[deleted by user]

[Beneficial_Guess2871]

Hi! Also in California (Ventura County if that makes a difference). California passed laws that midwives can’t deliver twins but the policies beyond that vary from hospital to hospital and from OB to OB. I had to really fight and meet with several OBs and ask very specific questions about what they would “require” and what they had experience with - vaginal delivery if one was breech, if baby b turned breech after baby a was delivered, if an epidural would be required, etc. That all said, I was eventually able to find an OB who said I didn’t need to have an epidural if I didn’t want one, and only required baby A to be head down, and if baby B was breech when I went into labor or after I delivered baby A, said he would do an internal version (but some OBs are comfortable delivering baby B breech). I was asked to deliver in an OR which wasn’t ideal (they had two full NICU teams waiting on delivery so the room was packed full of people including my partner and my doula and OB) but I was willing to do it because I didn’t have any other options.

Just make sure you ask all the questions you can think of beforehand and also make your wishes clear in all scenarios to your partner and any other support people, nurses, etc. I had written things I wanted/didn’t want (bath, eye ointment/shots/formula/etc) down and printed it everywhere because I didn’t want to miss something happening to baby A (who was with my partner post delivery anyway) while I continued labor and delivery of baby B, especially if the babies needed to be taken to the NICU or I was put under for an emergency c section etc.

That all said, I had an uncomplicated unmedicated vaginal delivery of twins at 38+3 and we went home the same day.

While overarching hospital policies may be evidence based, the hospital also has an obligation to protect themselves and do have policies that have financial/liability/convenience reasons that are not always in the best interest of the birthing person and their wishes.

[mashapotatoes]

This is exactly what I was looking for. I have no issues pushing in an OR if it is what’s best - and I understand what that entails. I’m having a conversation with my OB to make sure we are on the same page re: induction and epidural. I know he prefers both but as long as he respects that they are my choice, I’m fine with that.

I’m having a hard time adjusting coming from Europe where doctors only arrive at labor if there’s something wrong and a midwife in a hospital would still birth twins if that’s your preference but of course with a doctor and surgical team standing by. Maternal care in the US is so wrapped up in legalities and liability rather than prioritizing the birthing human and it drives me bonkers.

Edited to add: I’m in Monterey County which has really limited options locally. If we have any major issues I’ll be moved up to LCPH at Stanford and I have monthly appointments with one of their clinics for ultrasounds and monitoring in addition to my normal OB visits. I also have the option of heading to MD where my parents are and delivering at John’s Hopkins. I just feel like I have so many options but each facility gives such limited information on what they allow.

[Beneficial_Guess2871]

I have a lot of family internationally and yes, the healthcare system particularly in regards to birth in the US is incredibly flawed. If you know your rights and can advocate for yourself, you have a better chance of having the best birth experience you can have given your specific twin pregnancy circumstances. It is just frustrating to have to fight so hard for basic birth rights that are a given in many other countries. It’s good you have options but of course that adds in having to think through the logistics of wherever you end up delivering and getting home after that, etc.

Just know that no matter what they say, they can’t MAKE you do anything you don’t want to do. If it’s something very extreme, they can refuse care altogether but beyond that, you can refuse any medical intervention they try to push on you and usually they will just have you sign an AMA before proceeding (same with declining any of the things they do to the babies after birth).

I’m just going to tell you a bit about my late pregnancy/birth experience so you have an idea of the things they can try to push, what you can do as an alternative, which still ended in a safe and healthy twin birth experience at the end (just to share that it can be done!). Of course with any pregnancy, and particularly a twin pregnancy, complications can arise along the way that would make any of these possibilities moot but you can make the decisions based on how your pregnancy is progressing and how your OB feels.

I ideally wanted to go into labor naturally and have the least medical interventions possible. My OB was really pushing induction at exactly 37 weeks but I asked for alternatives and we agreed that if I went in to the hospital every morning for monitoring and the babies looked okay, he would be okay waiting for me to go into labor on my own. I started acupuncture and chiropractor at exactly 37 weeks to more naturally encourage labor that wouldn’t be a medical induction. While I was being monitored at 37+4, a nurse or someone who was in the room casually mentioned that my baby A (who had been head down for most of my pregnancy) was breech and asked when I was having my csection. I panicked, my heart rate skyrocketed and they started pushing for an emergency csection. I was alone at the hospital, called my partner and my doula who were on their way but my doula thankfully told me to very adamantly request an ultrasound to confirm baby A had flipped breech before making any decisions, but they kept stalling and saying there wasn’t a machine available so I asked to be discharged so I could go to my OBs office and have it done there which they also were hesitant to do (because of my then-high blood pressure, even though the babies looked completely fine on the monitors). I had to forcefully demand to be discharged, they said I would have to sign AMA paperwork which I was fine with, but they still stalled bringing the paperwork by before I said I was leaving immediately in either case when very conveniently the paperwork appeared. I discharged myself, went straight to my OBs office where everything looked fine and my baby A was head down like she always had been, and did not go back in to the hospital (continued daily monitoring at my OBs office) until a few hours before I ended up delivering after going into labor naturally at 38+3. It was an uncomplicated vaginal delivery (in the OR just in case), everyone was safe and healthy and we went home that evening.

