Vertex-Breech Twins

[tsippora]

Hi fellow future moms of multiples -

Do any of you know much about the safety of a vaginal delivery for vertex-breech twins? I'm 32 weeks along and Twin A is head-down and a few ounces larger than B. Both are average size for their gestation. There are a couple of studies that suggest a breech extraction (where the OB pulls Twin B out by the feet) is fine, but the OB also warned that use of forceps may be required. Would love as much info on this as you have, and any firsthand experience is most welcome! I have had one baby vaginally already (at term) and that delivery was smooth, so it would be nice to try again.

Best wishes to all for an easy pregnancy and delivery!

[Richluv]

hi i'm a labor and delivery RN and i've seen this case several times. Usually once Twin A comes out, Twin B automatically turn head down. This type of deliveries are usually done in the operating room, just incase the second twin doesn't turn, C-Section might be done. Discuss this with you OB and see what he/she says.

[tsippora]

Thanks for the information, Richluv. The dr. said they wouldn't try to turn the baby if it didn't turn on its own - they'd pull it out feet-first. Have you seen that? More important, have you seen anything bad happen to twin B during a breech extraction?

[LauraLou]

I'm also an OB nurse. I have seen several vertex-breech births. The only complication I've seen is the first baby was delivered vaginally, but the second baby had to be delivered c-section. Both babies were fine, but the mother had a heck of a recovery.

Good luck whatever you decide.

[tsippora]

Thanks for the info, Laura Lou. So much of what is known about breech birth pertains to singletons, where it's definitely not advised, so I'm not sure what to request. But this gives me some confidence that I can likely avoid a C-section if I give it a go. Congratulations to you on your twins!!!

[carisa]

tsippora-I have a gestational carrier who is 30 weeks with my twins. Her OB said as long as twin A was head first, they could pull twin B out by the legs if he needs to. I'm glad you asked this question because I was kind of confused about it as well. I guess it must be quite common if both of our OBs said it's fine. Good luck and congratulations on making it to 32 weeks!

[DeniseM]

I've experienced this delivery. I presented Twin A, head down, Twin B transverse. Twin A delivered head first, four minutes later they extracted Twin B, feet first. I only had to push while they delivered the head. Her first apgar was a two, her second was an eight. So, a stressful delivery for her, but she recovered quickly. I think this option really depends on the experience level of your OB. Anyone else would likely have c-sectioned me for the second baby.

[tsippora]

Thanks for sharing your personal experience, Denise. And may I add, yikes! It sounds like everything turned out OK, but an Apgar of 2 is kind of scary. I wonder if that's typical of this kind of delivery....all in all I am still not sure whether to request a scheduled C-section. I really do not want one, but if I'm taking a risk with my kids that seems short-sighted. Also, my OB seems to be totally comfortable with it, and I trust her, but she may not be the OB on call when I go into labor. She says her partners are fine with it, too, but how do I really know what that means?

In any case, thanks again for sharing and I hope others do the same!

[jude7702]

Firstly congrats on being 32 weeks. I am currently 27 with b/g twins, and my OB is saying that unless they are both vertex, they won't attempt a vaginal birth. There are 3 partners in the practise, and they all feel that there is a greater risk to baby b, and so a c-section is much more probable in this scenario, and they wont' risk the possible danger to baby b. One of the OBs said that if the second baby turns breech after baby a comes out, he personally would be okay with a breech birth if it had to be performed but said that not many OB's now are taught in school how to perform breech, and instead are told it is much 'better' and safer to go straight for a c section if this happens.

I'm glad you asked this question, I've been wondering what I can insist on, and what the best way forward is. I feel like you that whatever poses the least risk to the babies is the best, after all this, I don't want to risk something for the sake of being able to give birth vaginally,

hope all goes well with you, keep us posted