Twin delivery

[Derv78]

Currently 24wks +2 pregnant with identical twins. Both twins very healthy and no signs so far of TTTTS.
I had a 'normal' (suction & forceps) delivery with DD. I had hoped to try normal delivery with twins, and had hoped to deliver as close to 38/40wks as possible. But at last appointment with consultant she suggested that the most likely course of delivery is an elective C-section at 35/36 weeks. She did say it will depend on the babies' growth over the next few weeks.
Just wondering if anyone else has had normal delivery with identical twins, & if so at how many weeks?

They've changed the rules in the last few years, it seems. When mine were born (shared placenta) in 2000, they had been scanned every fortnight for months in case of TTTTS, but no one ever mentioned the syndrome arising during labour. I was induced at 37 and a half weeks. No TTTTS, twin 1 born vaginally, twin2 transverse born by section. [27 minutes later]

They now know labour is a risk, though, so it's all different. You could ask your consultant what the percentage risk is - it may be very tiny, like the risk of uterine rupture in a VBAC.

you don't have to have a CS. I have id twins - no ttts - but one stopped growing about 34 weeks (IUGR), was induced at 35 weeks, and had a normal delivery (with epidural).

There is no particular reason they should be born early if there are no problems like TTTS or IUGR - many get to 37 or more weeks.

I think you just have to get used to the idea it could be any time in the next 4 months - and the longer the stay in the better. Expect to be scanned at least every two weeks and hopefully they will pick up any signs of problems early and have time to watch and plan properly.

Good luck - id twins are very special

My twins are non identical but they were delivered vaginally at 37 weeks after spontaneous labour. I was told a few times during pregnancy that even if both twins were in good position i had a fairly high percentage chance of having a c-section.

Thankfully it was all very straightforward and had no epidural which i have heard can be more likely to then lead to a c section (not sure if this is true statistically). I did have to give birth in theatre though just in case emergency section was needed. Ds2 who came out second needed to be ventoused out.

I've had identical twins who survived severe TTTTS. I went into labour at 34 weeks, twin one was born vaginally head first and twin two was transverse right up until his brother was born then he turned and was born feet first!

I'm 21wks with identicals - and I've been told right from 12 weeks that they will be delivered by C-section at 35/36 weeks. I was a little surprised it would be so soon but having done some reading on the TAMBA site it seems that it is best because of the risk of TTTS IN labour, and the later in pregnancy you are. C-section doesn't bother me at all though - I had one with DS - and am looking forward to it without the preceeding 40 hours I had with him! I've also got other complications which won't be helped by weight gain at the end, so am trying to think of it positively. They are also scanning me fortnightly due to the risk of TTTS, so I think that's pretty standard.

can someone tell me of the risk of TTTS in labour ? Mine are 6.5 now - we were with a very experienced twin specialist but I don't remember talking about TTTS in labour. We did talk about lots of other things, lots of discussions about blood flow (DH is into fluid dynamics).

Maybe it was because we had found an AAA (arterio-arterial anastomoses) by scanning at an earlier stage that they weren't worried about TTTS in labour.

My consultants only request was that I had an epidural at least in place during labour so that if needed c/s was a quick option for twin 2. I don't remember any mention of time limits though.

throckenholt I read the most detailed information about it in the TAMBA forums - there was a specific thread (which of course inluded lots of anecdotal experience) but someone who had done their research linked to the studies about TTTTS in labour. I've been back this morning to try and find the particular thread but can't remember the thread title and have only used their forum once before so not an expert on searching, but will keep looking. The study was fairly recently I believe - as in within the last 4 years but I can't remember the details. What I do remember is before I read it I didn't really understand the fuss over the automatic section at 36 wks (although the c-section part of it didn't bother me to do with previous birth experience) - but having read everything I felt convinced that performing it at 36 weeks was the right decision, and what is now advocated. It seemed to me that was when they had got the best balance between the twin's being fully developed, lungs ready, some weight on (therefore less likely to need SCBU) and the increasing risk of severe TTTTS in the later stages of pregnancy and indeed labour. If anyone else knows the thread I'm talking about, or indeed finds it, could they link as I'd like to bookmark it!

Found the thread I was talking about... This is the study it refers to:

www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020172

I think you will only be able to read the thread if you are a TAMBA member but here it is:
www.tambamessageboard.org.uk/viewtopic.php?t=20849

PLEASE - anyone carrying MCDA choose a time when you are feeling quite robust to read that thread (not so much the study), maybe with your partner or someone to read it with you and discuss it with. I read it totally unprepared and it scared the hell out of me - it was only then with DH helping me understand the statistics and relative risks, etc that I felt calm about it and that although I agreed with the consultant's decision to deliver by section at 36 wks, I found it hard not to get emotional about people's experiences on there.

one thing I had to convince myself of when I was pregnant with my id twins - that 2/3 have no problems at all - that is a large proportion.

Of those that do - many many only have minor problems. And even those that have severe problems (especially TTTS) can be treated very well.

Mine were born at 35 weeks because of IUGR - but they were and are perfectly fine - we had a total of 2 days in SCBU being fed hourly, and a night under UV lights - and that is all.

Thanks for all your very helpful comments ladies.
Weegle; I haven't managed to get PLOSmedicine article to open yet but will definitely keep trying as I'm sure it's useful reading.
Haven't joined TAMBA (yet!) but if thread makes for emotional reading I might leave it for a while given my recent hormonal instability!
I definitely plan to listen to my consultant's advice very carefully. She is a consultant in fetal medicine, so knows what she is talking about. At the end of the day, the most important thing to me is to make sure both babies arrive safely, no matter what method of delivery.
Throckenholt; appreciate that babies could decide to make an appearance at any time from now, and just hope they decide to stay where they are for as long as possible. I have been being scanned every 2 weeks from 16weeks, & it's very reassuring to see both babies getting bigger & more active as the weeks go by. I am getting excited about getting to meet them both (& hope I manage not to mix them up!)
Also wondering about work. My job entails on call work & consultant advised me to stop on call nights from now (on call today & it's been busy, so glad that next 12hrs will finish my on call til after maternity leave). She also advised me to stop work altogether at 26weeks. Have spoken to my own boss as I'd like to work til 30weeks & he has agreed I can scale down my workload from now. Is that a sensible compromise?
Also very keen to bf twins. Any mums out there manage this? If so til what age? I bf DD til she was almost one (teeth & BFP were influences in decision to switch to cow's mill!).
Sorry, LONG post!!

I breastfed my two until 10 months. The only problem was in the very early days when I'd had a caesarean and they were tiny and fragile. It was impossible (for about the first 5 days) to get one latched on and then pick up the other without risking the first rolling away! So if you have a section I would advise having someone on hand to help you for the first week if at all possible.

I worked part time with my twins until 32 weeks. I wasn't advised when to give up, but I had to give 3 weeks notice and was getting pretty tired by 29 weeks so put in my notice then.

If I hadn't of gone into labour at 34 weeks, I was going to be induced at 37/38 weeks. I really wanted a c-section. But my consultant was adamant that all the time twin 1 was in the right place, it would be a normal delivery. I had an operation on the placenta at 23 weeks because of TTTTS. I was then scanned 10 days after to make sure they'd survived the op. I continued to have scans every week up until delivery. There was no mention of TTTTS being a risk in labour though. Also although I was dreading the birth, I opted for an epidural before the pain kicked in and it was really straight forward. The care I received was excellent. In my hospital, they deliver twins vaginally in the theatre, so a caesarean can be carried out straight away if necessary!