giving birth to twins - advice please

[Scotlian]

Hello

Very glad to find this bit of Mumsnet. Have just found out am 12 wks pg with twins, probably non identical. Ds was born at home no bother, but twin pregnancy labour and childbirth is totally new territory. So what happens? Do I have to get a section? Do twins always come early?

I am so ignorant and still in shock. Thanks in advance for all words of wisdom&experience...

Hi Scotlian, congratulations on your lovely news!! I think it's safe to say that twin pregnancies/births vary just as much as singleton ones. I had to have a c-section for mine because of their positions (one breech, the other transverse). They arrived a day before the section was booked at 38+1 wks. I think twins generally arrive early but I have heard of a few mums making it to 40 wks.

Lots of women have twins naturally though - I think I read somewhere once that about 60% are born via c-section. I would have opted to have mine naturally if I'd had a choice. Apparently twins are easier to give birth to because usually they're smaller than a singleton.

The good news is that if your's have separate placentas then they are not so high risk because the babies each have their own blood supply/food source. It doesn't necessarily mean they are non-identical though (as I'm sure you know). Mine had separate placentas but they turned out to be identical in the end (it's all to do with when the egg splits).

Hopefully some Mums will come along who had natural births and they can tell you all about it. Good luck with your pregnancy.

Congratulations. I also had a section with a breech and transverse at 34 weeks. With twins I think that you know a lot earlier if you need a section that with a singleton. I was told that I probably when I was 30wks pg. As far as I'm aware they don't try to turn babies as they would with a singleton.

I only know one twin mum who went full term (mind you I am going on a very small sample size!)

It is considered high risk so you will probably be monitored much more closely than with your first. I really liked that as my DTs are my first so I had no idea what to expect. If you have already had one you might find it too much.

I imagine that you will struggle to find a MW or consultant happy about a homebirth. I'm sure its not impossible though.

Hello & congrats! You're probably going to need more info about the babies before you know about chance of section etc, do you have an appt with consultant later on?

But no, plenty of us don't have sections and they don't always come early, I had my 2 at 39+3 weeks and epidural. And I'd had a previous section. I turned down 3 chances at induction to try for a 'natural' birth. It's possible, but I went entirely with what my consultant suggested/supported me to do. I didn't find the labour more difficult than with my second child & it was a darn sight quicker!

I was entirely ready for a section if that was necessary (e.g. many drs won't be happy to go natural if 1st twin is breech past a certain point). It's a very tough & emotional situation, hopefully you will have a good dr to guide you through.
I needed a good month after I'd found out (at 17 weeks!) to start taking it all in & stop panicking tbh. So don't worry if you're in shock for a while.

Oh AccessorizeQueen what lovely comforting words thank you.. it does feel like I will need a fair few weeks more for my mind to stop doing somersaults! I'm going to meet the Whoever Hospital Person at the 20wk scan, I'm sure I'll have questions for them then but any advice on useful things to ask is welcome! It is all so new, I thought "ah had 1 4kg baby at home so the next one will be no bother"...only it's 2 now . I do know the birth is only a teeny moment in their (our) lives, don't want to seem a crazy inflexible Only Home Birth For Me lady, just want to know more facts behind what sounds like fairly intimidating medicalese about "high risk birth monitoring"etc. So thanks all, sorry about ramble, keep advice&opinions coming...

Glad you're feeling a bit calmer, Scotlian! As potplant says, they can tell you quite early (I think I knew at 33 weeks whether I could try for a VB) based on the position of the babies. Funnily enough I was told I could deliver at any point from 28 weeks as one twin had too much fluid so got all anxious and waited for another 11 weeks!
I don't know the facts about high risk monitoring because I wasn't high risk (other than having twins). But if they are non-id with separate sacs then you'll have more scans and more checks so lots of going into the hospital which gets a bit tedious. The actual monitoring and the no of people in the room scared me quite a bit - the idea of it i mean but in reality it was fine. They were all laughing and joking and supporting me & dp and tbh I was concentrated on having 2 babies and not counting! I can see that going into hospital to have 2 babies is going to be a lot different for you than 1 at home, will taking some adjusting to but you have time to do that.Plenty of time!

