VBAC with twins – is it possible? . If you have experienced a cesarean delivery in the past, you are not alone.
As of 2014, the Medscape reported the national cesarean birth rate was the highest ever at 32.2%, which is over a quarter of all babies delivered. You’ll also hear many women who think a cesarean is easier on their bodies than a vaginal birth. The recovery period is actually much harder and longer.
If you really would like to try and have a vaginal delivery with your twins this time around, you’ll be happy to know that about 90% of women who have undergone cesarean deliveries are candidates for VBAC. Did you know that the highest rate of VBAC is in mothers who have experienced both a a vaginal and a cesarean birth and when given the choice, decide to deliver vaginally.
In most published studies, about three or four out of five women who have previously undergone cesarean birth can successfully give birth vaginally. After reading the information below and discussing it with your doctor or midwife, you will be able to make an informed decision on whether VBAC may be an option for you this time around. Your choice of obstetrician or midwife will also play a big part in your decision as many regular doctors prefer to just have a repeat cesarean with twins, without much discussion on the matter.
VBAC with twins and the Risk of Uterine Rupture:
The greatest concern for mothers who have had a previous cesarean is the risk of a uterine rupture or tearing during a vaginal birth. According to the American College of Obstetricians and Gynecologists (ACOG), if you had a previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5%, which is approximately 1 in 5001.
Some studies have show that there are increased rates of uterine rupture in women who undergo being induced into labor. You will want to discuss the possible complications of induction with your doctor so that you know all of the risks and possibilities. Recently, the American College of Obstetricians and Gynecologists stated that VBAC is safer than repeat cesarean and VBAC with more than one previous cesarean does not pose any increased risk.
If you were given the following reasons for a previous cesarean and are considering a repeat cesarean, you may wish to discuss the following with your doctor:
Dystocia:this refers to a long and difficult labor due to slow dilation of the cervix, a small pelvis, or an exceptionally large baby – otherwise kknow as the baby is too big to be delivered naturally. Many women who are given this reason for previous cesareans, deliver vaginally the next time, and give birth to a bigger baby than the first!
There is not evidence that a big baby makes a cesarean section necessary. The pelvis and the baby’s head are not rigid structures and both do mold and change shape to allow for birth. During labor there are also certain birthing positions that a woman can use to help open up the pelvis, allowing a larger baby to move through. For example, squatting opens the outlet of the pelvis by as much as ten percent.
Genital Herpes: For many years, women with a history of herpes almost always delivered by cesarean, due to the risk of passing herpes to the baby during delivery. Physicians would do cultures in the last weeks of pregnancy and if the virus were active, a cesarean would be scheduled. Now ACOG has determined and recommended that unless there is a visible lesion at the time of birth, a vaginal birth is acceptable.
Fetal Distress: When it comes to the life of the baby, there is no question in a mother’s mind of what to do. If the baby is in distress, cesarean deliveries can be life saving. According to the Centers for Disease Control and Prevention, nine percent of cesarean deliveries in 1991 were due to fetal distress. Fetal heart rate monitoring can be a routine part of the VBAC procedure, which helps detect fetal distress.
To to be considered for VBAC with twins you need to have:
– No more than 2 low transverse cesarean deliveries.
– No additional uterine scars, anomalies or previous ruptures.
– Your doctor or midwife should be prepared to monitor labor closely and be prepared to perform or refer for a cesarean if necessary . Sometimes the best laid out plans don’t turn out exactly as planned.
– The location in which you decide to have your babies should have on call staff available on weekends and evenings in case a cesarean section is deemed necessary.
What makes a good candidate for a VBAC with twins?
– If the original reason for a cesarean delivery is not repeated with this pregnancy
– You have no major medical problems and are in generally good health – no high risk pregnancies.
– The babies are a normal size
– At least one baby is head-down Be sure to educate yourself and consider all of your options and past history when deciding how you want to birth your twins. Remain in charge of your own prenatal care and your birth plan.Having a VBAC with twins is a big decision and it may or may not be the right one for you.
On the other hand, don’t let anyone force you into a decision just based on statistics. Twin pregnancies , while generally are automatically ‘high risk’, are not a life threatening condition. Do what’s best for you, your body and your babies.