32 weeks – growth scan and birth options

This week we had another growth scan and clinic appointment. It was lovely to see the babies again, it’s reassuring to know they’re OK in there, even though I do feel them move lots anyway. They are getting so big that it’s really hard to make anything out on screen, unless you’re a trained sonographer and know what you’re looking for. She pointed out a few things to me and I nodded with a kind of “if you say so” smile.

32 weeks

The main thing is they are growing nicely. Both are still around average size, one slightly longer than the other, meaning their estimated weights are slightly more different from each other than last time with a 10% difference. They are estimated to be around 4-4.5 lbs each, though as I wrote before, scanning at this gestation can be quite inaccurate so these stats have to be taken with a relatively large pinch of salt. There’s a good amount of amniotic fluid around them in each sac, and the placentas look healthy and well positioned at the back of the womb. Their cord blood flow rate is healthy, and they are both very active at scans – all the sonographers that I’ve seen have remarked on this! We produce very active kids it seems. I think it’s for this reason that they have moved position between every scan, never staying in the same place.

Unfortunately their positions are slightly less favourable than at the last scan (where twin 1 was transverse with head nearer the cervix than bottom, and twin 2 was head down). This time twin 1 was properly breech (bottom sitting on the neck of the womb by the cervix!) and twin 2 was transverse, with their heads together near my ribs. Whilst it’s lovely that they have their heads together, I’d rather that their heads were near the cervix. The sonographer said there was still time to turn, and since they’ve turned lots already, I have some reassurance that this is possible. I was slightly dreading then talking to the doctor in clinic about where we would go from here in terms of birth plans. However, it turned out to be a very positive conversation.

I saw a consultant who I haven’t seen before. She seemed very laid back from the start. The usual blood pressure conversation was short, she checked that my machine read high, which it did, and joked with me about there always being one who had white coat hypertension. Then we moved on to how I’d like the babies to be born. I said that I was hoping for a vaginal birth, because I’d had very fast and easy births with my singletons, but that I understood their current positions weren’t very favourable for a vaginal birth.

To my surprise, she then said that if I go into spontaneous labour and I dilate as quickly as, or more quickly than, previous labours, they would be happy to support me in a breech vaginal birth. After I nearly fell off my chair in shock, I replied with something like “oh really! Er… um…. thank you!” When I had previously talked to a registrar about this at our first twin clinic appointment, he said that twin 1 would have to be head down if I wanted a vaginal birth.¬†She said that if it’s fast then better to let it happen naturally than try to intervene surgically, and that they as obstetricians have the expertise to assist with a breech delivery. She then went on to say that if I was dilating more slowly than before, and there was therefore time to consider other options, that they would rather offer me a c-section at a lower dilation with sac and fluid still in tact than wait for me to go slowly to full dilation and then potentially need a c-section once my waters had broken, which was less favourable from their point of view. Although she added that I still wouldn’t need to accept the offer if I’d gone into labour spontaneously and wanted to carry on for a vaginal birth.

I think it was around this point of the discussion that she made a statement that made my ears really prick up because it was very much in line with the two central tenets of the Positive Birth Book (that I have CHOICES and RIGHTS in childbirth). She said “you do have choices in this you know, it’s not just me telling you what you can and can’t do.” Again I nearly fell off my chair in amazement!

Then she went on to talk about what would happen if I don’t go into labour spontaneously. Firstly, she said that they were happy for me to go to 38 weeks as long as all is well at my next scan. They wouldn’t offer induction at that point if twin 1 was still breech. That would mean either a planned c-section before labour starts naturally, or “wait it out” with daily monitoring to check for foetal well-being, and they would talk to me about the risks either way with both of those options if it got to that. Again I was pleased that she seemed to be quite relaxed about the prospect of waiting it out rather than just going straight for a c-section, if all is well. They would offer induction if twin 1 was head down by then, just not if he/she was breech. I’m fairly confident that my body will go into spontaneous labour by 38 weeks, because the boys were born on or just after the 40 week “due date” for singletons. Mums who go longer with twins tend to also go to 41/42 weeks with singletons – we’re all different.

And that was that! A much easier conversation than I was expecting, and a much more positive and mum-centred approach to twin birth than I was expecting from a consultant obstetrician. I feel bad for tarring them all with the same brush in my head now! She said they’d like to see me again in 3 weeks, when I’ll be nearly 36 weeks pregnant, to check the babies’ positions. Initially she said 4 weeks because all was well and the babies are growing beautifully, but then decided a week earlier would be good to give us a bit more time to discuss all options if they are still in awkward positions, which I agree with.

In the mean time, if I have any signs of labour, I have to go straight in to triage to be assessed. They would rather I came in on false alarms and they sent me home again than risk a home/car birth, which I can understand if twin 1 is breech. A twin breech home birth would be one step too far in her opinion, and I have to say that would scare me too I think! This is totally different from when I had the boys – the birth centre didn’t want us getting there too early and nearly sent us away again with Andrew, but thankfully they didn’t as he was born about an hour and a half later, and we only just made it there at all for Joel.

I came out of the appointment feeling much more positive than just after the scan which had made me fear the worst for lack of birth options. I’m praying that at least twin 1 will turn, and there is a team of friends at church who are praying the same. But if this is how it’s meant to be, I’m feeling confident in my ability to breech birth if all goes as quickly as before, and I have a sense of peace surrounding the fact that it’s not in my hands – what happens, happens. The position of twin 2 is less important at this stage because they often turn once twin 1 is out anyway.

So going into this week I’m trying to continue getting the balance right between rest and activity. I hope that swimming, yoga and spending time on all fours using my birth ball for support will give the babies as much room to turn as possible, though I know it’s getting less likely that they will. I’m still feeling nauseous and have to lie down for a rest in the afternoon and evening otherwise I think I’ll be sick. But I’m really holding onto the fact that it’s really not long to go now. If anyone used to watch the comedy quiz show Shooting Stars, I have this line from it in my head: “We don’t know how much time we’ve got, but when the time’s up you’ll hear this noise….. argh!” We’re living life on the edge right now!

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