If you wonder what to expect or what your care should be then read this, the full guidance is over 220 pages, but this briefly covers in in plan English.


http://www.nice.org.uk/newsroom/pres...yGuideline.jsp

Its new, 28th Sept, my consultant is prepared to follow it but I am not going down without a fight

The new guidance suggests for non-identical twins induction at exactly 37 weeks, rather than the 37th week. It talks about the risks and compared going past 38 weeks as going past 42 weeks in a single pregnancy.

I really hope this shakes up the system and the care that twin mums to be get here im England and Wales.

The research is limited, but so are any twin studies, wish me luck for Tuesday, my consultant thinks its acceptable to let me to get near 40 weeks, 39 + anyway, but Im not going down without a fight!

Good luck, it sounds like you have fire in your belly. I am trying to be more assertive. In my previous pregnancies I've felt in control, without actually doing anything, this time I just feel lost x

i suggest any multiple mum to take these to the consultant. i did and now have a dr appointment every 2 weeks, consultant appointment every 4 weeks and got the additional scans that previously they told me they didn't do. i have a scan at 32 weeks where they will assess delivery dates with me C v possible natural and have said i will then be in every couple of weeks to continue being assessed as their view is to keep bebes in as long as possible but said they will draw a line at 38+4 apparently. great guidelines but the notification that they've been updated is still filtering through so you need to take the paper in and leave it with them.

Thanks hun! I will be. My consultant is supposed to be a twin specialist and his attitude to them is that they are just guidelines and that he is the expert.

Alwilan - Me too, i felt I researched and knew what to expert with my son and that I ideally wanted, my birth plan was pointless as we had complications but i still felt in control, and despite not having what i had wanted, every step of the way they explained rationally to me why I couldn't or what was best due to the change of condition etc.

This time the attitude i get is, why the hell should you question me. If he explained to me reasons why I should go past 38 weeks then fine, but they just day, its unlikely you will get that far. Both twins are breach so its a section for me, which means emergency section of they did come earlier.

My body is really struggling, i have a young toddler to look after, i have pancreatitis and surgery at 17 weeks, i recovered well but i dont think its helped my body much. I generally feel done in now! Plus i have a fear of going overdue, Ive had 2 friends in RL lose babies past 41 weeks, and my son had complications due to distress at 40+6, so for me, going much past 38 weeks is terrifying.

I did some research last night and it looks like there is a lot of debate on when to deliver di-di twins. Most agree after 37 weeks, but that the doc should check for lung development before 38 weeks. Most of the studies I read recommended 38-40 weeks as being optimal with some data indicating that waiting for natural labor is best. Extra monitoring is suggested for waiting for natural labor. I found nothing indicating increased risk at 38w0d, although a 38w growth scan is recommended. In fact, the odds for special care go up prior to 38w0d. There is also debate on c-section versus natural. Twin outcomes are better for both twins with c-section, but perhaps not enough to outweigh the risk of surgery to the mother. Everything studied were small sample sizes, and indicate that further studies are needed. In other words, I wouldn't panic if your doctor wants to stick to 39 weeks, perhaps just insist on a 38 week scan to ease your mind.

it actually says in the guidelines there is increased risk of stillbirth after 38 wks. this must be backed by UK data or it wouldn't be there.

Yeah, I read the information reading the risk of still birth and neo natal death and yes its limited but it shows a correlation. Id of been happy to have gone to 38, but didn't feel happy to go over that. Turns out with my irritable uterus and bring in hospital on bed rest, and decreased growth, that my consultant would of been happy with before 37 weeks. But found s date that worked well at 37+1. That was my consultants decision without even mentioning the nice guidelines.

I do agree though, do your own research, some people in single pregnancies are happy to go past 42 weeks, as long as you know the risks to early delivery and later delivery. They can't publish the guidelines without evidence and support from the experts. But if course any change will be met with mixed opinions.