Trying to accept the prospect of a c-section

Hi Ladies

A few weeks ago I had my first OB appointment, and the OB told me that if I was having ID twins, I had no choice and would be having a c-section, end of discussion, and chances are that I should do that anyway because it will just be easier on everyone. He said there may be a chance they will try to come out at the same time, or they could be tangled in cords, but surely a quick scan would be able to determine that at the time?

I'm terrified of hospitals. I hate them. They're freakishly sterile (like there's neat and clean, and then there's hospitals), and full of sick people, and dying people, and god knows what else. Its just creepy. I have come to terms with the fact that it is probably best for my babies that they be born in a hospital, and so I have managed to make my peace with that, but I managed to do that by convincing myself it would be on my terms, and I would deliver them how I wanted. Now I've been told I may not have a choice in the matter, and I just don't know how to accept that.

I don't heal quickly, my sister was in hospital for 3 weeks after her c-section, its a family genetics thing. We take months to heal minor cuts and scrapes, its a trait that has been passed through my pop's bloodline. And then, we get scars from everything and anything. I don't want to be stuck in hospital, I don't want to have someone cut into my stomach and stitch me back up, and I certainly don't want to have to worry about VBAC issues down the line. People keep on telling me "but at least the babies will be healthy" but thats not good enough for me. I know its important but I'm sorry, my wishes and my right to decide are important too. Plenty of women have delivered healthy twins before me, the natural way, and their babies have been healthy too.

I just want the choice. I don't think its right to force a baby or babies into the world before they're ready. I'd like to at least go into labour, or experience some contractions first so I know that they're ready, and its on their terms, not because that time happens to be convenient for doctors.

What can I do? How can I start to get myself used to this possibility that I will likely have no choice in how my children are born? I know that in any birth there is the possibility of having to have an emergency caesarian, thats par for the course, but when its in the heat of the moment and its definitely necessary, the way my mind works that would be easier for me to accept. But being told I have no choice because there's a chance they might try to come out at the same time? Thats a hard pill to swallow for me.

Sorry for having such a long rant, I've just been trying to grapple with it for weeks now and the more I think about it the more angry and upset I get and I just need some advice from people who have more experience in these matters than me.

I think you always have a choice and that is the choice to be informed of both the pro's and con's on each option. If you do have to have a csection then make it yours; dont let yourself feel like you had no control.

I really dont see how its a decision that absolutely has to be made before birth day so do your research and then let the cards fall where they may. You could try a vaginal birth and end up with a csection. You could opt for the csection straight up. You could birth one twin vaginally and the other csection. Either way their coming out!

I'm so sorry you are feeling pressured into a CS. There is no reason twins must be delivered this way. In face a recent study has shown it is slightly safer for twins to be born vaginally. If you like I can dig this study out and you can take it to your next OB appointment. There are added complications with identical twins, but you are not in a situation where there can be no discussions. A CS may be easier on your OB, but caring for newborn twins is tough, and I can only imagine tougher with an abdominal wound so you have the right to make this decision for yourself.

My first advice would be to find yourself a new OB, one who will listen to your concerns and answer your questions, allowing you to make an informed choice.

Secondly, read my birth story (in my signature) of twins born vaginally without complication. Just to give you some hope. You are so right, lots of women have done this before you.

Thirdly, read some of the wonderful, positive CS stories we have in this area. A CS need not be a negative experience: in fact for many it is a wonderful experience. But if you feel your hand is being forced and your questions left unanswered then it is likely to be unnecessarily traumatic if you do decide to have a CS for any reason.

If you decide to have your twins vaginally, the chances are they will come out one at a time. One baby will be engaged in the pelvis, and this one will come first. The cords cannot get tangled if you have non identical twins each in their own sacs.

I hope this is of some help to you.

Trav
xx

Freya - Thats very true! One way or another they will come! PS- Are you and DH still Townsville bound?

Traveller - That would be great if you could dig up the article, or the title and I can have a dig around myself. I wish I could find a new OB but there are only 5 in Townsville and they are all booked up! I'm thinking of hiring a birth attendant or a doula to lend me some strength to stand up for myself. I usually don't have any problems doing that but when it comes to medical things I just turn into a doormat! I tried the link in your sig and it said 'page not found' :( We have no family for support up here either, and if I were to say we had friends I think I'd be being a little too optimistic, so I really can't afford to be out of action, especially since DH is army and who knows if they'll actually make good on his leave or not.

sorry I have fixed my sig now, thanks Fleur for pointing it out to me :D

At this stage most definitely, I'll be up there by May. And if you want some back up on your decisions at your last few appts Im more than happy to help! Just get enough research together to prove the validity of vaginal birthing multiples, cant deny facts ;)

And here is the research I was talking about http://www.medscape.com/viewarticle/737470?src=nl_topic

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NEW YORK (Reuters Health) Feb 15 - Twins tend to do better if born vaginally rather than by cesarean section, researchers report in a February 4th online paper in BJOG. But regardless of delivery mode, the first-born twin is less likely to suffer complications than the twin born second.

