9. Delivering More Than One Baby
Multiple fetuses are often delivered
early. How babies are delivered often depends on how they are lying in
the uterus. All possible combinations of fetal positions can occur.
Possible complications include abnormal presentation of one or more of
the babies, prolapse of the umbilical cord (the umbilical cord comes
out ahead of the babies), placental abruption, fetal stress or bleeding
Because there is higher risk, precautions
are taken before delivery and during labor. These include the need for
an I.V., the presence of an anesthesiologist, the ability to perform an
emergency Cesarean delivery and the availability and possible presence
of pediatricians or other medical personnel to take care of the babies.
With twins, all possible combinations of fetal positions can occur. Both babies may come head first (vertex). They may come breech, meaning bottom or feet first. They may be lying sideways or oblique, meaning at an angle that is neither breech nor vertex. Or they may come in any combination of the above.
I’m carrying twins. Will I need a Cesarean delivery?
Not necessarily. Delivery of twins has
more complications than delivering one baby, but many twins can be
delivered vaginally. Discuss it with your healthcare provider.
When both twins are head first, a vaginal
delivery may be attempted and may be accomplished safely. It may be
possible for one baby to deliver vaginally.
However, the second one could require a Cesarean delivery if it turns,
the cord comes out ahead of the baby or the baby is stressed following
delivery of the first fetus. Some doctors believe delivery of two or
more babies is more safely accomplished with a Cesarean delivery.
After delivery of two or more
babies, medical personnel pay close attention to maternal bleeding
because of the rapid change in the size of the uterus. With more than
one baby, it is greatly overdistended. Medication, usually oxytocin
(Pitocin), is given by I.V. to contract the uterus to stop bleeding so
the mother doesn’t lose too much blood. A heavy blood loss could
produce anemia and make a blood transfusion or long-term treatment with
iron supplementation necessary.