Transcript: Preparing For Your Twin Cesarean Birth
Twin Talks
Preparing For Your Twin Cesarean Birth
[00:00:00]
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
DR. TEVY TITH: Have you and your medical provider determine that you need to deliver your twins surgically? If you need a C-section for your twins, how can you prepare for it and how is it different from a singleton delivery? I’m Dr. Tevy Tith of the San Diego prenatal centre, here to talk to you about preparing for a twin caesarean birth. This is Twin Talks.
[Theme Music/Intro]
CHRISTINE STEWART-FITZGERALD: Well welcome to Twin Talks, broadcasting from the birth education center of San Diego. Twin Talks is your weekly online on the go support group for expecting and new parents of twins. I’m your host Christine Stewart-Fitzgerald. Now have you heard about the Twin Talks club? Our members get bonus content after each new show plus special giveaways and discounts.
You can subscribed to our monthly Twin Talks newsletter and learn about the latest episodes available. Another way for you to stay connected is by downloading our free Twin Talks app. It’s available from most smart phones. Well before we get started, let’s go around and introduce our panelists here in the room and I’ll start and I would say as your host, I just to share a little bit about my background.
I’ve got twin girls who are identical. They’re almost 5 years old and we did deliver via C-section after having some regular laboring and then I do have a singleton who is now 20 months old and she was a VBAC baby. So I can say I’ve experienced both types of deliveries.
SUNNY GAULT: Hey everyone, I’m Sunny. I’m the owner of New Mommy Media which produces Twin Talks, Parent Savers, Preggy Pals and The Boob Group and I’m a mommy to four children. My twins are my youngest. My girls, they’re only 7 months right now although they grew really, really fast.
They’re getting lots of rolls on them and yummy stuffs. Let’s say I’ve got a 4 year old and a 2 year old. As far as births go, my 4 year old was my vaginal birth and then I’ve had two caesarean births so I got to experience both too. Yeah.
SHELLY STEELY: I’m Shelly. I’m the producer here at Twin Talks. I’m also a High School history teacher. I’m off for the summer so yehey. I have identical twin boys who are almost 2 and they were born at 37 weeks via kind of urgent cesarean not it wasn’t an emergency but after an induction though I went into contractions, part of the labor but end up having a C-section. And I’m actually pregnant with my third, just one this time, and planning for a VBAC so maybe you can give me some tips.
I want to let you guys know about the virtual panelist program we have here at twin talks. So as you probably already know, you can follow us on Facebook or on Twitter but if you want to participate in the conversation from the comfort of your own home, you can use the #twintalksvp to actually be a panelist.
CHRISTINE STEWART-FITZGERALD: Alright.
[Theme Music]
SHELLY STEELY: So before we start today’s show, we want to look at some twin news and headlines. The most recent fascinating bit of twin headlines is we have miracle twins who are born 24 days apart. So I know you’ve heard maybe it is possible occasionally sometimes to have twins you know a few hours apart or born on different days but on this situation, this woman actually went into very preterm labor, 24 weeks, 5 days.
They were unable to stop that but they were able to keep the other twin safely inside for over three weeks. So her babies were born not just different days but I mean almost different months and different birth signs. So they’re healthy and happy and they just went home this weekend.
CHRISTINE STEWART-FITZGERALD: Oh my gosh. Now so I’m assuming that there they were both born vaginally so or was one the first one was born vaginally and then the second one born either of C-section or…
SHELLY STEELY: It looks like it doesn’t actually say…
CHRISTINE STEWART-FITZGERALD: Ha.
SHELLY STEELY: But it says that she I think so yeah vaginally because it says after she gave birth to her first twin who was born weighing only 1 pound 10 ounces…
CHRISTINE STEWART-FITZGERALD: Ooh tiny.
SUNNY GAULT: Oh my goodness.
SHELLY STEELY: Her labor slowed down and so the doctors decided that while the other baby was safe just to go ahead and keep him in.
CHRISTINE STEWART-FITZGERALD: Oh my gosh.
SUNNY GAULT: Imagine how you’d be feeling during those what 24 days you’ll be like on pins and needles like would I wouldn’t want to move. I’ll be so bed ridden like I wouldn’t want to do anything.
CHRISTINE STEWART-FITZGERALD: I mean that is just like a miracle in of itself.
SUNNY GAULT: I know.
CHRISTINE STEWART-FITZGERALD: And I knew we have our expert Dr. Tith and I’m sure sometimes you see I mean really early deliveries. I mean how I mean what are the statistics around this?
DR. TEVY TITH: That’s very rare. It’s definitely very rare. Definitely after you deliver the first twin, usually you expect the second twin to pop right out but you know really for the benefit of the babies and especially if mom is stable and there’s no sign or symptom of infection and the remaining baby appears to be stabled, that’s definitely an option. We definitely depending on the gestational age of the delivery of the first baby, we might actually bring that up as an option in terms of expected management of the second baby after delivery of the first.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. TEVY TITH: So and that in enough itself requires daily monitoring, making sure both mom and baby are safe.
CHRISTINE STEWART-FITZGERALD: Wow. Okay and I’m wondering normally with you give birth to one baby and then the second one comes through and there’s are there ways to help sort of slow it down and close everything up or are just or does that mean does the mom was the mom like fully dilated, has her baby and then she remains fully dilated and for the remainder of that time? I mean how does that work?
DR. TEVY TITH: It’s hard to say. I mean you have to figure you have to wonder what cause her to go into labor in the first place and if it’s truly an underlying infection then potentially she may have to deliver the second baby for the wellbeing of her both her and her baby but if she happens to go into active labor for whatever reason and delivers the first baby but doesn’t seem to have any signs of infection then potentially it is an option. Again it depends on the gestational age that this happens at.
SHELLY STEELY: It looks like it happen I found another one other time that I could find where and these boys where born 39 days apart but they said you know with babies born at 24 weeks the survival rate is really only around 50%. So in both cases with the twenty both cases the first one was born at 24 weeks and it’s really it was for the survival of the second baby to keep them in so I think this is something really…
SUNNY GAULT: Mostly anybody has [inaudible]
CHRISTINE STEWART-FITZGERALD: Yeah.
SHELLY STEELY: It is definitely fascinating.
DR. TEVY TITH: It is. It is.
SHELLY STEELY: I mean how do you?
SUNNY GAULT: Did they say if they were identicals or fraternals with that first article?
SHELLY STEELY: It didn’t say. No.
SUNNY GAULT: Because I mean…
CHRISTINE STEWART-FITZGERALD: But it has…
SHELLY STEELY: They have to be separate.
CHRISTINE STEWART-FITZGERALD: Yeah.
SHELLY STEELY: They have to be separate.
DR. TEVY TITH: Yeah they would have to be separate.
CHRISTINE STEWART-FITZGERALD: Oh sacs.
DR. TEVY TITH: Yeah.
SUNNY GAULT: Well separate sacs.
CHRISTINE STEWART-FITZGERALD: Separate sacs and then…
DR. TEVY TITH: They have three separate placentas.
CHRISTINE STEWART-FITZGERALD: Placentas. So yeah.
SUNNY GAULT: Oh okay. Oh yeah.
SHELLY STEELY: Which could be identical but from the health stand point It wouldn’t matter.
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: Yeah.
DR. TEVY TITH: Yeah. As long as they had separate placentas I mean they would have to have separate placentas because there could be some really major issues…
SUNNY GAULT: Right.
