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Multiple births

When do you start showing with twins? What is life with twins like? Join the conversation on our Multiple Births forum.

Twins- C Section or Vaginal Delivery?

41 replies

tb4122 · 21/12/2024 13:34

I'm 19 weeks with DCDA twins and not sure what sort of delivery I should opt for. My first was a water birth in the midwife led birth centre, dim lights, hands off car, delivered him myself straight into my chest for skin to skin etc and obviously they won't let me have that again this time.

I don't like the idea of a spinal injection, being paralysed and recovering from surgery with two newborns and a toddler. But I'm also worried about needing forceps or even an EMCS having delivered one baby, if twin 2 isn't in a good position. I also don't like the idea of a really medicalised vaginal birth with bright lights, constant monitoring and a room full of people. They have already recommended getting an epidural "just in case" and I feel that this will lower the threshold for interventions massively and I may end up with an episiotomy and forceps just because they can, whereas with a single birth we might change positions etc.

The c section feels like a more controlled situation in some ways but isn't really what I want in a lot of other ways.

OP posts:
MrsAvocet · 21/12/2024 13:52

I'm no expert, but presumably the position will make a big difference and you're not going to know that until much neared the time? When my DN was having her twins she was told she could consider a vaginal birth if both were head down but they'd strongly recommend a section if either or both were breech. In the end if I recall rightly she wanted to try vaginally but towards the end of her pregnancy twin 1 was transverse or something so she had a planned section. Not ideal, but better than getting into an emergency situation.
The fact you've had a straightforward birth before is probably a positive thing, but I'd keep as open a mind as possible until much later when it's clearer which way the babies are lying so the level of risk is easier to assess.
For what it's worth, I have had a planned section (only one baby though ) and whilst the recovery was longer than my vaginal births, it wasn't that bad, and I definitely think I was in better shape afterwards than the women on the ward who had had emergency surgery. I walked down multiple flights of stairs to the hospital shop the day after I had had my section and they were still struggling to get upright at the same stage. And it's not because I'm some kind of super woman, it just genuinely wasn't that bad. I think it's to do with a mixture of not having been tired out by labour first and that the surgeons are a bit more gentle and careful when the time pressure is not so great. Personally, if there was any more than a 50:50 chance of needing an emergency section I think I'd opt for an elective, but I can understand the rationale behind wanting a vaginal birth if it's possible.

Sleepingroundtheclock · 21/12/2024 14:11

I had a vaginal birth with gas and air only. It was induced, in a consultant led wing however I said I wanted minimal staff, had the bed in an upright position (couldn't move around because of monitors). Both babies had to be head down by 36 weeks for a 37 week induction. The doctors only came in after dt1 was born to scan and then left (much to their disappointment). I had 1 main midwife with another who helped as needed, dimmable lights till quite late on. Once everything kicked off they're were about 4 midwifes in the room (plus extras when needed) I actually had less staff than when I had a traumatic singleton birth. I think you need to go in with an open mind, I said best case scenario xyz, however if things were going wrong convert to a csection earlier because I didn't want to have a general anesthetic. I was very aware of needing to be up and about quickly (was a single parent with a 4 year old to).

SavingTheBestTillLast · 21/12/2024 14:16

You might find you don’t have much choice

I wanted a vaginal and was vehemently insistent only to find out at 37 weeks one of mine was breach as I had to have a c section.
One days notice after scan

As your pregnancy progresses you’ll have a scan every week so always ask which way up they both are.
I didn’t and only found out why I had to have a Caesarian a few months back when I was tidying away papers. I’d thought it was because one baby wasn’t growing
They are 20 now 🥴

MumChp · 21/12/2024 14:19

I would go for a Csection.
Good luck!

3within3 · 21/12/2024 14:48

I had an elective c section although you’re recovering from surgery it’s not traumatic and also you can sit down unlike after an episiotomy!

BunfightBetty · 21/12/2024 15:00

I think I’d want to ask the consultant what the chances are of being able to birth both babies without forceps or EMCS and decide from there. Without high odds, I would personally go for ELCS.

My opinion is probably coloured by the experience of a friend who had one twin vaginally and then needed an EMCS for the second. The worst of both worlds and recovering from both afterwards…

tb4122 · 21/12/2024 15:08

BunfightBetty · 21/12/2024 15:00

I think I’d want to ask the consultant what the chances are of being able to birth both babies without forceps or EMCS and decide from there. Without high odds, I would personally go for ELCS.

