Triplet VBAC in GA with Dr. Tate!!!

Posted on January 8, 2010. Filed under: Triplet VBAC, vbac | Tags: , , , |

Dr. Tate is the doc I would have used if I were going back to the States to VBAC. Instead I found Dr. Chung here in Korea who is, in my opinion, even better than Dr. Tate but both men are amazing docs with a calling to really provide care and options to birthing women in all scenarios.

The details are just coming out about this VBAC but apparently the woman had her triplets in a hospital attended by Dr. Tate. I am assuming she went natural, as in unmedicated, as that’s generally the way with a VBAC with Dr. Tate.  From what I am reading so far, the first two babies were head down and the third was footling breech. Here are the babies stats according to the ICAN of Atlanta chapter posting.
3 girls, all vaginal, all Apgar 8/9.

A= 4# 6oz, 18.25in @ 10:24pm, vertex.
B= 6# 4oz, 18.25in @ 10:37pm, vertex.
c= 3# 11oz, 16.5in @ 10:39pm, double footling breech extraction.

All three babies are successfully breastfeeding as well.

What an amazing day for this mother, her family, Dr. Tate and the VBAC world as a whole!

Congratulations everyone!

***EDIT: I was first informed by a commenter that the mother had an epidural and delivered in the OR. I have since been informed by Dr. Tate that the mother did have an epidural in the event that baby C got into some trouble and he had to reach up and get it out quickly, which is in fact what happened.

I found this study done on the safety of triplet vaginal delivery. One woman in the study was also a successful VBAC of triplets.

[6] Preliminary experience with a prospective protocol for planned vaginal delivery of triplet gestations.

AUTHORS: Alamia V Jr; Royek AB; Jaekle RK; Meyer BA

AUTHOR AFFILIATION: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, State University of New York at Stony Brook, New York, USA.
SOURCE: Am J Obstet Gynecol 1998 Nov;179(5):1133-5

CITATION IDS: PMID: 9822488 UI: 99039941

ABSTRACT: OBJECTIVE: The objective of the study was to evaluate a protocol for vaginal delivery of triplet gestations.
STUDY DESIGN: All women with triplet gestations managed between January 1, 1995, and December 31, 1997, by University Medical Center’s perinatal practice were offered enrollment in our vaginal delivery protocol. Our protocol offered attempt of vaginal delivery if triplet A was in vertex presentation, fetal monitoring was possible, and there were no other obstetric contraindications. Twenty-three triplet gestations were identified; 8 achieved vaginal delivery. Outcome parameters investigated included neonatal mortality, Apgar scores, neonatal intracranial hemorrhage, arterial cord pH, neonatal weight, and length of postpartum hospital stays of mother and neonates. All parameters were analyzed with analysis of variance and the Student t test as appropriate with the JMP 3.1 statistics program (Cary, NC).

RESULTS: Twenty-three sets of triplets were enrolled. Eight sets were delivered vaginally. Eight of 9 patients (88.9%) who attempted trial of labor were delivered vaginally, 1 of which was a vaginal birth after cesarean section. The remaining triplet gestation failed to progress at 4-cm dilation. Twelve sets of triplets had a nonvertex-presenting triplet and were delivered by the cesarean route. The remaining 2 triplet gestations were delivered by the cesarean route because of inadequate fetal monitoring. Neonatal survivals were 100% for both groups. No significant differences in neonatal mortality, Apgar scores, intracranial hemorrhage, arterial cord blood pH, hospital or neonatal intensive care unit stay of neonate, neonatal weight, and change in maternal or neonatal blood cell count were noted. There were no cases of grade III or IV intraventricular hemorrhage in either group. A significant reduction in postpartum hospital stay of mother was noted in the vaginal delivery group (2.8 vs 4.5 days, P <.001). The mean gestational age at delivery was significantly lower for the vaginal delivery group (31.3 vs 34.0 weeks, P <.02). The mean neonatal weight for the vaginal delivery group was significantly lower (1758 +/- 473 vs 2022 +/- 407 g, P <.02). There were no significant differences in outcome parameters for the first, second, and third triplets within each group when compared with each other or with the other study group. One patient who underwent vaginal delivery had retained products of conception and required curettage. A single fetal death occurred at 22 weeks’ gestation from twin-twin transfusion, with the remaining triplets being delivered vaginally at 35 weeks’ gestation. Cesarean hysterectomy was required in 1 case for uncontrollable bleeding at the time of cesarean delivery. Perinatal complications occurred in a large number of patients, with the incidence of premature labor 47. 8% (n = 11), that of preterm premature rupture of membranes 26.1% (n = 6), and that of preeclampsia 34.8% (n = 8).

CONCLUSION: In selected cases vaginal delivery of triplet gestations can be accomplished without increased maternal or neonatal morbidity and mortality and may significantly decrease maternal hospital stay and postoperative morbidity.

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21 Responses to “Triplet VBAC in GA with Dr. Tate!!!”

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HOLY COW! That’s all I can say. Wow. Bless her… Dr. Tate is quite the rebel! 😀 And I cannot IMAGINE bfing THREE! Way to go, momma!!