Congratulations! The rollercoaster of emotions I imagine you might be feeling is very normal and does settle down.

As others have said, it depends a lot on the position of the babies nearer the time - but they do scan as late as possible to ensure you have the best chance of a natural birth.

I had to have a section as my twin 1 (nearest the exit) turned stubbornly breech at about 24 weeks and refused to move.

I think it helps if you have given birth successfully before. I have 4 friends who all had singletons before their twins and were confident about giving birth and I think this helped them to argue their case against a section when the second twin was breech.

I think in the end they will do whatever is safest for you and the babies but will not do a section unless they have to for medical reasons - having twins doesn't automatically have to mean a section. If mine hadn't turned breech I would have had a vaginal birth, all being well.

I had id twins - they were both head down from 32 weeks so I had them both vaginally at 37+5. The consultant was keen to have them born by 38 wks (they shared a placenta, not sure if that's exactly why, bit of a blur now 21 months on!). My consultant was happy to go for vb as long as twin1 was head down - she was happy to deliver twin2 breech. There were 2 midwives with me, one stabilised twin2 from outside (hands on either side of my tummy) after no 1 was born so that she didn't turn and they were both born head down.

I had a good book on nutrition for helping twins get to term - basically about gaining enough maternal weight (more than you think!) and eating enough protein. Author is Barbara Luke, title is about healthy twin pg.

It took me ages to get my head round it - I still sometimes 'realise' I have twins! Good luck.

Hi Scotlian, I'm almost 11 weeks with twins, but found out there were two in there three weeks ago, so have had a little time to adjust. I also had a homebirth with my first. I think it would be very difficult to get a twin homebirth where we live on the NHS, but independent midwives are an option if you can afford it.

Anyway, I met my community midwife for a booking appt this week. And she has delivered at least two sets of twins vaginally at the hospital, which was good to hear. I said I wanted a normal, drug free vaginal birth, and she said that would be possible as long as the first twin is head down and I was clear about what I wanted, particularly as I'd already had one normal birth. If the first twin is breech or transverse, they would strongly recommend a c/s. I understand each hospital has a "twin protocol" which I'm trying to get hold of. I've also read about 50% of twins come before 37 weeks, but that twins who share a placenta are at greater risk of preterm birth.

I'm still gathering information, but am happy to share anything I find, and share the shock too!

Sorry - meant to say that I interpret the twins who share a placenta are at greater risk of preterm birth statistic as twins who have separate placentas (as mine do) are not at such greater risk of preterm birth.

Hi Mamachris, sounds like we're in similar places. Phew, such a relief in the middle of all this to read so many reassurances.

My twins have a placenta + sac each, so low risk I think.

Everything is a bit complicated by the fact that we were planning a move back to Edinburgh from VERY rural and remote Northern Scotland when we found out about the twins! Absolutely confirmed our decision to move back south (all women pg with twins here have to stay in Aberdeen a month before EDD ), but means we are juggling househunting at a distance, 1 yr old DS, packing and contacting hospitals/midwives etc for 20wk scan. It will all be ok (!) but stress levels a bit high at the mo.

"Twins protocol" at the hospital - great idea to get hold of that. I'm not looking for a home birth "for the sake of it" at all; I just want, as you say Mamachris, as active and drug-free a delivery as possible. Greatest fear = being tied to two monitors and a drip surrounded by dozens of onlookers under bright lights. Hmm. Yes let's share shock and info and hopefully delights of twindom when all goes well! I found on the TAMBA website a list of regional twin groups, there's one where we want to move back to in Edinburgh hurray, there might be one near you too...

