the "rules" for delivering twins

I find this stuff very interesting and thought some of you might, too...

I am hoping for a vaginal delivery with the twins. I chose my OB partly because she is one of only a very small handful (like, four) OBs in Houston who permit vaginal twin deliveries at all. Most schedule c-sections for all multiple deliveries. Now, twins are higher risk, and carry a greater risk of a c-section being necessary, which I know and understand. If I don't have to recover from major surgery while learning to nurse to newborns, though, I'd like to avoid it. Dr. Dryden is very supportive of my wishes, and says she hopes for the same.

Some of you also know enough about me to know that if I was carrying one little munchkin with no complications, I'd bail out of the hospital all together and deliver at home or in a birthing center with a midwife. There are several homebirth midwives in Houston that would happily deliver my twins. I don't feel like that is responsible, however, given the reading I've done on twin birth. (I heard that sigh of relief from some of you!) So, St. Luke's hospital in the medical center with Dr. Dryden it is.

There are some interesting "rules" for delivering twins, though. First of all, I am required to have an epidural once I'm in active labor. The reason for this is two-fold. The major risks in twin vaginal birth come with Baby B (our girl), the 2nd one out the door. Once Baby A (Yoho) is delivered, Banff will have more room than she knows what to do with. She will likely descend very quickly. She may or may not descend in a position ideal for her birth. Dr. Dryden is willing to do a breech (rear end or feet first) delivery of Baby B, but if she comes down shoulder first, or sideways, or in some other wonky presentation, an internal version (Google that one if you're brave! Yikes!) will be attempted. If that fails, a c-section delivery of Baby B is possible. Hence the epidural. Just in case.

The second "just in case" rule is that I will labor until complete in a normal labor & delivery room, but I'll be transferred to the operating room when it comes time to push those babies out. Now, delivering babies on a narrow metal table does not sound like my idea of fun, but if something happens, time will be criticial. I respect Dr. Dryden's wishes that I deliver in the OR, even though I'm not jumping up and down about it--she's trying to make sure everyone makes it to the other side safely.

Oh, I thought I would add that this seems to be fairly standard obstetrical practice when it comes to the vaginal delivery of twins. I have spoken to three other women who have had vaginal twin births and all of them were required to have an epidural and deliver in the OR. None of them were in Houston.

Interesting stuff, huh? Betcha learned something today!