As Dr. A. Cristina Rossi told Reuters Health by email, "My review shows that the first twin is less likely to experience adverse outcomes compared with the second co-twin. Vaginal delivery seems to be safer for the first twin than cesarean section."

Dr. Rossi of San Giacomo Hospital, Monopoli, Bari, Italy, and colleagues conducted a systematic review and meta-analysis involving 18 studies, 12 of which reported neonatal outcomes for both twins. In all studies, both twins were alive during labor and outcomes were stratified for birth order and presentation as well as planned and actual delivery mode.

More than 39,000 pairs of twins were involved.

Neonatal morbidity was lower in the first than the second twin (3.0% versus 4.6%). This was also true of mortality (0.35% versus 0.6%).

In either twin, there were no differences between vertex and non-vertex and attempted vaginal delivery versus planned cesarean section.

In the first twin, neonatal morbidity was lower after vaginal delivery than cesarean section (1.1% versus 2.1%).

When the first twin underwent vaginal delivery and the co-twin underwent cesarean section (combined delivery), morbidity was significantly higher in the co-twin (19.8%) than was the case for vaginal delivery (9%) or cesarean delivery of both newborns (7.2%).

"In the absence of more definitive data, our systematic review suggests that an attempt at vaginal delivery should be considered in twin pregnancies," say the investigators.

"With regard to the second twin, no differences are noted between cesarean section and vaginal delivery. Therefore, when the twins are both in vertex presentation, vaginal delivery can be attempted," added Dr. Rossi.

"If there is a vertex presentation of the first twin and nonvertex presentation of the second, women should be advised that trial of labor may be a safe option in the absence of risk factors for combined delivery."

"However, predicting combined delivery in the antenatal period can be very difficult," she concluded.

BJOG. Posted online February 4, 2011. Abstract

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:hug: I don't much like the sound of your ob. Is there any chance you can find a new one?

What is your local public hospital like? That is probably your best option for a VB rather than a private OB.

Freya - Yay! When you get here and you're all settled we'll have to have a catchup! Its a very easy town to figure out if you haven't been here before. It would be great to have a female friend around for support :)

Trav - Thanks! I'll take the article with me to our next appointment :)

Onyx - All booked up here :( There are only 5 choices in Townsville.

Fiona - I have heard good and bad things about the public hospital, but admittedly most of them have been bad. I have top level private health insurance, so I figure I pay good money for it and might as well make use of it and deliver in the private hospital.

I'm so sorry that you are being forced into doing something you don't want to do. Keep insisting that you want to deliver vaginally UNLESS there is a medical reason why you can't. If your OB has any respect for you then they will listen to your wishes.

BTW i too HATE hospitals its why i was out of hospital the day after DD was born.

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Fiona - I have heard good and bad things about the public hospital, but admittedly most of them have been bad. I have top level private health insurance, so I figure I pay good money for it and might as well make use of it and deliver in the private hospital.

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I completely understand your feelings on this. However is it worth having a nicer room if you are bullied throughout your pregnancy by this OB and pressured into a CS you don't want? Have a look round the public hospital, and speak to some of the staff there. You might be pleasantly surprised. I know that even with private health insurance, given the choice I would give birth at my local hospital any day of the week. Just don't discount the prospect of birth there before you have seen it for yourself.

What about hiring an independent midwife? You can still book into the hospital, but the midwife does all the pre and post natal care and assists at the birth...it might also be great in case you do have a csection because then you can be assured it's absolutely necessary and not for the convenience of your ob.

Good luck! Your body was made to birth. Don't let anyone bully you out of the experience you desire.

I'm so sorry you are feeling like this - but I go to the same OB as you, and I can tell you it's unlikely that he will change his mind on this. And like you said, the other Obs are all well and truly booked by now.

