Labor and Delivery with Twins: Section 2

Just a reminder: These responses are personal experiences, not medical advice. If you're wondering about the inclusion of a section on C-sections and not vaginal births, that's a reflection of the threads that were current during the compilation of the FAQ. I'll add on other sections as necessary. --Lisa

Epidurals and Spinals

I'm curious about this comment:

On the big day tho all I cared about was the babies. I didn't care what they did to me, just as long as the babies were all right. Baby A broke the water, they were both breech and I had them c-section. Worst epidural of my worst fears, but the babies were fine.
I'm 34 weeks with one transverse and one breech, facing a good chance of a c-section, and definitely planning on having an epidural, no matter if its a c-s or vaginal. I've heard such wonderful things about epidurals that it has kept my fears away about a first time LD experience. I'd like to hear about this "worst epidural of my worst fears." Thanks!

I had a semi-bad epidural experience. The epidural itself was fine, but they had a tough time getting it in. It took 3 tries before they were successful - almost an hour! The second anesthesiologist got it on the first try (after 2 tries, they have to call in someone new- thank goodness!). It was very hard to stay in the position you need to be in (sort of curled in a ball) to have it put in. I honestly was thinking that just feeling the contractions might be better by the time they got it in (vaginal delivery).

I'm interested to read about the numbness people describe, I never experienced that total loss of feeling. I definitely knew when to push and had sensation everywhere, it was just dulled. I could never have slept thru a contraction! It wasn't bad though. It didn't prolong my labor either, I don't think. They finally got the epidural in at 5 pm and I delivered Baby A at 7:47 (her water had been broken at about 1-1:30pm).

The day I was discharged I got a spinal headache (from all the attempts?) which was painful. The anesth. were very good about calling me daily at home to check on me. Just drinking caffeinated drinks as they recommended (I didn't breastfeed) helped me to feel better, though I know some people have much worse experiences.

Our hospital had a monthly "Meet the Anesthesiologist" night, but we hadn't gone. In hindsight, I think it would have been quite useful.

I have had two epidurals. Neither was horrible. But they were different. For the first one I was totally numb from the abdomen down to my thighs. I could feel no contractions nor the baby coming out, it was hard to know or feel myself trying to push. It seemed to take a long time to dissipate which wasn't overly pleasant, but not the worst thing in the world at all, at all. The second one was wonderful. It took away the pain but I could feel the babies coming out some and was more able to help in pushing them out. It also didn't seem to affect my legs at all. So once the babies were out I wasn't left feeling weird, and had no problem voiding or walking right away.

The same wonderful aneasthetist was present for a day-surgery procedure my boys had. When he came in the room I said "Oh it's you! You gave me my epidural!' He was a bit uncomfortable with that. He probably didn't know if I meant it in a good way or a bad way! He came back later and said he did remember me and I said "You give the BEST epidurals!" He was very pleased then. He saved me from having a c-section. My OBS said that if I hadn't had an epidural he would have had to section me because of the difficulty they had in getting Baby B out. So, of course that was really great.

The best thing is just to read about epidurals, learn from others experiences and then it isn't so scary if and when it happens.

To offset "worst epidural" experience, I'll share my very positive experience.

When we arrived at the hospital at approx 3:00 am (my water broke at 2:30 am) I inquired about the epidural. While I was not in tremendous pain, I had heard stories about women who inquired too late and "missed the opportunity" for an epidural.

I was asked to hold out as long as possible, and when the pain got to be too much, to call for the epidural. Well, I lasted until about 7:00 a.m. When the anesthesiologist arrived, I tried to be as still as possible (my sister-in-law had had a bad experience just 2 weeks prior - different hospital) - it took a couple of minutes and then it was heaven - pain all but vanished, yet I still had some feeling left in my legs. The epidural basically let me kick back, nap, watch TV, etc. for the next 8 hours. At 3:00 pm, the Doctor looked and saw Baby A's head, they rushed my into the delivery room, Baby A came out in one push - Baby B was a bit harder since he was so far up, and I did need the doctors to tell me when I was having a contraction so I would know when to push. 20 minutes later, Baby B came out.

All in all, a completely positive experience. Just make sure that you insist that someone with alot of experience (not a resident) give you the epidural.

Are you familiar with the intrathecal shot? I just had it with my most recent child (a singleton born in '97). It is a one-time shot in the spine with a small needle. No catheter like an epidural. My dr. was great about putting it in, it was not painful at all.

