Home birth for twins-yes, no, too dangerous to even talk about?

[Scotlian]

I'd like to hear your experiences / opinions about giving birth to twins. Have just found out am pg with twins (12wks), gave birth to ds at home and have NO CLUE what twin pregnancy, labour and birth involve.

So thank you all in advance.

Am still in shock.

I have twins and had to have a caesarean as one was transverse and had no way of turning round. You would obv be told this quite a way before the due date as you'll have loads and loads of scans!

I suppose it is possible to have a home birth with twins, although I do remember readng that it is reasonably common for one to come out quite easily and the other refused to budge down and then a caesarean is needed, so bit tricky at home if that did happen.

Congratulations, twins are fab!

Have a look at www.homebirth.org.uk Under the section "You can't have a homebirth because..." there is info on twin homebirth. I would mentally prepare yourself for a long and drawn out battle though - its not very common, and probably for valid reasons.

Best of luck!

Another vote for the homebirth website linked to by flybynight above. It's an excellent site and will give you all tyhe pros and cons and what can go wrong etc.

Also it's very rare for twins to be born at home and you will find that many midwives will feel very anxious about it. Trying to identify one heart beat from another in twins can be problematic. Many midwives don't get much opportunity to deliver twins -as an example in 10 years as a midwife I only delivered one set of twins. So understandably worry that they are hearing two seperate heartbeats etc.

IMO, for saftey reasons i wouldn't consider a HB, unless you lived across from the hospital lol.
there are plenty of ways you can make a VB at hospital feel more homely, but i would prepare yourself for a highly monitered and intervention laden birth.

But it needn't be highly monitored and intervention laden if they are well, in good positions, good gestations and all progresses uneventfully.
I considered a homebirth but didn't do it. Instead I stayed at home until I was 9cm then went in. In retrospect I very much wish I had stayed at home, but I wasn't to know it would be so straightforward.
Another idea might be contacting your local homebirth support group?

If you have the twins in hospital you will be coerced into continuous monitoring, venous access, doctor present for delivery of twin 2, doctor delivering any twin presenting breech (on back in stirrups), managed 3rd stage blah blah blah.

This is my experience (I am 36 weeks) in a very laid back hospital with a consultant who is pro natural / active birth. So I don't blame you one bit for having them at home. In fact I envy you. I would have done it if I could get an independent midwife here where we live. The community midwives here are not experienced at all in twin and breech delivery so I would not want to be attended by them which leaves me little option.

Where are you? Are you are anywhere near Liverpool Women's Hospital? They are fab there and will let you delivery in the midwife led unit as long as they think you know what you are doing.

Very Good Luck!

e3chick, my plan is to stay at home as long as I can too. But how the hell do you know when to go in? With DD1 I knew I was heading to a lovely warm pool with a fab independent midwife so I was keen to leave home but this time will be different - how did you know or did you not? Was it just luck?

I wouldn't. I have several friends who've recently had twins. They all had good experiences in hospital - weren't overly monitored etc, able to stay mobile etc. What they did say was that whilst the 1st baby was very much like a single delivery, they then needed extra people to deliver the 2nd (for example by physically stopping the baby turning round in the extra space that has suddenly become available following the birth of twin 1.

So it is possible to have a 'good' experience in hospital - it needn't be very 'medicalised'.

Thank you thank you thank you all so much. I honestly haven't made up my mind yet - just had the scan! - but want to know as much as poss before deciding. It is all completely new to me. Will be giving birth in Edinburgh area, PeasPlease. Will def check out the website above, thanks flybynight and jollypirate. And also have a Good Talk to whoever might be "responsible" for things in hospital - my fears are indeed being tied to machines/drips, not being able to move about, and having zillions of people watching dozens of others rummage about inside me (!!). I also understand the potential for things to go horribly wrong esp with twin2 so ho hum. Your opinions and experiences help loads so keep 'em coming...

Also speak to the Multiple Birth Foundation. There are issues specific to IDENTICAL twin pregnancies which you need to research if your twins are indeed identical.