If you feel this strongly about it, make an appt at the PUblic hospital, and talk to them about what options they are williing to offer? Unfortunately, to my knowledge, here in Townsville it's pretty much standard to deliver identical twins by C-section. I'm quite happy to be corrected if anyone knows about anyone who has done it though! :)

There is nothing to say you can't have an appt at the public hospital, and if you don't like what they say either, and would rather go with the private Ob and private hospital that you can't go back to him. I had an appt at the public hospital at around 24 weeks last time because I was frustrated with the way the private Ob was talking to me (or not talking to me, about things i wanted to discuss) BUT in the end, I didn't cancel the private ob and I'm so gld I didn't. I ended up spending a week in the private hospital, in my own room - which would likely NOT have happened at the public hospital.

Either way, hope you get some peace about the decisions to be made. :)

Yeah I got that impression from the way he said it :(

I may have to forcefully remind him that if the decisions I'm making are informed - and they are, I've been trawling medical journals for weeks now, reading and making notes and summaries, then he has to stick to what I want. I'm starting on the legal journals this week just to add weight to my point. I have a knack for making threats without being at all threatening so I think I might have to put it to use.

I don't think he realises that I'm an unemployed academic with nothing better to do and access to copious amounts of tertiary resources! Someones in for a nasty surprise come Friday... :P

FWIW - I think his reaction is going to by something along the lines of "my way, or the highway...". Which isn't fair, or reasonable, and I don't know if he actually can say that or not. But, good luck anyway hun! :)

Have you considered a home birth at all? It sounds like it might be the only way you are going to birth these twins vaginally. And don't forget that all his scaremongering is based on your babies being identical twins. Unless there are issues with Twin to twin transfusion syndrome in the event that they are identical, then there is really no medical reason at this stage for you to even consider a surgical birth. Good luck with your decision - it sounds like you are really informed on this matter and I reckon you should stick it to your Ob, because afterall, he is being employed by you to perform a service, and if that service isn't up to scratch then you find another option. We don't put up with treatment like this from any other people we pay for a service, so we shouldn't have to put up with it when it comes to how we birth.

My best gf safely birthed identical twin girls vaginally 8 years ago. It doesn't sound like he's the right care provider for you with his attitude anyway - regardless of how your birth proceeds! I would check all alternatives, other obs, the public hospital and homebirth private midwives. This is your birth and you have the right to explore all options until you feel equipped to decide. GL!

sorry you are going through this hun....

there is the problems with mo-mo twins (i presume yours are if they are identical??) are they in the same sac? shared placenta?
your embryo split??
maybe this is what your OB is worried about.....OB may be concerned about the following...
cord entaglement/compression
cord prolapse after first bub is born
ttts
peak more with your OB hunni...i know it's not what you wanted to hear BUT this may be why he is recommending a caesar earlier

So I'm going back this afternoon to the OB, and I'm going to make him sit there and answer my questions whether he feels like it or not. I don't feel like being left in the dark, and I'm the one paying him so he will sit there and do his damn job even if it kills him.

He said they may try to come out at the same time, or they may get tangled in their cords, but he even said that its a pretty slim chance and entanglement can probably be determined on the day with a quick scan. He also said that due to my family history and DH's family history, there is also a very high chance they are not identical and we just couldn't pick that up on the scan at the time. There are twins and triplets in both sides of my family, and twins in both sides of DH's, so there is a chance that it could go either way. We will probably get a better picture of how things are today since I was only 8 weeks last time I was there, and now I'm 12 going on 13.

Sarah - I think Sam is going to be in for a very rude awakening today since I'm in a particularly foul mood lol I know he's a need to know basis kind of guy but...I'm a need to know everything regardless kind of girl! If I have to ring him at 2am when I can't sleep because I'm wondering about something, I will!

Trillian - We don't really have a room in our house big enough! Most of the bedrooms only fit the bed in them plus a side table if that. Its tiny. Plus I really don't like the house, it has bad vibes for me. I don't know if its because of where it is, or the fact that our fence is so ridiculously low we are constantly on show, but DHA keep insisting they can't give us a new one, despite all the things wrong with it and how unsuitable its going to be for kids :rolleyes:

sounds like a good plan, the first thing should be determining how many placentas and amniotic sacs you have, because that changes a lot of the management of the pregnancy and birth. Good luck and let us know how you get on :)

I will! I'm actually a little scared that he might have missed a heartbeat and theres 3 in there - eep! I didn't know about the triplets until last week and I had my mother send me the family biography and there are a few sets in there from back a couple of generations. I immediately emailed all my female cousins to circulate that memo!

