingly banished from using my own name.

anyway, to get to the point, as i approach 37 weeks, i've started thinking i ought to write something on the birth plan part of my mat notes. wasn't going to bother, given how far from my plan my dd1's birth was (embarrassed looking back it now, all the 'i don't want pain relief' stuff before ending up demanding an epidural!)

In your experience, what is it actually worth writing when you've got twins, particularly mono-chorionic ones? the hosp policy is for continuous monitoring, which i feel inclined to go along with having been terrified to death by the flipping tamba message boards full of people saying things like no way under any circumstances would they consider a VB with MC twins because of acute TTTS etc... but my host (st thomas) seem v experienced and are v encouraging of a VB if poss, but with continuous monitoring. So that's fine by me. (lots of hospitals seem to do a 36 week c sec for MC twins by default which strikes me as OTT, and consultant won't do that anyway even if i wanted).

ANYWAY, realistically, how upright and mobile can you be with continuous monitoring of twins? Is it even worth bothering to write that down? obviously i don't want to be stuck lying on a bed on my back... will they just assume its obvious i don't want that? or am i being daft to presume anything else is possible with a twin VB and monitoring?

I'm also not anti epidurals (loved my last one although it did make pushing hard and long). But if i put that down, will they just assume I actively want all interventions going? (i don't, just haven't closed off the possibility).

i'm rambling now, but if anyone can remember what their twins birth plan said and how useful (or irrelevant!) it was, i'd appreciate a nosey at what you said. and also what then actually happened...

thanks ladies.

xxx

or I could simply look under multi births. Right! Hang on will read then post!

You can ask to have 20 mins on and 20 mins off whilst in early labour. What you really need is the ability to move about to encourage the babies down. I think that with an encouraging hospital, esp one with lots of experience they should be able to accomodate a compromise. STOP reading the TAMBA boards. Honestly, they are only for the stout of heart and hard of skin.

If you have an epidural then you will have to be continually monitored because epidurals don't suit all babies. Of course you can ask to have one sited in case it needs to be administered quickly.

I'm happy for you to email me and I'll send you some examples of twin birth plans that I have. mars at mammydoula dot co dot uk

oh, fab. thankyou. email coming now! glad its not just me that finds Tamba boards a bit on the alarmist / worst possible case side of things. i stopped reading them after discovering that i was seemingly the only (apparently mad & irresponsible) person to be considering a VB with MCDA twins... got quite aggressive posts from people saying it was utterly irresponsible of me and the hospital not to do a c sec which was upsetting but also v worrying! i grilled the consultant (pippa kyle) at st thomas long and hard and she was very reassuring which helped a bit. does seem to have delivered heaps of twins and triplets and specialises in mono chorionic ones so i've relaxed slightly, but as it all gets nearer you know how your mind starts ticking.

I have banned myself from the Tamba boards. My Mantra: Just because someone is also a member of Tamba DOES NOT mean they have a similar view of parenting/birthing/feeding etc. to you. Stick with MN!

This is not from experience but when I was researching the same questions I found people who had had cont mon. and sat on birthing ball to stay upright instead of lay on bed.

This IS from experience - write a C-section plan too - both for an emergency (think about whether you want DH with you or with the babies, who should introduce the babies to you if you have GA, whether you want the babies to have bottles or be latched on to you while you still unconsious etc.) and for elective (I was still on for VB at 35 weeks and then both babies turned breech at 36 and were born by elcs at 38). Then if you do end up having a cs for whatever reason you will feel in control of the whole thing. My ELCS was fantastic - skin to skin in the theatre, bf in recovery, DH took pictures, surgeon held up babies for me to see when they were born. The team were happy to do all of these things, but you might just need to ask/have them written down so DH can ask. If you don't need it, so much the better!

PS. If DH is inappropriate apologies, but not clear from your post who birthing partner will be - please read as whomever!

thank you. that's a v good tip. i will do that because i'm aware i may well yet have a c sec. next scan is thursday so will know more then i guess (that'll be exactly 37 wks) booked for induction (or c sec) on 38 weeks at mo.

