twins in 40th week of pregnancy
My daughter is 39 weeks pregnant with twins, and her doctor told
her last week that she won't let her go beyond 40 weeks because of
the danger to the babies. The doctor wants to do a C-section.
I have read that more than half of twins arrive before their due
date, so that leaves a lot who don't, so why would a doctor want to
take them? Her doctor said that it's dangerous to carry twins
beyond 40 weeks because of degrading of the placenta, etc.
The question here is whether your daughter can trust her doctor's
judgment. My recommendation is for her to ask him his c/section
rate. If the number is higher than 15%, she will know that she
can't because her ob does more cesarean surgeries than are
justifiable. Both the World Health Organization and any number of
studies on practice variation show that in a mixed risk population,
that is, the normal run where some women in the practice are high
risk but most aren't, the cesarean rate can safely be under 15%. If
he won't say what his rate is, that’s a red flag too. He
should be keeping track of this important statistic. If her
ob’s rate is in the range supported by the research, she can
have confidence in his judgment.
If it turns out her ob’s cesarean surgery rate is high, she
should seek out an ob who has a cesarean rate in the appropriate
range, although I have to say that finding one may be difficult.
Local doulas, educators, or midwives may know who the appropriate
cesarean rate obs are. Once she has found such a doc, she can get a
2nd opinion. If the 2nd ob concurs with the 1st, then again, she
can have confidence in the 1st ob’s judgment. If the 2nd ob
disagrees, she’ll have a much better notion of where she
I also recommend going the Maternity Center Association’s
website and reading What
should I know about cesarean section?
In order to make an
informed decision, she should know the benefits and harms of all
her options. So far, it sounds like she has only heard the
(possible) harms of planned vaginal birth.
I don't know if you noticed, but there is another thread on this
issue as part of this Forum. You might find useful information
-- Henci By: Henci Goer
After reading some of the other threads and doing further research,
I'm wondering where one might find the most reliable information on
pregnancy? For instance, today I was browsing the web, and I came
across several articles that stated depending on your monthly
cycle, your size, etc., your "due" date might be off by 3 weeks! I
also read that there is a "slightly" higher risk for twins over
singletons, and the risk for post term babies is only "slightly"
I'm beginning to think that my daughter's due date may not be
correct. I have never carried twins, but my first child was 1 week
past his "due" date, and I have siblings who carried some of their
babies over 2 weeks past their "due" dates. My daughter was keeping
an ovulation chart, and according to it, she ovulated on Jan 15.
She was about 50 #s over weight when she became pregnant, but she
has only gained about 35 #s, so she looks great!
I also talked to a friend today who knows someone who carried her
twins 3 weeks past her "due" date, and they were healthy and
weighed over 6#s! By: missy
For reliable information, you can't beat this site, that is, the
Lamaze Institute for Normal Birth website that is home to this
Forum, or the Maternity Center Association site to which I sent
you. Both sites have lots of sound information supporting normal
birth. You can jump to a bunch of articles from my own personal
website at www.HenciGoer.com
Now that I think of it, there is another good article on the MCA
website: Making informed
And while I'm at it, I find your daughter's ob's attitude very odd,
although, unfortunately, not unusual. Instead of celebrating that
they no longer need to worry about preterm birth, which is always a
concern with twins, he seems to regard that these babies will be
born at full-term and full-weight as a problem that needs to be
fixed. What I would say to your daughter--a quote from Birth:
by Karen Brody-- is that her body rocks! That's the
thought I would want her to take into labor and new motherhood.
P.S. Along the same lines as her ob's attitude toward birthing
twins, your daughter may be told that it isn't possible to
breastfeed twins without supplementation or even at all. That is
true! By: Henci Goer
You're right, my daughter rocks!! She is strong and tough, and her
OB/GYN calls her a "miracle" for carrying her babies so long. I
think fear of malpractice might be the driving force behind the
doctor wanting to do a C-section. So, hopefully, when my daughter
tells her that she plans to carry the babies until she goes into
labor, her doctor will support her!
So, what's the longest twin pregnancy that you know of? We're
hoping that our babie are almost ready to make their grand
Thanks for the information! I'll keep you posted!
P.S. Her doctor's C-section rate is less than 10%! By: missy
I consulted Elizabeth Noble's book Having Twins and More,
and she says that a 1990 survey of the database of the National
Organization of Mothers of Twins reported that 13% of twins were
born after the 9th month. She also says the World Health
Organization regards twin pregnancies longer than 40 wks as
"postmature," however I don't know on what research this is based.