Sassybeast makes a good point. IIRC homebirth is only viable if your twins are non-identical, as ID twins share the placenta and therefore after the first baby has been delivered, the oxygen supply to the second becomes compromised.

Our local hosp stipulated twin births in theatre, and I had venous access in case EMCS was required. We had a very quick labour after waters broke spontaneously @ 34wks, it progressed too quickly for a CS and both delivered within 2 hours. I was wheeled into theatre, gave birth to DT1 who was bottom breech, then DT2 having been head down flipped to transverse. MW had to do an external version and hold her in place while her membranes were ruptured and she was delivered 20 mins later.

So we were lucky to have a good outcome, without a CS, but even though I had a homebirth for DC1 I didn't consider it for the DTs. I felt it was too risky, even though we're 5 mins from hospital; there were too many variables. I just did lots of reading up and asked the obs consultants/registrars plenty of questions about the reasons behind their clinical policies for twin births. Although you're expecting twins, you still have choices; but as with any birth, you should be prepared for curveballs!

I'd recommend asking your midwife about antenatal evenings at the hospital for expectant parents of multiples (ours held one every couple of months to explain procedures and show you SCBU/NICU in case of prem birth or complications). Also, get yourself over to the Multiple Births thread here on Mumsnet, and to TAMBA (Twins and Multiple Births Association) which has an active forum and loads of information to send you plus a support telephone line.

Hope this helps. Good luck with the pregnancy and birth, and congratulations; having twins is really special.

Another suggestion - if you have a twins group locally, get in touch and speak to women there about their experiences. Obviously since they're local, they will be able to give you specifics about local hospitals etc and how medicalised they felt their twin births were.

I have ID twins (3.5 now) and we were told at the 12 wk scan that they were ID. I was immediately classed a "high risk" pregnancy, and became consultant-led rather than midwife-led. Also my twin 1 was breech and twin 2 transverse, so I had no hope of anything other than a c-section (which was fine, btw - all v positive). I was told at 34 weeks that they would be very unlikely to shift position, so I had two warnings (IYSWIM) - one when we found out they were ID and one when we were told they were unlikely to move, that my birth options would be fewer. My point being that the decision doesn't have to be made just yet, and you are in a position where you can wait until you have more info about your specific pregnancy before deciding about birthing options.

COngratualtions - twins are fab. Can't recommend twin clubs more though - our is amazing.

Peasplease, it was more by accident that we went in then. I called the midwife as soon as I got period pain and knew things were starting. I called her an hour or so later just to update her and to tell her the period pain was getting more intense but wasn't coming as defined contractions and we were just chilling out. Then we called to say that she should come to check me as I could no longer concentrate on the tv. I really didn't have much of a clue that I was very far on - I thought I was just starting. When she got here, she chatted to me and then got me to lie on the bed to relax me. 10 minutes of relaxing and I felt pressure, so she checked me and found me to be 9cm so I went in by ambulance.

I was more comfortable doing it this way than she was, because I have had 2 long second stages before so didn't feel that the birth was imminent even though I was nearly fully dilated. It was an hour later that baby 1 arrived so we were in hospital very comfortably in time. (I think the transfer slowed the contractions down too).

Scotlian, if you are still around, have a look at this LOVELY twin birth story. Not a home birth but very unmedicalised:

www.mumsnet.com/Talk/birth_announcements/931475-PixieOnaLeaf-has-BABIES

Congratulations Scotlian! I am 38 weeks with non id twins and waiting for them to arrive. I agree with the other posters who say you just need to do your own research and then go with what feels right. If I'd been having one baby I would have gone for home birth, but have decided that this is too risky for me with twin 2. Stay open minded is my advice - the other twin mums to be that I have met through Tamba due around my time have all (bar one) delivered before 37 weeks, and some of them have had to be by c-section because of health issues. Also, you don't know what positions they might end up in by D-day!

Wishing you the best of luck!

Crystaltits ( at name) - rock solid advice there, thanks.

