Monday, May 4, 2009

Twin-Sections?

If you've suffered through my ramblings of late (totally your fault), then you know I'm struggling with the lack of birthing options available for twin pregnancies here at the beach.  My current options include:
  • C-section by a doctor
  • Labor at home then C-section by a doctor
  • Labor at hospital then C-section by a doctor
Why are doctors here so unwilling to allow vaginal births for twin pregnancies?  I haven't really asked that question yet (I've been too busy asking if I could even have a vaginal birth).  In the meantime I might have a theory.  

Back in 2007 the Atlanta Journal-Constitution reported on a British research study which found c-sections to be safer for twin babies than vaginal deliveries.  Basically there was an increased risk in post-delivery deaths for the second-born baby when twins were delivered vaginally.  

The researchers were quick to state while there was an increased risk for the second-born baby, it was still very small compared to other risks like premature birth.  In fact, one doctor was quoted as saying:
"I would hate to see this study used as an excuse to have every mother with twins have a Caesarean section."

-Dr. F Sessions Cole, director of newborn medicine and head of neonatal intensive care unit at St. Louis Children's Hospital.
I have no idea if this study has influenced my doctors' viewpoints on c-sections vs. vaginal delivery where twins are concerned.  If it has than the above quote becomes extremely ironic.

There is a second issue at hand obstetricians face when delivering twins:  malpractice risk.  I can only assume my doctors are more comfortable doing routine c-sections on twin pregnancies because it minimizes the malpractice risk of any complications arising from a vaginal birth.

To be honest, having a c-section does not upset me, the few people I know who've had them say they are not bad.  What does upset me is the lack of control and choice I've been given.  Personally, I feel it should be my right to have whichever birth I want for these babies (technically I still have these choices, but who really wants to have a twin vaginal birth when every doctor you've talked to tells you they aren't comfortable doing them).

Ideally, a c-section shouldn't be the first course of action for twin pregnancies, but the last course of action used in emergency situations.  Isn't that how c-sections originally evolved? 

For those of you wondering 'what's the big hype about c-sections vs. vaginal births?'  First, c-sections are much harder on the mother's body recovery-wise than actually having a vaginal birth (provided the mother has proper training on how to prepare/cope with vaginal births).  

Second, laboring and vaginal birthing release natural hormones inside the mother's body and womb to help prepare both for delivery.  For the mother, these hormones aid in a quicker recovery post-delivery.  For the baby, the hormones and actual act of labor prepare the baby's brain and lungs for independent living (bye bye umbilical cord).

One final note, would-be Dr. Kammer said it best (and so very eloquently) when he said 'Research on pregnancies is really crappy, Em.  Nobody wants to do testing on a pregnant woman.'  He's got a great point.  I certainly wouldn't sign up for any research studies while pregnant . . . would you?

4 comments:

Zoo Keeper said...

Kammer's right. We run into the same issue at work. I work in aerosol delivery and "technically" no meds are approved for children under 2 years. Then explain what to do when a newborn has asthma or some other respirtaory issue that requires medication... The doctor makes the call but it's comsidered "off label" use. Drug companies provide all kinds of studies on their drugs but none are for under 2 yr. - no one wants to offer up their infant for testing....

Amanda said...

I understand that no preg woman wants to undergo "testing", but what about just some observational documentation?

Where are all the stats on the increased mortality rate for the mothers during CSections vs Vaginal delivery?

Where are the stats on the increased number of blood clots while recovering from major surgery vs. vaginal birth.

What about the lesser lung development in babies that are removed from the uterus before 40 weeks? I'm searching.

Are OBs even trained in regular vaginal births anymore? It concerns me that they aren't confident in their own abilities to attend (watch a woman do all the work) during a typical non-surgical birth.

Their job (surgeon) exists for the TRUE EMERGENCIES and complications. It just seems like they consistently add their own complications with drugs and interventions and pressuring women towards CSections so that birth BECOMES an emergency.

grrr...I'm looking for midwives in the Wilmington area...in honor of international midwives day 5/5/09.

xoxoxoxox

Dave K. said...

Lungs are generally mature before 37 weeks, and there is a good blood tst you can use to determine lung maturity. Just for clarification, my remark was made about meds, not about C-Sections. One thing to consider in the statement "Their job (surgeon) exists for the TRUE EMERGENCIES"... Many would argue that a major part of the OB's job is too avoid emergencies. If you've ever seen a "crash" (emergent) C-Section you can probably imagine why many people prefer a planned C-Section.

That being said, while 60% of twin deliveries are C-Section, the expert opinion seems to be against proscribing it's routine use. The best study looking at the was a meta analysis called "Cesarean delivery for twins: a systematic review and meta-analysis" in Am J Obstet Gynecol 2003 Jan which concluded "CONCLUSION: Planned cesarean section may decrease the risk of a low 5-minute Apgar score, particularly if twin A is breech. There were no significant differences in perinatal or neonatal mortality, neonatal morbidity, or maternal morbidity. Otherwise, there is no evidence to support planned cesarean section for twins."

ps - "would-be doctor"? That makes it sound like I'm some loser who can't cut it. How about "soon to be" Doctor?

Dave K. said...

Turns out you could enroll in a study:
http://clinicaltrials.gov/ct2/show/NCT00187369

The mere existence of a study like this tells you that the current research leaves the question wide open.