just how medicalised is natural twin labour and birth?

[rubyred84]

just that really! I have visions of a vaginal birth with twins being very medicalised and interventional....induction, no active labour, constant monitoring, doctors strongly suggesting epidurals, theatre delivery (this is how all twins are delivered in the hospital I'm going to), instrumental assistance etc.

I know I'm trying to prepare myself for the above, as it is so far from what I had originally hoped before finding out I was having twins (first pregnancy, DCDA). was thinking hypno/water birth! ha!

have also been reading up about vaginal birth of twins and the risks specifically to the second baby, which can often require intervention and assistance.

would be interested to hear your twin birth stories (both good and bad please.....I'm a strong believer in a full perspective!!) if you had a fully medicalised birth, how did you find it? any regrets? does anyone wish they had instead elected for a c-section?

I had an elective c section. This was due to twin 1 being breach. She actually turned right before the c section, but tbh I had got really ill towards the end and wanted them OUT as soon as poss. I went for the c section, even though I could have opted to go wait and go naturally, and it was brilliant. (Much more brilliant than my medicalised first labour with single baby). Labour is overrated in my opinion, but it does depend on your build etc.

I had a vaginal birth, DT now 14, I used a Tens machine to start with, the doctors were all ready to send me home until the midwife insisted they take a look at me... I was 9cm dilated and had just gas and air, lots of doctors peadiatrician, and midwives around, DT1 was born, the doctor told me yo get a move on or they would take me to theatre midwife told me to ignore him, 13 minutes later DT2 was born :)

Only intervention was an episiotomy...

They were six weeks early and spent two weeks in SCBU.

I was as active as I could have been and there is no way I would have agreed to an epidural (I hate needles more than I was worried about childbirth!) I wanted a water birth but told too risky with twins.

Do you have any birth centres close to you as an alternative?

Hope that helps,

I went for a vaginal birth knowing the 2nd twin was breech. ended up with a emergency section after 1st delivered vaginally. I regretted not having the elective section offered by my lovely consultant . the midwife who encouraged the 'natural' birth panicked when twin 2 didn't turn and told me afterwards she was traumatised by the deterioration of the 2 bd twin and c section . not half as much as I was , I can tell you. should have complained about her , but both twins are perfect and about to sit GCSEs!

I'm going to follow this closely as I'm 30+4 and need to think about my options if twin one is head down at next weeks scan.
For those who ended up with an emergency section for twin two was this just with an epidural or under GA? I'm about to switch hospitals as we're moving and my current trust has a higher elective c-section rate but much lower use of epidurals and emergency sections than the trust I'm moving to who encourage an early epidural just in case intervention is needed and if you don't have it you might have to have a GA for an emergency.
Sorry-didn't mean to hijack the thread with my question

I had an early epidural and induction. first twin born vaginally 3 hours after start of induction . second twin epidural section . was wide awake hand help her immediately

thanks for all the comments, I know they say with DCDA twins there's no reason why you shouldn't have a vaginal birth, however the reality with twins just seems so medicalised that I'm wondering if I should save the worry and ask for an ELCS instead.

I would love to experience the whole birth process, but the risks (especially to the second baby) just don't seem worth it with what I have researched ? a lady posted on a thread recently and said she preferred to take the calculated risks of a elcs vs the unknown risk of twin labour/vaginal delivery. she puts it perfectly - this is how I'm feeling at the moment.

do any of you who went the vaginal route wish you had just had an elcs? or vice versa?

My twins were both around 6lbs. One 6 lb 5 and one 5lb 13. That was at 37 weeks. Later and they would have been bigger. The thought of doing that to my vagina twice - oweeee....

ie. No I don't regret it. And the recovery from c section much easier than from my first vaginal birth.

I had a section when my waters broke for my twins at 37+2. Twin1 was breech and a vaginal delivery was never really on the cards for me. I'm actually thankful in retrospect to have had the section because it went smoothly and was not traumatic at all, I had a spinal and recovered well. No regrets at all because the babies came out healthy.

Friend A had her twins with only gas and air, also at around 37 weeks. Both babies were head down. No complications.

Friend B had a vaginal delivery around 37 weeks: Twin1 was head down, Twin2 breech. Her midwife manually turned Twin2 so that Twin2 could be delivered. I believe Friend B had gas and air, it was too late to be given an epidural. Friend B found it quite difficult all in all. No tearing apparently though.