He’s not a rebel, he just GETS it. The risk of rupture for a twin VBAC is not much higher than a singleton and there is no data on a trip VBAC so in the absence of that data and based on everything else he knows about UR and risk factors, there was no reason not to agree to do this. Also, the data shows that vaginal birth of triplets is as safe as vag birth for twins. Again, no reason not to attempt it. Many mainstream OBs wouldn’t consider this because of lack of experience but Tate I am sure doesn’t consider himself a rebel, just practical. He’s a numbers man and if you look at the numbers then all says GO! Plus, how much you wanna bet that those 8/9 apgars would have been less had there been a section? Tate has been attending VBACs for many years and in circumstances no other doc would touch, VBA5C, classical and inverted t, twin VBAC etc. Not saying it’s for every doc but if I were in that situation he would have been the only one I’d consider. Dr. Chung here in Korea is great and all but Dr. Tate has more experience hands down.

Dr Tate is indeed a rebel by definition. A rebel WITH a cause 😉 and we are lucky to have him on our side! This is a beautiful story. Thank you for sharing!

I saw that and thought that was just amazing. Now if only MORE OBs would do this sort of thing, then maybe so many women wouldn’t have to resort to unassisted homebirths. Birth CAN be better in the US, we just need more doctors like Dr. Tate.

AGREED Janeen. The world could do with many more Dr. Tate’s and Dr. Chung’s both. They are both doing great work on so many levels but it is sad that they are rare and not the norm.

Truly amazing. What an awesome experience that must have been for both mother and doctor. And to think that my doc wanted me to have a c-section just because I had 11.5lbs of twin in me.

60% of twins are sectioned in the US. I think that unless you go into to it with that knowledge and with a doc who is really pro twin vaginal birth that most likely you will have a c section or at best deliver in the OR with a mandatory epidural (no pressure!!!). Even if you had all that knowledge going into it, it’s hard to find a doc who is supportive and experienced enough to be confident. That’s the bigger issue really. I can’t wait to hear about your VBAC journey when the time comes!

More kudos for Dr. Tate!! 🙂

This is the first time I’ve heard of Dr. Tate – does he have a website? I’d like to learn more about him. Amazing story.

To learn more about Dr Tate, watch this
http://www.pbs.org/wnet/religionandethics/episodes/august-14-2009/dr-t/3115/

You will learn why he practices the way he does.

Thanks Elaine! That was very informative. The video portion didn’t work when I tried it but hopefully it was just a connection issue.

Actually, a correction if I may:) The mom had an epidural and pushed in the OR in the event that a CS was medically indicated for one or all of the babies. Whole family is doing well.

Thanks Catherine! I was making assumptions although it did cross my mind that she was in the OR.

Part of the reason for an epidural in a case like this, is that the 3rd baby is at the most risk and you may have to reach up and get it out quickly. That’s what actually happened.

Thanks Dr. Tate. And thanks for all the wonderful work you are doing. It really is amazing to hear this story and that the mother made the decision to do this and physically did do it but you deserve the credit for supporting her when most doctors wouldn’t think of it.

I talked to you last year about attending my VBAC with inverted t incision and you were very honest and willing and prompt with your responses. You gave me the confidence that I needed to be able to consider getting pregnant again because I needed to know there was a doctor, albeit on the other side of the world as i am in Korea, who would support me before I could do it. Well, I AM pregnant again and I did find a “Korean Dr. Tate”. In a country that has a 45% c section rate and over 90% epidural rate, there is a doc that has gone “the natural way” and who attends home births (which is why I said he is ‘better’ 😉 , and in hospital VBAC, breech vaginal and ECV. He accepted me as a patient and saved me from having to separate my family for 9 months and move to back to the States. You and he are both one in a million and I wish you could meet. But I owe you a big thanks for talking to me last year and helping me find my strength. So again, THANKYOU for all your hard work!

[…] the amazing! A vaginal Triplet Birth! and it was a VBAC! A multi baby vaginal birth is practically unheard of now a days let alone […]

The mom of triplets did have an epidural.

Thanks Chelsea, we do know that, Dr. Tate explained why.

I was forced to have a c-section with my triplets at 36 1/2 weeks (they would have had a longer gestation if I was allowed to go into labor), because I could not find a midwife or a doctor who would assist me in the birth in a natural way, even though I had an amazingly uncomplicated pregnancy. But I always had this very strong feeling that my body could and would do this for my triplets if I could just find someone who would let me do so, and assist me! It bothers me to this day that I did not get to enjoy their birth, when I wanted to so much, but rather, I passed out from pain while the triplets were being delivered by c-section, after sweating profusely from this pain, because the doctor was pushing so hard on my intestines, which were resting on my uterus where he was trying to push out the last baby’s body, and this was because the part of my body that was numb with the epidural was below where he was pushing! After I awoke from the shock, exhaustion, and pain, the babies were about 9 hours old already, and I had only seen each one for a fraction of a second before I had passed out, even though they never needed to be in the NICU, so finally, at 10 hours old, I asked why no one had brought the babies to me! I wanted to see what they looked like, and who they were!!! Talk about an unsatisfying birth experience! BUT, the babies were absolutely beautiful and very healthy, and I was so happy to have all three of them in my life forever! But, still, it would have been so nice to have held each one separately while waiting for the next one to be born, as it is in a natural multiple birth! …if I had only found a doctor like Dr. Tate! It sounds like it would have been so wonderful (and possible!). I often have wondered for years why most ob gyn’s have sooo little faith in a woman’s body to do what God made it to do! I am so glad to hear of doctors like Dr. Tate. How refreshing!

Wow, this gives me hope!

If she can do it with 3, surely I can do it with 1!!!

I just wanted to post a follow up in case anyone runs across this. The triplet mama and babes are doing fantastically. In the meantime, Doc T delivered a triplet VBA2C. That mama and babies are also doing well. 🙂


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