DR. TEVY TITH: If they shared a placenta…
SUNNY GAULT: Right.
DR. TEVY TITH: And one of them delivered.
CHRISTINE STEWART-FITZGERALD: Yeah.
DR. TEVY TITH: Then you would have to deliver the second one.
SUNNY GAULT: Okay.
CHRISTINE STEWART-FITZGERALD: Yeah. Now you know okay I’m thinking okay fast forward you know years for so you got…
SUNNY GAULT: I know.
CHRISTINE STEWART-FITZGERALD: Twins with different birthdays and then so how do you…
SHELLY STEELY: Do you throw separate parties?
CHRISTINE STEWART-FITZGERALD: Yeah.
SUNNY GAULT: I think you would probably have to but…
SHELLY STEELY: Maybe you meet in the middle. Can you imagine explaining that to every people…
SUNNY GAULT: That’s what I mean. That’s a nightmare.
SHELLY STEELY: Like to the IRS. I mean I don’t think they would audit you immediately if you’re going to have two babies born a month apart? I mean…
SUNNY GAULT: They’ll think you are on smoke or something or whatever when you file out he paper work.
SHELLY STEELY: I just can’t imagine every doctor’s visit you went to, every form you had to allow…
SUNNY GAULT: It does need so much explanation.
SHELLY STEELY: Enrolling the kids for kindergarten. Yeah this are my twins, they were born 39 days apart.
SUNNY GAULT: I think at some point you’d probably quit saying twins honestly. You’ll just say these are my kids. No seriously because the moment you say twins, you’re going to get all the questions. And then they’re probably, they may not look a lot alike if they’re fraternals so…
SHELLY STEELY: Even the crazy eyes when you’re like his birthday is in March and his birthday is in April.
SUNNY GAULT: Well you [inaudible] adopt one; I don’t know I think It would lead to a lot less conversation if you left out the twin part.
SHELLY STEELY: I mean clearly they’re probably just overwhelmed with excitement about the fact that they have two healthy babies but in about five years it would probably be…
SUNNY GAULT: Yeah.
SHELLY STEELY: A whole another kind of adventure.
SUNNY GAULT: Seriously.
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Okay well today’s topic is preparing for cesarean birth and today we’re talking with Dr. Tevy Tith who is here to help us understand what an expectant twin mom needs to know to plan for surgical delivery. So thanks for joining us today.
DR. TEVY TITH: Thanks for having me.
CHRISTINE STEWART-FITZGERALD: Well we know there’re so many different decisions going on and you know twin moms spend a lot of time talking to their medical provider throughout the pregnancy. So what are what are some of the reasons that a twin mom may need to have a plan cesarean?
DR. TEVY TITH: I like to divide the reasons up into three different categories and that being maternal reasons or fetal reasons or obstetric reasons or kind of a mix of the two but maternal reasons can things can be things like pre-existing pulmonary disease, heart disease or brain diseases that they have that wouldn’t allow them to push for instance. Different examples of fetal indications would be fetal anomalies or potentially like growth discrepancies between the two or anything of that nature. Obstetrical reasons would be things like we’ve gone through labor for a very long time, there hasn’t been very much progression and so we would end up having to deliver the babies by C-section.
CHRISTINE STEWART-FITZGERALD: And that’s for past for past pregnancies and deliveries and usually there’s a history of you know maybe either really long laboring periods…
DR. TEVY TITH: No actually like for instance if a like in [inaudible 00:10:53] for like a plan cesarean delivery well the other potential reasons could be things like uterine incision being in the wrong being in the wrong direction and that would make it unsafe for a woman to have…
CHRISTINE STEWART-FITZGERALD: A vaginal…
DR. TEVY TITH: A vaginal delivery. So…
CHRISTINE STEWART-FITZGERALD: Being in the wrong direction meaning vertical…
DR. TEVY TITH: Yeah.
CHRISTINE STEWART-FITZGERALD: As opposed to horizontal.
DR. TEVY TITH: Horizontal.
CHRISTINE STEWART-FITZGERALD: Okay. And I thought that vertical incisions are not as nearly as common as they have been in the past. Except for…
DR. TEVY TITH: Right. No. We don’t routinely do vertical incisions. They tend to be weaker when they heal so there’s a higher risk of rupture in a subsequent pregnancy and the risk of rupture is not always during labor. It can actually happen before labor occurs.
CHRISTINE STEWART-FITZGERALD: Oh wow.
DR. TEVY TITH: So that’s why we would recommend a repeat C-section usually at an earlier gestation.
CHRISTINE STEWART-FITZGERALD: Okay. So for mom who has a prior C-section you know either the vertical or horizontal then there’s a weakening of the uterine muscle and scar tissue and so then that of itself might be a reason say that plan cesarean is recommended. Now I’ve also heard also the location of the placenta as well?
DR. TEVY TITH: Yes. Absolutely. So definitely if [inaudible] if the placenta is low for instance if it’s covering the opening or the cervix then we would recommend a plan C-section as well.
CHRISTINE STEWART-FITZGERALD: Okay. And do those things change or pretty much it’s there and you know pretty early on…
DR. TEVY TITH: No. Actually it’s a dynamic organ.
CHRISTINE STEWART-FITZGERALD: Okay.
DR. TEVY TITH: It can definitely start out being low and then it can move as the uterus grows and it can move out of the way and so later on in the pregnancy it’s usually it cannot present a problem.
CHRISTINE STEWART-FITZGERALD: Okay. And…
SHELLY STEELY: Are there other kinds of like urgent medical concerns or serious medical like if there’s something that I’m pregnant with twins and I now have this complication so I have to have a C-section. Is there like a list of I mean what would, what on the mom side would absolutely necessitate a cesarean?
DR. TEVY TITH: I think if there were a concern for instance so if you know there are things that can happen during the pregnancy so for instance there’s a sudden diagnosis of for instance like a stroke in mom or you know mom has vision issues or neurologic issues and then we end up doing imaging and we find like a malformation in the brain that would present a huge problem if she tried to push. So those things for instance can happen during the pregnancy that you don’t anticipate before mom gets pregnant.
Those things are fairly rare though. It’s typically rare and you know and you know from a fetal perspective for instance if you have twins and one baby is normal but the other one isn’t so if one baby had a spinal defect or something like that then we might actually recommend we would recommend a C-section instead of a vaginal delivery for the safety of the baby.
SHELLY STEELY: So on the mom’s end I mean assuming she’s had you know no prior C-sections or she has a low transverse incision and the babies you know just on the maternal side there’s really not there’s really nothing normal or common that would necessitate a C-section?
DR. TEVY TITH: No. Not usually. Not usually. I mean even things such as diabetes as long as it’s really well controlled during the pregnancy the or even preeclampsia is actually not an indication for a C-section unless you think that mom is deteriorating really quickly and you need to deliver the babies very quickly. That’s not usually an indication for a C-section. It’s an indication for delivery but not a C-section.
SHELLY STEELY: So most of the indications are kind of it’s kind of all to the babies. Right?
DR. TEVY TITH: Yeah.
SHELLY STEELY: The mother hasn’t much of control.
CHRISTINE STEWART-FITZGERALD: You know it’s so funny because I think so often in the twin worlds I mean we know C-sections are very common for a lot of different reasons and I think sometimes you know twin moms or expecting moms just automatically assume well I’m going to have it by C-section but I mean in this case what’s your experience as far as percentage of moms who are having a plan C-section versus having a plan vaginal birth?