These were all first pregnancies / births.

We had all been told (maybe cause it was the same hospital) that we would have to deliver in theatre - not birthing pool etc. due the inherent greater risks and possible need for an emergency section. And probably the need for more space as there was a team of paediatricians / nurses for each baby as they appeared!

Good luck with the birth.

I was induced with my MCDA twins in June. Epidural (due to chance of c section if twin 2 turned) and episiotomy as twin 1 became distressed and twin 2 had her hand above her head. Induced due to reaching 36 weeks and IUGR in twin 2 (although no signs of twin to twin and a very healthy placenta - no idea why twin 2 was so 40% smaller).

Your hospital ought to be able to tell you how many twin pregnancies result in one baby delivered vaginally and the second by c-section. While it's something mothers to be fear most (I did!), I think the actual numbers are quite low.

Although v medicalised, my labour was brilliant and I felt safe, secure and happy throughout. Contractions pre-epidural were very strong and painful (though I've nothing to compare it to!), but the tens machine helped a lot, as did the breathing / visualising techniques I'd done with my yoga teacher.

Pushing was difficult as the epidural meant I couldn't be sure I was feeling a contraction so my timing was a bit off. The pushing stage didn't hurt, as such, but I found myself totally out of breath.

As I was on my back, it's harder for the baby and makes the journey less smooth (again, most mums or mums to be might know this). My OH said he could see the baby coming with each push but she appeared to regress back after each one. Forceps were used to help her, again, not painful but not the most pleasant sensation.

I wasn't hugely mobile as they had monitors around my tummy for the babies, and one on twin 1's head.

Hope that's of use - I recovered really quickly but milk took a while to come in (either epidural or being stressed by hospital stay).

I had a emcs at 34 weeks (both babies were transverse) after my waters with twin1 went. The whole experience was great and recovery was fine.

The other twin mothers I know who had their twins around the same time as me...
1: vaginal birth on just gas & air at 32 week, all fine (dcda). Non time for epidural
2: vaginal birth at 32 weeks with just paracetamol, all fine (dcda) No time for epidural

1. Vaginal birth with epidural at 36 weeks, twin2 born with forceps. Dcda identical

4 elcs (this was her second set of twins, her first set were born vaginally and twin2 went into distress with plummeting heart rate). She chose a c section for her second set because of this. Both sets dcda

1. Vaginal birth with epidural at 38 weeks, all fine. Dcda

I went into labour spontaneously at 34 weeks with MCDA twins. Both were head down and my labour was no different to any of my singletons. Other than six minutes later after a couple of pushes there was another baby. No stitches were needed.
I really did not want a section and was very glad I avoided one.

Oh I forgot they did recommend an epidural which I accepted it case if problems leading to a section. I could have refused though.

Is this your first?

Afaik if twin 1's head is down and engaged they will attempt a vaginal birth. If they are both head down they will both probably come out that way. Usually twin 2 is breach though. Singleton breach deliveries are often elcs now so there is a lack of experience & expertise amongst midwives & OB's in managing this type of delivery whether 2nd twin or singleton. So in these cases it isn't uncommon for twin 2 to be delivered by emcs after a vaginal birth. I can see why this 'worst of both worlds' scenario isn't appealing!

The women I know who have had twin birth have had them both vaginally though.

I had emcs at 33 weeks, twin 1 breech.
At my hospital all twins born in theatre, multiple staff in attendance, no option of water birth, so yes very medicalised. They also routinely do a spinal incase of complications. I had a GA as I have an impacted spine so spinal would'nt work. Best of luck, keep us posted

This is such an interesting thread-thank you to everyone for sharing.
OP-have a look at this document which breaks down how many ladies at this trust proportionately need intervention
www.royalberkshire.nhs.uk/Downloads/GPs/GP%20protocols%20and%20guidelines/Maternity%20Guidelines%20and%20Policies/Anaesthetics%20relating%20to%20Obstetrics/Anaesthetic_twin_delivery_V1.0_GL950.pdf

I found it a useful starting point to then ask my own antenatal team what their rates of the same thing were. The Royal Berks info gives useful differences between the various anaesthetic options as well which I found very good to know because the one thing I know I definitely want to try and avoid is a GA.