I'm getting all nervous waiting for it, this is why I normally do things in the morning but DH couldn't get morning time off work :(

I was terrified the 2nd scan would reveal 3 too :lol:

So good news is there is still only 2 of them! The bad news is both hospitals in town will only deliver ID twins by Caesarian due to hospital policy and capability in the event of an emergency. So unless I want to fly to Brisbane I don't have a choice - and even then because they are very active babies hospitals there may still refuse. He did seem much more interested in answering my questions today though, possibly thanks to the woman who had the appointment before mine who is expecting triplets! I'm fairly sure she yelled at him for not answering her questions, there was definitely raised voices, so I think she softened him up for us!

I did get him to agree that I would not be delivering until I had experienced labour pains unless there was an issue with the babies. I told him even if I have to be on bed rest getting into the last month or two, I don't want to bring them into the world unless they are ready, or it is absolutely medically necessary i.e, life threatening for the babies. I don't care how big I am, if its not threatening my life or theirs, then we will be waiting. He agreed to that, and I wrote it down and had him sign it. I think he could tell I wasn't going to back down on it, and next time I will take a printed copy for us all to sign, me, him, and DH, that way there will be no confusion, and no re-negging. So at least I know my babies will be entering the world on their terms.

As for the crippling fear of hospitals, I informed him that I suffer from anxiety, so I need to be out of the hospital ASAP. He said since I have been prescribed medication for my anxiety, they can't ignore that, and if it does prove to be too great an issue they would be able to get me home in a couple of days and organise for home-care since my health insurance covers me for such a service. He said a general surgeon may be able to give me something to help the healing process along if it does prove to be taking too long as well.

So I'm feeling a little better now, I'll still call the public hospital just to confirm they won't deliver vaginally either, just to be sure he's not pulling a fast one on me.

They are EXTREMELY active babies - they were jumping all over each other and we even saw them high 5! One also seems to be big on howling or something because it kept opening and closing its mouth like it was sucking and blowing out. The other one just kept mooning us and hitting his/her sibling!

so are the twins definitely identical?

Yep. Same gestational sac. They were wrestling each other and everything!

aw how cute! I can understand why they are concerned, with the twins sharing a sac and (I presume) a placenta there is a greater risk. You can still refuse a CS, and if you are in labour they cannot refuse to treat you, but the risks of the cords getting tangled is very real. I'm glad you got some answers though :D Are you having regular scans now?

Yeah, and really my major concern was bringing them into the world before they're ready, and if he's willing to let me go into labour then prep me for surgery, I think thats a pretty fair compromise. I go see him again in another month but he said if I go to the hospital they will give me a scan/listen for a heartbeat at any time. Its basically because he is really busy this month, and he said after 16 weeks we will scan fortnightly, but he'll just give me a referral to QXray rather than have me come to him every time since I explained that fortnightly visits aren't really in our budget.

that sounds like a really good compromise, a lot of OB's would have refused to agree to that. Well done you for fighting your corner :D

Yeah I'm pretty happy with it, obviously I would be happier if I got my way completely but still its the best I'll get. So far I haven't had any problems at all so he thinks there is a good chance I will carry until at least 37 weeks, and maybe even to term since I have agreed to bed rest towards the end - which really I would have had to do anyway because I have a terrible back!

the last few weeks of a twin pregnancy can be pretty uncomfortable, I was in a lot of pain but managed to get to 38 weeks which was great. It's all so worth it though.

Yeah I'm expecting the pain to be bad. I fractured my back when I was 12, and I still get quite bad pain as a result so I can only imagine how bad it will be by trimester 3! But because of that I have a pretty high tolerance for pain, so far nothing I've experienced has hurt much more, accept for getting stitches in the roof of my mouth sans anaesthetic. That was pain! Plus I got a really good wheatie and some natural Chinese medical oils for pain, so fingers crossed I will get through!

I just wanted to jump in to let you know that I am having a repeat c/s for my DC/DA twins, mainly because I had a c/s with DD and my Ob doesn't want to risk the chance of my uterus rupturing and I live in Regional Vic and if there were any complications during a v/b we are too far from Melbourne.

My only advise is to make sure that as you are having identicals that they are closely monitored for TTTS as this could mean early delivery. As my boys are in there own sac's with there own placenta's I don't have to worry about TTTS although at my Ob appt on Thursday my OB arranged for me to have steriod injections to help develop the babies lungs as he thinks they will be here sooner rather than later. Definately have your ideas and plans in place but the one thing with multiples is that even the best laid plans can fly out the window.

Good luck and I hope you have a smooth pregnancy.