DR. TEVY TITH: I think it’s very patient dependent and typically when a patient comes to our practice or approaches any physician’s practice, you have to examine really what kind of twins are they first and if they’re the mono, mono kind I mean they share a placenta and they share a sac those would I think right off the bat be candidates for a C-section just because the risk of cord entanglement is so high.
But typically if they don’t share a sac then they would be candidates for vaginal delivery and again the same conditions apply in the singleton as it would to a twin delivery in terms of who’s the candidate for a C-section and who’s a candidate for vaginal delivery. I don’t dismiss it right off the bat that oh this is a twin pregnancy we have to have an we have to do a C-section. I don’t think that that is I think that’s a disservice to patients. So…
CHRISTINE STEWART-FITZGERALD: Oh definitely. And what are so the pros and cons of a C-section both for the maternal and the fetal health standpoint?
DR. TEVY TITH: Definitely. So for in terms of maternal I mean again it depends on if there’s any underlying pre-existing maternal conditions. A C-section maybe more maybe safer for mom but typically if you have twins and if you’re planning a vaginal delivery for instance and the vaginal delivery doesn’t go quite right then you can actually have an increased risk of blood lost and so if you have a plan C-section, there can be a decrease in the blood lost or really the decrease in the risk of what we call the postpartum hemorrhage and decrease the need for transfusion.
There are some studies that have look at things such as incontinence later on in the lifetime of the woman but there’s those studies haven’t panned out in terms of saying that a C-section is better than you know than a vaginal delivery.
SUNNY GAULT: You know I have to comment on that because that’s that was actually my situation. So my first baby was a singleton and that was a vaginal birth and I had some major complications. I’d actually didn’t realized there were complications until after he was out and everything but it cause severe urinary incontinence and so they said I mean I had to get a bunch of different types of treatment and see your gynecologist and everything and I remember one of my first appointments with him he said okay so we’re going to recommend that every future baby is a cesarean. And I went…
CHRISTINE STEWART-FITZGERALD: Wow.
SUNNY GAULT: And I went what? Because I just had this amazing vaginal birth of I had a mirror there every hour I was push. I push for two and a half hours. There wasn’t even a mention of cesarean. Nothing. Right? And welcome this beautiful baby into the world and then they said yeah cesarean here on out and it took me a really long time to get over that. I actually went to some I can meetings and stuff. It was such a rare thing because it was like I hadn’t have the cesarean yet they just told me that I have to have cesarean.
By the time I got to my twins because I did have a cesarean birth with my second baby, a singleton baby, by the time I got to my twins I was kind of like you know I didn’t push for a vaginal you know for multiple reasons so I was like well you know I already have you know I had the experience of having a vaginal birth and you know I had the cesarean with my middle guy and actually both were both really good experiences. So anyways you comment on the urinary incontinence…
DR. TEVY TITH: Yeah. Yeah.
SUNNY GAULT: I’m like hey…
DR. TEVY TITH: Yeah.
SUNNY GAULT: That’s what they told me.
DR. TEVY TITH: Yeah. Definitely in the first year after a vaginal birth the rates of incontinence has seen to be a little bit higher in patients who’ve had a vaginal birth but when you look at studies that have followed the woman out for three years or five years it doesn’t look like there’s much of a difference. So again I think that is can be controversial and again you have to really tailor your counselling to the patient.
CHRISTINE STEWART-FITZGERALD: I mean of course a C-section in itself I mean it’s a surgical procedure it’s major abdominal surgery…
DR. TEVY TITH: Yeah.
SUNNY GAULT: It is. Yeah.
CHRISTINE STEWART-FITZGERALD: So there’s you know major recovery going on and you know you have if you open up an organ then you’re going to have scar tissue and so there are the downside of that as well…
DR. TEVY TITH: Yes.
CHRISTINE STEWART-FITZGERALD: Just to consider.
DR. TEVY TITH: Yeah so definitely you know with a C-section like you said it’s a major abdominal surgery. There are as with any procedures associated risk things like infection, bleeding, injury to organs and these are all things that we talk to our patients about but I think particularly unique to the pregnancy population is really counselling about future pregnancy planning because if your patient really wants to have a lot of kids, a C-section may not be the right route to go with her especially with her first delivery because it can increase the risk of issues later on. So we’re having, we’re seeing a lot of patients now where there are problems with the placenta.
The placenta is really stuck to the uterus and it causes major bleeding to the point where women need transfusions to the point where they need to remove the uterus after the C-section or after the delivery. So we’re definitely seeing a lot more placentation issues in patients who have had repeat C-sections.
SHELLY STEELY: So for somebody who is thinking I mean there’s a lot of unknowns that come into twin pregnancy and so I’ve heard people say no I just want my plan C-section. I want to know how they’re coming. I want to know when they’re coming. Something you would counsel about is how many children are you planning on having.
DR. TEVY TITH: Absolutely. I mean I think that it’s you’re going to be this patient’s doctor and potentially maybe her doctor for her next several pregnancies and you want to do what’s best for her and you know what’s least morbid for her. So…
CHRISTINE STEWART-FITZGERALD: That’s an excellent point just to think about. It’s not just this pregnancy I mean [inaudible] twin pregnancy is a really big deal but down the road you know what are the longer term consequences of that.
DR. TEVY TITH: Absolutely.
CHRISTINE STEWART-FITZGERALD: Alright when we come back we’re going to talk about what’s happening in the OR and the gentle or family centered C-section.
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Well welcome back. Today we’re talking with Dr. Tevy Tith who’s helping us understand what’s happening in the OR and what the usual procedures and some of the different types of approaches including the gentle C-section or family centered C-section. I mean what exactly is that?
DR. TEVY TITH: I had actually never heard of this until I looked it up a few days ago and I think it’s something that’s been pioneered at least at the Brigham where there are just a few key differences in terms of the setup of this of the OR room. So for instance in a family centered C-section you would have typically cleared drapes so the mom can actually watch the delivery.
I mean they’re still usually like a blue drape between patients and the surgeons throughout the C-section until the point of the delivery of the baby and then they bring down the blue drapes and then they allow through the clear drapes mom can actually see can actually watch her baby being birth.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. TEVY TITH: Which is amazing and which has been…
CHRISTINE STEWART-FITZGERALD: That is really revolutionary I have to say.
DR. TEVY TITH: Yeah.
SUNNY GAULT: Yeah.
DR. TEVY TITH: Yeah. And then there is a lot of communication with anesthesiology and with the surgeons to make sure that mom is comfortable and to make sure that they’re doing everything that they could to make this as much of a an amazing experience for mom and dad as possible so a lot more communication. They will also place the monitors in different places so that the mom can have her arms free so that after the birth she can actually hold the baby on her chest so just a few key differences but nothing that compromises the safety of her the baby.
CHRISTINE STEWART-FITZGERALD: And what would the advantages be I mean it sound like so the mom gets to watch the actual where the baby is coming out and having that first moment. It’s not just the dads I know typically….
DR. TEVY TITH: Yeah.
CHRISTINE STEWART-FITZGERALD: We think of C-sections and the dads on the other side sometimes with you know can watch and say wow it’s a boy and the mom sort of like you know going okay I mean I kind of have sensation but I have no idea what’s going on down there and doctor it sounds like I mean this is kind of a new concept for you as well. So if you know the moms are you know interested in having you know more bonding time or more visual and that sort of thing is that something that they can talk to their provider or is it also communicating to the hospital what should they do?