Eviltwins, and Superbean also, you are so so right about there stillbeing loads of time. I suppose that's why I want to find out as much as possible while I can, but am completely aware that so much can happen in the next 5-6 months...informed openmindedness sounds very Zen, I'll aim for the stars and hopefully manage some sort of calm . Saw on Tamba that there's a twin group where we're about to move to in Edinburgh so that's great.

Sassybeast, good point, but my twins have separate sacs and placentas so would seem to be 99% non identical, from what I gather?

Off to look at that link Flybynight.

You are all fabby fab and helpful thank you!

AWWWWWWW Pixie's birth story

Hi Nocca,
I was a doula at a twin birth- non identicalm third pregnancy. She had the babies in a midwife led unit, intermittent monitoring and used the pool in the first stage.
Read about it here-
www.magicalbirth.co.uk/13.html
Selina

There was a good Consultant. Find out if there is a consultant midwife at your hospital. There was lots of discussion.
I will post an anonymised version of her birth plan in case it helps-
PS I would suggest considering a doula to support you!
Selina

Plan of care

Twin pregnancy

Following a number of discussions held between myself (Consultant midwife), K, her partner and L (Consultant obstetrician) the following plan for labour and birth has been devised.

If gets (37 weeks) can labour on MLU
If labours before then to go to delivery suite but same plan applies.

Wishes to be intermittently monitored and free to mobilise through out labour. Happy for an admission CTG when presents in labour. Wishes to be able to eat and drink in labour.

Happy for vaginal examinations as necessary.

Happy for students.

Is keen to use birthing pool for first stage of labour.

Will get out for 2nd stage. Triggers for getting out will be rectal pressure and / or waters breaking.

Happy for position of twin 2 to be stabilised by staff as twin 1 born.
(Ultrasound scan to be performed if unable to determine presentation abdominally. Can be undertaken on MLU by staff from delivery suite)

Does not want waters breaking for twin 2.

Happy for examination to confirm presentation.

If transverse lie aware will be transferred to delivery suite / theatre

If breech wishes to aim for vaginal birth. To be conducted by Midwife with support from Senior Reg, who should be on MLU during birth if breech.
Aware if Senior Reg unable to attend MLU then will need to be transferred to delivery suite.

Happy for paeds to attend but not in room for birth, only attend to babies if needed. To be present in room if 2nd twin is to be born breech.

Does not want time limit placed on expected birth of twin 2 if fetal heart rate normal.

Happy for active management of 3rd stage.

Not keen on cannula being in situ but may reconsider on the day.

Aware of reasons for transfer to delivery suite.
1 Abnormal admission CTG or any concerns around fetal heart rates
2 Meconium liquor
3 Transverse lie twin 2
4 Placenta retained
5 Excessive blood loss
6 Unavailability of staff that feel confident in caring for her on MLU
(In this instance then shift leader on delivery suite to be contacted and an assessment made of the Midwives that are on duty throughout the unit to determine if there are any Midwives that would feel confident in providing care to K as per this plan of care.)

K will be supported by a doula ?Selina? in labour.

K is very well read on twin birth and aware that this plan of care falls outside the care we would normally provide to women having twins, and the guidelines upon which that usual plan of care is based.

Will be guided by staff, but will question any changes in her plan of care that are suggested.

I have informed K that if available I will provide care to her in labour, but would envisage it being in a supportive role to the Midwives on the MLU.

If I am unable to attend when K presents in labour then I am happy to be contacted by phone to support MLU Midwifes.

Supervisor of Midwives on call to be informed when in established labour. Delivery suite co-ordinator and Senior Registrar also to be informed on admission.
Consultant on call / on delivery suite to be informed of admission and plan of care.
MLU staff to keep shift leader on delivery suite and obstetric staff informed of Katherine?s progress and of any concerns / changes to proposed plan.

These plans have been made prior to labour and over a number of appointments. It would be inappropriate for professionals to make attempts to coerce or attempt to convince K to change her plans once in established labour.

S
Consultant Midwife
2009

Selina - as a midwife, I think that birthplan is very well balanced and sensible, so nice to hear of women being supported in their choices.