TAMBA is an interesting site!! The only reason I go on there now is that I am the only person who seems to be able to dish out breastfeeding advice which is correct!! I feel I have to continue otherwise all the Mums will be told to top-up and that their baby had bottles of formula and was fine etc etc!! Not how to go abut breastfeeding successfully, right rant over!!

I had continuous monitoring but I was being induced. However I would have asked for 20 mins on 20 mins off if I'd known (hindsight huh!!)

I did end up with an emergency c-section!

I don't get the Tamba dislike from everyone here?

hiya, its not really dislike, it was just my experience that it was quite a doom and gloom bunch, and some posters were quite aggressive about the pov which didn't, at the time, help me much when i was keen to get some balanced opinions from all angles. but maybe they just shouted loudest. it was on a very specific topic around childbirth protocol for MCDA twins and i think someone had had a bad experience recently which perhaps coloured the view of the bunch of people posting on that forum at the time. seems from this thread that its not just me that found that to be the case though.

Flumpity - I had issues with the continuous monitoring too. It's pretty standard for twins full stop as mine are fraternal b/g completely separate with separate placentas. You should be able to move around with the monitors on. My first hospital wanted me strapped to the bed but my current one emphasised that if I need continuous monitoring I should not be prevented from moving around.

IME it is worth writing anything you feel in your birth plan. Basically you write what you would like and they try to facilitate it. If things aren't possible then they'll tell you and you can ask why e.t.c. so write a rough plan and get the hospital to look it over.

From your first post it sounds to me like the things which are most important to you are being able to move around, having the opportunity to have an epidural if you want or need one and having interventions that are necessary discussed and explained to you before they are done. You could just write those three things. It is possible that they might have the wireless kind of monitors that enable you to move more freely. If your write the important points you can discuss how the hospital can facilitate them.

Are you having weekly CTG monitoring now and have they been checking cord dopplers by ultrasound?

The birthing ball sound like a good plan, you could bring your own to be sure of having access to one?

My first hospital wanted internal monitoring of twin1 and external for twin2, strapped to bed from early labour for a good trace, I had a thread about it and the continuous monitoring thing here if that is any use to you?

kathryn you are so right. I find some of the posting on feeding exasperating...

Sorry to have hijacked your thread flumpity!

hiya curiosity - i thought you were probably in the throws of labour right now having not seen you post today!!! take it you're still waiting then...

thanks. will read your thread. they've said they will try keep me "as mobile as possible", i was just unsure quite what that means but the birth ball is a good idea, i know they have loads there.

yes, have been having 3 weekly scans because all seems fine, but last one was 2 weeks ago, next one a week after that (this thurs), then half way through following week again just because i'm approaching term (for mcda anyway). they've always with doppler cord check too. so i feel i've been in good hands really.

feeling confident to write the plan tomorrow then. in fact, you've summed up my plan very well in your last post i think!

kathryn / mrsf no hijack don't worry. how others have found the tamba stuff is interesting actually. x

curiosity - i've never heard of internal monitoring! sounds a nightmare. you'd have to be on your back with stirrups surely? how hideous.

Nope, dts nice and comfy inside and I'm happy to keep them there until they want to come out

Internal monitor is horrible, particularly when there is no need as I've had a perfect pregnancy and have completely separate fraternal twins! They break the waters and attach an electrode to the scalp of the baby

I've conceded to weekly CTG monitoring because it is building up a profile of the babies heartrates and making them feel more comfortable that the babies are OK. I think it's going to help the MLU to feel confident in their intermittent monitoring during labour. As is the checking the cord dopplers to show that the placenta is functioning OK.

There's a huge limit as to the amount of movement you'll get with continuous monitoring. Because they find it hard to find the separate heartbeats all you need to do is move for the belt to slip or one of the babies to move from position. However, you need to do what you feel is right when you get there.

Have you written that birth plan yet? You can run it by me if you like, though I do have a lovely lady brewing as we speak/post!

mars - I don't know, my hospital said they'd sacrifice the reliability of the trace to allow me as much freedom of movement as was possible I think because if the monitor is there it might lose the baby one second but start picking it up again another second so quicker and more constant than with intermittent monitoring. They can't stop you moving even if you are on the monitors

It's just if you have the wired kind of monitors rather than wireless that you have to wheel the trolley around with you. Also, I suspect if the babies are in funny positions close together they might be more easily confused, mine are on separate sides so OK for monitors.