DR. TEVY TITH: I think they can definitely talk to their provider. They can also call the hospital and see if it’s something that’s available. I know that actually in some hospitals instead of the clear drape they can actually put a mirror on top so that they can watch it and we don’t the mirror isn’t angled at the entire time until the point of the delivery but they can watch it from above and then it’s actually a little bit easier for them that way.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. TEVY TITH: Yeah.
CHRISTINE STEWART-FITZGERALD: You know I guess I didn’t realize that they had mirrors in ORs.
SUNNY GAULT: I probably would’ve opted for that. I mean I watch my vaginal birth and I was fascinated by that and that actually empowered me because you’re pushing and you’re trying to accomplish something.
DR. TEVY TITH: It’s like biofeedback.
SUNNY GAULT: It is. It is. It’s like oh that’s what I’m doing okay got it. I’ve got my goal on mind.
SHELLY STEELY: We did have one of the nurses took my camera and took pictures of the actual delivery so that was really nice to have.
SUNNY GAULT: Oh that’s nice.
SHELLY STEELY: Because there is no way my husband was going to take pictures.
SUNNY GAULT: Right.
SHELLY STEELY: During that situation so I think if the hospital offered that I mean priceless really because there is no other way that I would’ve had and so I actually have pictures of like right as the babies are being pulled out which was really nice to have.
CHRISTINE STEWART-FITZGERALD: How about so for babies that do require some time in the NICU I mean maybe you know for those who are born we got you know baby twin A or twin A or twin B. What are some of the logistics behind this? You’ve got a whole team of people and then you know one baby is born and maybe one goes off to the NICU or you know and then dad is there and wants to be present for all of that I mean you know what are some of the different choices or options that parents can do as far as you know spending time with the babies and with mom?
DR. TEVY TITH: So you know it’s probably a better question for the NICU nurses and the NICU staff just because they know better than I do you know but you really just do your best and you know at this point mom is still is recovering from a C-section so really making sure that mom is comfortable first and mom has the ability to bond with her babies and making sure that you set aside some time for mom and for dad and you know the parents to bond with their babies in the NICU or outside of the NICU. Sometimes they may have to split their time up. I mean it’s just it’s so vary able for different parent.
CHRISTINE STEWART-FITZGERALD: I remember one of my girls was did go to the NICU just for a few hours. She wasn’t breathing when she first came out and so we were doing kind of you know a lot of just a merry go around. My husband was visiting her and staying with me and then I had twin A so I think that just requires kind of a just an open mind set. It’s like okay I’m going to…
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: I’m not going to be upset you know I can’t we can’t control it. We can’t control the situation. We’ll go with the flow.
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: Take a deep breath and then how about just from a recovery stand point. Is recovering from a twin C-section any different than recovering from a singleton C-section?
DR. TEVY TITH: Not really. It’s still the actual process itself is pretty much the same except that you’re delivering a second twin but everything in terms of you know everything up to the uterine incision and then everything from the delivery of the babies and removing the placentas, it’s all pretty much the same. It’s you know there can be a little bit more of a blood lost after the delivery of twins. So we monitor closely for that. We you know the real major difference is actually after the delivery in the postpartum period you now have two babies to breastfeed. So it’s…
SUNNY GAULT: Yeah.
DR. TEVY TITH: That’s probably the biggest difference but as far as physical recovery not really and It also depends on you know for whatever reason if you were like on bed rest you might be a little bit more deconditioned so I mean…
CHRISTINE STEWART-FITZGERALD: So as far as like having your muscles being as not as strong.
DR. TEVY TITH: Yeah. Exactly.
CHRISTINE STEWART-FITZGERALD: Okay. If you weren’t as ambulatory before having them and you were then you might be not as strong…
DR. TEVY TITH: Right.
CHRISTINE STEWART-FITZGERALD: To lift and walk and carry and all those other things.
SUNNY GAULT: You know I found that my uterine contractions were more intense with my twins and I don’t know if that’s because my uterus got bigger and when I was breastfeeding in the hospital you know that triggers you know your uterus to shrink and I just I remember specifically having to ask for some pain relief for that and I don’t remember that at all with my singletons.
DR. TEVY TITH: Yeah that’s definitely that’s definitely possible too…
SUNNY GAULT: Yeah.
DR. TEVY TITH: But in general it’s pretty similar.
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: Oh it’s good to know. Well thanks so much for everyone for joining us today. For more information about preparing for cesarean birth or for more information about any of our speakers or panelist, visit the episode page on our website. This conversation continues for members of our Twin Talks club and we’re going to talk to Dr. Tith about how we can be proactive in correcting diastasis recti if you’re having that plan cesareans. So for more information about the Twin Talks club, visit our website www.twintalks.com .
[Theme Music]
CHRISTINE STEWART-FITZGERALD: We have a question from Claudia in St. Petersburg Florida and she says my boys are almost 3 years old and I’m trying to get them into a local preschool that requires kids to be potty trained. We’ve done some potty training were they sit on the potty but they just play with each other. They don’t seem to be interested in getting out of diapers even though they can go for hours without peeing. So what can I do to get them on track?
DR. DEBRA PONTILLO: I’m Dr. Debra Pontillo, child psychologist, developmental and behavioral specialist and voluntary assistant clinical professor in the University of California San Diego. My website if you like to contact me is www.how2helpmychild.com, that’s in numeric 2. I really appreciate your question. It sounds like a very frustrating thing that your twins are kind of goofing off when you’re trying to get down and dirty in the business.
I appreciate that you shared with me that you’re children are demonstrating a physical readiness sign of staying dry for couple of hours. That’s important. I’m also going to assume that they demonstrate some of the other social [inaudible] and communication skill that we would look for which I can’t go into here but just remember that 50% of kids are potty trained at 36 months of age that means the other 50% are still working on it between they’re third and fourth birthday.
But here’s what you can do to get back on track assuming that they’re ready to move forward. First of all unique to twins remember they are buddies and they’re going to the bathroom together. Not so with singletons. [inaudible 00:30:27] what motivates a singleton child to acquire potty training skills as the individual time they get with mom in the potty, the rewards, the praise and that one on one interaction.
So my first recommendation is get your children going to the bathroom separately taking turns so that they can focus on their time with you and the feedback that you want to give them and not on interacting with each other. Number two is you know twins are not always ready at the same time even identical twins and you may see that one child grasp things quicker than others. So having that individual time can allow that one child to pull forward if they are ready for it.
Obviously using rewards can be helpful to get them used to the idea and adding potty time to the daily routine so that it becomes something they do every time they go out, every time they go come home or right before bath, etc. So that it becomes second nature can also help reinforce it. Lastly if you are not able to get your children potty trained in order to get them to this preschool, do not fret.
A lot of 3 year olds do exceedingly well on potty trained in a preschool environment with there are some pure modeling going on. There is a different adult who have taken them to the bathroom, different expectations and structure and that can really help with them along wonderfully. So do not be afraid of looking for a preschool who will help you in this process. I’m Dr. Debra Pontillo for Twin Talks and www.how2helpmychild.com .
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Well, that wraps up our show for today. We appreciate you listening to Twin Talks.
Don’t forget to check our sister show:
• Preggie Pals for expecting parents
• Our show The Boob Group for moms who breastfeed their babies and
• Parent Savers, your parenting resource on-the-go.
