pregnant with twins!... is it possible to have a VBAC???

Hey guys,

I just found out that I'm pregnant with twins!!! oh it was a little shock lol....

I had a C-section the first time around beacuse my son ended up having his embilical cord around his shoulder.....

I really wanted to try a VBAC with the second one.... but now...with twins... i fear im doomed to having another c-section......

has any one had a VBAC with twins?????? or am i pretty much doomed to having a c-section.......

Sorry nit much help but GL

I haven't, myself, but I've heard of women that had twin/triplet home VBACs, so it can be done! Good luck and welcome to bellybelly :hug:

Oh, and congratulations on your twins! :happyforyou:

provided everything is OK and you have the right support people I can't see why not (I just watched a you tube video of a homebirth VBAC with twins earlier today!)

Hi and welcome to BB

Congratulations on your twin pregnancy, i wish you all the best.

My Aunty birthed her twins vaginally but they were her first so she didnt have any descision like your faced with.

I have watched one VBAC with twins this afternoon.... but after talking to my doctor he thinks the hospital will not allow me to have one.... :( ...... do hospitals allow trial by scar???? even if it's twins???

Thanks for the kind support and well wishes....... feeling a little depressed at the moment because i really really wanted a natural birth this time around :(

Have you considered getting a second opinion?
You could try speaking to an Independent Midwife for their opinion. (If you are in Victoria I can recommend some otherwise visit the Maternity coalition website for some names)

I just had a VBAC at home with the support of an IM, I didn't want to face any opposition at a hospital in trying to have a vaginal birth. In this way I know how you feel, although in your situation it is doubly opposed due to the twins. I am not sure of what chance you have of having a VBAC with twins but I honestly cannot see a problem with it if there are no other complications in the pregnancy. If you speak with an IM they can give you their professional opinion - An IM can support you with a home birth or be with you in hospital to be your advocate. Either way, this may be the sort of info you are looking for.

I am so sorry to hear that you are feeling depressed about the possibility of your birth choices being taken away (Forgive me if I have read between the lines incorrectly). It really is not fair. I hope you can get more answers so that you can make a definitive decision either way.

Oh, and congratulations on the conception of TWINS! Woo Hoo.

Hi Miss Mustang,

Yes it can be done, not sure about the situation of you having already had a C-section, but I had mine naturally. My GF wanted to have hers naturally and her doc said no, then she fighted for it and he was on leave when she ended up having them and the other doc agreed to let her have them that way and they were fine. Naturally if there's no complications, I think it comes down to th docs insurance! So if you want to have them naturally fight for it, and yes docs will say no, but at the end of the day their saying it for their sake not yours! Like any birth there can be things that might go wrong but really my 2nd twin was breach, and was delivered breach and was fine as was my mothers twins! So don't get down about it, just as previous girls have said plan it that way from the start and don't back down, even switch docs if you need too, because it can be done and is perfectly safe, it's just the same as any other birth, they just like to scare you into C-sections!

In the hospital system you've got next to diddly squat chance. You'd be best investigating your options with an independent midwife, of which there are a few who would assist with twins but not many anymore. Not due to safety but skills - the medical model is pretty much wiping out every other option.

Hello

congratulations on your pregnancy. A VBAC with twins is, as the other posters have said, very possible. However you are likely to face considerable opposition from your OB when arranging it. At your next appointment try asking your OB why he is initially saying no, and be prepared to compromise to have a VBAC (for example, if you agree to constant monitoring the doc will possibly be more optimistic about helping you, equally if you agree to go into hospital from first contraction. What you actually do in labour is of course up to you and you alone but in the weeks beforehand an agreement to be closely monitored will help your case).

The alternative is to homebirth with an IM who may be more receptive to your birth plan.

Good luck, twins are just the best

T
xx

Thanks guys for your support.....

it just got me down because i was really really wanting natural.... my first time around was so scarey and scaring that i sore to myself i didnt want anymore children...lol.....

I'm scared about home birth...what if something goes horribly wrong......

I guess all i can do is ask the hospital at my next vist going to the Mater in South Brisbane...... fingers crossed there may be someone there to let me try vaginal......but seriously think at the moment the answer will be no.....

its just so conflicting.... on one hand i want natural then on the other i just want healthy safe babies.....

is there anyone in QLD that is in the same situation as me that has had VBAC with twins??

plus i have to go public this time.... which also makes me think the answer will be a no....