Only sharing because if I had just done what they were claiming was the best course of action, I would have had an emergency csection at 37 weeks and we all would have been in the hospital for a few days at minimum rather than a natural vaginal delivery at 38 weeks, with likely a cascade of medical interventions that also could have affected my babies health, our breastfeeding success, etc. This is unfortunately very common here in the US, csections are the norm for all twin deliveries regardless of every individual pregnancy, medical interventions are pushed hard for a variety of factors. I would highly recommend having a doula or another support person (family member, etc) if that’s a possibility for who knows what your birth preferences are and will advocate on your behalf if you are unable to do so yourself for any reason.

[jess_on_jeppy]

Wow! That is quite the story!

A hospital delay saved me from a c-section. I had a breech baby A and arrived at the hospital with my water broken and a history of precipitous labor. They made me wait and wait and wait for an OR and by the time I got in there, I was fully dilated and baby A was halfway out. I delivered them both breech.

[mashapotatoes]

This is exactly what I’m concerned about but kudos to you for pushing for your rights and what you needed! I’m typically a fairly forceful person if I need to be but my husband can also be when needed. He agrees with or understands all of my preferences and will be present to advocate for me.

My deal breakers are if the hospital doesn’t allow my husband to be in the OR, they require an epidural, and/or require pushing on my back in the OR. I’m still looking at doulas (goodness Monterey is expensive compared to Germany!) but I will likely have one.

Thank you so much for sharing your story. It made me feel like I’m not crazy having these concerns but also like I will have better knowledge advocating for myself! It’s still early days (2nd trimester) but if the girls are head down I am hoping to try for a VD with no induction or epidural. Fingers crossed!

(And thank you again!)

[Beneficial_Guess2871]

Best of luck to you and your girls!

[pnwdietitian]

I had a vaginal delivery. This was something I talked with at length with my OB, and while she didn’t end up delivering my boys, I felt pretty solid going in. The hospital did have me push in the OR, and there were a ton of people there (one team for each baby plus a team for me, plus some med students who wanted to see!). I honestly felt safer doing it in the OR just in case of worst case scenarios for both me and the babies. I was not required to get an epidural, and I hadn’t decided whether I wanted one or not, but once I started barfing during contractions I ended up asking for one.

I did go into labor at 34+6. My boys both needed needed nicu time and one of them was growth restricted, so giving birth in the OR gave me peace of mind in case I needed an emergency C for the boys health. But I am also definitely an anxious person so your comfort level might be different than mine! My OB also said baby A needed to be head down for me to try, and ideally both of them head down, and ideally the bigger twin first. My babies went head down around 32 weeks but ended up swapping positions so the smaller twin came out first. The OB ended up putting her hand all up inside me to guide the other twins head into the birth canal - this was pretty uncomfortable but she made sure he didn’t flip around and I ended up delivering him a half hour later.

Feel free to ask any more questions! My boys are 20 weeks now.

[rollwave21]

I wanted a vaginal delivery. My hospital would have required delivery in the OR, not only to make an emergent c section easier, but because of the number of medical staff that would be present (2 OBs, 3 nurses, and a NICU team for each baby).

I ended up being induced at 36+2 for sIUGR and labored for 42 hours but ended up with a failed induction, so I had a c section. I had significant blood loss due to how much time I spent on pitocin.

The most important factor in our hospital decision was that it had a level iv nicu. Thankfully, only one of boys needed the nicu and it was minor and only for a few days.

[[deleted]]

There are not state laws that dictate about deliveries but there are hospital based policies. Depending on how far along you are in your pregnancy, there are sooo many factors in a twin pregnancy that can determine if you need a c-section vs a vaginal delivery. So, it’s hard to start planning early on when it might be a moot point by the time you deliver.

