Congratulations Sally on making the space for that woman to birth her babies.
I recently had the opportunity to observe 2 sets of twin births about a week apart. The first woman (a multip)came into labour spontaneously at home so that by the time she was admitted etc.. she was fully. So, the birth proceded naturally, she did allow an IV for the hospitals protocol for the 2nd twin but it wasn't needed as everything just proceded beautifully, midwives delivered both babies with OB and peds standing by, but not needed. Hospital /OB protocols re the epidural were not followed. The second woman was not so lucky, the twins were her first pregnancy, the second twin was diagnosed as IUGR so she was induced at 39 weeks. OB insisted on an epidural, there were language barriers so the woman was not able to effectively refuse, although she was 9+ cm when the epidural was finally in place. Second stage was rushed to say the least with the OB using a vacuum on both babies (I think 2.6 kg and 1.9 kg respectively). Babies were fine but cared for by the peds as mom proceded to have a postpartum hemorrhage despite a barrage of oxytocics on hand and had to be sent to theatre. She had a torn cervix not uterine atony or placental fragments. Anyway, after seeing that birth of twins, I cannot imagine recommending IOL for a healthy twin pregnancy at term, it just seemed to make it all so much worse. To be honest, I can't imagine recommending IOL for a complicated twin pregnancy either, I mean if you have IUGR going on then you have problems with placentation and sufficient blood to the compromised baby, couldn't/wouldn't you be making a bad situation worse by causing uterine hyper stim.. I guess I am wondering, if you are concerned about the babies' inutero environment and want them born, in that scenario wouldn't either a cesarean if they have to be born NOW be better or if it really isn't that urgent, waiting for a natural more gentle (perhaps) labor? I don't know? Has anyone seen a twin birth with IOL and epidural on board go smoothly? marilyn -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