This is Twin Talks parenting times two.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com
[00:33:19]
[End of Audio]
Episode Transcript
Twin Talks
Preparing For Your Twin Cesarean Birth
[00:00:00]
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
DR. TEVY TITH: Have you and your medical provider determine that you need to deliver your twins surgically? If you need a C-section for your twins, how can you prepare for it and how is it different from a singleton delivery? I’m Dr. Tevy Tith of the San Diego prenatal centre, here to talk to you about preparing for a twin caesarean birth. This is Twin Talks.
[Theme Music/Intro]
CHRISTINE STEWART-FITZGERALD: Well welcome to Twin Talks, broadcasting from the birth education center of San Diego. Twin Talks is your weekly online on the go support group for expecting and new parents of twins. I’m your host Christine Stewart-Fitzgerald. Now have you heard about the Twin Talks club? Our members get bonus content after each new show plus special giveaways and discounts.
You can subscribed to our monthly Twin Talks newsletter and learn about the latest episodes available. Another way for you to stay connected is by downloading our free Twin Talks app. It’s available from most smart phones. Well before we get started, let’s go around and introduce our panelists here in the room and I’ll start and I would say as your host, I just to share a little bit about my background.
I’ve got twin girls who are identical. They’re almost 5 years old and we did deliver via C-section after having some regular laboring and then I do have a singleton who is now 20 months old and she was a VBAC baby. So I can say I’ve experienced both types of deliveries.
SUNNY GAULT: Hey everyone, I’m Sunny. I’m the owner of New Mommy Media which produces Twin Talks, Parent Savers, Preggy Pals and The Boob Group and I’m a mommy to four children. My twins are my youngest. My girls, they’re only 7 months right now although they grew really, really fast.
They’re getting lots of rolls on them and yummy stuffs. Let’s say I’ve got a 4 year old and a 2 year old. As far as births go, my 4 year old was my vaginal birth and then I’ve had two caesarean births so I got to experience both too. Yeah.
SHELLY STEELY: I’m Shelly. I’m the producer here at Twin Talks. I’m also a High School history teacher. I’m off for the summer so yehey. I have identical twin boys who are almost 2 and they were born at 37 weeks via kind of urgent cesarean not it wasn’t an emergency but after an induction though I went into contractions, part of the labor but end up having a C-section. And I’m actually pregnant with my third, just one this time, and planning for a VBAC so maybe you can give me some tips.
I want to let you guys know about the virtual panelist program we have here at twin talks. So as you probably already know, you can follow us on Facebook or on Twitter but if you want to participate in the conversation from the comfort of your own home, you can use the #twintalksvp to actually be a panelist.
CHRISTINE STEWART-FITZGERALD: Alright.
[Theme Music]
SHELLY STEELY: So before we start today’s show, we want to look at some twin news and headlines. The most recent fascinating bit of twin headlines is we have miracle twins who are born 24 days apart. So I know you’ve heard maybe it is possible occasionally sometimes to have twins you know a few hours apart or born on different days but on this situation, this woman actually went into very preterm labor, 24 weeks, 5 days.
They were unable to stop that but they were able to keep the other twin safely inside for over three weeks. So her babies were born not just different days but I mean almost different months and different birth signs. So they’re healthy and happy and they just went home this weekend.
CHRISTINE STEWART-FITZGERALD: Oh my gosh. Now so I’m assuming that there they were both born vaginally so or was one the first one was born vaginally and then the second one born either of C-section or…
SHELLY STEELY: It looks like it doesn’t actually say…
CHRISTINE STEWART-FITZGERALD: Ha.
SHELLY STEELY: But it says that she I think so yeah vaginally because it says after she gave birth to her first twin who was born weighing only 1 pound 10 ounces…
CHRISTINE STEWART-FITZGERALD: Ooh tiny.
SUNNY GAULT: Oh my goodness.
SHELLY STEELY: Her labor slowed down and so the doctors decided that while the other baby was safe just to go ahead and keep him in.
CHRISTINE STEWART-FITZGERALD: Oh my gosh.
SUNNY GAULT: Imagine how you’d be feeling during those what 24 days you’ll be like on pins and needles like would I wouldn’t want to move. I’ll be so bed ridden like I wouldn’t want to do anything.
CHRISTINE STEWART-FITZGERALD: I mean that is just like a miracle in of itself.
SUNNY GAULT: I know.
CHRISTINE STEWART-FITZGERALD: And I knew we have our expert Dr. Tith and I’m sure sometimes you see I mean really early deliveries. I mean how I mean what are the statistics around this?
DR. TEVY TITH: That’s very rare. It’s definitely very rare. Definitely after you deliver the first twin, usually you expect the second twin to pop right out but you know really for the benefit of the babies and especially if mom is stable and there’s no sign or symptom of infection and the remaining baby appears to be stabled, that’s definitely an option. We definitely depending on the gestational age of the delivery of the first baby, we might actually bring that up as an option in terms of expected management of the second baby after delivery of the first.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. TEVY TITH: So and that in enough itself requires daily monitoring, making sure both mom and baby are safe.
CHRISTINE STEWART-FITZGERALD: Wow. Okay and I’m wondering normally with you give birth to one baby and then the second one comes through and there’s are there ways to help sort of slow it down and close everything up or are just or does that mean does the mom was the mom like fully dilated, has her baby and then she remains fully dilated and for the remainder of that time? I mean how does that work?
DR. TEVY TITH: It’s hard to say. I mean you have to figure you have to wonder what cause her to go into labor in the first place and if it’s truly an underlying infection then potentially she may have to deliver the second baby for the wellbeing of her both her and her baby but if she happens to go into active labor for whatever reason and delivers the first baby but doesn’t seem to have any signs of infection then potentially it is an option. Again it depends on the gestational age that this happens at.
SHELLY STEELY: It looks like it happen I found another one other time that I could find where and these boys where born 39 days apart but they said you know with babies born at 24 weeks the survival rate is really only around 50%. So in both cases with the twenty both cases the first one was born at 24 weeks and it’s really it was for the survival of the second baby to keep them in so I think this is something really…
SUNNY GAULT: Mostly anybody has [inaudible]
CHRISTINE STEWART-FITZGERALD: Yeah.
SHELLY STEELY: It is definitely fascinating.
DR. TEVY TITH: It is. It is.
SHELLY STEELY: I mean how do you?
SUNNY GAULT: Did they say if they were identicals or fraternals with that first article?
SHELLY STEELY: It didn’t say. No.
SUNNY GAULT: Because I mean…
CHRISTINE STEWART-FITZGERALD: But it has…
SHELLY STEELY: They have to be separate.
CHRISTINE STEWART-FITZGERALD: Yeah.
SHELLY STEELY: They have to be separate.
DR. TEVY TITH: Yeah they would have to be separate.
CHRISTINE STEWART-FITZGERALD: Oh sacs.
DR. TEVY TITH: Yeah.
SUNNY GAULT: Well separate sacs.
CHRISTINE STEWART-FITZGERALD: Separate sacs and then…
DR. TEVY TITH: They have three separate placentas.
CHRISTINE STEWART-FITZGERALD: Placentas. So yeah.
SUNNY GAULT: Oh okay. Oh yeah.
SHELLY STEELY: Which could be identical but from the health stand point It wouldn’t matter.
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: Yeah.
DR. TEVY TITH: Yeah. As long as they had separate placentas I mean they would have to have separate placentas because there could be some really major issues…
SUNNY GAULT: Right.
DR. TEVY TITH: If they shared a placenta…
SUNNY GAULT: Right.
DR. TEVY TITH: And one of them delivered.
