Triplet VBAC

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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