Curlyredhead that book sounds interesting will look out for it ta

Hi scotlian! Congrats! Don't worry too much! My boy/girl twins are 4 months now. They are numbers 3 & 4 for us, concieved naturally and my last two were born naturally (number 2 at home) and without any instrumental assistance. I had TENS and pethidine for number 1 who was a 60 hour labour and 6lb 5, number 2 I only had TENS and she was born at home after a 12 hour labour and was 7lbs, the twins were born in Liverpool women's midwifery unit entirely naturally with no assistance, delivered entirely by midwives after a 10 hour labour using TENS, Entonox and the water pool for pain relief. I had intermittent (not continous) monitoring in labour and no epidural and the twins were completely separate (we knew they were fraternal because they were b/g) and 5lb 6 and 7lb 3 when they were born at 40+3. I had some high BP and was on bed rest for the last 4 weeks and a lot of monitoring to keep an eye but everything went very naturally and without much (or in fact any!) medical involvement.

I would disagree with the assertion that you'll know if you need a section very early because things can change right up until the very end. It depends on a lot of different circumstances including the type of twins, the size of the twins, their positions and your obstetric history as well as any developinh issues with water levels, BP, Pre-eclampsia, pelvic obstruction e.t.c. Sectioning for malposition is not always necessary as the babies can move right at the last minute. My twin1 was head down from 26 weeks and stayed that way throughout. Twin2 was head down until late on (think around 36weeks) then changed to transverse and then to breech (3 days before the birth) and then was born head down! We know because I was being scanned, it wasn't from palpations. You might know very early but it is likely that expectations will change throughout your pregnancy so my advice would be to think about all the possibilities and decide which battles you are going to fight and which things you don't mind letting them decide for you.

Twin birth is largely unresearched and hospital policy tends to err on the side of caution in my experience, sometimes being very eager to section or get the babies out before 40 weeks which is often more of a decision than they let on. If you feel very strongly about wanting as natural a birth as possible you need to remember to be flexible but it is not true that safe natural birth with twins is not possible. I believe it can be probable but often needs to be pushed for. I have done a lot of research and had very good joint consultants (consultant midwife for normalcy and consultant obstetrician) and would be very happy to give you my birth plan and birth story and any help or research you need if you want to push for a sensible natural birth plan (or if you just want to chat about experiences)? My e-mail is [email protected]

Should add I'm all for homebirth but I didn't feel it was a realistic sensible plan for twins given the extra risks and pressures on twin2 and felt planning homebirth might be likely to make people twitchy about transferring me to hospital for the slightest worry which I felt would be worse than facilitating a natural delivery in an environment the HCPs were more comfortable with. You all have choice though, I have some interesting things about twin homebirth experiences if you feel that's the way to go? Anyone can e-mail me, I might take a bit to reply due to having many children!!! My parents are both doctors as is my sister so I have the benfit of being able to look up relevant recent research too.

Absolutely felt the same fear as you Scotlian, but in reality you can negotiate about monitoring (I had to have it constantly as I'd had problems with previous babies) and of course choose not to have an epidural. If things are fine, you'll just have one midwife there a lot of the time, it's only if there's problems that people come screaming in and you do need 2 paeds to do checks after they're born. I had 2 midwives with my 2nd child because he needed 'catching' apparently.

Can you visit the hospital in Edinburgh once you're set up there, will make you feel a lot better to see a labour room. I believe the twinsclub website has lists of all hospitals which you could check out? Does sound v.stressful about moving, but my god do it before not after! We're planning it this year and now they're all walking & (nearly) talking it will be a nightmare.

Curiosity, I think I was saying that dr will be able to tell you early if you can try for a vaginal labour (if twin1 head down) rather than definite section. Other way round iyswim. How are you doing, you've got dts for nos 3 & 4 like me (mine were nearly 5 and nearly 3 when dts born).