My opinion is probably coloured by the experience of a friend who had one twin vaginally and then needed an EMCS for the second. The worst of both worlds and recovering from both afterwards…

Yes, this is ultimately my biggest fear, ending up doing both!

OP posts:
Shityshitybangbang · 21/12/2024 15:09

My mum had my sister and I 52 years ago. A vaginal delivery. My sister first, she was breach then me 15 min later. Ooouch!!

Judgejudysno1fan · 21/12/2024 15:31

MrsAvocet · 21/12/2024 13:52

I'm no expert, but presumably the position will make a big difference and you're not going to know that until much neared the time? When my DN was having her twins she was told she could consider a vaginal birth if both were head down but they'd strongly recommend a section if either or both were breech. In the end if I recall rightly she wanted to try vaginally but towards the end of her pregnancy twin 1 was transverse or something so she had a planned section. Not ideal, but better than getting into an emergency situation.
The fact you've had a straightforward birth before is probably a positive thing, but I'd keep as open a mind as possible until much later when it's clearer which way the babies are lying so the level of risk is easier to assess.
For what it's worth, I have had a planned section (only one baby though ) and whilst the recovery was longer than my vaginal births, it wasn't that bad, and I definitely think I was in better shape afterwards than the women on the ward who had had emergency surgery. I walked down multiple flights of stairs to the hospital shop the day after I had had my section and they were still struggling to get upright at the same stage. And it's not because I'm some kind of super woman, it just genuinely wasn't that bad. I think it's to do with a mixture of not having been tired out by labour first and that the surgeons are a bit more gentle and careful when the time pressure is not so great. Personally, if there was any more than a 50:50 chance of needing an emergency section I think I'd opt for an elective, but I can understand the rationale behind wanting a vaginal birth if it's possible.

Wow, you must have a really strong pain threshold to do that. Why not take the lift?

My recovery was awful. It was emcs. I had 5 previous normal vaginally births

AnotherUnoriginalUsername · 21/12/2024 15:41

My opinion is probably coloured by the experience of a friend who had one twin vaginally and then needed an EMCS for the second. The worst of both worlds and recovering from both afterwards…

This happened to me. First baby delivered fine, 2nd baby wouldn't come out and got distressed so I had to be whisked off for emergency c-section. It was fairly traumatic Confused
But what I would say is the recovery from a vaginal birth is so much easier than a c-section. I couldn’t stand up for more than 5 minutes for weeks and weeks after, it was dreadful. If I had a choice I would opt for vaginal every single time.

NameChanges123 · 21/12/2024 16:14

Apparently it's the presenting twin's position that's most important initially as the other one can turn any which way after the first is born.

I had mine vaginally with very little intervention (just a scalp monitor on first baby's head) and they broke second baby's waters after first baby was born. Oh, and a cannula for a drip, which I believe is standard for twin births.

It was a pretty quick birth (4.5 hours) with no pain relief.

I was lucky - it was fast and straightforward!! I wouldn't have fancied recovering from a c-section with two babies.

PrincessOfPreschool · 21/12/2024 16:21

I had epidural with my first which led to episiotomy and third degree tear. Obviously your body has had a 'good' natural birth already so it will probably cope better. But giving birth with an epidural is very episiotomy when you can't really feel the pushing.

For my twins I had an elcs even though by the end they were both head down and I could've gone natural. The elcs was fantastic compared to the natural birth. Obviously there was recovery/ pain from the op and I felt quite nauseous (threw up everything I ate soon after the birth. I ate a bit too soon as I hadn't eaten for about 20 hours by this point and was starving). But overall I had a MUCH better time of it, during and after, than my natural birth.

PrincessOfPreschool · 21/12/2024 16:22

Giving birth with an epidural is very difficult

Greeneyegirl · 21/12/2024 16:29

Currently pregnant with twins and am going to do elective c section. I had a antepartum hemorrhage, forceps, 3b tear and post partum hemorrhage with my first so think this is the best option for me. My mum has an emergency c section, vaginal birth and planned C-section and said the planned c section was the easiest recovery wise. Like someone else said, there was no time constraints, no rush, everything was done gently etc and as a result less internal bruising than the emergency c section

SavingTheBestTillLast · 21/12/2024 17:17

Greeneyegirl · 21/12/2024 16:29

Currently pregnant with twins and am going to do elective c section. I had a antepartum hemorrhage, forceps, 3b tear and post partum hemorrhage with my first so think this is the best option for me. My mum has an emergency c section, vaginal birth and planned C-section and said the planned c section was the easiest recovery wise. Like someone else said, there was no time constraints, no rush, everything was done gently etc and as a result less internal bruising than the emergency c section

I had a third degree tear with my first as he was back to back. The twin c section was a longer and more difficult recovery for me though.

