twin homebirth - crazy?

[MamaChris]

I had a homebirth with ds, and fully intended to have a homebirth this pregnancy, till I found out they were twins. Having read up on the risks (mainly to the second baby, after the birth of the first), I decided I would try and have a low intervention birth in hospital. I'm negotiating all this with the consultant midwife at the moment (I'm 27 weeks).

But I've heard a twin birth story from a friend who was negotiating a normal birth too, and it sounds traumatic. Everything went wrong after a staff changeover, and she says she doesn't think anyone in the room (there were many) had read her birth plan. After which she had to fight to be led out of the post natal ward 3 days later.

If nothing goes wrong, I want to give birth without a big audience and be home asap. On top of which my neighbour just had a lovely (singleton) homebirth which has reminded me of the kind of birth I really want. Would I be crazy to consider a twin homebirth or is it just too risky?

Hi there,
I'm mum to 3.5 year old twins. I gave birth in hospital, and am very glad I did. DS (twin 1) had great difficulty getting out, twin 2 (DD) was transverse and had the cord around her neck. I had to be cut to get DS out, as DD was in serious trouble. I lost half my blood in the process, but all was well in the end - DD was purple but pinked up quickly, and both are in perfect health.
I know you want a home birth, but ime there are too many things that can go wrong and in the event I was so, so glad that I was in hospital and in the hands of medics. I was determined to have a vaginal birth rather than a C-section, but with hindsight I wonder if I should have had an elective C-section after all, as the loss of blood made me very anaemic (even after a transfusion); I felt rubbish for weeks and my milk didn't come in properly as a direct consequence of being anaemic, so never really breastfed.
It's your decision, of course. But I really feel the big audience at the DTs birth literally saved my daughter's life!
Good luck with whatever you choose - my experience doesn't necessarily mean you'll encounter the same, and you could have a home birth without complications.
And good luck with the twins, too. It's bloody hard work, but wonderful.

The homebirth.org.uk has a quite balanced set of articles here.

Personally and reluctantly, I don't think I would go for it without an operating theatre on standby. Apart from anything, I would be concerned that most midwives would probably not be comfortable handling a twin birth at home.

Do you know what type of twins they are? From what I read up for a friend, if they have separate sacks, cords and placentas then HB may be a realistic option. As I'm sure you found out when planning your HB with DS, there are risks to any birth in any location - its just trying to work out which set of risks is most appropriate for you and your family at the time.

You might find this article by Mary Cronk on twin pregnancies interesting to read.

DD1 was breech. We didn't see why breech automatically necessitated a CS - but felt that the safety of vaginal breech birth lay in the competence of the MWs. And that resulted in us having a HB with IMs as the NHS just could not guarantee that they would have breech skilled MWs available (in any location). If you do decide to go for a HB you might want to look into the same solution - IM's tend to be more experienced in the more unusual cases and tend to be better at supporting women to make informed choices (rather than providing the information needed to make the decision the HCP desires - sorry, my innate cynicism coming through... )

That said, there are stories on here from ladies who did have what sounds like a lovely twin birth in hospital, so don't rule it out or assume its all going to be vile before you start.

Good luck making your decision, and for a straightforward birth wheresoever it ends up being

It's a terrible dilemma to be in. I am v pro HB, have had one. But I really dont know what I would do with twins.

In a way a twin birth puts me off hospital even more because it is classed as high risk and would therefore be managed in a way I wouldnt want in hospital. They might say you can have a calm birth there but that doesnt mean they can be trusted to keep their word on the day.

I'd base my decision on a number of factors-

-how easy was first birth
-how many week gestation when go into labour
-whether both are head down

and anything else that came up

Good Luck!

"I'd base my decision on a number of factors
....... whether both are heads down"

I don't know much about it, but a friend who recently had twins said that even if both babies are head down when labour starts, after the first baby is born, twin 2 has so much space it can flip around and there is a real possibility of a breech birth.

I have to say, having listened to my friend talk about twin births, if I was in your position I would go into hospital. (And I am very pro home birth in general.)

Good luck.

PLEASE don't do it.

I normally avoid the pregnancy threads like the plague as I lost one of our twins (she was stillborn, resulting in 32 week delivery of her sister) and it's a difficult subject for me.