This shot is different from the epidural because it only numbs your midsection and leaves you with mobility in your legs. You can actually walk around, but you don't feel the pain of contractions. You still feel the urges to push so you still have the "birth experience". It was GREAT! No headache afterwards and I don't think as risky to administer. Best benefit is that it provided pain relief up to 18 hours afterwards. My recovery was a breeze. All I needed was a couple of Ibuprophens for cramping. I don't know if it is an option for a c-section, but for a vag. delivery it is my first, and only choice.

The hardest part about the spinal was trying to curl up in a ball around my big belly on the edge of the operating table and to hold perfectly still! I felt like I was going to fall off the table! The anesthesiologist was excellent, though. Needle went in with no problem and immediately numbed me from the armpits down. Felt really weird. You feel a little like you can't breathe because your chest is numb. I also had the shakes post surgery. Felt like I was freezing! They also inject pain medication with the spinal anesthetic to provide up to 12 hours of relief post surgery.

I never did labor or dilate at all, so others' experiences might be different.

My doctor would not give me an epidural because he wanted me to be able to push. I had 2 shots of demarol and was able to "sleep" through most of it. My water broke about 9:30 pm and I deliverd Baby A at 3:14 am and Baby B (one push) at 3:19 am. Labor and delivery was a piece of cake compared to the "pregnancy from hell".

I've had 3 emergency sections: 2 spinals, 1 epideral - 2 singletons & 1 set of twins. My first was a single w/a spinal, recovery was very slow and painful. It was an emergency delivery, she was out within 1/2 hour, so I didn't have enough time to get scared. The spinal was fine, except for the part that it feels like your lungs are caving in, at the end of the delivery, when they are cleaning up your insides and sewing up.

My second was a single also, my water broken while at the doctor's (all over the scale, what sweet revenge). They sent me right to the hospital and started me on pitocin, that was horrible!! They kept increasing it and I wasn't dilating, after 6 hours of piggy-back contractions and still only 3 cm they decided it was time to section me. I had an epidural-it was also horrible, the doctor on call had a really hard time getting it in and they were going to call a different doctor in, it was the middle of the night, and it was finally done. The section went as usual. It took forever for the epidural to wear off, the doctor kept coming in to see if the feeling in my legs had come back and told me it should have come back a hour or so ago, real comforting.

So i was stuck in the recovery room alone, my husband was with the baby. Then I finally demanded that they bring the baby to me, he kept saying that they hadn't cleaned her yet or whatever. Around 3 or 4 I sent him home.

My twin pregnancy was normal, my water started leaking so I was sent to the hospital. They decided to section me then- the boys were transverse, so they won't even let me try to go natural. I was very nervous and upset, I didn't want to be there, I wanted to skip the whole thing. They had originally told me that they would do the catheter after the spinal (I requested a spinal), they changed their mind on this.

I was in full labor, 3 cm and no pain at all, but they still took them. I had a hard time relaxing in the operating room and the anesthesiologist stopped everything for a while until I could calm down and relax-she may have even given me something, I was so upset. I think it was easier when I didn't know it was going to happen. The boys came out fine, I did remind the doctors quite a few times to tie my tubes.

They brought me the babies in the recovery room so that I could start breastfeeding and would feel like I actually had a child (or 2)! Each section is easier for recovery.

My first one I couldn't drive for 6-7 weeks, my 2nd one it was 4 weeks and the 3rd one I was driving after 1 1/2 weeks. I took the pain meds as I needed them or before they wore off for the first week at least. A mom in pain is not a pretty sight for a newborn.

Good luck, it's certainly worth it!

I'm feeling very nervous about being awake during a C-section! Can I opt for general anaesthesia instead?!

In the big scheme of things, an epidural is MUCH easier on your body than general anaesthesia! I can't remember, are you having a c-sec for sure? My epidural with my c-section was of longer duration & more numbing than the one I had w/my v-bac, but neither was too bad. I was numb from chest to toes with the c-section, and they did have my arms tied down, but not everyone I know had that, so talk with your doctor if you're really worried about that part of it. I think it's customary to give you some sort of a relaxant, so although you're awake, you're not as "uptight" as you might be otherwise.

My v-bac epidural was even better, I was only numb from about my belly button to my mid-thigh (except on my left leg, where I was numb to my toes - but that was from lying on my left side too much when it was first put in). It eliminated all labor pain, allowed me to sleep through contractions, and overall was much better than having gone through unmedicated.

If you're still unsure, ask to schedule an appointment with someone from the anaesthesiology dept. at the hospital where you'll deliver. They can discuss options with you, and the risks of both. Unfortunately, if you're like me, hearing the risks can sometimes be more scary. To balance that, ask how many uncomplicated epidurals they give every day!

