So you had the Pitocin. Then what?

Then we were back to waiting.  We started with one unit (3 cc).  Nothing.  Contractions were still even milder than they were on the magnesium sulfate.  So we ramped it up to two units, then three.  Each time, Ginger protested, but at that point, having lost the principle of the thing, the amount was becoming irrelevant.  We just didn't want the Pitocin to go faster than Ginger's body.  This was supposed to be a kick-start, and we didn't want to push the car to the destination.

Then there was the problem of pain relief.  We'd wanted to stick with natural childbirth, which means keeping pain relief at a minimum in order to avoid interfering with the body's natural response to labor, but the nursing staff suggested a consult with the anesthesiologist anyway.

Here's why:  Twin births are different, and not just because there are two babies to be delivered.  In a singleton birth, if the baby starts the day head-down, he or she is likely to finish the day that way.  Not so with twins.  Even though our twins were both presenting head down, the perinatologist said that it's possible that the delivery of Baby A will inadvertently create enough abdominal room to cause Baby B to flip-flop into a sideways or breach position.  This is more likely to happen when Baby B is on the smallish side.  If it happens, you might be delivering Baby A vaginally and then be forced to do a C-section to get Baby B out.  And if you need to do a C-section, you pretty much need to apply some form of pain relief, unless you're trying to reenact a torture scene from a Mel Gibson movie.  So our approach to anesthesia was now no longer just a question of Ginger's tolerance for pain; it also included a component of risk-tolerance for Baby B.  Were we willing to bet that Baby B would stay upside-down after A was delivered?  I'm not a betting man, but that was a hell of a question to ask me to decide under duress.

The day nurse suggested that it might be possible to "run the epidural" and just decide whether to use it later, on an "as-needed" basis only.  Okay, I can live with that.  Send in the anesthesiologist!