A friend of mine decided, against medical advice, to have a homebirth with her twins. Both sadly died due to complications and she was unable to get to hospital in time.

All twin pregnancies are high risk, it is true that identical twin pregnancies pose more risks, but still fraternal twin pregnancies are high risk too. Both my, and my friend's pregnancies were fraternal, ie. not identical, separate sacks etc.

Please don't do it, it simply isn't worth the risk.

Loopy - just checked in to see how the thread had progressed. I'm so, so sorry for you and your friend.
OP: on the basis of my experience (which did have a happy ending, but at home would have not - I'm in no doubt about that); and the tragic experiences of Loopy and her friend, I really think a hospital birth is the wisest option.
And Neolara - you're right; both my twins were head down to start with, but DD turned during the latter stages of my labour. So even if both are head-down to start with, there's absolutely no guarantee things will stay that way.

Even if you are in hospital, they can only intervene if you agree, and after four pregnancies, the last one a twin pregnancy, I have managed to stay lucid enough during my labours to discuss and make decisions, plus refuse anything I didn't want. I have never written a birth plan, except a very sketchy one with my first.

I was adamant that I didn't want a c-section with my twins, and having sucessfully delivered three babies, two of which were fairly large, with no problems, I felt confident I could have a vaginal delivery even if twin 2 was breech prior to labour. As it happens, I went into labour at 23+5 and the birth, although extremely traumatic, was physically a breeze.

Personally, I am not for or against home births, but I do like the security of being around/near experienced obstetricians should I need one, and I do think for twins, that is a must.

MamaChris. I don't think it's as simple as everyone is making out i.e. hospital sensible , home bad.

I've got twins girls who were my first children. All the wat through my pregnancy DT1 was head down DT2 breech. I delivered naturally in hospital with happy consultants as I was told that the only real issue with a breech birth is whether you are capable of delivering a baby's head. That means that so long as you have had a baby (even if it was only 23minutes earlier as in my case) being breech in itself is not an issue.

If your baby is breech then your medics need to be very hands off, as breech babies deliver themselves.

All the while that I was pregnant I wished I could do what a friend of mine did. She was having DC3&4 and decided to have them at home and in water which she did successfully and everyone was fine.

Tangle's post was very good as what matters most is how you laboured and delivered previously, what type of twins you have (i.e. fraternal or identical, your 11 week scan should be able to shed light on this or the sonographer who did the scan) and who is going to deliver.
My friend used Independent Midwives as the NHS couldn't guarantee which midwife would deliver her.

I think you should really sit down and consider ALL factors. Things like: how far are you from a hospital, experience of IM's at which point (should something go wrong will you go to hospital).
Also, I think that ultimately you don't need a birth plan in hospital but you do need someone you trust to make decisions on your behalf should you be unable to.
All you need to remember is BRAN.

For any drug/procedure you are offered ask the following 4 questions to get all the info you need to make a decision.
Benefits - what are the benefits of this?
Risks - what are the risks of doing this?
Alternatives - what are the alternatives to this?
Nothing - what happens if we do nothing ad wait for a while?

Armed with this knowledge just make sure you're asked before anyone intervenes.

It's a tough decision, but not necessarily mad. Only you can make it. There are as many happy as sad tales to birthing twins at home.
Good luck!

Thanks all. It's sobering to hear the sad stories, and I am very sorry to hear your tale loopy, that must have been devastating.

Regards making the decision, there are pros for HB:

• fraternal twins (separate sacs)
• first labour quick and easy
• I am near the hospital (15 minutes gentle walk from our front door to the delivery unit)

don't think we can afford IM though, which is a big negative, but at least at home we'd have MWs who were pro-normality.

I (and the hospital) feel confident about vaginal birth if baby two is breech, as the way is "open", as it were, (not so clear cut if baby one is breech), and I certainly wouldn't have a HB if labour starts before 37 weeks - would want NICU nearby just in case.

But even after 37 weeks, I am worried about the risks for the second baby. I think I need to understand those risks better. I would only be able to have a HB if I felt completely confident. The thing is - I can't see I will ever feel confident about either hospital or home birth in this situation.