When my wife was getting closer to her delivery date we scheduled an appointment with the chief anesthesiologist on the labor floor at the hospital (giant teaching hospital). We had a long frank discussion about what we wanted and didn't want.

When she was in labor and needed the epidural (back labor) there were never any doubts on his part because he referred back to the notes for our meeting. Results were excellent.

" The other problem I had was my back started to hurt once the spinal started to wear off. I think that was from having to lay down flat for 8 hours to avoid a spinal headache and not from the spinal itself."
Just FYI, this isn't always the procedure anymore, I believe it has to do with the type of needle they use for the spinal, which varies from place to place. Anyway, after my c-section w/spinal, they told me NOT to lie flat, that it would be better to keep the head of the bed elevated. I guess it worked, I didn't get a spinal headache or have any other trouble.

My spinal was, really, a text-book example of how they're supposed to work. I wish they'd warned me that the local anesthetic they use before doing the spinal was going to sting so much, but that's the only pain I felt. They'll tell you to roll flat on your back right after they do the spinal because otherwise only the side of your body that's on the bottom when they do the spinal will get anesthetized -- my top leg went numb quite a bit later and the feeling came back quite a bit sooner, but I was totally numb for the surgery. I could feel some pushing/pulling/tugging sensations while the babies were being delivered but that was it. Mostly it got hard to breathe in when they were pushing on me to get the babies out, and then easier once they were born.


Regarding C-sections: What should I be prepared for, both within the operation and within recovery? Is there anything you would have preferred to be done differently if you had to live it over again?

I had a C-section with the girls and, for me, there were other things beside the epidural which "surprised" me. I was prepared for the C-section mentally. I understood the basics even though I hadn't had a "class" in it or seen a video of one. However.... the first thing that surprised me was the catheter. I guess I just never really thought about it. Having never had one before... that was suprise #1. The next thing was all the people in the operating room and all the bright lights and my nakedness- surprise #2. The really big surprise (#3) was being able to feel them "rooting around" in there. I just thought they'll make an incision and POP! there they'll be. It never hurt but it kept feeling like somebody was shoving me or elbowing me in the stomach while they were getting the girls out. I kept jumping when they "shoved" on me and the anesth. kept thinking I was in pain. When I had my singleton vaginally I couldn't feel anything after the eipdural. You know there are always those "things" no medical person thinks about and alot of regular people would just rather not discuss..... I think knowing those about those things before you go in are key to being able to prepare- especially if you're a first timer. None of the things that happened to me were bad, they were just unsettling and I had to kind of "adjust on the fly".

So glad to see someone saying this. All of these things are surprises, and better to know about ahead of time.

I asked the doctor/hospital/nurses (and they agreed) to shave the surgical area and insert the catheter AFTER I got my spinal. Thus, I didn't feel anything for either of those things.

Also asked them to keep the number of people in the delivery room down to a minimum. Not sure how successful I was on that front: there were about 9 people in the room (besides self, husband and our two new babies, that is!)

The catheter did not hurt coming out, by the way.

A minor thing for those of you looking forward to a C-section: If you're going to be staying in a birthing room in a labor and delivery ward, ask the hospital to switch the birthing bed for a regular hospital bed. Since you won't need the birthing bed, anyway, you'll find the regular hospital bed much more comfortable during your post-C-section hospital stay.

"The whole time I was VERY carefully thinking about absolutely anything EXCEPT what the doctors were doing, because if I thought about it I probably would have freaked, but all in all it really was OK."

I did freak right before surgery. I was calm right up to the point when the anesthesiologist told me matter-of-factly that they were going to be using a spinal (not an epidural which I had been led to believe up to that point) and that really threw me. For some reason, I was much more afraid of the spinal than the epidural.

Suffice it to say, I ended up being very afraid, and I think I had a worse time than if I had been able to process the fear somewhat ahead of time. I had a hard time with the spinal...wasn't supposed to hurt going in, and it did. Then I threw up on the operating table. Then I started feeling them pushing around to ge the second baby out and freaked out again. By the time they got baby number two out, they knocked me out because I was so upset. But when I woke up an hour later, babies were out and I was quite relieved.

Could have cared less about the pain, because by then I knew all three of us were going to be all right.

I know the recovery room was confusing- I remember being cold and thirsty.

Even the time in my regular room afterward is hard to remember. I was on a morphine drip for about 12 hours- the kind where you have to dose yourself. A real important thing about those pumps is that you need somebody "normal" to remind you to press the pump. I can't remember the details right now but my FIL had the same problem when he had surgery. Something about waiting until the pain has totally returned and then you're bad off but still groggy? I'm not sure. I don't remember pain in a specific place (like the incision) just overall feeling like HELL.

