Saturday, June 26, 2010

Making The Choice About Delivery Methods

I helped facilitate an Expectant Parents group the other night and there was a young mother, pregnant with identical boys, who had been told by her OB that she (the doctor) was uncomfortable delivering the babies vaginally. No discussion, this mother-to-be was just told that she would not be given the choice. I really felt for her. The choice of how you want to give birth can be complex, confusing and very, very intimate. There is so much that goes into this decision that for someone to simply take that choice away from you without considering what it might mean to you is cruel.

This particular mother has identical twins who are sharing a single sac, which may be why her doctor isn't comfortable with trying. From

"Certain situations that might affect your twin birth planning can include whether or not your twins share a sac or are at risk for TTTS [Twin-to-Twin Transfusion Syndrome]. Twins who share a sac (monoamniotic twins) are at significantly higher risk for cord entanglement, cord compression, TTTS, and preterm birth; they will require additional monitoring throughout the pregnancy and most experts recommend a scheduled cesarean for this kind of birth. Monoamniotic twins are extremely rare; however, even the most naturally-minded mothers expecting twins support having at least one ultrasound to determine the number of amniotic sacs and placentas. Identical ("monozygotic," or MZ) twins can be at risk for twin-to-twin transfusion syndrome (TTTS), a situation in which the flow of blood to the babies becomes (for lack of a better description) rewired, causing one twin (the donor twin) to not get enough, and the other twin (the recipient) to get too much. Twins at risk for TTTS should be monitored throughout the pregnancy; if it is determined that the pregnancy has become too risky for the babies, an induction or Cesarean may be encouraged. It is important to note that there have been acute cases of TTTS that present during labor itself; ask your provider about this risk."
I wasn't one of those women who dreamed about having babies or who was adamant about a natural childbirth. I, briefly, considered a water birth because I had always loved the idea of the baby leaving the warm, watery environment of the womb only to arrive into the warm, dimly lit, watery welcome of a bath, as opposed to the cold, brightly lit stark environment in a hospital. Once I learned we were having twins (that's me to the left there, 9 months pregnant), I let the scary stories of possible complications scare me away from this idea. But I was adamant I wanted to have (or at least try my hardest to have) a vaginal delivery.
There were a number of reasons for this; on a practical level, I knew that the recovery from a c-section was so much more difficult and the stay in the hospital was more than twice as long. On a medical level, I knew that the act of being pushed through the birth canal was extremely good for a newborn's breathing and lung capacity. And on a spiritual level, there was something that spoke to me about allowing my children to successfully push their way through "adversity"; I didn't want to take that away from them. My greatest fear in attempting this was that I would end up with one baby born vaginally and the other via c-section. Thankfully, my OB was very familiar with birthing twins, had thoughtful and respectful answers for all of my concerns and, even when our daughter took an hour and ten minutes to emerge after our son was born, never once gave up on my body to be able to give birth naturally. Thank you, Dr. Suzanne Gilberg-Lenz.

I was thinking about all of this as today there was an article in the Los Angeles Times about some recent scientific studies that suggest that cesarean births may expose newborns to specific bacteria that could play a role in their future health. 
"The finding is significant, scientists said, because the types of bacteria residing on newborns influence the development of their digestive and immune systems and may affect their health later....previous studies had suggested that babies delivered by caesarean section lacked the benefit of protective vaginal bacteria, making them more susceptible to certain pathogens, allergies and asthma..."
You can read the entire article here.

Sometimes with a twin birth you just don't have a choice as to whether you will have a c-section or not. There is so much less room inside your body when you have two babies; even when baby A is head down, it is very common for baby B to be breech or transverse. We were lucky that our fraternal twins were both head down, but there are many qualified OBs who will attempt a vaginal birth regardless. The Berlin Wellness Group, where I do my coaching sessions, is a big supporter of mothers wishing to attempt a VBAC (Vaginal Birth After Cesarean) and it's chief chiropractor, Dr. Elliot Berlin, along with his team, are well-known in LA for success in turning breech babies in utero. 

All this being said, don't let your wish to have a vaginal birth cloud your judgment; your "birth plan" is less important than making sure both mother and babies are healthy and survive the birth. It is important to discuss your wishes and concerns as early on as you can. If your doctor isn't on the same page as you or your partner, speak up and change doctors if you feel you need to. Just remember, your babies are really the ones with the plan; you ultimately will have to follow their lead.

What about you? Did your babies' birth go as you had hoped or planned? What was your experience, emotionally and physically, if you did have a cesarean? If you had a choice, what factors went into deciding? I'd love to know your thoughts on the topic.

Thanks for reading!
The Twin Coach

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