CHRISTINE STEWART-FITZGERALD: Yeah.
DR. TEVY TITH: Then you would have to deliver the second one.
SUNNY GAULT: Okay.
CHRISTINE STEWART-FITZGERALD: Yeah. Now you know okay I’m thinking okay fast forward you know years for so you got…
SUNNY GAULT: I know.
CHRISTINE STEWART-FITZGERALD: Twins with different birthdays and then so how do you…
SHELLY STEELY: Do you throw separate parties?
CHRISTINE STEWART-FITZGERALD: Yeah.
SUNNY GAULT: I think you would probably have to but…
SHELLY STEELY: Maybe you meet in the middle. Can you imagine explaining that to every people…
SUNNY GAULT: That’s what I mean. That’s a nightmare.
SHELLY STEELY: Like to the IRS. I mean I don’t think they would audit you immediately if you’re going to have two babies born a month apart? I mean…
SUNNY GAULT: They’ll think you are on smoke or something or whatever when you file out he paper work.
SHELLY STEELY: I just can’t imagine every doctor’s visit you went to, every form you had to allow…
SUNNY GAULT: It does need so much explanation.
SHELLY STEELY: Enrolling the kids for kindergarten. Yeah this are my twins, they were born 39 days apart.
SUNNY GAULT: I think at some point you’d probably quit saying twins honestly. You’ll just say these are my kids. No seriously because the moment you say twins, you’re going to get all the questions. And then they’re probably, they may not look a lot alike if they’re fraternals so…
SHELLY STEELY: Even the crazy eyes when you’re like his birthday is in March and his birthday is in April.
SUNNY GAULT: Well you [inaudible] adopt one; I don’t know I think It would lead to a lot less conversation if you left out the twin part.
SHELLY STEELY: I mean clearly they’re probably just overwhelmed with excitement about the fact that they have two healthy babies but in about five years it would probably be…
SUNNY GAULT: Yeah.
SHELLY STEELY: A whole another kind of adventure.
SUNNY GAULT: Seriously.
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Okay well today’s topic is preparing for cesarean birth and today we’re talking with Dr. Tevy Tith who is here to help us understand what an expectant twin mom needs to know to plan for surgical delivery. So thanks for joining us today.
DR. TEVY TITH: Thanks for having me.
CHRISTINE STEWART-FITZGERALD: Well we know there’re so many different decisions going on and you know twin moms spend a lot of time talking to their medical provider throughout the pregnancy. So what are what are some of the reasons that a twin mom may need to have a plan cesarean?
DR. TEVY TITH: I like to divide the reasons up into three different categories and that being maternal reasons or fetal reasons or obstetric reasons or kind of a mix of the two but maternal reasons can things can be things like pre-existing pulmonary disease, heart disease or brain diseases that they have that wouldn’t allow them to push for instance. Different examples of fetal indications would be fetal anomalies or potentially like growth discrepancies between the two or anything of that nature. Obstetrical reasons would be things like we’ve gone through labor for a very long time, there hasn’t been very much progression and so we would end up having to deliver the babies by C-section.
CHRISTINE STEWART-FITZGERALD: And that’s for past for past pregnancies and deliveries and usually there’s a history of you know maybe either really long laboring periods…
DR. TEVY TITH: No actually like for instance if a like in [inaudible 00:10:53] for like a plan cesarean delivery well the other potential reasons could be things like uterine incision being in the wrong being in the wrong direction and that would make it unsafe for a woman to have…
CHRISTINE STEWART-FITZGERALD: A vaginal…
DR. TEVY TITH: A vaginal delivery. So…
CHRISTINE STEWART-FITZGERALD: Being in the wrong direction meaning vertical…
DR. TEVY TITH: Yeah.
CHRISTINE STEWART-FITZGERALD: As opposed to horizontal.
DR. TEVY TITH: Horizontal.
CHRISTINE STEWART-FITZGERALD: Okay. And I thought that vertical incisions are not as nearly as common as they have been in the past. Except for…
DR. TEVY TITH: Right. No. We don’t routinely do vertical incisions. They tend to be weaker when they heal so there’s a higher risk of rupture in a subsequent pregnancy and the risk of rupture is not always during labor. It can actually happen before labor occurs.
CHRISTINE STEWART-FITZGERALD: Oh wow.
DR. TEVY TITH: So that’s why we would recommend a repeat C-section usually at an earlier gestation.
CHRISTINE STEWART-FITZGERALD: Okay. So for mom who has a prior C-section you know either the vertical or horizontal then there’s a weakening of the uterine muscle and scar tissue and so then that of itself might be a reason say that plan cesarean is recommended. Now I’ve also heard also the location of the placenta as well?
DR. TEVY TITH: Yes. Absolutely. So definitely if [inaudible] if the placenta is low for instance if it’s covering the opening or the cervix then we would recommend a plan C-section as well.
CHRISTINE STEWART-FITZGERALD: Okay. And do those things change or pretty much it’s there and you know pretty early on…
DR. TEVY TITH: No. Actually it’s a dynamic organ.
CHRISTINE STEWART-FITZGERALD: Okay.
DR. TEVY TITH: It can definitely start out being low and then it can move as the uterus grows and it can move out of the way and so later on in the pregnancy it’s usually it cannot present a problem.
CHRISTINE STEWART-FITZGERALD: Okay. And…
SHELLY STEELY: Are there other kinds of like urgent medical concerns or serious medical like if there’s something that I’m pregnant with twins and I now have this complication so I have to have a C-section. Is there like a list of I mean what would, what on the mom side would absolutely necessitate a cesarean?
DR. TEVY TITH: I think if there were a concern for instance so if you know there are things that can happen during the pregnancy so for instance there’s a sudden diagnosis of for instance like a stroke in mom or you know mom has vision issues or neurologic issues and then we end up doing imaging and we find like a malformation in the brain that would present a huge problem if she tried to push. So those things for instance can happen during the pregnancy that you don’t anticipate before mom gets pregnant.
Those things are fairly rare though. It’s typically rare and you know and you know from a fetal perspective for instance if you have twins and one baby is normal but the other one isn’t so if one baby had a spinal defect or something like that then we might actually recommend we would recommend a C-section instead of a vaginal delivery for the safety of the baby.
SHELLY STEELY: So on the mom’s end I mean assuming she’s had you know no prior C-sections or she has a low transverse incision and the babies you know just on the maternal side there’s really not there’s really nothing normal or common that would necessitate a C-section?
DR. TEVY TITH: No. Not usually. Not usually. I mean even things such as diabetes as long as it’s really well controlled during the pregnancy the or even preeclampsia is actually not an indication for a C-section unless you think that mom is deteriorating really quickly and you need to deliver the babies very quickly. That’s not usually an indication for a C-section. It’s an indication for delivery but not a C-section.
SHELLY STEELY: So most of the indications are kind of it’s kind of all to the babies. Right?
DR. TEVY TITH: Yeah.
SHELLY STEELY: The mother hasn’t much of control.
CHRISTINE STEWART-FITZGERALD: You know it’s so funny because I think so often in the twin worlds I mean we know C-sections are very common for a lot of different reasons and I think sometimes you know twin moms or expecting moms just automatically assume well I’m going to have it by C-section but I mean in this case what’s your experience as far as percentage of moms who are having a plan C-section versus having a plan vaginal birth?