Certainly the current belief that singleton pregnancies are overdue
at 41 wks is based on extremely flawed research. She goes on to say
(and I agree) that there are various tests for evaluating the
babies' well-being if the pregnancy extends past 40 wks. I would
add that they all have a high false-positive rate, in other words,
the test says there is a problem when there isn't, but it is still
a middle path between simply waiting or inducing on a particular
date, which also has potential harms.
Given your daughter's ob's attitude toward her pregnancy, I have to
say that I feel skeptical of his cesarean surgery rate. I would bet
that there are fewer than 100 obstetricians in the U.S. with a
c/sec rate less than 10%, and I am not by nature a betting
woman--unless Baby A, the first baby into the chute, is breech
(bottom down). I haven't done a lot of research into twin births,
but I have read that if the first twin is breech, a planned
cesarean is lower risk for the babies.
-- Henci By: Henci Goer
My daughter just called me, and her OB/GYN looked at the ultrasound
results and said the ambiotic fluid is low in the girl's sac, and
she thinks a C-section is the only viable option!
How low is too low, and what are the dangers?
In my experience, doctors love to play the low amniotic fluid card
to talk moms into c/s or inductions. They rarely mention that in a
well-hydrated mom the fluid will replenish every few hours, and
that rest and lots of fluids will bring it back up. Even fewer
mention that guaging fluid levels is even trickier (read useless)
than guaging fetal size in the third trimester. Gloria Lemay has
compared it to being underneath a plexiglass tub with an adult in
it and trying to guage the bath water level around them. It always
strikes me as an odd excuse because if low fluid is really such an
imminent danger to these babies, why aren't the moms being
ambulanced in for crash c/s instead of being sent home and told to
come back a few days or a week later for planned inductions or c/s?
My question is, if there is really a danger of low fluid
(oligohydramnios) what are the immergent symptoms right in that
moment - low fetal heart tones, movement, anything? Not just going
by what the ultrasound shows. My thoughts anyway. I'm very
interested to hear Ms. Goer's take on this.
Aron By: dancindoula
Thanks for your post!
My daughter's doctor spent 20 minutes on the phone with her Friday,
convincing her that if the babies don't come right away, she is
risking their lives by not doing a C-section!
My daughter said she wouldn't be comfortable doing anything before
Monday, and told her doctor that she's hoping they will "pop out"
this weekend. Her doctor laughed and said she would schedule the
C-section for Monday!!!
After telling her doctor that I want her to go to a midwife for a
second opinion, her doctor told her to read Oprah's book club book,
"Midwives." I haven't read it, but I was told that it's about a
midwife charged with murder after she did a C-section on a woman
whom she thought was dead!! I was appalled that a doctor would
suggest this book to a pregnant woman, and especially one who might
have a C-section.
Thankfully, my daughter is tired of reading, and she didn't
purchase the book!
So, we are praying that her babies are ready to be born, and she
will start labor any minute now!
In response to Aron, very low amniotic fluid volume indicates
potential trouble. Somewhat diminished amniotic fluid volume is
much less clear cut. Diminished volume appears to correlate with
increased likelihood of nonreassuring fetal heart tones in labor.
However, it is also true that amniotic fluid volume is not static.
It responds to the woman's state of hydration. And being at risk
for something doesn't mean it will necessarily happen. One also has
to consider the logic of inducing labor (which increases stress on
the baby) and which usually involves rupturing membranes (so now
you have no amniotic fluid).
You are also correct that amniotic fluid volume measurement is an
inexact science. You are trying to measure a complex, 3-dimensional
volume using a 2-dimensional image. I've got a study that compared
two different methods of estimating volume. One resulted in more
abnormal ratings and more c-sections but no improvements in
Still, while common beliefs about the accuracy and predictive value
of amniotic fluid volume estimates can be challenged, I think most
obs genuinely believe that what they are doing is in their
patients' best interest.
By: Henci Goer
My premise is that my daughter has been healthy throughout her
pregnancy, and according to every source I have read recently, she
should be allowed to continue in her pregnancy until she goes into
labor or until 42 weeks, unless an emergency develops.
The ultrasound should have been repeated to assess the level of
amniotic fluid as my daughter purposely reduced her fluid intake
last week, to keep from making so many trips to the bathroom during
the night, although, the doctor didn't base her recommendation for
terminating my daughter's pregnancy on the ultrasound. She based it
on her "due" date of 40 weeks, and she made my daughter feel like
she "had" to start labor or her babies would be taken from her!
