Tuesday, January 27, 2009

Bad News, Good News, Bad News

I am a little disgruntled about this whole twin pregnancy thing. It isn't so much my actual twin pregnancy, which is (knock on wood) going well. My frustration is with the rules and customs of twin pregnancy and birth. I can't imagine I am the first to complain about this, but I am still feeling a little shocked about some of what is considered "normal" for twin pregnancies. I feel like I am being constantly presented with bad news that only I see as bad.

Bad news: Twin pregnancies usually go through a doctor, so no midwife for me.
Good news: I asked a lot of people for recommendations and this one doctor's name came up a bunch. Plus, she's the mother of twins.

Bad news: The scheduler who makes my 13 week ultrasound appointment at the perinatology office across town says, "Oh, twins. We'll be seeing you a lot!"
Good news: The scheduler was wrong. I have scheduled my other ultrasounds elsewhere.
Bad news: Scheduling double ultrasound appointments is a pain in the ass. You'd think the schedulers had never dealt with twin pregnancies before.

Bad news: Many doctors are not trained to (or comfortable with) breech delivery or performing a version.
Good news: My doctor is comfortable with this and willing to do it if needed.
Bad news: I have no guarantee that she'll be at the hospital when I go into labor.
Good news: She offered to be back up to the doc in the hospital, in case that person is not comfortable with breech presentation.
Bad news: If I have another fast labor, she might not be able to get to the hospital in time.

Bad news: It is accepted procedure for women delivering twins to labor in an operating room.
Good news (sort of): My doctor says that it will be "normal" with people able to talk, move around, etc.
Bad news: Generally the laboring woman is only permitted to bring in one person with her into the operating room, even if she is just laboring normally.
Good news: My doctor was very open to my doula (my pal Ellen, who, when not helping me labor, is a hospital-based midwife) and says she'll see if she can get some kind of special dispensation/special agreement deal. Ellen is also working on this through her contacts at our preferred hospital.
Bad news: Did I mention that I will be laboring in an operating room? Doesn't exactly scream warm and comfortable.

Bad news: Going back to that whole "some docs are not comfortable with breech deliveries" thing, looking for information on twin c-section rates I find less-than comforting comments like this:

The chance of a c-section increases with the number of babies . . . But many doctors are at least willing to attempt a vaginal delivery if conditions are favorable for both babies in a twin birth.
At least willing to attempt? If conditions are favorable? Strong words there, very comforting.

I have read that as many as 60% of twins are delivered by c-section. This sounds outrageous to me, and I am not over my frustration that because many doctors are not trained to deal with breech delivery, they are not comfortable exploring the options. This can push women (not just those with twins) into a c-section that could have been avoided.

I readily acknowledge that there are lots of good reasons for women to have c-sections. I know women whose labor went on for a long time and failed to progress at key stages. I know babies that were in distress who were saved by c-section. I also know that some women think a c-section is "easier" than a vaginal delivery.

I happen not to be someone who sees a section as an easy way out. The idea of spending a couple of weeks (at least) fairly well incapacitated, plus additional time to really heal - all while caring for two newborns - that sounds a lot harder than delivering vaginally. I recognize that not all women labor as I did with Ada. I had a four hour labor, start to finish, with minimal tearing and mostly just the normal healing. A few days after Ada was born, I was walking (albeit v-e-r-y slowly) around the block. I was achy but not in a recovering-from-surgery kind of way.

I have my fingers crossed that the twins will cooperate by getting their heads down as we get closer to their exit date (whenever that might be). But right now, I feel pretty nervous and unhappy about all the rules for twin delivery, all the (forgive the pun) standard operating procedures. Part of me needs to accept that this may be the way things go, and part of me needs to rail against these rules. Maybe we can bend some of them, and maybe some will hold fast. I need to push a bit so that my sadness does exhaust me.


  1. Hey. I can say FOR SURE that the recovery from c-section sucks. It's managable, and some parts of it don't suck so much (no lifting laundry baskets? Excellent!). But this is Portland, and you're delivering at a new facility, and I would think that if you argue for what you want, you may get some of it. Maybe all of it. Hang in there.

  2. Is there a way you can get prepared for the worst while still expecting the best? It is frustrating that so much is out of your control. No matter how much you plan, in the end, it's still going to go the way it goes. I realize that's very easy to say, and very hard to do.

    Deep breaths?

  3. I think it's awesome that you may be able to have your friend the midwife as your doula. I think that will help keep you sane.

    I wish I had good words of advice for you, but all I have is support and good wishes.

  4. I had really hoped for twins during my IVF, but the one part about it that I didn't like was the thought that I'd probably never get to try vaginal delivery with twins. Of course, that's all water under the bridge now.

    That's great that you've found a reasonable doctor and can get your doula in the room and everything. Maybe a tour of the OR might help with the ambiance thing; can lights be dimmed?

    If you want a vaginal delivery, you have a better chance at this I think. I don't know that many women with twins even consider it, or actively try to prevent sections.

  5. This is such a hard time because when you are waiting for it you want so hard to control the outcome- but you just can't.

    As someone with two Cs under her belt I can tell you they are not fun, but a couple of months later when you are smiling at your babies and they are smiling back it won't even be a blip in your radar.

    Healthy babies. That's all that counts.

  6. Wow I can't believe that operating room rule. That is just...suck.

    Good news: 2nd labours are faster than firsts, usually. So you might not have to be in the OR very long at all.

    I know the pre-birth anxiety (not with twins but in general) and I wish you peace coming to terms with it. And if you haven't, read "Baby Catcher" by midwife Peggy Vincent. Not twin specific but loads of positive birth stories. I read it in the weeks before both of my labours and it made me feel powerful and calm.

  7. I delivered one twin vaginally and one via C-section. The second was breech and despite 70 minutes of trying, doctors were unable to turn or deliver him without surgery. He seemed quite pissed off by all the wrangling - and fair enough!

    I've heard that since my twins were born (not because of their birth!) Canadian hospitals will not even attempt vaginal delivery of twins (same in South Africa where we now live). Seems the skills for breech delivery will soon be lost, at least among conventional practioners.

    Anyway, everyone has a story, especially Mom's of twins. I do wish you the best. Sounds like you've thought things through as best as possible.

  8. I had twins and delivered both of them vaginally at 36 weeks. They were vertex from about 28 weeks or so onward. I don't know about the laboring in the operating room, but I was in a standard L&D room until the first one crowned and they moved me to the operating room. My OB (who had delivered several sets of twins) said it was because there wasn't enough room in the standard delivery room for the two sets of medical personnel necessary for each baby. Good luck!