Childbirth with Twins

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OB Gyn who supports natural birth for twins

April 2010

I am pregnant with twins and am looking for an OB/Gyn who will fully support my desire to deliver vaginally in the absence of complications. I like my OB a lot, but feel she is skittish about natural twin births and I am concerned that she will push for medical interventions at the drop of a hat. We are Blue Cross HMO members, which probably means we'll be delivering at Alta Bates (despite the inhumane policy that all twin births take place in an operating room even if there are no problems). Debra

All the doctors at the East Bay Physicians Med. Group support natural birth for twins when possible. My twins were born full term naturally although I had assumed that I would probably have a c-section just because the risk of complications is that much greater with twins.

And on your comment about the inhumane practice of giving birth in an OR instead of some pastel-coated birthing room, there's actually a good reason for it. For twins they need double everything - equipment, people, etc. as you never know what might happen. There's just not the physical space in a birthing room for all that stuff. You need to focus on what's important, not on what the room looks like where you give birth. Seriously... Twin mom who doesn't care what the room looks like as long as the babies are healthy!

When I was pregnant with my twins it was all so very overwhelming - too much information and way too much going on while pregnant with my own body. Though I ended up having a c section because Twin A was breech, I still ended up with two really wonderful kids. Yes, operating rooms are not romantic and visually pleasing, but I decided it was not about the birth but the kids' childhood and being a parent. Like its about the marriage, not really the wedding.

Yes, you will need extra help to recover from a major surgery and it would have been great not to go through it - and perhaps you will be lucky and more power to you. The best thing is to join your local twins club now! Twins by the bay I think is this local one-- cheap stuff and plenty of twin specific advice from members. My biggest tip - get as much help as you can afford and when people ask what you want tell them all diapers and fully cooked meals that you can heat up for you and your husband! been there and back

I'd like a homebirth or at least a vaginal birth

June 2006

Hi, I am currently 31 weeks pregnant with fraternal girl twins and I am starting to rethink my birth plan. My partner and I have desired a home birth all along, but were told by the MDs at UCSF that twins are a high risk pregnancy. We were scared into deciding to deliver at UCSF b/c they have the best NICU in town, and god forbid we should need it! That said, I have been given the details of their expectations about my birth plan, including desired interventions, and quite honestly, I'm scared. I don't want to have an epidural, I don't want to have a breech extraction, I'd like to try to deliver both babies vaginally, but they are in the typical yin/yang position (one vertex, one breech). UC doctors have told me their options are breech extraction or C-section. My questions... can people please tell me about their twin birthing experiences? Has anybody had these interventions before? Any advice on how I can be more flexible? Has anybody delivered twins w/ midwifes at home or in St. Lukes midwife delievery system? Am I being dumb by even thinking of delivering in a different way than traditional UC doctors suggest? THANKS A MILLION!!! I need some calming down. :) -Rina

Hi I am a Doula who works with twins a lot and also has done twin births at UCSF. I would strongly suggest that you continue to talk about natural birth for twins at UC. I have attneded several women there who had natural births. no Epicurals, only IVs in place.

All Twins are born in the OR and all twin deliveries have a pediactirc team available.

I would also suggest that you look into getting a Doula who has twin experience and even better if she has it at UC. Patty lipinska 510-849-1082 or Esther Gallagher at 415 821 4490 are both great. A Doula can help you navigate the system, keep your vision of the birth alive, and support you as you become parents.

I do not know if there are any homebirth midwives who are currently attending twins and even if they were if your are a canidate. It is a really big picture decision. I would encourge you to keep looking at all of your options however. treesa

First, congrats! Parenting twins is fabulous. Having twins is fabulous. Two sets of giggles. Two hugs. Two silly people in the bathtub.

