women

Multiple Births

Carrying twins or more increases the risk of complications during birth and you and your babies will be closely monitored.

Twin pregnancies occur naturally in around 1 in 53 women, but some factors increase the chance of you conceiving twins or more, including the use of some fertility treatments, becoming pregnant when you’re older, already having children, and having a family history of twins.

Monitoring during pregnancy

Because multiple pregnancies are high risk, you’ll receive extra monitoring; the type of delivery depends on the position of your twins and other complications. A concern is whether twins will be born prematurely with a small birth weight, which can mean spending time in a neonatal intensive care unit .

Toward the end of pregnancy, you may have extra scans to monitor the babies’ growth, since the ability of the placenta to provide oxygen can be reduced in a twin pregnancy. The volume of the fluid around each baby and their heart rates may be measured to check their well-being.

Possible complications

Certain complications with the babies or the mother can influence the delivery and mean that a cesarean is planned.

Fetal complications

Twin-to-twin transfusion syndrome (TTTS) is a condition unique to identical twins who share a placenta . It occurs if there is a direct link in the blood supply between the babies and can put the lives of both at risk. Babies with TTTS need specialized treatment that may involve reducing the fluid around one baby or using a laser to separate the circulations.

Rarely, twins can develop in the same sac, known as monoamniotic twins. The main risk of this condition is that the cords become tangled, affecting the oxygen supply. The twins may have heart traces at the end of pregnancy and are delivered early by cesarean.

Maternal complications

When you’re carrying twins, you’re at a higher risk of complications, such as preeclampsia, possibly because of the additional strain on the kidneys; the liver condition cholestasis, for reasons that are unclear; and thrombosis, because there is an additional strain on your circulation. These conditions may also mean that an early cesarean is recommended.

Going into labor

You’re more likely to go into labor early and your babies may be lighter than average. With twins, you’re likely to go into labor around 37 weeks; with triplets around 33 weeks; and with quadruplets around 30 weeks. The average birthweight for twins is 5.5 lb (2.5 kg); triplets and quadruplets are almost always low-birthweight.

Labor and birth with twins

Current recommendations are that an obstetrician should attend a twin birth. If you’re planning to have a vaginal birth, the labor should be almost as quick as it is with one baby.

Continuous monitoring of both heartbeats is recommended during a multiple labor. This is usually done by putting one strap around your belly for each baby, but sometimes the second baby is monitored in this way and the first baby may have a scalp electrode put on his head , which gives a clearer picture of the first baby’s heartbeat if it has been difficult to find.

Delivering the first twin

For your first baby, the chance of using forceps or vacuum is the same as for a singleton birth, although the birth of the first twin may need to be assisted so that the doctor can gain quick access to the second twin. After the first twin’s delivery, his cord is clamped and cut, but the placenta usually remains in the uterus until the second baby has been born.

Delivering the second twin

The medical team will confirm whether your second baby is head- or bottom-first, either by feeling your abdomen, doing an internal examination, or by scanning you. As the second baby’s head or bottom enters the pelvis, the second bag of water may be broken to encourage strong contractions. A normal birth should follow in about 30 minutes, and forceps or vacuum are only used if problems arise. If the second twin is bottom-first, a doctor should be on hand to help. It’s unusual for the first twin to be born vaginally and the second to be born by a cesarean, but this may happen if the second baby needs an urgent delivery and a vaginal birth seems unsafe.

Delivering the placenta

There is a greater risk of postpartum hemorrhage with twins, which means that an active management of the third stage may be advised .

With a twin delivery a larger medical team will be on hand to deal with any complications and to take care of both babies at birth.

Q: Will I have a say in how I deliver my twins?
A: If you are having twins, you will get the chance to discuss your plans for giving birth with your obstetrician during the pregnancy. Your decision to have a vaginal birth or a cesarean section will probably be based upon several factors, such as the position of the babies. Once you have been given enough time to consider all of the relevant information, safety is the most important factor.
Q: Can I have a home birth with twins?
A: Home births in the US are very rare, and organizations like the American College of Obstetricians and Gynecologists and the American Medical Association recommend against them because of the potential for complications, even in low-risk singleton pregnancies. For the safety of your babies, a hospital birth is recommended.
Birth story: a twin birth

Gillian found out she was having twins at an early scan. At first she was worried that the pregnancy and birth would be hard, but her confidence grew as she saw her babies growing well. She went into labor at 35 weeks.

Gillian’s story: I was shocked when they told me I was carrying twins, since none of my family has had twins. The pregnancy was tough because I was so tired and I had such a big belly. I enjoyed the scans though because they were really reassuring.

I went into labor at just over 35 weeks. After initial contractions, my water broke at 2 am. My husband got me to the hospital in 15 minutes; I think he was in a bit of a panic. Jonathan, our first twin, was born just after 4 pm, so the first part of my labor was quite long. I managed without much pain relief medication. Celia came 20 minutes later. They broke my second bag of water since her heartbeat was low, but she was fine at birth. I remember the birthing room being crowded, and even though people introduced themselves to me, I couldn’t have told you who they were. However, they all disappeared soon after the birth and left us to spend some time alone with our babies. That was the best time. All the worries disappeared and we could just get on with being a mom and a dad.

The doctor’s comments: Like many women with a twin pregnancy, Gillian was worried about what might happen to her and her babies during labor. She had talked at length to me and the doctor during her pregnancy, but still felt anxious. When she arrived on the labor ward however, she could see that the people caring for her were highly professional and experienced. This gave her the confidence to deal with events as they unfolded. Both babies were doing very well when they left the hospital and Gillian was making an excellent recovery too.

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