Her doctor agreed that the aminotic fluid varies daily, based on
the mother's fluid consumption!
My major concern is that her doctor expected her to go into labor
by 37 weeks, and when she didn't, she pressured for a C-section. No
one knows for sure when my daughter became pregnant, but her
largest baby, according to ultrasound, is about 2 weeks ahead of
the smaller baby in growth.
I'm not faulting the doctor for feeling that a C-section may be the
best outcome since one baby is breech, although, I think her view
is based on her limited skill in this area. But, I do fault her for
not letting my daughter go into labor, and for using
Dr. Robert Bradley, Husband Coached Childbirth, an OB/GYN,
with many more years of experience than my daughter's doctor,
believed that babies don't all "ripen" at the same time and should
be allowed to choose their own birthdays. He said that a doctor's
greatest virtue is patience, when it comes to childbirth. Dr.
Bradley had one patient carry her baby 12 months, giving birth to a
I'm not proposing my daughter's doctor wait 12 months.
Our country's high C-section rate will never diminish as long as
doctors and patients insist on choosing the birthdays of our
children! More and more patients are allowed to choose their
babies' birthdays, provided they choose a date earlier than 40
I forgot to mention that my daughter prepared well for labor and
She and her husband took three classes: birthing classes, twins
classes, and a breastfeeding class. They also took a CPR class. By:
You mentioned that there is more than one test for low amniotic
fluid volume. Other than ultrasound, what is the test? My daughter
is planning to have another ultrasound before making her final
Thanks! By: missy
Apologies for not being clear. Both methods of estimating amniotic
fluid volume used ultrasound imaging. They just differed in how the
measurements were done. I was just trying to make the point that
other than at high and low extremes, estimating amniotic fluid
volume is very inexact.
-- Henci By: Henci Goer
This was posted a long time ago, but I am responding incase
anyone comes here to read this info for help. I had a twin
birth and baby A was head down and baby B was breech. My
doctor did not like the idea of twins coming after 38 wks. I
also read Elizabeth Noble's book "Having Twins" and it was
excellent in preparing me what a good healthy twin pregnancy and
delivery were. I stuck to my guns that I would allow my
pregnancy to go as natural as possible. My doctor was
climbing the walls. At 34 wks, I was dialated to 4 cm for
about two weeks, after that 6 cm for a week and a half, then 8 cm
for week. The doctor was so itching to induce me!
Finally he was going to go on vacation and I was 38 wks 5
days. I would have had the "C" section doctor if I went
into labor while my doctor was on vacation. He was the only
doctor in my area that was willing to deliver vaginally if baby B
was breech. So I reluctantly consented to being induce. My
labor wasn't as natural as I liked, but I did get my natural
birth. The babies were born in one hour. Baby B was
breech. The babies came 8 min. apart. Baby A was 7 lbs.
and baby B was 7 lbs. 8 oz. They were the buzz of the
hospital. The hospital which is known for a high intervention
rate, had never seen a birth so late for twins and such big
babies. It was far the easiest birth I had ever had! I
am expecting again and am just hoping and praying that all goes so
good. This time singleton!
I have known about 5 women who went to 40 wks with twins and all
had healthy babies. Babies cook according to their conception
dates and not according to last menstrual period which so many
doctors base their dating. It is just not accurate at
all. Unless the exact conception date is known, no one will
know for sure how long the baby will need to go to.
Also, fraternal twins conceive at different times and sometimes can
be a few days apart. If that happens, then one twin will be
smaller than the other. So the smaller twin may need to cook
longer. Too many doctors take birthing into their own hands
and make things far worse. The best thing to do is to
interview the OB in the beginning and see what his C section rate
and protocal is for twin delivery. Does her do breech
delivery with Baby B, how is C section rate with twins, etc...
Congratulations on the birth of your healthy, full-term twins! I
repeat what I just posted to a woman writing about needing to "jump
through hoops" to avoid unnecessary medical intervention. It's
wrong. It's wrong to have to have to do that. It's wrong that you
needed to agree to an unneeded induction to avoid unnecessary
cesarean surgery. Since this baby is a singleton, have you
considered a midwife and having your baby at home or at a
free-standing birth center? Based on what seems to be available in
your community, you and your baby would be much better off.
All Times America/New_York
Please note that this Forum is intended to help women make informed decisions about their care. The content is not a substitute for medical advice.