This post was written Wednesday, March 6, 2013.  

So, the Babies Blue will be arriving next week at an undetermined time through an undetermined method of delivery.  Yeah, there's a lot up in the air, and this little . . . ahem . . . gigantic mama is ready to have some decisions made.  Here's the situation.

When we learned we were having twins, our doctors assured us that they were fine with doing a vaginal delivery as long as Baby A (the one closest to the cervix) was head down. They had no issue with Baby B being breech and were comfortable delivering him breech if he didn't turn after Baby A came out.  The idea is that Baby A comes out head down and opens everything up and if he fits, it's almost guaranteed that there will be plenty of room for Baby B to fit through.

The Babies Blue were doing exactly as they should from the very beginning with Baby A head down and Baby B breech.  Then, I went to my 28 week ultrasound, and what do you know, Baby A had turned and was breech and Baby B had turned head down.  Not helpful, babies.  At the next ultrasound, Baby A was still breech, but Baby B had turned again, meaning we had two little breech babies.  The doctors assured me that it was still possible for them to turn, even though room was starting to be at a premium in my tummy.  Our little boys stayed perfectly content with their faces next to each other, just hanging out and being best friends.

The last 8 weeks, every ultrasound has found me hoping that somehow Baby A had turned head down, and every ultrasound my little man has shown me that he has a mind of his own and is quite content exactly how he is.  About 4 weeks ago, I decided I better start looking into and coming to terms with the idea of having a c-section.  I spoke with my OB about the process, what it would be like, and the recovery.  I felt pretty comfortable with everything, even though it wasn't the way I had envisioned my "perfect" birth.

Last Monday, my MFM (the high-risk doctor) called to discuss my last ultrasound since he had been out of town at the time.  For the first time in my entire pregnancy, he dropped the bomb that he would consider delivering our babies vaginally in a double breech delivery (actually, Baby B had turned transverse, or sideways).  He explained that he has delivered Baby A breech multiple times, even though it's not common, and that our babies were small enough that he felt it would be safe to attempt it.  I would be delivering in the OR regardless, so if anything went wrong we would go into an immediate c-section and would be able to have the babies out immediately.  He further explained that he would only consider delivering us this way if my cervix was already softening and showing signs of preparation for going into labor because a lengthy induction would be too risky for the babies.

I asked some questions, and we decided to consider the option at our final ultrasound.  He will sit down with Mr. Blue and me and discuss the options, risks, and benefits in detail, as well as doing a cervical check and reviewing our ultrasound.  Then, if he feels we're still candidates for doing a breech vaginal delivery, it will be up to Mr. Blue and me to make the final decision.

Assuming that we are given that option, I have absolutely no idea what we should do.  Here are out thoughts as of now...

B R E E C H  V A G I N A L  D E L I V E R Y

  • I feel very confident in my MFM and my OB.  Both are experienced in breech deliveries and regularly deliver at least Baby B breech.  Further, they have experience delivering Baby A breech.  They have been cautious and careful in their care of me and of our mono-di twins, so I trust that they wouldn't allow us this option if they felt it was exponentially riskier for any of our health.  If they were not experienced in breech delivery, I would never consider this option.
  • It is much safer to deliver twins breech than to deliver a singleton breech.  Many people balk as soon as I say we are considering a breech delivery, but it really is a different scenario with twins.  Because twins tend to be smaller, there is less risk of the head becoming entrapped, which is one of the major risks of a breech delivery.   Two weeks ago at our ultrasound, the boys were estimated to weigh 4 lbs. 11 oz. and 4 lbs. 8 oz.  They aren't tiny, but they certainly are not big fellows.  Not that this is a deciding factor, but I have some serious child-birthing hips, so I'm not tooo concerned about them not fitting based on my pelvic size.
  • Our Baby A is in the best possible position for a breech delivery.  There are three different breech positions.  The most dangerous for delivery is called footling breech.  The safest position is called frank breech, which means the baby's bottom is down with its legs up along its chest.  A baby in footling breech can start descending in the birth canal before you are fully dilated.  This means that when the baby's biggest parts (shoulders and head) come through, there is a much greater risk of there not being room and either the head can get stuck or the umbilical cord can become trapped cutting off the baby's blood and oxygen supply.  With a frank breech baby, the bottom and thighs coming out first help ensure full dilation before delivery, reducing the risk of entrapment of the cord or head.
  • If anything goes wrong, we would already be in the OR, epidural in place and ready to immediately switch to a c-section.
  • I do have some additional worries because breech deliveries are generally considered so much riskier and they are done far less frequently.  There just aren't nearly as many birth experiences to read about and our families' general nervousness adds to my nervousness.  The things that can happen during a breech delivery are scary, and I have to remind myself frequently that the risks are reduced in our situation and that I have experienced doctors who won't hesitate to pull the plug if things take a turn for the worst.
  • A vaginal delivery could give our boys a better chance at avoiding NICU.  They will be born 3-4 weeks early, and being pushed through the birth canal would help remove any fluid in their lungs, giving them a better shot at breathing properly from the beginning.  (Thanks, @arden, for giving me a heads up on this!)
  • Though this is at the bottom of my concerns, doing a vaginal delivery is less risky for the mother and would ensure I could try for a vaginal delivery if we decide to have more children.

C  -  S E C T I O N

  • C-sections are far more common for twin births generally and certainly for breech delivery.  Because of this, there are just so many more stories and information available to use to prepare for delivery.  It's easier to imagine what it could be like because I can find so many birth stories, both good and bad.
  • The babies would come out quickly and wouldn't be at risk for entrapment, etc. Even though the risk for our boys in a breech delivery appears to be fairly small, that risk is removed by having a c-section.
  • Because the process of delivering vaginally helps babies prepare for being outside the womb, our babies might have a little more difficult transition if they are born via c-section.  I'm not terribly worried about them not being okay eventually since they will be at least 36 weeks, but it would be awesome if they didn't have NICU time at all and could just stay with us!  If a vaginal birth would help ensure that happens, that's a huge perk.
  • I always wanted to avoid a c-section.  It is not my chosen method of delivery at all, although I will obviously do it in a heartbeat if we decide it is better for our sons.
  • The recovery would be more difficult with a c-section.  It would be great to be back to full speed ahead as quickly as possible because I'll have two little guys to look over.

So, that's where we're at.  I would love to avoid having a c-section, but only if we feel that it is a safe way for our boys to enter the world.  Our appointment with the MFM should be informative and help us make our decision.  We would love to have your thoughts or prayers for wisdom and making the right decision for our family!

Would you ever consider a breech delivery?