Delivering Twins: What You Can ExpectMeredith O'Brien
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Delivering twins is a much different endeavor than delivering a single baby. Sure, we’re talking about the same basic premise — getting something big out of an impossibly small opening — but from there, it’s a whole different ballgame.
There will be two separate trips down the birth canal. One baby could be head-first while the other could be feet-first. There’s the possibility that you could have both a vaginal and a C-section delivery. There are two umbilical cords that could become tangled. There are sometimes two placentas. Your uterus may be too stretched out by the twins to muster enough steam to generate strong contractions. The list goes on and on.
“Whether the birth of twins occurs vaginally or by Cesarean section (or both), it is truly an amazing experience,” writes Linda Albi and a group of mothers of twins in Mothering Twins. “Nothing compares to it, and no two experiences are alike. There can be great drama and suspense.”
What affects how the birth of your twins will proceed? Let’s take a look at several factors that contribute to twin labor and delivery.
Shorter Twin Pregnancies
Most twins are born prematurely. “In the majority of twin pregnancies, labor will begin before 37 weeks,” according to Twins! Pregnancy, Birth and the First Year of Life. The average duration of a twin pregnancy is 258 days, compared to 282 for a singleton birth, the National Organization of Mothers of Twins Clubs’ (NOMOTC) website reports. That’s why twin birth experts advise moms expecting twins to take child birthing classes by the sixth month of pregnancy, so you won’t be attending classes after your babies have been born.
While there’s not much you can do if your water breaks when you’re only 34 weeks along, there are some things experts recommend you do to try to prevent premature labor:
- Rest several times a day once you’ve reached 20 weeks
- Keep hydrated by drinking a lot of water
- Avoid heavy activity
- Avoid long commutes
- Avoid traveling
- Consider stopping work (on doctor’s recommendation)
Regardless of whether your physician puts you on bed rest, most medical personnel urge women carrying twins to be on the lookout for signs of premature labor. “An expectant mother of multiples must be keenly aware of her body and babies in order to detect any threatening changes,” Elizabeth Noble says in Having Twins. “It is much better to check with your doctor when in doubt (and don’t be put off with, ‘You’re just carrying twins—of course it’s a bit uncomfortable’) rather than waiting until it is too late and labor is established.”
So should you be concerned? Not necessarily. But you should be aware of the following symptoms of premature labor:
- Contractions at regular intervals
- Menstrual period-like cramps
- Sensation of fullness in pelvic area
- Vaginal discharge
- Flu-like feelings
- Lower backache
If you go into premature labor—as long as the water hasn’t broken for one or both of your twins—there are a few things that can be done to try to stop labor. “When your medical team diagnoses signs of early labor, they may admit you to the hospital or treat you as an outpatient,” write Patricia Maxwell Malmstrom and Janet Poland in The Art of Parenting Twins. Options include hospitalization, complete bed rest, using an at-home contraction monitor, and medications taken either orally or intravenously to stave off contractions.
Noble agrees that it is possible in some instances for labor to be stopped if it’s too early. “If you can detect preterm labor in its early phases, before the cervix has undergone significant changes and before the membranes have ruptured, it can sometimes be stopped with rest and increased fluid intake,” she says.
Positioning of Twins
Once it’s been determined that you’re in labor, one of the first things you’ll want to know is which ways your babies are facing. The positioning of the babies will have a tremendous impact on whether you’ll be able to attempt to deliver them vaginally or whether your doctor will insist that you have a Cesarean section. Sometimes, a woman will deliver one baby vaginally and have a C-section for the second baby.
While it used to be standard procedure to do a C-section for a mother expecting twins, with the advent of sophisticated ultrasound capabilities, more and more mothers are able to deliver their babies vaginally because the doctors can determine the babies’ positions in the womb. The conventional wisdom is that if the first baby is headfirst, that child can be delivered vaginally. If the second baby is breech, the doctor can sometimes manually turn him in the uterus after the first baby is out of the way. Or, if the baby is small enough, he can be delivered breech. About 40 percent of twin pregnancies have at least one of the babies in a breech position, and eight percent have both babies in the breech position, reports Noble.