SavingTheBestTillLast · 21/12/2024 17:18

NameChanges123 · 21/12/2024 16:14

Apparently it's the presenting twin's position that's most important initially as the other one can turn any which way after the first is born.

I had mine vaginally with very little intervention (just a scalp monitor on first baby's head) and they broke second baby's waters after first baby was born. Oh, and a cannula for a drip, which I believe is standard for twin births.

It was a pretty quick birth (4.5 hours) with no pain relief.

I was lucky - it was fast and straightforward!! I wouldn't have fancied recovering from a c-section with two babies.

With me.
Twin 1 was the right way up but it was Twin 2 that was breach that meant I was told I’d have to have a Caesarian ( with one days notice ).

Twinsybalinsy · 21/12/2024 17:33

ELCS for me - wouldn't have done it any other way as the pregnancy had been so fraught and complicated that by the time I'd made it to a decent gestation I just wanted them out and safe (and a natural delivery could have been pretty disastrous for twin 2). Recover was absolutely fine for me, I was up and walking short distances by the afternoon and felt pretty much fine by 7 days in, but the birth experience was super clinical, albeit very calm and in control. I think it did have an impact on breastfeeding which is worth considering if you are really focussed on that.

Autumnblackberries · 21/12/2024 17:33

Section. Definitely

Destiny123 · 21/12/2024 17:50

tb4122 · 21/12/2024 13:34

I'm 19 weeks with DCDA twins and not sure what sort of delivery I should opt for. My first was a water birth in the midwife led birth centre, dim lights, hands off car, delivered him myself straight into my chest for skin to skin etc and obviously they won't let me have that again this time.

I don't like the idea of a spinal injection, being paralysed and recovering from surgery with two newborns and a toddler. But I'm also worried about needing forceps or even an EMCS having delivered one baby, if twin 2 isn't in a good position. I also don't like the idea of a really medicalised vaginal birth with bright lights, constant monitoring and a room full of people. They have already recommended getting an epidural "just in case" and I feel that this will lower the threshold for interventions massively and I may end up with an episiotomy and forceps just because they can, whereas with a single birth we might change positions etc.

The c section feels like a more controlled situation in some ways but isn't really what I want in a lot of other ways.

Obs anaesthetist. Even normally delivered twins, deliver in theatre and we numb you fully whilst pushing, just in case 2nd baby gets stuck/distressed and needs to be a quick section, in the vast majority of patients. Don't worry about the paralysis it'll be gone within a few hours and we will make it v pleasant

It's not mandated to deliver un theatre but we strongly recommend an epidural if you want to birth in the room to protect twin 2

My best twins theatre delivery was either side of midnight nye so they were born in 2 different years

anicecuppateaa · 21/12/2024 17:55

I have twins and every twin mum I know apart from one had a section. One mum had a vaginal birth for T1 and then needed an emcs with T2….

boulevardofbrokendreamss · 21/12/2024 18:08

I have twins, had an emcs would have had a cs anyway. Can't think of anything worse than labouring and delivering one and then needing section for second

Greeneyegirl · 21/12/2024 20:12

SavingTheBestTillLast · 21/12/2024 17:17

I had a third degree tear with my first as he was back to back. The twin c section was a longer and more difficult recovery for me though.

It's not the recovery time I'm worried about tbh. I recovered from the 3b very easily, quickly and fully. I'd never know I had one. My worry is risking opening it up fully again with 2 births with probably the second needing forceps again. The long term implications could be double incontinence if I don't heal as well again.

SavingTheBestTillLast · 21/12/2024 20:20

Greeneyegirl · 21/12/2024 20:12

It's not the recovery time I'm worried about tbh. I recovered from the 3b very easily, quickly and fully. I'd never know I had one. My worry is risking opening it up fully again with 2 births with probably the second needing forceps again. The long term implications could be double incontinence if I don't heal as well again.