I'm off to read homebirth.org.uk

ps midori, easywriter. If I was sure I would be lucid enough to refuse unnecessary interventions, and that having those discussions wouldn't disturb my labouring, I think I would be ok with a hospital birth.

The birth plan I am negotiating with the consultant midwife is to be signed off by her and my consultant, so if anyone talks about unnecessary interventions, I can just wave their superiors' signatures at them. The problem is that some key parts are conditional on the midwife on the day feeling competent. Which I understand is important, but does seem a bit random. eg, I can avoid CFM if the midwife feels competent to monitor two heartbeats intermittently.

I would plan a twin homebirth in a shot if they were fraternal, twin 1 was cephalic, they were born at term and there were no problems during the pregnancy - IF - I had independent midwives who were really experienced - and more importantly TRUSTING - in natural twin birth!

Wouldn't begin to go there with the NHS I'm afraid :-( too much stress and anxiety and fighting your corner.

www.aims.org.uk might be good for you.

the hard thing, childrenchildren, is that I have to fight my corner with the NHS either at home or in hospital, if I want to avoid the "standard" twin birth at our local hospital (epidural on admission, CFM, etc).

I thought a breech birth for a second twin was potentially more risky as your cervix often partially closes between births, and if your baby is quite small the body but not the head can start to descend when you're not fully dilated?
Have yu thought about a doula for a hospital birth to help fight your corner? Apparently some trainee doulas will take clients for very little money (if any) for the experience?

yep absolutely, I'm a doula and am only too aware of the battles you will have to fight having supported twin clients planning NHS births - and even if things are agreed antenatally, sadly all too often you may be coerced into what you don't what on the day - hence my IM suggestion.

i don't think you'd be crazy at all/

have you checked out the homebirth.org.uk pages?
one about twins here

My understanding is that as long as the interval between births isn't long (and the hospital won't allow me more than 15 minutes without contractions before they start syntocinon), that the cervix remains open, and that because the first baby is generally the heavier one, there should be room to birth a breech second baby.

We do have a (very good) doula who I hope will fight my corner for me on the day. Eg, even though consultant has already agreed no epidural, she's already said I will need to rerun my arguments on arrival with the registrar. I'm hoping that my doula, armed with the consultant's signature will be enough and I will be able to focus on labouring well.

If you have any tips on these negotiations, childrenchildren, I'd be interested to hear them.

Remember that the hospital really can't make you do anything. If you don't want syntocinon, you absolutely can refuse it (and brief your dh/dp/birth partner on these wishes). A doula shouldn't speak for you but she will hopefully be good support.

I don't know whether this helps but I had a good VBAC experience in hospital in Guernsey which is close to the UK experience - I made a very clear birth plan and though it wasn't the way they wanted to do it and we'd squabbled about it during my pregnancy, they went along with my wishes on the day and were quite supportive once I'd signed all the disclaimers.

ahhhh, I've just seen where you live (v.close to me) and think I know your doula - who is utterly fantastic and wonderful - however I am guessing I also know your hospital and know what you are facing (having supported twin mums at the same and knowing said hospital's twin policy v.well), remember you doula cannot fight your corner, what she can (and most definitely will) do is help boost you and your DH's confidence, help you to make informed choices and be a sounding board on the day as well as a calming influenced.

It's vital that you have a cast iron birth plan that your DH and doula know inside out and back to front, that has been run by the consultant midwife at said hospital and your consultant - signed off and circulated amongst staff beforehand. You could also write to the HOM stating your intentions.

You DO NOT have to be contracting again within 15mins (and God what pressure on you to do so!!!!! just knowing this is enough to inhibit oxytocin and stall it starting!) similarly you do not have to have prophylactic venflons, epidurals, give birth in the large high risk room, have to have consultants/paeds present, have managed 3rd stage, forbidden use of birth pool or be induced at 37-38wks - remember these are YOUR babies, YOUR birth, YOUR choices, of course they should be informed choices that shouldn't put your babies or you at risk but they are YOUR choices nevertheless. It is also your right to request care only from those confident in natural twin birth.