DR. TEVY TITH: I think it’s very patient dependent and typically when a patient comes to our practice or approaches any physician’s practice, you have to examine really what kind of twins are they first and if they’re the mono, mono kind I mean they share a placenta and they share a sac those would I think right off the bat be candidates for a C-section just because the risk of cord entanglement is so high.
But typically if they don’t share a sac then they would be candidates for vaginal delivery and again the same conditions apply in the singleton as it would to a twin delivery in terms of who’s the candidate for a C-section and who’s a candidate for vaginal delivery. I don’t dismiss it right off the bat that oh this is a twin pregnancy we have to have an we have to do a C-section. I don’t think that that is I think that’s a disservice to patients. So…
CHRISTINE STEWART-FITZGERALD: Oh definitely. And what are so the pros and cons of a C-section both for the maternal and the fetal health standpoint?
DR. TEVY TITH: Definitely. So for in terms of maternal I mean again it depends on if there’s any underlying pre-existing maternal conditions. A C-section maybe more maybe safer for mom but typically if you have twins and if you’re planning a vaginal delivery for instance and the vaginal delivery doesn’t go quite right then you can actually have an increased risk of blood lost and so if you have a plan C-section, there can be a decrease in the blood lost or really the decrease in the risk of what we call the postpartum hemorrhage and decrease the need for transfusion.
There are some studies that have look at things such as incontinence later on in the lifetime of the woman but there’s those studies haven’t panned out in terms of saying that a C-section is better than you know than a vaginal delivery.
SUNNY GAULT: You know I have to comment on that because that’s that was actually my situation. So my first baby was a singleton and that was a vaginal birth and I had some major complications. I’d actually didn’t realized there were complications until after he was out and everything but it cause severe urinary incontinence and so they said I mean I had to get a bunch of different types of treatment and see your gynecologist and everything and I remember one of my first appointments with him he said okay so we’re going to recommend that every future baby is a cesarean. And I went…
CHRISTINE STEWART-FITZGERALD: Wow.
SUNNY GAULT: And I went what? Because I just had this amazing vaginal birth of I had a mirror there every hour I was push. I push for two and a half hours. There wasn’t even a mention of cesarean. Nothing. Right? And welcome this beautiful baby into the world and then they said yeah cesarean here on out and it took me a really long time to get over that. I actually went to some I can meetings and stuff. It was such a rare thing because it was like I hadn’t have the cesarean yet they just told me that I have to have cesarean.
By the time I got to my twins because I did have a cesarean birth with my second baby, a singleton baby, by the time I got to my twins I was kind of like you know I didn’t push for a vaginal you know for multiple reasons so I was like well you know I already have you know I had the experience of having a vaginal birth and you know I had the cesarean with my middle guy and actually both were both really good experiences. So anyways you comment on the urinary incontinence…
DR. TEVY TITH: Yeah. Yeah.
SUNNY GAULT: I’m like hey…
DR. TEVY TITH: Yeah.
SUNNY GAULT: That’s what they told me.
DR. TEVY TITH: Yeah. Definitely in the first year after a vaginal birth the rates of incontinence has seen to be a little bit higher in patients who’ve had a vaginal birth but when you look at studies that have followed the woman out for three years or five years it doesn’t look like there’s much of a difference. So again I think that is can be controversial and again you have to really tailor your counselling to the patient.
CHRISTINE STEWART-FITZGERALD: I mean of course a C-section in itself I mean it’s a surgical procedure it’s major abdominal surgery…
DR. TEVY TITH: Yeah.
SUNNY GAULT: It is. Yeah.
CHRISTINE STEWART-FITZGERALD: So there’s you know major recovery going on and you know you have if you open up an organ then you’re going to have scar tissue and so there are the downside of that as well…
DR. TEVY TITH: Yes.
CHRISTINE STEWART-FITZGERALD: Just to consider.
DR. TEVY TITH: Yeah so definitely you know with a C-section like you said it’s a major abdominal surgery. There are as with any procedures associated risk things like infection, bleeding, injury to organs and these are all things that we talk to our patients about but I think particularly unique to the pregnancy population is really counselling about future pregnancy planning because if your patient really wants to have a lot of kids, a C-section may not be the right route to go with her especially with her first delivery because it can increase the risk of issues later on. So we’re having, we’re seeing a lot of patients now where there are problems with the placenta.
The placenta is really stuck to the uterus and it causes major bleeding to the point where women need transfusions to the point where they need to remove the uterus after the C-section or after the delivery. So we’re definitely seeing a lot more placentation issues in patients who have had repeat C-sections.
SHELLY STEELY: So for somebody who is thinking I mean there’s a lot of unknowns that come into twin pregnancy and so I’ve heard people say no I just want my plan C-section. I want to know how they’re coming. I want to know when they’re coming. Something you would counsel about is how many children are you planning on having.
DR. TEVY TITH: Absolutely. I mean I think that it’s you’re going to be this patient’s doctor and potentially maybe her doctor for her next several pregnancies and you want to do what’s best for her and you know what’s least morbid for her. So…
CHRISTINE STEWART-FITZGERALD: That’s an excellent point just to think about. It’s not just this pregnancy I mean [inaudible] twin pregnancy is a really big deal but down the road you know what are the longer term consequences of that.
DR. TEVY TITH: Absolutely.
CHRISTINE STEWART-FITZGERALD: Alright when we come back we’re going to talk about what’s happening in the OR and the gentle or family centered C-section.
[Theme Music]
CHRISTINE STEWART-FITZGERALD: Well welcome back. Today we’re talking with Dr. Tevy Tith who’s helping us understand what’s happening in the OR and what the usual procedures and some of the different types of approaches including the gentle C-section or family centered C-section. I mean what exactly is that?
DR. TEVY TITH: I had actually never heard of this until I looked it up a few days ago and I think it’s something that’s been pioneered at least at the Brigham where there are just a few key differences in terms of the setup of this of the OR room. So for instance in a family centered C-section you would have typically cleared drapes so the mom can actually watch the delivery.
I mean they’re still usually like a blue drape between patients and the surgeons throughout the C-section until the point of the delivery of the baby and then they bring down the blue drapes and then they allow through the clear drapes mom can actually see can actually watch her baby being birth.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. TEVY TITH: Which is amazing and which has been…
CHRISTINE STEWART-FITZGERALD: That is really revolutionary I have to say.
DR. TEVY TITH: Yeah.
SUNNY GAULT: Yeah.
DR. TEVY TITH: Yeah. And then there is a lot of communication with anesthesiology and with the surgeons to make sure that mom is comfortable and to make sure that they’re doing everything that they could to make this as much of a an amazing experience for mom and dad as possible so a lot more communication. They will also place the monitors in different places so that the mom can have her arms free so that after the birth she can actually hold the baby on her chest so just a few key differences but nothing that compromises the safety of her the baby.
CHRISTINE STEWART-FITZGERALD: And what would the advantages be I mean it sound like so the mom gets to watch the actual where the baby is coming out and having that first moment. It’s not just the dads I know typically….
DR. TEVY TITH: Yeah.
CHRISTINE STEWART-FITZGERALD: We think of C-sections and the dads on the other side sometimes with you know can watch and say wow it’s a boy and the mom sort of like you know going okay I mean I kind of have sensation but I have no idea what’s going on down there and doctor it sounds like I mean this is kind of a new concept for you as well. So if you know the moms are you know interested in having you know more bonding time or more visual and that sort of thing is that something that they can talk to their provider or is it also communicating to the hospital what should they do?