We had our twins at a hospital. I had preterm labor and was an antepartum patient. They came at 33 weeks and spent 3 weeks in the NICU. At our hospital (John Muir) all multiples are delivered in the OR because of risk of having to do a c section. There are so many variables with twins I'd not want to take the risk of delivering without lots of help. I was amazed how many people were in the OR when I delivered -- 2 OBs, 2 pediatricians, 1 anesthesiologist, me, my partner, 2 surgical nurses, 2 pediatric nurses, one other nurse who seemed to be orchestrating the whole thing. It was a carefully choreographed dance.

One of my best friends is a NICU nurse at UCSF. I was so fortunate to know a lot about what she did for a living because if not, I would have been scared to death when my kids had to live there for their first three weeks.

I don't know anyone who had twins not in a hospital. And I belong to a 400 member mother of twins club.

Again, congrats. Your life will never be the same Mommy of three

Here's my take on things: The doctors know what they are doing. They have a ton of experience and truly want what is best for everyone's health. To them, that means minimizing the chance of any Rbad outcomesS for babies or mom. Will that tend to make them more interventionist? Absolutely. But if they are seeing warning signs that the babies may be in distress, they will feel strongly that they should act to keep the situation from worsening, even if the statistical risk is small. They don't want you to be part of that small statistic.

In your case, the risk of trying to deliver vaginally is actually not small. The risk of trying to deliver at home is HUGE. Is your midwife trained for this situation? Has she faced it before? How many times? What were the outcomes? Why do you feel more comfortable with her helping to make your medical decisions than the UCSF doctors? I'm even wondering if there are there any midwives out there who would feel comfortable taking this situation on.

Remember that making a birth plan is MORE than twice as hard with twins, because there are more decision points (this is true regardless of where and with whom you deliver). For example, what if you deliver the first baby vaginally, with no problems, but the second baby is breech and/or in distress?

For me, I had hopes for my delivery but very few expectations. I decided my bottom line was that we all remain as healthy as possible. If the doctors thought it necessary for me to have a caesarean to minimize the risk to either baby, I would do it without hesitation. In the end, I was induced at 39 weeks and delivered both babies vaginally. BUT the babies were both in a head-down position all along. If I were in your position, I would schedule the c-section and just try to look at the advantages of having that decision already made, and prepare accordingly.

For the record, my OB thought that one of the main reasons I had a relatively smooth delivery was my attitude. Deciding early on that the doctors would do what was right was very freeing, and allowed me to concentrate more fully on what I had to do Melissa

I'm sure you'll get lots of advice on how to manage a home birth for twins, and I don't want to be a downer, but your post really struck me.

Our birth experiences are sooo important, but not nearly as important as delivering healthy children. I lost twins to early labor and was very sad when I learned my next child was full breech. I so wanted a natural birth experience after the hideous medicalized experience of a stillbirth. However, I was also scared to death to endanger this baby at all. I don't love that I had a caesarian, and birth stories are such a part of those first few weeks after your baby is born, and I actually had people give me condolences for my c-section! But within five months, when she was smiling and giggling and really interacting with us, my birth experience ceded so far into the background, and today I am so grateful to have this happy healthy toddler in my life that I rarely think about it. The most important thing, IMO, since birthing is filled with so many surprises, is to adopt a flexible attitude about it and keep looking ahead to holding those beautiful healthy babies in your arms.

Best of luck in whatever you decide to do, but please keep in mind that your birth experience is just the beginning of the most empowering, frustrating, awesome, surprise-filled and amazing journey you'll ever take Been there

I gave birth to twins 11 years ago-I was lucky enough to deliver vaginally, which was great. I had them in the hospital, and while there was more intervention than I wanted, in the end, I was just so happy to have 2 healthy babies. I really don't think you should have them at home-there is a high risk of complication, and you need to be in a hospital in case something happens. But I highly recommend having a doula or someone besides your partner (who needs to attend to you) to advocate for you-could you have a midwife at UCSF? I think it is important you maintain control of the process. I also had an epidural, which was a godsend. Before childbirth a lot of people have a lot of ideas of how they want it to be, but truly what matters most is that everyone is healthy. If you need an epidural, it's okay to get one, and if you need a c-section, it's okay too. In the big picture your health and your babies' health is what matters most. anon

I would encourage you to take a deep, deep breath and remember what is important here. I will say I have never had -- or really desired -- a home birth. I had three children - the second and third were unplanned, non-emergency c-section (they just wouldn't come out vaginally).

