Prenatal Appointment #9 / Pregnancy Ultrasound #16

Today is 37 weeks, 5 days and we had another prenatal appointment with our OB. We went into it pretty much knowing what our options are, in terms of a scheduled C-section or waiting for labor to start naturally, because of a couple email exchanges with him since our last ultrasound with radiology. At that scan last week, Baby A was still breech and further down into the pelvic canal, so our OB had emailed us potential options for the birth. He presented them as:

  1. Elective cesarean section at 38 weeks,
  2. Wait on the babies until Molly goes labor and make a delivery decision at that time depending if Baby A flips around or not,
  3. Repeat ultrasound at 38.5 weeks and depending on their growth, either do a cesarean section, continue to observe, or induce labor.

He said that all of the options would be equally acceptable. However, if Baby A remains breech, he would prefer to do a scheduled C-section so he could appropriately prepare for and manage the complicated issues around Molly’s bleeding disorders (von Willebrand’s and Platelet Storage Pool Deficiency) under controlled circumstances.

This was an incredibly difficult decision for us to make, and we didn’t want to make one until after our appointment with him today. On one hand, we had said from the beginning that, even though late-term twin pregnancy is uncomfortable and it would oh-so-convenient to schedule a C-section, etc. that we both wanted what was best for the babies…which would most likely mean waiting until they initiated labor. However, we also didn’t anticipate having so much trouble around finding an OB we actually trusted. Each OB in the practice works at the hospital 2-3 times per month…and our current OB – the only person we’ve found that obviously is willing to go the extra steps to do background research on how best to manage Molly’s bleeding disorders and prepare a solid plan to not only help prevent but also treat if necessary – conveniently has his hospital day coming up soon, when Molly will have reached at least 38 weeks. His next day in the hospital is more than two weeks later.

While natural, vaginal delivery is most definitely preferred (shorter recovery time for mom, better for the babies), we realized that the only way a natural delivery will occur is if Baby A turns around – which at this point is technically still possible, but unlikely. Today’s findings showed that Baby A (breech) is definitely winning the race and is further down in the pelvis, so it is also unlikely that Baby B (head-down) will try to appear first. And even if Baby B did squeak by Baby A, meaning Baby B could be delivered naturally head-first, Baby A is still breech and has consistently measured larger on the ultrasounds. Sure, the ultrasound measurements could be wrong, and that became blatently obvious when our friend’s twins were born recently and weighed just one ounce apart when they had been measuring over a full pound apart, but the measurements are still what the doctors will base their decisions on. Even if Baby B could be delivered head-first vaginally, if the ultrasounds are saying that Baby A likely is bigger than Baby B, that means whatever doctor is on call may be even more unwilling to do a breech extraction…which would mean C-section anyway.

So if, most likely, Molly will end up needing a C-section, why not wait until labor starts and then just do it then? Because, while it is impossible to predict what would happen if we waited until labor started on its own, ultimately, we know what we absolutely don’t want. We don’t want to wait until labor stars, go to the hospital, decide that a C-section is necessary, and get some random doctor who knows nothing about Molly’s bleeding disorders because one of them is rare and who doesn’t have time to do research into them because Molly’s in the middle of labor. Doing the C-section at 38 weeks (instead of waiting until 39 or later), guarantees that we’ll have our own doctor who we have been extremely impressed with in terms of, well, everything. His knowledge and willingness to go the extra steps to provide the best care possible have instilled in us a strong sense of security with his care. While we recognize that waiting until the babies initiate labor may be the ideal, Molly’s safety and security also needs to be taken into consideration. The fact that we can only get this kind of security if the babies are delivered by C-section at 38 weeks is not our fault – it is due to the medical insurance conglomerate (from which Molly will likely be switching after the babies are born) and the frustrations we have had with other providers so far – that is what is truly unfortunate.

So, while we would have liked to have waited until labor started naturally (and who knows – it could still before the scheduled C-section!), and because there is no major medical contraindication to have a C-section at 38 weeks (the risks to the babies, compared to at 39 weeks, are “minimal”), we are scheduled to have these babies by C-section in a few days (gestational age 38 weeks and change) when our doctor is on call at the hospital. They’re going to blood type and cross Molly in a couple of days so that everything will be prepared when we go in for the C-section. The photographer won’t be allowed in the OR, but apparently she’ll be allowed into the recovery room so we can get some photos of the measuring/weighing/foot-printing.

Suddenly everything is so real. I can’t wait to hold those two little things. Happy (almost) birthday, babies!

2 responses to “Prenatal Appointment #9 / Pregnancy Ultrasound #16

  1. WOW! That’s so soon! I hope that Baby A decides to turn hirself around, but it sounds like your doctor really has Molly and the babies’ best interests in mind. Wonderful! I CANNOT wait to see pictures of those cuties and to find out their names!

  2. Sooooooooooooooooooo excited and soooooooooooooooo happy for the four of you!! Waiting, waiting, waiting……………………………

    Love you! 🙂

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