Further complications can arise if too much time has elapsed between the delivery of the two babies and the cervix has begun to close, or if the second baby is bigger than the first. If the first baby’s position presents a problem (if she’s not head-first) or there’s a concern that the umbilical cords may become tangled, a C-section is usually done.
“Difficult birth positions may sometimes be resolved through manipulation of the babies by the attending practitioners,” according to the book Mothering Twins. “Emergency situations that necessitate Cesarean birth may arise during labor after preventative, alternative, or medical techniques have failed. These include fetal distress, prolonged or arrested labor due to ineffective contractions, or to a disproportionate fit of the head/buttocks to the pelvis.”
Author Paula Spencer says the situation may be aggravated if the mother’s contractions aren’t strong enough. “Mothers of twins tend to have slow labors, perhaps because the overstretched uterus doesn’t contract as efficiently,” she writes in Parenting Guide to Pregnancy and Childbirth. “On the other hand, the cervix has usually begun to dilate before a twin labor starts, which can make things seem to go faster. Twins also tend to be smaller than full-term singletons, making their delivery easier.”
The average birth weight for twins is 5 pounds, 5 ounces, compared to 7 pounds, 7 ounces, for single babies, NOMOTC reports, adding that a set of twins can vary in weight by two to three pounds. The interval between the births of twins is usually less than an hour, with five to 10 minutes between starting the delivery of the second baby, the group’s website says.
Many healthcare providers like to have women delivering twins outfitted with an IV and an epidural—regardless of whether a vaginal or Cesarean birth is planned—in the event that an emergency C-section is needed, explains Denise Chism in The High-Risk Pregnancy Sourcebook. If an epidural is in place, the mother may remain awake during an unexpected C-section.
Preterm labor of twins may also dictate other elements of the birth. “If you are laboring prematurely, your care provider will most likely want the babies monitored during the entire labor, which means you will be in bed during the labor,” Chism writes, adding that, “Delivery of twins is most safely accomplished in the room where Cesarean sections are done.”
But the Mothering Twins authors urge mothers who are hoping for a vaginal delivery to be vocal about their desires. They suggest that women discuss the following with their doctors:
- Freedom to change positions or walk around during labor
- Use of medication for pain relief or to stimulate contractions
- When and if electronic fetal monitors should be used
- What would necessitate a C-section
Mothering Twins also suggests that mothers explore their healthcare providers’ attitudes toward delivering twins by inquiring about the number of twins they’ve delivered vaginally, by C-section, by both, and the situations in which those deliveries occurred.
Preparing for the NICU
If you’re pregnant with twins, you need to come to grips with the distinct possibility that your babies will be born early, may be small, and may spend some time in the Neonatal Intensive Care Unit (NICU). Though baby product commercials are packed with emotional images of parents lovingly cradling their newborn minutes after birth, your reality may be a far cry from that scene. Your babies may be shown to you for just seconds and then whisked away.
Even if you believe you are prepared for that moment, when it actually happens it’s difficult. “Most parents of prematurely born infants experience a similar sadness about being left out of the first meeting with their babies,” Albi writes. “Though parents intellectually understand the reason for the babies being taken immediately to the neonatal intensive care unit for evaluation and treatment, their hearts may feel deprived.”
Albi and her co-authors think it’s helpful for parents visit the NICU in the hospital where they’ll be delivering before the babies are born. Go in, look around, speak with the NICU staff and, if possible, with some parents who have had or currently have babies in the unit. Seeing what goes on, how parents and newborns are treated can help you mentally prepare for this possibility.
Because there are many opportunities for the birth of twins to take unforeseen turns, experts suggest that mothers pregnant with multiples be ready for anything. “Having multiples makes you very conscious of the unexpected and in many ways prepares you to be more flexible,” the moms in Mothering Twins advise. “A lowering of expectations was one of several things that contributed to an overall positive birth experience for us.”