Dr. Marjorie Greenfield
Specializing in pregnancy and birth.
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 Ask Dr. Greenfield
Birth Options When Second Twin Is Transverse | | | QUESTION | | | Dear Dr. Greenfield,
I'm currently 33½ weeks pregnant with twins. My doctor said the one on top is transverse and the baby on bottom is head down. He prefers that I have a c-section, but I'm real scared of having a major operation. Is it possible to have the baby manually moved into the head down position after the first one is born?— Candymarie in Illinois | | | ANSWER |
September 27, 2001 | | | Dear Candymarie,
First of all--congratulations! Although multiple births may be challenging, most parents of twins say that having a twosome is very special.
There are a few different approaches to twin delivery when the first baby is headfirst and the second isn't Some doctors will deliver the first one vaginally and then see how the second one comes down, especially if the second one is transverse (crossways, not breech). Sometimes they can guide the baby's head into the pelvis by pressing on your abdomen after the first baby is born--called external cephalic version. Others will reach up into the uterus, find the baby's feet, and deliver the second baby by breech extraction after the first one is born. Still others, like your doctor, prefer cesarean for any twins that aren't both headfirst. All of these arrangements are reasonable, provided that the physician feels comfortable with the contingencies. He will, after all, be the one to deal with any complications that occur. The problem is, you need your doctor to feel at ease with the plan. Breech vaginal delivery is controversial, even for the second twin, and some doctors just don't want to deal with it. And I think you might agree that having both a vaginal birth and a cesarean is not a good solution to the problem.
There is still some chance that both your babies will be headfirst by the time you are getting ready to give birth, and in that case your doctor will hopefully be willing to go for a vaginal delivery. It's reasonable to see what their positions are when you are closer to your due date.
Try talking to your doctor about what he is and is not comfortable with. If you are totally dissatisfied, you may have to change physicians, although that might be a difficult challenge at this late date. I don't recommend putting pressure on your doctor to go against his better judgment. For more information about cesarean (just in case) see our articles. Take care!— by Marjorie Greenfield, M.D. |
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