I'll only end up on monitors if I'm induced or they are worried but I've thought it out just in case. I don't think they'll try restricting my movement at all, they don't seem motivated to but they can't really anyway. You just move, innit I think I'd also ask for the volume to be switched off or turned right down. Try and make it as un-intrusive as possible.

Well you'll have to let me know because in all the twin births I've been to and the twin birth stories I've heard whilst doing my PN work... they get very antsy if one of the traces drops off.

Babies react differently to contractions and measuring the contraction can help record how the babies are doing.

I'm looking forward to your birth story btw.

oh yes, well reminded about the volume. It was very stressful having to listen to it when i had continuous monitoring for dd1 (after the epidural/syntocin). It would be MUCH better to have it on silent so the mw can look at the trace without us having to listen to thumpity thumpity all the time!

haven't written plan yet. must do it. took all my energy getting to the hosp for a mw app today so have just flopped on the sofa all afternoon.

mars you are an absolute star. i will email something when i've done it. don't worry if you don't have time though or are in the throws of your lady's labour!

saw MW today. all well. both cephalic and presenting one v low down. (i am very waddly now). they seem to have settled with one backbone on each side of my front at last having one been transverse on the top all the way through. Makes a change from dd1 who was frank breech and back to back, awkward little thing that she was. what with also being over 42 weeks and induced, she didn't make for my ideal labour at all!!! but we got there and she eventually came out via the flue.

you never know, despite being identical twins, maybe this time will be a bit easier / shorter. god i hope so anyway.

I hope so too!

mars - Yes I will! lol I think my hospital is very progressive as is my obstetrician, they are the only hospital I've known of to have a consultant midwife for normalcy. I believe he is newly appointed and is implementing a lot of changes. I am rather exciting for them (which is great as before I was only a problem) as they've never had anyone with multiples in the MLU and the staff are various levels of excited and nervous. They've been co-ordinating things for a long time and providing staff training specially for my natural birth demands but they seem to want to move the hospital in the direction I would like - less interventions, more comfortable birth environments, more patient choice, individualised care e.t.c.

The main thing with my hospital is that I trust them and we have talked about all the things. My old hospital nearly died at the thought of me moving off the bed or not having the monitors, I suspect that'd be the norm maybe! I think that's the reason I majorly fell out with them - they refused to discuss things with me and wanted me to do what I was told which doesn't sit well with me.

That was the main problem, fundamentally I believe you need to build a great relationship with your care providers and that you can't push them out of their comfort zone because they won't be equipped to provide good care. The new hospital suits me better because the consultants have both signed off the plan and prepared the other staff in various ways. Rather than risking me jumping up and peeling off monitors and panicking everyone like I might have done in Ormskirk, I'll have the monitors if necessary and move around how I like and they'll all be prepared for it and supported by various structures in the women's.

I am a stroppy mare.

Yes I'm all for the building of good relationships with the HCPs. It's what all of my ladies do. We request the multiples birth policy and my ladies go through it with their Consultants.

Which hospital are you at? It would be handy to have one to refer people to with regards to the MBPolicy.

flumpity - It's all sounding good. Sounds like your hospital and consultant are good and supportive too. I'm sure you'll be fine, me ma says twins are normally easier to deliver than singletons as they are normally smaller and second time around should be easier than your first too. I think the things you've listed on this thread sound like they'll be compatible with your consultant's attitude and you won't have any problems with them, they are sensible things which might just happen anyway. I was going to say maybe you'll have them before me but if you're a late deliverer you might not! lol

Mars - Liverpool Women's of recent Rooney fame

They are facilitating individual care for me outside the policy, the point of contact would be Simon Mehigan who is the Consultant midwife for Normalcy.

I'm pretty sure he might not mind being contacted by other women or doulas outside Liverpool. He works with my Doula fairly frequently. I'll ask him shall I? He has some interesting ideas and if everything is OK and I end up with MLU he could be a useful point of contact for people across the country.

That would very handy and hugely interesting. Ta