Should say, the link above takes you to a hospital guideline so it us written in medical terms with a lot of detail. If this might frighten anyone please avoid x

I had an induction with my DCDA twins a year ago. I didn't have to have a pessary as I was already dilated so they broke the waters for DT1 and off we went. I had an epidural under the advice of my consultant. DT1 was born with little problems. DT2 turned to breech and I was taken to theatre for that delivery but was still allowed to delivery vaginally. I don't regret the epidural as things could have been more complicated/ stressful with the second delivery if I hadn't. Something I hadn't considered beforehand was that if I hadn't had the epidural for DT1 I wouldn't have had as much time with him before his sister arrived as they would have been prepping me for that before taking me to theatre. It afforded me some precious time with him first before the 2nd birth.

I had mcda twins last May. I was very restricted to the bed as they struggled to monitor both heart beats. I choose to have an epidural just incase. Both babies were head down and on paper it reads like a textbook delivery.
There were many people present at the time and the Dr that was present for twin 2's delivery was a stupid mare. She missed twin 1 birth as no one called for her in time (can't imagine how that happened ) that's the only thing with natural deliveries you don't know who will be working at the time.

My twins were induced at 36 weeks. DT2 was breach. Other than the drip in my arm and the heart rate monitor on DT1's head I had no other interventions or epidural, and no tearing. The birth turned out to be a fantastic experience with the babies both weighing over 6lbs and needing no special care. However, I was absolutely terrified that there would be complications, especially with DT2, and this caused me a lot of stress leading up to the day of the birth.

I had dcda twins in October. Were transverse and breech through whole pregnancy and I resigned myself to ecs. At 36 weeks they went both head down so opted for vaginal delivery (previous baby vaginal delivery, better the devil u know) .

Induced at 38 weeks, pessary... Nothing. Waters broken .... Nothing. Drip up....eventually went into labour. Had opted for hghly recommended epidural (in case emcs needed, and cos labour hurts). Some time between the pessary and the drip twin 2 turned breech. Asked if I would have to have a section and doc replied "no we will just pull him out by the legs".
Twin 1 delivered with suction at 6'1. Twin 2 was delivered breech 8 mins later with epiesotomy and forceps at a whopping 7'9. My DP said it did look at but brutal.
Was very medicailsed with consultant and a doc, 2 midwifes, anaesthetist and a few others. But I didn't mind, they are all there to keep u and ur babies safe.
My advice would be try not to have too firm an idea of what u want, roll with the punches so to speak.
And its soooo worth it

Bit brutal, medicalised, sorry

Forceps are very brutal. I had that with my singleton. He has some developmental issues and I still wonder if it was due to the forceps delivery as he had very severe bruising on his head (and I was a mess down below). There were also way more people in the room than with my twin C section, which was quite straightforward. The C section was so peaceful in comparison. (Sorry, am passionate about C since my experiences).

I had MCDA twins. My consultant and I werre planning a vaginal birth after induction at 37 weeks as both were head down. However, my waters went at 35 weeks but I didn't go into labour. I was admitted and observed for three days. In this time, twin one was so far down that his head pressed on my ureter meaning I couldn't wee for 72 hrs. None of the midwives noticed this (and ignored the fact I had been saying I was in terrible pain and couldn't go to the loo!) until my bladder went into acute retention and I had to be catheterised. By the time it came for me to go to the induction bay (three days after arriving in hospital) I didn't feel strong enough to go through the process of induction and labour so opted to have a ELCS the following morning. The procedure itself was fine, very relaxed and not at all traumatic. Unfortunately the twins had undiagnosed TTTS which meant they were whisked off to NICU immediately. I was fine though and was in much less pain after the section than the days beforehand. So not at all what I planned in terms of birth. It took me a long while to get over the fact that I opted for a c-section (I felt that I had cheated and should have gone through the induction process) but it was definitely the right thing to do for me and my babies given the circumstances we found ourselves in.

Mine were DCDA and both head down. I was induced (pessary and drip) but stayed active. I refused an epidural so I could stay on my feet, but had got my consultant to agree to that in advance - the doctors on the day were really pushy about having an epidural but I'd got it written in my notes I wasn't going to have a precautionary one.

Babies both delivered naturally with no problems, lots of people in the room but not too medicalised given the circumstances!