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    Oct 03
    2005

    twins in 40th week of pregnancy

    Archived User
    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.

    THANKS!


    By: missy
    Archived User
    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 stands.

    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 there too.

    -- Henci By: Henci Goer
    Archived User
    Thanks Henci.

    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" higher also.

    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
    Archived User
    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. Hmm. Now that I think of it, there is another good article on the MCA website: Making informed decisions.

    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: the Play by Karen Brody-- is that her body rocks! That's the thought I would want her to take into labor and new motherhood.

    -- Henci

    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 not true! By: Henci Goer
    Archived User
    Henci,

    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 entrances!

    Thanks for the information! I'll keep you posted!

    P.S. Her doctor's C-section rate is less than 10%! By: missy
    Archived User
    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
    Archived User
    Henci,

    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?

    THANKS!
    By: missy
    Archived User
    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.

    Blessings,
    Aron By: dancindoula
    Archived User
    Aron,

    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!

    By: missy
    Archived User
    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 outcomes.

    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.

    -- Henci

    By: Henci Goer
    Archived User
    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 intimidation!

    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 healthy girl!

    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 weeks!
    By: missy
    Archived User
    I forgot to mention that my daughter prepared well for labor and childbirth!

    She and her husband took three classes: birthing classes, twins classes, and a breastfeeding class. They also took a CPR class. By: missy
    Archived User
    Henci,

    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 decision!

    Thanks! By: missy
    Archived User
    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
    Archived User

    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...

    Henci Goer

    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.

    -- Henci


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