Oh cool AQ, mine were 3 and 1 month and 4 and 5 months when the twins were born. I'm doing OK, it was really just that I was so incapacitated and helpless and needed help and DH had gone back to work. I would have been OK if the older two were at home and not going to school and presschool. EVen if I could drive I think I'd be too tired to manage most of the time anyway! I coped with not having help but couldn't both make enough milk and run myself ragged and then had a do with a HV who told me she would call SS if I didn't give the babies formula but provided me with zero support just weekly weight targets for the babies and missed that I was getting isolated and down. I had a bit of a breakdown, got medicine, switched HVs and now I'm OK. The babies are weaning from 4 months rather than having formula which I discussed with the GP and paediatrician but am just lying to and placating the HV because when I discussed it with her she wanted me to wait and didn't seem to understand/believe that I had discussed a plan with various doctors. I didn't want the relationship to deteriorate so it is easier just to pretend, nod smile and agree but I feel like a fraud!!! lol

I'm actually fine now I'm not being hounded by that horribe HV. I think I don't have true PND, just normal stress but the medicine is a very low dose and has helped rescue me from the depths so I'm still taking it just to help give me a leg up.

I still think, looking at things from a medical need perspective, the doctor shouldn't really be able to tell you early whether you need a section. I think it is bad, but common practice to approach twin pregnancy in this way. If you have two separate sacs and two placentas you may need to plan a section if the first twin is still transverse at 36 weeks but this just playing the percentages as it is theoretically possible that the baby could move even at that late a stage although more likely that the baby is malpositioned for a reason such as there is an unseen pelvic obstruction or not enough water for the babies to move. You can deliver twin2 breech if you can find midwives trained and experienced in breech delivery as it is not risky like breech delivery of a singleton and if twin2 is transverse late on you may also want to plan a section for certainty as although twin2 can turn (or be manually manipulated during labour for which you'd need to have an epi or local anaesthesia) it may end in a vaginal delivery of twin1 followed by a ECS for twin2. I actually think it is much better to make allowances for only finding out how things will be right at the last minute and being flexible and planning for all possibilities. Like I say twin1 was head down and engaged for a long time with me, twin2 was also head down until they had a little fight for who was coming out first at around 36 weeks and I had terrible SPD because twin1 was engaged at 5 and twin2 engaged at 3!!! She was basically trying to ram him out of the way with her head, then she had a hissy fit and went transverse and then breech at my 40 week check up and was head down when I went into labour 3 days later.

I also think it can be common hospital policy to want 2 midwives, 2 paeds, continuous monitoring, an epi 'just in case' and even to have you sited in an operating theatre and this often depends more on the attitude of the hospital than the medical need when it exists as a hospital policy rather than is advised based on circumstances IYSWIM? ANYway, I think it is very important to work together with you HCPs to produce an individually tailored birth plan that everyone is happy with.

I got absolutely desperate with all the antenatal monitoring I had (bi weekly CTGs, BP profiles, ultrasounds, cord dopplers for the last 4 weeks) but it built up a profile of information that made the hospital and the midwives feel comfortable in allowing me to spontaneously labour at 40 +3 and to allow intermittent monitoring and an MLU delivery with no doctors (my consultant obstetrician came very very briefly just to double check twin2 was not still breech and then went away again very quickly but I had no paeds just midwives) For most of the labour I was just with my husband and doula and the delivery was mostly managed by one midwife and the consultant midwife who was there really only to support her and give her confidence and then another midwife helped to actually deliver twin2. They also let me have a bath in the water pool after the birth and just left us to it in the birthing suite for a good few hours after the birth before they did the majority of their paperwork - they just made sure we were all OK, checked on us occasionally and left us alone to bond.

If you have twins who share a placenta then your obstetrician may want you to plan an earlier section because of the risk of twin to twin transfusion but it is possible to plan an induction instead or even push to labour naturally if you have a lot of monitoring for early signs of TTTS but this is more risky for the babies. You should still have input and choices though.

If you have conjoined twins or twins that share a sac and a placenta then you should plan a section mainly because of a risk of entanglement. So if you have MCMA twins, yeah they'll tell you early but everything else is uncertain until the last minute.

