-----Original Message-----[Ken Ward] *From:*
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of
*Lindsay & Yvette
*Sent:* Thursday, 26 May 2005 3:26 PM
*To:* ozmidwifery@acegraphics.com.au
*Subject:* [ozmidwifery] monochorionic diamniotic twins birth in a
public hospital, hopefully vaginal.
Hello list. I've subscribed so I can submit details of my
situation for anyone who wants to respond, and so I can keep an
eye out for anything that comes up about twins births. I'm not a
midwife or anything, so I hope it's ok to do this.
I'm a public patient at Box Hill hospital in Melbourne, and
due to
have twin girls on 5th Sept, or by 38 weeks which is 22nd Aug.
They are identical, sharing a placenta but each in her own
amniotic sac. I want a vaginal birth without unnecessary
intervention provided this is safe. I'm looking for any advice,
information, studies, articles, comments etc relevant to my
situation. I'm having ultrasounds every 2 weeks, and no signs of
TTTS as yet, though their sizes have been varying. The baby girls
have been fine and are kicking and wiggling nicely.
The hospital has a 'know your midwife' thing, so I know and am
happy with the midwife who will be attending me. She was with me
for the birth of my 11 month old son at the same hospital. I'll
also have my husband and a support person with me, and hopefully
my 2 daughters, 12 & 8. My daughters were both born at home, and
all 3 of my births so far have been vaginal with no drugs or
intervention. I'm 39 and in good health, no GD, no high BP ever,
no health probs. I'm 5'6" and 75 kg at 25 weeks. I've always
gone 13 hours from the very first contraction, and the waters have
always broken 1-3 hours before the birth, with the head never
engaging until well into labour. My son turned himself from
posterior a couple of hours before birth while I was lying on my
side.
The hospital tell me I will have one of the 11 consultants
attending me, and he/she will be running it, but my midwife may
get to catch the first baby. They say I must be induced if I get
past 38 weeks, and they very much want me to have an epidural
incase of needing to reach in for the second baby. They don't
want more than 10 mins between babies. One Ob I saw said no
vaginal births are done for this type of pg, one I've seen since
then says it can be attempted if 1st one presents head down, but
65% of all twins in Melb are born by c/section. I've asked about
having the epi in with no drugs in it, but it seems it depends on
the views/wishes of whichever anaesthetist happens to be on when I
get there. If I go earlier than 32-34 weeks I get transferred to
Monash, & they've told me over the phone that I would get a
c/section for monochorionic diamniotic twins.
My impression is that changing hospitals will not increase my
chances of a vaginal birth, I'm just going to have to be very well
informed & prepared to refuse treatment if necessary. Getting
info from the hospital is extremely difficult. The Ob
appointments are 10 minutes, they just don't have time to
discuss. The midwife doesn't have the same time problems & I've
decided to just see her & have the u/s & not bother with most of
the Ob appointments as they just don't have time to talk to me.
I've written to the head of obstetrics though, requesting a proper
appointment just for the purpose of discussing the birth. I feel
it's important to get their take on things so I know what I'll be
dealing with. Also, because I have to have a consultant present,
I want to arrive at the hospital early so I know who I'm dealing
with and have time to discuss with them while I'm not in strong
contractions.
AMBA don't seem to have any birth info, but I've been to one of
their ante natal nights anyway just to start meeting people. I've
been reading all the twins birth stories I can find, but have not
found any info about differences in types of twins pregnancies, ie
sharing a placenta increasing the risks, or discussion on when
c/section is really needed and when it isn't. I'm trying
to understand what the risks are that we'll be looking
for. What can happen with cord prolapse and how can you
anticipate it? Just to clarify, my twins are */monochorionic,
diamniotic/* - 2 sacs, 1 placenta. They are*/ not/* mo mo twins,
where cord prolapse & cord issues in general would be much more of
a risk, but I gather cord prolapse is still a risk with diamniotic
twins as there is more chance of waters breaking before the head
has engaged for the first, (I'm not sure why), and for the second
baby waters breaking while she is still high up or breech or
transverse. Zygosity was diagnosed at the 12 week ultrasound,
and I've had u/s every 2 weeks since 18 weeks, so there's no
uncertainty about the 1 placenta & 2 sacs. Might cutting the first
cord cause extra blood flow to the second baby and that creates a
time limit? What can happen with the second baby moving into
position and coming down? If the contractions don't come back
fast enough I'll be under time pressure, if they come too fast
they'll be worried about the placenta separating or the 2nd baby
getting squashed into a bad position. What is the problem with
time between babies and how does it relate to the type of twins
you are having? I'm worried on one hand epidural could increase
need for reach in or c/section, and on the other hand not having
it could increase risk of c/section if doctor does need to reach
in. I'm also worried because I have no way of knowing which of 11
consultants I will get when I go in. If the first one is breech
it would seem c/section is definite, but if 2nd one is breech or
transverse it seems it will depend on the experience of the doctor
& the epidural situation, & how much time is allowed & whether I
can be upright. I don't want to be induced, and I feel confident
about refusing this up to 38 weeks if we're all ok, but I can see
them trying it for the 2nd baby perhaps. What if I do get to 38
weeks. I've heard of people being induced & nothing bad happening
with the epi, but I've heard so many more where it just means
getting the works.
Anyway, this is way long already. I'll be really grateful
for any
input at all. Hope you don't mind a lay person crashing your list
like this.
Yvette
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