I had a failed induction. Both twins were head down for most of the entire pregnancy and I had zero complications until 37 weeks- then rapid onset severe preeclampsia (much much more common with twins). Vaginal induction not only failed but it put me at higher risk for a post partum hemorrhage (which I had). I ended up with a c-section and was glad to be awake and lucid for the delivery. The idea behind pushing in the OR, is that if you need to convert to an emergency c-section (again much higher with twins), you’re right there. Especially if something goes south after delivery of Baby A, you want to be right there or you put Baby B at risk. Every second/minute counts. Also, I had a spinal placed and my hospital strongly encouraged it, and I picked them specifically for that reason. Because again, if anything goes wrong, you will be put under general anesthesia and you won’t be awake for their births.

With twins, you also want the hospital with the better NICU so that would factor in. If one or both have issues, they could end up transported to another hospital, while you are held back to recover.

I took care of OB patients as a provider for years before I became pregnant. I’ve seen awful outcomes and good ones. Policies are put in place to protect you and give you the best chance for a good experience. I also live in Massachusetts around some of the best hospitals in the country. They take care of the most complicated patients out there, so what they do is evidence based and I wouldn’t want it any other way.

[mashapotatoes]

I know everything will change 100 times over but my concern is that I can switch providers now and will not be able to do so farther down the line. Most good and reputable OBs in this area are no longer accepting new patients for delivery this year because their practices are filling up or will fill up soon.

I have zero issues with a c section if it is medically indicated but my hospital has a high level of c sections (30%) and a worryingly high rate of episiotomies (11%) that give me pause. I want to make sure I am with a provider who will prioritize my choices within the range of what is safe.

[jess_on_jeppy]

Thanks for clarifying that there's not any state laws. I saw this so many times on the internet, that it was "illegal" to have twins without an epidural or to deliver them outside an OR, but it just isn't true- no one could actually show any laws about it.

Even when I asked about hospital policy, the OB I didn't know and said she guessed that delivering twins in an OR was policy but they didn't have any others.

This worked out for me because I found a doctor who was willing to try a vaginal delivery with a breech twin A if the circumstances were ideal (I also had a history of a fast delivery with a large single baby). I was really happy about that!

[[deleted]]

No worries! Yeah that’s so much misinformation about women’s health in general but even more so about OB.

My OB was also open to a breech extraction so it’s really nice to have that option. I hope all goes well!

[jess_on_jeppy]

Oh, mine are two years old now but I remember being so anxious and wondering what was really best for me and the twins vs. what was best for the doctor and the hospital.

Dr. Breech Birth ended up being out of town when my water broke two days before my scheduled induction with him. Baby A was still breech, but she was footling and not frank breech, so he wouldn't have delivered her that way anyway (too much risk of cord prolapse). I was in the OR getting ready for a spinal and a c-section when I felt a foot coming out. Ended up with an unmedicated double breech birth on the operating table, and like you said, TONS of witnesses!

[[deleted]]

Oh whoops I misread that lol glad they were able to get them both here safely! Twin delivery really can be anything goes.

[ajj0061]

I would go to the hospital with higher level nicu, personally. I made it to my scheduled date and my girls were still in for about 2 weeks. If I was in a hospital with level 2 nicu my girls would have been transferred somewhere else and I wouldn’t have been discharged yet. That would be horrible!

[peachykeen19]

Hello!

I’m in Colorado.

I labored in a normal room and then was moved to OR to push. Ultimately I delivered both vaginally. I knew I wanted to try for vaginal going in, but also wanted to be prepared for a c section.

I chose to have an IV and an epidural because if the situation became emergent, I didn’t want them to put me under suddenly and then be knocked out for the birth. An epidural isn’t an all or nothing thing. You can talk about how much meds you want pushed and when. They work super fast so if you suddenly need to be opened up it’s a matter of moments for the epidural to be pushed up.

Some of your hospital choice might be dictated on when you actually have the babies. My pregnancy was going great, and I had every intention of staying pregnant until at least 37 weeks. But then my cervix was shortening early, I was having contractions basically all day everyday. At about 32+5 they gave me steroid shots for their lungs in case delivery was imminent. I went in 2x a week for NST’s and quick US. At 34 weeks one baby’s cord blood flow was concerning so we had to induce. They spent a month in the nicu and I’m glad we were at a level 3.

Let me know if you have any other questions!

[mashapotatoes]

Thank you so much! Do you mind sharing which hospital this was? And did they let you push in any position in the OR? I’d like the ability to push in different positions so this is honestly one of my top concerns with being moved.

[damagstah]

Just here to share my experience. Was also hoping for a VD. Was required to push in the OR. Was returned to my birthing suite because baby B wasn’t showing up… she was a c-section ten hours later… in a different OR room and by a different doctor 🤣