No I agree.
I wouldn’t want a vaginal for twins. I didn’t
I was simply commenting on pp who said C-section was easier recovery. Just pointing out it wasn’t for me having had both. Just as a reminder We’re not all the same. That’s all.

tb4122 · 22/12/2024 18:24

@Destiny123 can I ask you a couple of questions re the anaesthesia?

What medication is used for the spinal? I'm a vet so the clinical info helps! Also how often does the terrible headache occur after a spinal, as the dura will be punctured by default I assume?

I'm someone who often reacts to things and gets itchy- is there medication I can have if I react to meds in this way?

I also tend to get nauseous if my BP drops, but I have read that's common and can be quite easily remedied in theatre with drugs to make it go away?

Does the feeling and movement just gradually return to your body and does it tingle like when you have a nerve block for a dental procedure?

My DP is squeamish- I know he won't see anything but sometimes that's actually worse and his imagination runs away with him...! Is there much clinical talking about what's going on or are the surgical team fairly quiet generally?

OP posts:
Destiny123 · 23/12/2024 13:31

Of course, my best mates an equine vet so we love comparing the similarities and differences haha (she's mad and just started medical school in her mid 30s tho!

Spinals are a mixture of heavy bupivacaine 0.5% (sorry no clue if you use such so excuse if patronising, the heavy, means it is mixed with dextrose which allows us to change the height of the block by tilting you head up or head down) to actually numb you + ideally diamorphine for the longer analgesia (we have had a lot of supply issues with diamorph lately though so if we can't get it then we use fentanyl)

Post dural headaches have an incidence rate of 1 in 100. About 50% ish from spinals self resolve, the rest can need treatment (blood patch, performing an epidural then injecting blood from your own arm into your epidural space). If you get a dural tap from an epidural (if the needle goes slightly too far, as the epidural space is more superficial than the dura) then these universally need patching as the needle is significantly higher

Most people will get shivery with a spinal (it can be pretty dramatic) it's just a side effect, we aren't entirely sure why. Some people get opiate itch, it's not really that common and most aren't really bothered by it (we ask everyone on our day1 follow up ward round). If it bothers you, ask for some ondansetron (the midwives love giving chlorphenamine for it, it doesn't really do anything, just makes them feel like they're doing something, there's more evidence for ondansetron via the 5ht3 receptors) or if its really annoying then we can give naloxone ... but tbh its rarely an issue

if you labour with an epidural they have higher chances of itching (uses 2mic/ml fentanyl), if that bothers you we can swap it to a plain LA bag. Again fairly rare maybe done it 5x in 9y of labour ward

Spinals always drop BP by nature of how they work. Everyone immediately goes onto a vasopressor infusion as soon as they lay down to counteract it, we check the BP every 3mins but sometimes it drops between, just let us know you feel sick, we can fix it relatively quickly, don't suffer unnecessarily. Unfortunately approx 50% of people get nauseous in a section maybe 20% vomit. We can fix it quickly there's bowls on our machine. Normal antiemetics have minimal role as it's a combo of spinal hypotension and bump causing aorto-caval compression

My "normal chit chat" haha for legs recovery is... your legs will come back to normal over the next 3-4h, they get a bit more tingly, bit more pins and needle-y as they come back, often feels like when you've sat on your arm for too long and given yourself a dead limb. It's really important when your legs come back to always have a midwife with you when you first stand up as sometimes they can feel a bit stronger than they actually are, and I don't want you to fall over as that's a lot of paperwork"

Sorry never had a spinal so can't give an actual comparison but assume so

You can't see anything as there's high drapes, we lower them for lion King moment showing of baby but you can't see anything of the surgery as the incision is the other side of the bump. The only thing to be aware of is mum can occasionally see the op from the reflection in the operating lights, just tell us if you can and we will move them

Surgeons generally don't talk to u at all during the op beyond saying "big stretch" when they're splitting the muscles as that's the sensation you feel (we watch and tell you case they dont), and saying congrats after the baby is out. They'll come and explain how it went once they've closed

We chat to you the whole time, not about the surgery tho haha all sorts, people often bring their own music play list so often about that, I get lots of song recommendations out of that. Baby names. Siblings of babies. Are you prepared? Are siblings looking forward to baby or jealous. Your jobs often. Random news. Random music if we just have Spotify on shuffle if parents haven't choose their own music. Tbh baby is out within 9mins of knife to skin so you then have a cute baby distraction anyway at which point we take over Chief photographer role lol

Shout if you think of anything else, we love obs tho super happy joyful theatre list is one of my favs x