I was breastfeeding and I kept falling asleep in the middle of it. My husband would have to wake me up or talk to me non-stop.

Oh! now I remember something gross. What about having to measure how much urine you passed? They gave me a piece of paper and I had to write down everytime I went to the bathroom and how much. There was this little potty seat you sat on that had markings in it(like a measuring cup). Then after you stood up and looked at how much was in there you dumped and flushed. I had to do that while I was dragging along my morphine pump IV.

Of course for first timers they should also know that there will be all that blood--- C-section or not.

I also remember finally sending one twin back to the nursery even thought they were rooming in. I just couldn't take her moving around-- it was making me jumpy. I just called the nurse and said I need my sleep take her with you and they did- no questions asked.

I truly believe that a positive attitude can be immensely helpful. I had a C-section, and found the second day afterwards to be pretty uncomfortable, but that was the worst day. As usual, I was not allowed to drive afterwards. On day 6, I walked from the hospital (where the children were) to the doctor's office (a pretty long walk). As my OB was about to chastise me for driving (no one accompanied me to the visit) I informed him that I had walked. He told me that if I was able to that, I was ready to drive again.

We reluctantly attended the C-section preparation class offered at the hospital. After which we decided we definitely did NOT want to take the C-section route. However, at 32 weeks the doctor said we had to have an emergency C-section right now to save baby A.

It really wasn't as bad as I had thought it might be. To me the biggest factor in C-section success stories is the effectiveness of the epidural. The epidural was thorough in my case. They say the epidural numbs you from about the nipples downwards....this one got me clear up to my grey matter! The anesthesiologist had a nice sense of humor, but I took everything he said Literally. I just couldn't make sense of him!

There was no pain, only slight sensation of tugging during the surgery. The hardest part for me was the first day after the surgery. It's still very difficult to lay in one position for any length of time because of soft hip joints, so you want to roll over, but now your abdominal muscles are cut. Get help to roll over! The kindest nurse in the world was thankfully on shift while I was recovering, and she brought me a warm blanket (they keep blankets in warming ovens on the maternity ward to wrap the babies in) to hold to my belly. It really helped!

The only other thing was recovering from all the medications. It took 12 to 13 hours after the surgery before I could sit up without vomiting. Since the babies were in NICU it was 13 hours before I could see them. I wish you all the best of luck with your labor and delivery!

I was dreading the possibility of a c-section, but that's what I ended up with and it went just fine. Although I missed having a natural child birth experience and was momentarily disappointed about that, having our precious babies safe and healthy was our primary concern. Every once in a while when I hear people talking abou the birth of their children, I am sorry that ours weren't born vaginally, but just looking at my little boy and thinking about what might have happened to him reminds me that we made the right decision.

I hope the delivery goes well. IMHO, from our experience, I would suggest going in with a birth plan with how you want things to go (we presented our birth plan in writing to our dr. a few weeks earlier and discussed options with her and then she had it placed in our chart at the hospital) but be prepared to be flexible if the delivery does not go quite as planned. Good luck.

I want to reasure you that a C-section is not necessarily a very unpleasant experience. I had a scheduled C due to breech-breech presentation and it went totally fine. These days most C-sections are done with regional anesthesia (an epidural or spinal) so you get to be up when they deliver the babies. After the surgery they put a 24 hour dose of painkiller (I think it was called a durablock) in and after that they gave me either percoset or demerol and there really wasn't much pain. A lot of hospitals make you ask for painkillers so don't be shy. I had the babies on a Monday and by Wednesday I was off all meds. The only problem was that it was difficult to change position (ie get off the bed, etc). I slept with a heating pad and that helped too. By 2 weeks I was relatively ok and by 6 totally back to normal except for normal fatigue due to night feeding . I felt better after the surgery than the last few weeks of my pregnancy!! Good luck and be sure that the best way to have a baby is the one that is safest for mom and babies - if in your case that is a section be happy that it is available!!

When does the pain from the cesarean incision go away? I'm 7 days post-op, and still hurt a lot!

Any suggestions for reducing this pain would be appreciated - especially before the twins are home and I get to take care of them! (I'm taking percocette, but hate taking drugs + I don't like it getting in the precious ounces of breastmilk I'm pumping for the boys.) I'm walking great, but getting up and down is murder.

Re the pain of the c-section, I found that the more I bent over ie putting dishes in the dishwasher, cleaning out the cat litter box, the sooner I discharged a lot of backed up gas (sorry for being graphic). It did hurt but the end of week 2 was better than week 1. It does take awhile for your muscles in your abdomen (sp?) to heal also. I just learned to appreciate less pain & discomfort than the day before. By the way, I would just take the pain meds now & get as much sleep as you can before the babies come home.