I was disappointed with each section. HOWEVER, having three healthy kids was what was most important. I do know of people who lost babies in home births that were too complicated and should have been done at a hospital. The risk of living with that kind of regret and grief should also factor in to your decision -- along with the risk of not having the birth you desire.

The birth seems so much more important going forward than looking back. Looking back, all I really remember is moments in the hospital with the baby and a life together afterwards. Don't put too much importance on the birth -- it's only a moment in a lifetime of moments (assuming you're lucky).

That said, I think you do want to arm yourself with information, know the facts, argue for what you want within reason. Find out the reasons for the hospital's and doctor's preferences -- it's probably to protect themselves against real risks associated with breech birth. Just because so and so had a breech birth OK doesn't mean the statistics make it a gamble worth trying. I don't know what the precise numbers are, myself, but I would find out.

Finding a way to be open about the birth is good practice for all those ways in which you will have to be open about those two lovely girls not being exactly the girls you are imagining in your mind - they will be who they are; the birth will be what it is. Welcome to the lack of control that is parenting!

Enjoy! Anonymous in this home birthing town

congratulations on becoming a twin mom.

i know many, many twin parents and have never in my life heard of anyone choosing a home birth for a multiple pregnancy. it is a high risk pregnancy - just think, you have twice the chance of having something happen to you or the babies. it is important to have a quality NICU and all the fetal monitoring equipment.

i delivered at cpmc at 37 weeks, vaginally, in the OR, with an epidural. from what i've heard, cpmc is a bit more ''touchy feely'' of an experience but you are pretty late in your pregnancy to be switching doctors (unless you don't like yours). my pregnancy was awful but my delivery was smooth. however, i would say about 75% of the women i have met who have delivered twins have had complications. i'd be safe and stick to ucsf.

give yourself a few more weeks and you will just want them OUT! in any way possible! anon

In my view, the absolutely most important thing of all is delivering healthy babies. To that end, with twins, and twins in complicated positions in utero, I would toss my prefered birth plan out the window and head to the hospital, where I'd expect the safest possible delivery experience. In my birthing class at Kaiser many years ago, we all diligently wrote up our ''birthing plans'', picturing the music we'd be listening to, the things we'd want our partners to say to us, etc. All of this was made meaningless when I had an emergency C section. Now I have a happy healthy gorgeous smart twelve year old; we absolutely made the right choice to be in a hospital where they could detect the possible complication and bring her safely into the world in a mere 14 minutes after recognizing the potential problem. Better safe than anything else

I had two children in two deliveries (ie singletons), with the certified nurse-midwife team at Stanford. All the talk about the mood and warmth of home deliveries aside, this is a serious medical process and you would be very foolish to do anything other than deliver at a hospital. If you can have a certified nurse midwife with you that would be better, I guess, but if something goes wrong at home you could have a nightmare on your hands. Daphne

Hi there, I am a midwife who has delivered twins and I will say it is definitely high risk and you should only deliver in a hospital. The reasons are too many to get into. It is very possible to do a vaginal birth with breech extraction, as long as your OB thinks your pelvis feels fairly adequate. Most midwives in the area don't do twins, but some groups that deliver twins might have a midwife working with them and they might be able to work as a team. I don't really see the benefit of this though since it is high risk and obstetricians are going to have to be involved. Really I think you should focus on the health of the babies, and not the idealized birth. Best wishes anon midwife