That said, on the day itself you need to be just a labouring mum, not worried about any of this.........and in order for a birth to go as smoothyl as possible oxytocin needs to be inhibited as much as poss - bloody hard in the circs most find themselves in :-(

Are you sure you cannot afford an IM? if you sorted some sort of payment plan? Or would you consider going 15miles north to a different hospital more relaxed with twin birth? I can hook you up with a twin mum who went to said hospital if that helps?

gosh that should say not inhibit oxytocin, LOL!!!

Just remembered, have taught a couple who went to what I suspect is your hospital, they had a lovely birth (their words), but they insisted on keeping her in/monitored from early on and having an epidural put in place and she had to deliver in the big/high risk room with a lot of people present. Twin 1 was head down, twin 2 breech (vaginal) born 45mins after twin 2 (with no augmentation) - managed 3rd stage. They said it was all v.calm, so not all bad!

thanks children. By the description, I'd say you do know both my doula and hospital! Is the hospital 15 miles north really more likely to be more relaxed? If so I'd consider going there (apparently might have to anyway, if local DU is closed on the day).

I really don't think we can afford IM. I am main earner, and will be taking a year off to care for babies - double childcare under a year makes it not worth working anyway - so even a payment plan not much good. Plus, can IMs work in hospitals if I don't feel confident for a homebirth?

Negotiating not to have peads there has resulted in "ok, but they will need to come in in advance to check equipment". Again, sounds reasonable, but not conducive to privacy & oxytocin - I really don't want an audience!

I don't seem to be able to give birth anywhere but the DU, but hopefully the pool room - I assume that's not the high risk room?

The 15 minutes is a tough ask, I think! Plus during that time they will be doing a VE and scan... planning to revisit that at next visit, but consultant was pretty fixed on that one. Also, part of me thinks, by then, perhaps just get on with it. I will apparently require 4 hours IV syntocinon after birth, which I have agreed to partly because I am anemic and any blood loss therefore more risky.

Yes from what I've heard it is v.different - their C-Section rate is pretty much half your one. I would be v.surprised if you would be "allowed" in DU pool room? has that been cleared? Have you discussed induction with them yet? You have to remember that your hospital may be a centre of excellance, but it is a centre used to dealing with high risk cases, very very large - and thus v.conservative/active in its management of labour (even labour without risks).

Would you like me to ask if "my" twin mum (lives in a big new built "village" beginning with C, west of C. city centre) who went to the hospital north of you would be happy to chat about her experiences there? she did end up with a C-Section in the end, but it was just bad luck. She went into labour on her due date, was allowed to use birth pool, no intervention, but sadly one baby went into distress when she was fully dilated, hence the section - overall though she found it a v.positive experience.

I understand totally what you say about not being confident at home, however if you did decide to go that route, it is the HOM's responsibility to assign you midwives who are happy and totally OK with home twin birth, thus meaning you are likely to get v.experienced midwives - one of whom at your hospital is an ex IM and lovely (your doula knows her well).

Don't know if it's your "thing" or not, but I could send you an NLP exercise that you can do entirely by yourself aimed at reducing fear (of wherever/however you give birth), it could help.

oh re. IMs, no if you went to hospital they could not work as a midwife, they would act effectively in a doula capacity.

Thanks, I'd be very interested to hear about twin experiences at the "northern" hospital. Do they have a NICU there?

So far, my local hospital does seem more flexible than I had expected (although not quite as much as I might like!). They are ok with the pool (for 1st stage) as long as either they can hire an additional telemetry belt or the midwife on the day feels competent to monitor intermittently. The consultant also sees no reason to induce if babies are monitored and healthy.

I'm not anti NLP, but don't think that's what I need - I need the information to be confident that the real risks associated with twin birth could be as safely managed at home as hospital. Or, equally, reassurance that I can avoid unwanted interventions in hospital.

Total madness as far as I'm concerned.

I had a very easy first labour and both my twins were head down. Twin 1 was born with no assistance after a very straightforward (intervention free) three hour labour with just one midwife present. After twin 1 was born, twin 2 spun round into a posterior position and became very distressed, her heartbeat started to dip very rapidly. Luckily I had a whole team of people waiting (outside until they were needed!) to assist in delivering her, and she was delivered very quickly with a ventuose. I dread to think what would have happened had I decided to give birth at home.