I've supported a woman to give birth in hospital - VBAC twins - on her terms. Successful, no dramas on the day with staff support.

I would ask. Be ready for all their excuses with answers pro vbac.
Have your research memorised, print out anything you think will help your case & push as hard as you can.
You may not have much chance, but its worth the try. Maybe even a birth centre if possible?
Good luck & congrats on your twins :D

It sounds well possible, but I think you might have to be prepared to fight for it and research alot so you are armed with info!

BB is a great place for that - GL!

:

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plus i have to go public this time.... which also makes me think the answer will be a no....

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Hiya,

I have read through the post and I'm sorry you're having a hard time. If you are not comfortable with HB then that's okay, it's not for everyone, although you also have to accept that in excluding that option you are giving up your best chance of a successful vbac birth.

Your comment above is interesting and makes me think I should point out something very important...

In the private system if you don't follow their policies and procedures you will be transferred or refused care HOWEVER, in the public system you can assert what you want and still receive care, if your public hospital is small they may cite inability to deal with emergencies as a reason to transfer you to a larger tertiary hospital (however, this would be at their cost, ie ambulance, if you arrive in labour) if they are a large hospital then there is no reason legally for them to tranafer you and whatever care you refuse has to be accepted by staff, they can threaten you but they CANNOT do anything without your consent.

If you intend to take this hardline approach then I suggest writing your wishes down as evidence and giving copies to the staff when you arrive in labour. Statements such as "I do not consent to a cs due to being a twin vbac" should be included and anything and everything else you can think of.

It is not nice to have to do this, but, this is exactly what I did for my vba2c, it was completely worth it althought the most stressful part of my labour.

Sarah :D

Hey Sarah,

Thanks for your relpy.

I have my first appointment with the Mater Mothers next month and while im going public there they have been known for supporting VBACs.... not sure how supportive they are with twin VBACs but i guess i will just have to find out.....lol I have done a fair bit of research so I will be taking that in with me..... to push if the babies are all in the right position than i shouldn't be refused a VBAC.

I am a little too scared of trying a home birth....... too frighten what is something goes horribly wrong.... i think if that might happen i would rather be in a hospital where i know they can treat me asap if i need it....

I am actually meeting with Liz Leys this arvo..... to interveiw for my doula.... so fingers crossed...im sure she is lovely...she comes well recomended and sounded lovely on the phone.....

so hopefully this time around i will get my natural birth i have always wanted... even though it seems the odds are against me.....

For Release: July 21, 2010
Ob-Gyns Issue Less Restrictive VBAC Guidelines

Washington, DC -- Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.

The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in 1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to 28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC) as well as decisions by patients when presented with the risks and benefits.

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

VBAC Counseling on Benefits and Risks

"In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).

Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.

Uterine Rupture

The risk of uterine rupture during a TOLAC is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available.

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."

Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added.

The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.

Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August 2010 issue of Obstetrics & Gynecology.

wow Thanks melbell for the info....

Very useful and incitive!...... Had my first appointment with the Mater and the student midwife was quite supportive of a VBAC with my twins, however her superior midwife didnt.... You could hear her from the hall saying..... VBAC... WITH TWINS???? she must of repeated it 4 times..... i could hear everything!..... and you know what... I dont care what they say.... I want my VBAC and I will not be forced into another c-section without good cause.....

I have an appointment this friday with a Ob at the Mater..... probably going to cop it there too.... but you know what.... Im not going to let it affect me... with information such as what you have presented, I should be offered and supported a TOL.... and I wont get into an argue with him/her... I will simply state, there are risks associated with both and I have made my informed decision that will not change, so there is no point in us sitting her debating each others side for our choices because they will not change..... all you can do is simply accept my choice for how i wish to deliver my babies and i hope that i will recieve the support i deserve based on that decision.....

If things go wrong during my labour and i require anthoer c-section so be it.... but i want to give my babies and my body the opportunity they deserve in this natural process of life.... and with my doula (liz leys) and my husband...... I believe i have a good change of accomplishing this dream!....

Thanks again for your post of information!.... if you come across more.... post it!!! I love to read it.....