I hurt for a while and was still taking Tylox and Motrin for about 10 days before we figured out that the babies were sleeping too much because of it. They were a little jaundiced so we thought they were sleeping too much because of that. The first visiting nurse said the drugs wouldn't affect the babies so I kept taking them. The second nurse had a different opinion and called to find out that yes they do go through to breast milk and could make them drowsy. I stopped, pumped and dumped for a night and then they stayed awake long enough to nurse. I was lucky in that I had a hospital bed at home. My DH, the collector of everything, just happened to have one he'd gotten from his uncle. It was a big help.

I don't know if you've had a vaginal birth before or what your feelings are about the vaginal/c-section thing but if it makes you feel better my recovery was about the same. Just lots of pain in different places but everyone is different.

Hope you're feeling better now and get all the sleep you can before they come home.

I had a c/sect after inducing failed (at 37.5 wks). The first night was miserable, I couldn't even roll over in bed without extreme pain. They took me off the percoset on the second day, and gave me ibuprofen. I really felt when the ibuprofen kicked in, the pain switched off like a light. I found it much more effective, even though ibuprofen is not a narcotic. I really really don't like narcotic pain killers, anyway. The first week home was grim, I really felt rotten, and tired very easily. By two weeks, I felt that I was probably about on a par with moms who had delivered vaginally. Still a little sore, very tired, but not too bad physically, but emotionally overwhelmed. But my induced labor didn't get very far (never dilated), so I didn't have much trauma before hand. A friend who delivered twins at 36 weeks fared much worse than I did. She got to 8 cm dilated and stalled there, started running a fever, they had her packed in ice, just a whole bunch of fun. She had a long hard labor, and they still ended up inducing. She was flying low for about a month. I don't remember what they gave her for pain management.

I had a c-section because both boys were breech (my vertex Baby A turned breech at about 34 weeks!). I had part of my colon removed 4 years ago, so have a previous scar from just below my breasts to about the pubic area. My OB was going to go through the same incision (up and down) because she expected to encounter a lot of scar tissue. As it turned out, she was on vacation, and the OB who did my surgery did a bikini line (side to side) incision with had no problems with scar tissue. The recovery from my c-section was SO MUCH EASIER than from the up and down incision I had previously. When I had that one, it hurt to cough, to laugh, to move etc. for a long, long time afterward. It didn't hurt anywhere near as badly after my c-section... only mildly getting into and out of bed. I think it's because of not being "split down the middle" so to speak. I think that in emergency situations they sometimes have to do the up and down incision. I'd ask for the bikini line, if possible.

Vag and C Delivery

For those of you who have had a C-section and Vaginal birth with twins, is it harder to recover from both rather than having twins either vaginally or C-section? (I realize that you can't compare if you haven't had one or the other before).

After having 2 singletons via vag, then twins as one of each (second one had prolapsed cord after 45-min. of external manipulation), I would have to say a resounding "yes!" I was a quick healer with my vag deliveries for singletons. However, the stress of having one of each delivery (I think) played a major role in my getting a uterine infection (which extended my hospital stay) and complications with an abcessed gland from the bag delivery. Trying to take care of pain and stitches in two different areas was not exactly what I needed when I had two newborns to attend to. I tried to push the attending ob to deliver both via c-section, but no luck. Hope this answers your question.

I am one the few "lucky" ones to have the first twin naturally and then have the second by c-section. Both my girls were vertex up until the last week or so. Even when they checked me in to induce me (pre-eclampsia/HELLP) they planned on a vertex vaginal birth and then delivering Baby B as a breech vaginal birth.

After Baby A was born they attempted to turn Baby B, but realized she was in distress. They put me under anesthesia and took her 31 minutes after her sister was born. She was blue and floppy with an apgar of 2, so I'm glad they did the emergency c for her.

Yes, it's major surgery, but it doesn't necessarily mean you'll be out forever recovering. The girls were born on Tuesday, I went home Friday and was driving myself to the hospital to see them two days later. I was home alone when I went home and when the babies came home I was pretty much alone. I may just be a quick healer or handle pain well, but don't automatically assume that you will be in gruesome pain and never walk for a week.

Take care of yourself and attempt the vaginal if you want...I'm *sooo* glad I did even if I did end up having one each way. I can't compare it to either a c-section alone or a vaginal deliver alone, but I'm still glad that I attempted the vaginal delivery.

Once I have the baby I'm carrying now, then I'll have something to compare to and I'll update you then!

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