A mother's concern

As much as I fought for my previous VBACs and believe that there are far too many routine cesareans performed I have basically come to a place where I am "ok" with a cesarean.  This does not mean that I have scheduled a section date.  What it does mean is if after I do everything within my power to give myself the best chance at a vaginal birth but it appears not to be the best option then I am ok with a cesarean.  And honestly, the thought of vaginally birthing 3 babies is a little daunting, but not completely out the question.  My main concern for a cesarean is the post partum experience and physically being able to care for 6 kids.  Talk about daunting. But nothing has been decided, there is still lots of time for things to change, and then change some more.  My OB and I have agreed to continue to have a dialogue and assess the pregnancy/birth along the way.

Monday's ultrasound has thrown a bit of a wrench into the situation.

The report from Monday's ultrasound indicated that the twins are Mo/Mo or monochorionic and monoamniotic.  They share a sac and a placenta.  The photos were not great and so my OB could not definitively one way or the other, but he is pretty certain that they are Mo/Mo.  This means that the babies are skin to skin and their cords can very easily become entangled.  It also essentially means that a cesarean is the only option for a birth. 

Like I said, I am not opposed to a cesarean.  What makes me nervous is the postpartum experience.  I brought this up at our monthly ICAN meeting tonight.  I began to cry as I talked about recovering from major surgery and possibly having my babies in the NICU and the rest of my family at home.  What will I physically be able to do?  Will I have to rely on someone else anytime I want to go to the NICU and if so, for how long?  After Evelyn it was weeks before I could sneeze, laugh, cough, and cry without pain.  Taylor changed every single one of Evelyn's diapers within the first 2-3 weeks that she was born.  There was no hopping out of bed to do anything.  I distinctly remember one time I was trying to get out of bed and I didn't have the strength and I fell, leaving half my body on the bed and half on the floor.  I had to yell for Taylor to help me up.  I laughed because it was so absurd and cried simultaneously because it hurt.  I was fortunate that I did not have issues with the scar; no infections, no reopening of the wound.  There isn't a guarantee with a repeat cesarean. 

I have heard people say the repeat cesarean recovery isn't as bad.  For some women was it better because they actually had a say in their care and so psychologically they were better off which in turn helped with their physical recovery?  Or is there something scientific about the recovery of subsequent cesareans?

I do believe these babies are a blessing from God.  I know that He is faithful.  I know that He loves me and each of my children.  Yet, it doesn't really change a mother's worry and concern, or at least not this mother's.

In the meantime, I need to keep eating my liver, protein rich diet, and all the calcium to keep those babies growing for as long as possible!

What does evidence say about multiples and vaginal birth?

Disclaimer: I am not a medical professional.  I am merely a mom doing some basic research.

This post won't be anything you will write home about saying it changed your life, ha!  It is meant to simply be informative.  It is not at all exhaustive of the research that is out there regarding multiples and birth.

I think there is a belief that a multiples pregnancy must always result in a cesarean.  This is just not true and frankly not completely supported by evidence.  This doesn't mean that a mom can't choose to have a cesarean.  In general, a vaginal birth should still be on the table.  Now I understand that with each additional baby other factors must be taken into consideration.  And from the limited research I've done thus far there is more data on twins than triplets.

I think it's often wise to see what ACOG says about a particular birth option.  The ACOG bulletinon multiple gestation states the following:

“The route of delivery for twins should be determined by the position of the fetuses, the ease of fetal heart rate monitoring and the maternal and fetal status.”6

So, if baby A is position right and is looking good that should determine the birth route not the fact that it is a multiple.

According to an article in Reviews in OB/GYN if your first birth was a cesarean and you find yourself pregnant with twins a VBAC is not contraindicated.  The data indicates that a mom attempting a twin VBAC is at no greater risk for uterine rupture than a singleton VBAC.  

Ok, now for some triplet specific articles:
Preliminary experience with a prospective protocol for planned vaginal delivery of triplet gestations.:  In selected cases vaginal delivery of triplet gestations can be accomplished without increased maternal or neonatal morbidity and mortality and may significantly decrease maternal hospital stay and postoperative morbidity.

Neonatal outcomes in triplet gestations after a trial of labor:  Our experience suggests that offering vaginal delivery is an acceptable management plan for triplet gestations.

Birth in triplet pregnancies. Vaginal delivery--how often is it possible?:  In terms of fetal outcome cesarean section in triplets is not superior to a policy of vaginal delivery. Vaginal delivery may be suggested when there are no obvious obstetrical contraindications.

I will leave it at that for tonight, this mama is exhausted.  As you can see from this very small pool of evidence that a vaginal birth is not contraindicated.  For what it's worth, I didn't have to go on a great expedition to find this data, nor did I skip over articles that didn't agree with my point.  I merely read the first few articles that appeared in my search.  I would say that's rather encouraging.  What is also encouraging is that my OB has asked me to share articles that I find!