Thankyou for the further replies received from: Justine Caines,
Jesse/Jayne, Lieve Huybrechts, Lindsay Kennedy, Leanne Wynne, Ken Ward, Judy
Chapman, Mary Murphy, Diane Gardner, Rachele Meredith & Bernadine.
Lindsay & Bernadine, do you have your birth stories posted anywhere I could
see them?
Leanne, Judy & Rachele, thanks heaps for the articles.
I've read them & printed them out. All 5 seem to conclude that time between
twins doesn't need to be limited.
Michigan one 2005 113 sets
French one 2002 78 sets over 2-3 year period
Midwifery Today one 1996, 199 sets, doesn't say where when or by whom
?Portuguese one 50 sets, doesn't say where, when or by whom
American one 1984 115 sets 1982 & 1982
I tried to get into the Cochrane library but you have to pay to subscribe.
I had my half hour appointment with a consultant today (the one I had to
write to the head of obstetrics to get). What he said is totally at odds
with these articles, but I don't get to ask how he's come to the view he
has. What he told me today is as follows:-
- If both babies are head down, he thinks it would be ok to not even
have an epidural in.
- If the first one is head down but the second one breech or
transverse, then the focus is on avoiding c/section. This is where timing
between babies & management of second baby comes in. He's told me
previously he wouldn't want more than 10 minutes between babies. He reckons
contractions start up again in about 15 minutes after the first baby is
born, then about 15 minutes after that the cervix starts to reform and the
placenta starts to come away. He says once the cervix starts to reform, any
chance of birthing the second baby vaginally is stuffed, you can't do
anything and so c/section becomes an emergency situation, which we obviously
don't want. He says the reason for the very high c/section rate in
Victoria, which he now says is 60 to 80%, is because of doctors waiting too
long for the second twin, then having no choice because it's too late to
reach in. There's also the fact that even consultants often have very
little or no experience in grabbing the second baby if it's breech or
transverse. The 3 risks for the second baby are the cervix reforming,
distress because of placenta, and cord prolapse.
- He therefore thinks that if second baby is breech or transverse, &
I want the best chance of avoiding c/section, then what needs to happen is
this: Epidural in place with at least a test dose by 4-5cm dilation, along
with drip. Full block in the epidural for 2nd stage. As soon as first baby
is born, Syntocinon in the drip to get contractions going asap for second
baby, and ready to reach in for 2nd baby if she hasn't come down within 10
minutes. Because epidural needs to be a full block for a reach in, no
chance of me being upright.
- The shared placenta thing is not a factor in any of this, he doesn't
know why I've been told this. (both by a registrar & by Monash).
- Re induction at 38 weeks, he is absolutely adamant that this is
essential. He says 38 weeks for twins is like 42 weeks for singletons. I
asked about ways of assessing the condition of the placenta at 38 weeks,
ultrasound, non-stress test, that if it all looked good wouldn't it be
better to give the babies a bit longer & keep a close eye rather than
subject them to the risks of induction. "What risks?" I mentioned the
obvious ones briefly, and he said that was because of the finesse of the
person administering the Syntocinon. I asked how they know about the
placenta deteriorating sooner for twins, and he said "because of dead
babies". I asked so have they examined the placentas and found something
wrong with them? Didn't get any further with this discussion, he started
going on about babies in India suffering because of lack of intervention.
So if both head down it looks good. If the first one is not head down it's
planned c/section & all new questions, & I'll know after about 35 weeks how
that's looking. If first one is head down and second one isn't, then I have
to make decisions. And if I get to 38 weeks I have that decision to make
too. Arrrrggggghhhh! I'm wondering, if I say no to the epidural, or yes to
the epidural & no to the Syntocinon, and we're monitoring the 2nd baby's
heartbeat & position, and it's been 10 minutes & she's transverse, or breech
& still high up, to keep waiting or not, and if we do, what if the heartrate
does start to drop. The doctor's argument would be it's already too late to
get pain relief for a reach in so it'll be c/section. If I do allow the
epidural, to serve the purpose of preventing c/section in this situation I
would have to have drugs in it, meaning I'm not upright, meaning it's harder
for the second baby to come down, meaning high chance of reach in. What if
all that was in place but the consultant or registrar doesn't know how to
reach in for a breech anyway?
At the moment both babies are transverse, both heads together on my left,
and they've been there for a week. Up til now baby A has been mostly head
down and baby B has been all over the place.
So that's my update at the moment. If this isn't long and boring enough
already, check out my journal on the website:
http://www.babiesonline.com/babies/t/twingirlslb/ and also the really cool
3D photos.
Yvette
pg with monochorionic diamniotic twins due 5th Sept
public patient, Melbourne
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