Hi Curiosity, haven't checked up on you in a long time. Just wanted to say hello but I'm really sorry to see you've had such a tough time of it. Wish I'd looked for you again before now, even though I wouldn't've been able to do anything to help.

Hope things continue to improve for you.

Good luck with it all scotlian!
my id t boys were induced at 38 weeks because they shared a placenta. Had a trouble free pregnancy and was surprised that my consultant advised a natural birth because I already had a DD and he wanted me to get back to normal quickly and not have to recover from a C/S. he advised an epidural just in case anything changed at the last minute and having had one with DD I was happy to have it again. I laboured for 7 hours and then they were born - had to be rushed to theatre before DT1 was born by von-t and then twin 2 was born breech by a fantastic registrar. There were loads of people in the room, midwives/paeds/students because I think a vaginal delivery with twins was unusual so they all wanted a look! By that stage I would not have cared who was looking!!

Hi again Scotlian,

I saw you are moving to Edinburgh - that's where I live, so chances are you are heading for same hospital. Happy to chat about things more by email, if you'd like to bally hoolly at g mail dot com (no spaces!).

Good luck with all you have on - it's a busy year you have coming up!

Curiosity, what a brilliant epic post . Also very wise. I will wait til I see the consultant for the 20wks scan and talk to her properly then... Teddymummy you're probably right about not caring how many folk there are as long as all is going well. Here's hoping.

Curlyredhead am about to email you thank you!

Am sure I can feel the wee ones wiggling about like bubbles inside. That possible at 13 weeks? DH says no I say yes. Hah.

Wow Pixie what a beautiful birth story am so grateful you shared in on MN. Congratulations! Hope things are going well with your new wee ladies

Pixie - congratulations - great story

Have just found a leaflet on twin pregnancies from my hospital and it is scary reading. They recommend induction at 38 weeks, epidural (in case of forceps/need to turn twin 2), continuous monitoring, and say there will be lots of people in the room at time of delivery, but it's for the babies' safety. Everything I really don't want.

Am 12 weeks now, and have my first appt with consultant in another month. Hoping I can find some flexibility in their protocols as, really, I think I would prefer a c/s and have the babies taken out of my tummy than have them removed by forceps with a huge audience. If I'm going to be numb from the waist down anyway...

How're your plans going Scotlian? Have you found somewhere to move to? We moved when ds was 9 months, and it was tough packing/unpacking etc as he was mobile but didn't yet understand "no". But I imagine it would be so much tougher with a toddler and twins, really worth getting it done before they arrive, I think.

God, just re-read my last post and even I struggled lol! Here's my birth plan and story in case anyone would like to see; birth story

Don't know if you emailed - but if you did, I didn't get it! I had little bubbly movement feelings from about 11 weeks so I reckon you can feel them - wait till they are bigger, mine were non-stop party girls!

Congratulations.

I've supported lots of twin mums through birth both vaginal and caesaraean birth. Do get hold of the Multiple Birth policy. It will help you know where your hospital is coming from and gives you ground to base your discussions. Sometimes the policies have more flexibility than the Consultants/MWs.

Scotlian
I have id twin girls (17 months). I spent my entire pregnancy researching twin home births and reading loads of medical journals about time between delivery, perinatal stats on twin 2 (usually the riskier birth) and all sorts of other things. I had had my son (3 years old) at home in London - a long if uncomplicated delivery. Like you, I am pro homebirth but I didn't want to be doing it for the sake of it. After 5 months of umming and aahing, I decided to have them in hospital with my midwife as the lead carer. 2 days later I had them at 35 weeks, delivered vaginally - twin1 was head down, twin2 was breech but flipped round (thanks to expert midwife). I did spend the morning having a fairly heated discussion with the consultant who wanted me to have an epidural immediately and deliver in theatre but once we said no to those things he was very respectful and things moved perfectly. It was miles easier than my singleton first child.
Do lots of research, chat to lots of people and have faith that you will make the best decision for you and your family.
A friend of mine has had a homebirth and a hospital birth too and we both came to the conclusion that there are pros and cons to both.