Private care and vaginal birth for identical twin pregnancy

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I would love to hear from any other London mums who have had vaginal births privately with identical twins. Apologies for the long post, but I am sharing my details below in case anyone else finds it useful...

I have recently found out I am expecting identical twins. My first singleton pregnancy was very straight forward. I had a fast and uncomplicated vaginal birth.

Having done extensive research myself on the recommendations for identical twin pregnancy, the current guidelines published by both the Royal College of Obstetricians (RCOG) in the UK and by the American College of Obstetricians (ACOG) in the US state that for uncomplicated identical (monochorionic diamoniotic) twin pregnancies, vaginal birth can be attempted as long as the first twin is head down. The most comprehensive study on twin births shows no difference in outcomes (for either mother or babies) between planned caesarean and planned vaginal birth for identical twins.

Despite the above, I was shocked to learn that at Chelsea and Westminster Hospital, which is nearest to me, the private obstetricians there have concluded that all identical twins should be delivered via planned cesarean section at 36 weeks. I was told this by two different consultants who I met with. Apparently were I opt for NHS care, I would have the chance of a vaginal birth if I really fought for it, but not on the private side.

Having decided I would like to opt for private care (primarily for continuity of care and also because of convenience given I work full time), I am now in search of a consultant who is experienced with twins and would support my choice to try for a vaginal birth, assuming the pregnancy is uncomplicated (fingers crossed).

Of course I am fully aware that complications arise both during pregnancy and birth and I may eventually not have the option of a vaginal birth in which case I will not hesitate to have a c-section, but I want to give myself the option of a vaginal birth.

If anyone has had a similar experience, I would love to hear from you.

Your difficulty is likely to be to do with whether they can get professional indemnity insurance rather than their own views/preference.

If insurers consider that the risk of a claim is too high then no obstetrician will do a vaginal birth because they won’t be able to get insured to do it, and you can hardly expect them to put their house and all assets on the line.

Obviously the NHS is structured differently and the insurance position will be different as claims are managed differently.

I don’t really understand your problem with the NHS in this area given that they are vastly more experienced than the private sector at twin births and most complicated births get transferred straight to the NHS from private wings anyway because the cost of full facilities is not worth it from the profit involved.

I’d be asking when the last time the private wing had a vaginal delivery of twins. If the answer is never or a long time ago then they’re not experienced enough to deal with it. If you want a vaginal birth then the NHS are your people here.

Ask to speak to the senior midwife for Delivery Suite. She will know exactly what expertise is in your unit and who can work with you, obstetrician wise to achieve what you want.