Running out of delivery options - HELP

Twins - 37 Week 4 days -
Baby A - Frank Breech
Baby B - Transverse
Perfectly healthy with no medical history. Second birth. No complications so far. Two ECVs performed (one by primary doctor and one by a 2nd opinion because primary doctor originally declined to perform the ECV citing poor results and difficulty to turn twins). We feel we are lucky and thankful to have two doctors performing ECVs on us.

We have been seeing a primary OB/GYN doctor that have been providing excellent care and is typically pro natural vaginal over c-section. However, primary doctor has adamantly refused to deliver twins vaginally if Baby A continues to be breech. He is willing to work with baby B if baby A is head down which is much more then a lot of doctors around here are willing to do. We questioned the necessity of medical intervention for a major surgery and he's stating it is too high of a risk of injury to the baby. He's citing a 1 out of 10 chance. Wife is not afraid of C-Section but strongly believes the risk shift and the many negative social ramifications for the baby far outweighs the "danger". Wife knows her body well and she's a terrible healer and part of the major reason why we think a c-section is more devastating to the wife for her life than the miniscule risk to attempt a vaginal twin breech delivery provided no complications at onset of labor. We have no issue to shift mid-gear to surgery if there are issues. We have had 2 formal opinions with one agreeing to do the ECV. The ECV was partially successfully but it turned back. We called many hospitals and spoken to nurses/physicians to ask about their delivery protocols if we show up unexpectedly, while they cannot give a firm answer with what would happen, they stated that likely it is going to be a c-section. We don't want to be shooting darts and want a clear birth plan. At this point, we are running out of options. Most physicians will not see us due to being this late in pregnancy and I'm sure insurance is not going to cover for a 3rd, 4th, 5th opinion either.


All doctors around the area seem to share the same medical protocols of NOT performing a frank breech twins vaginal birth. The real kicker today for us is our wonderful primary doctor pulled if you do not go along with the c-section, he will lawyer up with a psychiastrist and declare us as unfit parents simply because we want to exercise our patients right. He made it clear if we show up at the hospital where he is, its c-section if baby is breech regardless of medical condition. He suggest if we want our way is to deliver at home. We would if we could but finding a midwife has been tough and we have called numerous places for the last few weeks.
I'm not sure if we are giving the impression off that we are selfish parents and care only for the mother but he stated his responsibility is to protect the fetus at all cost. We have done our research reading medical journals and publications by government agencies. All of them seem to indicate it is perfectly acceptable to proceed with a vaginal birth on certain type of breech (frank) twins.

http://www.ncbi.nlm.nih.gov/pubmed/9180784
" CONCLUSION: Vaginal delivery of breech-breech and breech-transverse twin gestations appears a reasonable option provided criteria for vaginal breech delivery are adhered to."
The criteria they speak of is pelvis size, high blood pressuer, baby weights/size.

http://www.acog.org/publications/patient_education/bp079.cfm
"Most breech babies are born healthy. If your baby is still in the breech position as your due date draws near, talk with your doctor." They do NOT make a specific recommendation to go either way.

Our hospital St Charles cited in their Labor and Delivery guides given to all expectant mothers checking in -- "Non-vertex Presenting Twins - Cesarean delivery is generally recommended". It does NOT state its not recommended. The guide has a NOT RECOMMENDED section which includes when second baby is considerably larger, pelvis is judged too small, or baby is very small (less than 4 lbs).
Anyone have any last minute suggestions? We just WANT A PEACEFUL birth but the medical system is making it very difficult and we feel our patient's rights does not exist. We are sorely disappointed with the medical system have a all or nothing view on breech delivery.

Message edited 8/16/2011 9:04:36 PM.

Re: Running out of delivery options - HELP

Unfortunately this is VERY common. My Dr's were very open to a vaginal delivery but even they said if baby A is breech there is a very small chance I will go natural.

Luckily both of my babies were head down and I had a vaginal deliver. Even still many people are surprised because they didn't think Dr's did that these days. A lot of women are told c-section from the get go!

All I can say is tell them what YOU want and tell them you want to at least try and make sure you have a Dr that has experience delivering breech babies. If you don't then you will be better off having a c-section for the safety of the baby and you!

Lots of prayers that you get the delivery you want!!!

Re: Running out of delivery options - HELP

Have you tried the Gaia midwives? What about a doula? Anyway here is the the local ICAN info (pro-vaginal and VBAC group). Maybe they can help you find someone. Good Luck!!

ICAN Link

Re: Running out of delivery options - HELP

I'm sorry but this sounds insane to me. Negative social ramifications of a c-section? What exactly does that mean?

You do realize that these are doctors giving you medical advice right - not med students, not dentists.

If the ECV isn't working, the babies are still breech, and you go ahead with a vaginal birth you could be risking your babies lives AND that of your wife. Medical journal articles are awesome but unless you've got clear-cut data that the risk is almost non-existent I'd never go through with it.

I wish you the best of luck but in all honesty you sound crazy to me.

Re: Running out of delivery options - HELP

Re: Running out of delivery options - HELP

Re: Running out of delivery options - HELP

I can't imagine even thinking of trying to deliver vaginally unless the babies (or at least baby A) were head down! There is way too much risk involved for me.

My OB was 100% onboard for a vaginal delivery AS LONG AS BABY A was head down. Otherwise the risk is too high.

Re: Running out of delivery options - HELP

Message edited 8/17/2011 10:01:11 AM.

Re: Running out of delivery options - HELP

Message edited 8/17/2011 10:14:32 AM.

Re: Running out of delivery options - HELP

Re: Running out of delivery options - HELP

Has DW had successful vaginal deliveries before?

I would take what all the doctors are telling you as a sign. Just because there are medical journals saying breech babies can be born vaginally, there are still underlying medical reasons why doctors prefer to reduce the risk of complications and choose to do c-sections.

My OB would allow a vaginal delivery of twins ONLY if Twin A was head down and Twin B was either the same or transverse. Additionally he made it a point to remind me numerous times that I could possibly deliver A vaginally but still have complications with B resulting in me having an emergency c-section.

While I understand the social ramifications you speak of, maybe hearing some success stories would ease your mind?

I wound up needing an emergency c-section because of an issue with A's growth. Had them at 10:35 and 10:36 pm. A needed to go straight to the nursery because at 37 weeks she was a tiny 4lbs 12oz and they needed to make sure she could breathe properly on her own and keep her temperature regulated. Because of the circumstances, I sent B with her, I wanted them to remain together.

A and B both wound up being perfect and needed no medical intervention. They are now almost 4.5 months old and have been EBF only.

Regardless of the path you choose, I hope your DW and babies are healthy and perfect.

Re: Running out of delivery options - HELP

try the stony brook midwives

Re: Running out of delivery options - HELP

You have FM