DR. TEVY TITH: I think they can definitely talk to their provider. They can also call the hospital and see if it’s something that’s available. I know that actually in some hospitals instead of the clear drape they can actually put a mirror on top so that they can watch it and we don’t the mirror isn’t angled at the entire time until the point of the delivery but they can watch it from above and then it’s actually a little bit easier for them that way.
CHRISTINE STEWART-FITZGERALD: Wow.
DR. TEVY TITH: Yeah.
CHRISTINE STEWART-FITZGERALD: You know I guess I didn’t realize that they had mirrors in ORs.
SUNNY GAULT: I probably would’ve opted for that. I mean I watch my vaginal birth and I was fascinated by that and that actually empowered me because you’re pushing and you’re trying to accomplish something.
DR. TEVY TITH: It’s like biofeedback.
SUNNY GAULT: It is. It is. It’s like oh that’s what I’m doing okay got it. I’ve got my goal on mind.
SHELLY STEELY: We did have one of the nurses took my camera and took pictures of the actual delivery so that was really nice to have.
SUNNY GAULT: Oh that’s nice.
SHELLY STEELY: Because there is no way my husband was going to take pictures.
SUNNY GAULT: Right.
SHELLY STEELY: During that situation so I think if the hospital offered that I mean priceless really because there is no other way that I would’ve had and so I actually have pictures of like right as the babies are being pulled out which was really nice to have.
CHRISTINE STEWART-FITZGERALD: How about so for babies that do require some time in the NICU I mean maybe you know for those who are born we got you know baby twin A or twin A or twin B. What are some of the logistics behind this? You’ve got a whole team of people and then you know one baby is born and maybe one goes off to the NICU or you know and then dad is there and wants to be present for all of that I mean you know what are some of the different choices or options that parents can do as far as you know spending time with the babies and with mom?
DR. TEVY TITH: So you know it’s probably a better question for the NICU nurses and the NICU staff just because they know better than I do you know but you really just do your best and you know at this point mom is still is recovering from a C-section so really making sure that mom is comfortable first and mom has the ability to bond with her babies and making sure that you set aside some time for mom and for dad and you know the parents to bond with their babies in the NICU or outside of the NICU. Sometimes they may have to split their time up. I mean it’s just it’s so vary able for different parent.
CHRISTINE STEWART-FITZGERALD: I remember one of my girls was did go to the NICU just for a few hours. She wasn’t breathing when she first came out and so we were doing kind of you know a lot of just a merry go around. My husband was visiting her and staying with me and then I had twin A so I think that just requires kind of a just an open mind set. It’s like okay I’m going to…
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: I’m not going to be upset you know I can’t we can’t control it. We can’t control the situation. We’ll go with the flow.
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: Take a deep breath and then how about just from a recovery stand point. Is recovering from a twin C-section any different than recovering from a singleton C-section?
DR. TEVY TITH: Not really. It’s still the actual process itself is pretty much the same except that you’re delivering a second twin but everything in terms of you know everything up to the uterine incision and then everything from the delivery of the babies and removing the placentas, it’s all pretty much the same. It’s you know there can be a little bit more of a blood lost after the delivery of twins. So we monitor closely for that. We you know the real major difference is actually after the delivery in the postpartum period you now have two babies to breastfeed. So it’s…
SUNNY GAULT: Yeah.
DR. TEVY TITH: That’s probably the biggest difference but as far as physical recovery not really and It also depends on you know for whatever reason if you were like on bed rest you might be a little bit more deconditioned so I mean…
CHRISTINE STEWART-FITZGERALD: So as far as like having your muscles being as not as strong.
DR. TEVY TITH: Yeah. Exactly.
CHRISTINE STEWART-FITZGERALD: Okay. If you weren’t as ambulatory before having them and you were then you might be not as strong…
DR. TEVY TITH: Right.
CHRISTINE STEWART-FITZGERALD: To lift and walk and carry and all those other things.
SUNNY GAULT: You know I found that my uterine contractions were more intense with my twins and I don’t know if that’s because my uterus got bigger and when I was breastfeeding in the hospital you know that triggers you know your uterus to shrink and I just I remember specifically having to ask for some pain relief for that and I don’t remember that at all with my singletons.
DR. TEVY TITH: Yeah that’s definitely that’s definitely possible too…
SUNNY GAULT: Yeah.
DR. TEVY TITH: But in general it’s pretty similar.
SUNNY GAULT: Yeah.
CHRISTINE STEWART-FITZGERALD: Oh it’s good to know. Well thanks so much for everyone for joining us today. For more information about preparing for cesarean birth or for more information about any of our speakers or panelist, visit the episode page on our website. This conversation continues for members of our Twin Talks club and we’re going to talk to Dr. Tith about how we can be proactive in correcting diastasis recti if you’re having that plan cesareans. So for more information about the Twin Talks club, visit our website www.twintalks.com .
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CHRISTINE STEWART-FITZGERALD: We have a question from Claudia in St. Petersburg Florida and she says my boys are almost 3 years old and I’m trying to get them into a local preschool that requires kids to be potty trained. We’ve done some potty training were they sit on the potty but they just play with each other. They don’t seem to be interested in getting out of diapers even though they can go for hours without peeing. So what can I do to get them on track?
DR. DEBRA PONTILLO: I’m Dr. Debra Pontillo, child psychologist, developmental and behavioral specialist and voluntary assistant clinical professor in the University of California San Diego. My website if you like to contact me is www.how2helpmychild.com, that’s in numeric 2. I really appreciate your question. It sounds like a very frustrating thing that your twins are kind of goofing off when you’re trying to get down and dirty in the business.
I appreciate that you shared with me that you’re children are demonstrating a physical readiness sign of staying dry for couple of hours. That’s important. I’m also going to assume that they demonstrate some of the other social [inaudible] and communication skill that we would look for which I can’t go into here but just remember that 50% of kids are potty trained at 36 months of age that means the other 50% are still working on it between they’re third and fourth birthday.
But here’s what you can do to get back on track assuming that they’re ready to move forward. First of all unique to twins remember they are buddies and they’re going to the bathroom together. Not so with singletons. [inaudible 00:30:27] what motivates a singleton child to acquire potty training skills as the individual time they get with mom in the potty, the rewards, the praise and that one on one interaction.
So my first recommendation is get your children going to the bathroom separately taking turns so that they can focus on their time with you and the feedback that you want to give them and not on interacting with each other. Number two is you know twins are not always ready at the same time even identical twins and you may see that one child grasp things quicker than others. So having that individual time can allow that one child to pull forward if they are ready for it.
Obviously using rewards can be helpful to get them used to the idea and adding potty time to the daily routine so that it becomes something they do every time they go out, every time they go come home or right before bath, etc. So that it becomes second nature can also help reinforce it. Lastly if you are not able to get your children potty trained in order to get them to this preschool, do not fret.
A lot of 3 year olds do exceedingly well on potty trained in a preschool environment with there are some pure modeling going on. There is a different adult who have taken them to the bathroom, different expectations and structure and that can really help with them along wonderfully. So do not be afraid of looking for a preschool who will help you in this process. I’m Dr. Debra Pontillo for Twin Talks and www.how2helpmychild.com .
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CHRISTINE STEWART-FITZGERALD: Well, that wraps up our show for today. We appreciate you listening to Twin Talks.
Don’t forget to check our sister show:
• Preggie Pals for expecting parents
• Our show The Boob Group for moms who breastfeed their babies and
• Parent Savers, your parenting resource on-the-go.
This is Twin Talks parenting times two.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com
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