Must I Have an Epidural When I Give Birth to My Twins?

I'm expecting twins in July. I already have a 22-month-old daughter whom I gave birth to using Lamaze and without the use of drugs. If I'm able to deliver my babies vaginally, I'm hoping not to use any pain-relief medication. However, my doctor has told me that I will most likely have to have an epidural and that if I choose not to I run the risk of being totally knocked out in the case of an emergency C-section. I don't want that to happen. She said if I already have an epidural I will be fine.

Do you have any other suggestions, or is this the most reasonable way to go? My doctor implied that she knows of nobody who has given birth to multiples without the use of pain-relief drugs.

Question:

I'm glad you wrote, and congratulations on the two new babies you're expecting. I'm sure you're discovering that carrying a twin pregnancy brings with it a unique set of challenges.

Your letter brings up concerns. The first is the information you're receiving regarding twin birth without pain medication, and the second is that your preferences for birth don't seem to carry a lot of weight with your doctor.

Contrary to what your doctor is telling you, many women who have multiples deliver without pain medication. Some physicians and midwives actually prefer that mothers delivering multiples not have an epidural so that they can better respond to what they're feeling and push more effectively. If you look through the birth stories in the Birth section of Lamaze.com, you'll find a story sent in by a new mother titled "I Gave Birth to Twins Naturally."

While it's true that you have an increased chance of having your babies by cesarean, it's by no means a given. Your health, the position of the babies and their state of well-being at the end of pregnancy are important factors in determining the best method of delivery. I would suggest asking your doctor what criteria she uses in making this decision, as well as what percentage of her patients with twins deliver vaginally. If the answer is close to zero, you may want to consider interviewing some other obstetricians (or midwives, if any in your area deliver twins) who are willing to give you a fair chance.

I don't understand the rationale of "have an epidural in case a problem develops and we have to do a cesarean." It would be very unusual to have a problem develop so quickly that there's no time to put in an epidural, especially if you already have an IV (or a heparin lock) in place.

Your doctor's comment that she has never heard of anyone who delivered twins without pain-relieving drugs is very telling and certainly could be a self-fulfilling prophecy. Your confidence and ability to give birth are greatly influenced -- in either a positive or negative way -- by the people who care for and support you during pregnancy, labor and birth. She is telling you, in no uncertain terms, what her philosophy of birth is.

The bottom line is that you need to have accurate, unbiased and up-to-date information on all aspects of your care -- including what options you have -- so that you can make informed choices. Your caregiver needs to listen to and respect your point of view (and you, hers) for you to have a good working relationship.

There are resources you might find helpful. Two books I like are Everything You Need to Know to Have a Healthy Twin Pregnancy by Gila Leiter, M.D., and When You're Expecting Twins, Triplets, or Quads: A Complete Resource by Barbara Luke and Tamara Eberlein. A helpful organization (both now and after the babies are born) is the National Mothers of Multiples [800]243-2276.

Try to find a good childbirth educator in your area. Mothers of multiples need to prepare for a positive, normal birth experience while at the same time realistically preparing for possible complications. This requires that you be well informed on all the "usual" topics and receive additional information on subjects such as the special nutritional needs of mothers of multiples, identifying preterm labor, cesarean birth and recovery, and breastfeeding twins. Good luck -- and let us know how it goes.

For more information on twin a read, "I Gave Birth to Twins Naturally."

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