How does your hospital handle twins?

klone, MSN, RN · Jul 22, 2013

That's about how we handle it. If the lower baby is vertex, they can try to do a lady partsl delivery. If B is breech, they will often go in as soon as A is delivered and try to turn B. Once the woman is ready to start pushing, they move her to the OR for second stage.

seemerun · Jul 22, 2013

I had my first twins experience and I have to say I didn't like it much. Once A was born everybody immediately were all over mom. Hands up inside feeling for presentation (mind you no epidural) pushing on her tummy to make baby "descend". Then when a shoulder presentation was identified it was immediately section. It was basically treated as a crash even though baby looked fine on the monitor. I am not a crunchy granola type at all but even I didn't understand why if baby was stable, everybody couldn't chill the heck out for a few minutes, see how baby B descended on their own (without the pushing and torquing on the tummy) maybe let mom hold and bond with the first one for a few minutes. It just seemed so needlessly chaotic and I am sure scary for mom and dad.

klone, MSN, RN · Jul 22, 2013

Mono/mono?

seemerun · Jul 23, 2013

One placenta/2 sacs

klone, MSN, RN · Jul 23, 2013

I think there is a concern about premature placental separation.

seemerun · Jul 23, 2013

Well that helps a little. I hadn't thought about that. That wasn't an issue, but obviously it COULD have become one.

Elvish, BSN, DNP, RN, NP · Jul 23, 2013

lady partsl if A is vertex, and they deliver in OR. In recent memory we had a lady partsl triplet delivery, too. :up:

lovemyjoblandd · Jul 23, 2013

As long as I've been here (not quite a year) all multiples are sections, point blank. Even if the woman comes in complete and vertex.....

klone, MSN, RN · Jul 23, 2013

As long as I've been here (not quite a year) all multiples are sections, point blank. Even if the woman comes in complete and vertex.....

That's how it was at the community hospital where I worked at the beginning of my career - no lady partsl birth for multiples, no TOLAC. The private practice docs, while super nice (except one), did not really practice evidence-based medicine. Then I moved to a large city and started working at a very progressive teaching hospital, and we have midwives, we have CRNAs, we TOLAC, we attempt SVD for multiples, we don't give Mag as a tocolytic, we don't "pit to distress", we do things like CSTs instead of just automatically sectioning a woman. Basically, we do things for the best wellbeing of the mom and baby, and not the convenience of the doc. I LOVE it.

**LibraSunCNM, BSN, MSN, CNM** · Jul 23, 2013

lady partsl if A is vertex, and they deliver in OR. In recent memory we had a lady partsl triplet delivery, too.

Wow triplets! That makes me think of Phoebe from "Friends" having her brother's triplets lady partslly, and thinking "No way! That would never happen!" That's great though.

Elvish, BSN, DNP, RN, NP · Jul 23, 2013

Wow triplets! That makes me think of Phoebe from "Friends" having her brother's triplets lady partslly, and thinking "No way! That would never happen!" That's great though.

It was inadvertent, and fortunately it was with a doc that's great at lady partsl multiples. Mom got complete and baby A descended so rapidly, there was really no choice but to catch! After that, he said, it was 'technically a twin delivery'. :)