Hello Rina, Well, I know that you have heard all of the stats and have been scared enough on that line. I am a mom of twins, and I chose a planned caesarian for my twins' birth for several reasons: 1) the odds are quite high that the second twin will need assistance, and I didn't want to have to heal in two places (vaginally for the first, tummy for the second) 2) I have had several friends who have had a long labors that ended in c-section, then a second pregnancy with a planned c-section. All of them report that a planned section without the hours and hours of labor is extremely easy to recover from compared to the reverse. I can tell you that I thought the c-section was pretty easy to recover from. The spinal was no big deal at all! The day after delivery, I was quite sore, but easily managed with pain meds. All in all, I'd do it in a heartbeat. It seemed to me to be the safest way to give birth both for me and my babies. And, take it from me: you are going to do countless things differently simply because you are having two at once--this is only the beginning. Feeding, dressing, bathing, traveling--you are going to be amazed at how differently things have to be because you are having twins. It will be a much larger challenge--but a much larger reward as well! Twin mom too

I would advise against at home birth for twins. I was extremely healthy and young when my girls were born, but still had unforeseen problems. My twin A rested in the birth canal for a very long time and my twin B was breech. I would trust the physician. She speaks from experience. Good luck and congratulations! twin mom

I don't have specific advice for you, but I wanted to recommend you Google ''Unassisted Twin Homebirth'' - just for a different perspective from the Western medical one on what is doable with a twin birth. What you'll find is a website about a couple who faced the same dilemma as you and also wanted to have a homebirth for their twins. They had a really hard time finding a midwife who would do that, and eventually decided to have their babies at home anyway, but unassisted. The babies went full term - she delivered at 40 weeks, and the babies ended up weighing around 8 lb each. They have and sell a video of the birth, which my doula recently showed me (I am 34 weeks pregnant but with a singleton), and it was absolutely amazing - just the couple and their 2 year old were there, and the dad was filming the whole time while also watching the toddler. The woman gave birth on a towel in the bathroom to both babies, and it was a really beautiful, calm, completely panic-free birth. The second one was actually a footling breech, but came out just fine without any medical help at all, and both babies and the mama were healthy.

Now, I would personally be reluctant to have an unassisted birth, especially with twins - but the video really changed my perspective on what's possible in birth in general (so much so that my husband and I are now considering a homebirth after planning this whole time to have a hospital birth). You may have more luck than they did finding a midwife who will deliver twins at home.

Lots of luck with whatever you decide - I wish you the best! anon

I know that countless other women have had homebirths for twins before, but yes there are more risks associated with twins, one of them being breech. I am familiar with many of the midwives in this area and don't know any who would do a twin birth at home; many don't have enough experience to do this and it is actually ''illegal'' per the State of California to perform this, if you are a licensed midwife. Did you already have a homebirth midwife who said she'd do this? If so, I hope she's had plenty of experience and that you understand the liability. I am not saying you shouldn't do it, because I'm sure many women have had successful vaginal homebirths with twins, but these are just a few things to consider. There is one or two OBs who are still willing to deliver a breech baby in hospital (I think one is at UCSF or SF General), but I don't know if they'd do it for twins (I don't see why not). Your midwife would probably know which OB this is. Good luck to you! homebirth mom of 2

Well, I had a c-section and an epidural, and after it was all over, all I could focus on was my new little guy. I understand that natural childbirth at home is the optimal situation for you, however, if your doctor recommends a c-section and other intervention methods, follow her/his advice. At the end of it all, the health and welfare of your new babies is the ultimate issue, not the method of childbirth. Even if you went looking for a second opinion, respect the doctors at UCSF, because generally they know what they're talking about.

Good luck and trust me, even if you have the c-section, you will be so happy that you did what was best for your children. anon

Hi- I had fraternal twins, and baby A was vertex, baby B was breech. My bloodpressure started to go up as I neared my due date, and i got induced. I had an epidural, which was fine for me, made me able to think about more things than my discomfort. The plan was to try to turn baby B after baby A was out. I knew it was a possibility that I could have one baby vaginally and one by c-section, but as long as we all ended up healthy that was OK. Baby B didn't want to turn, but was smaller than baby A and they were able to pull baby B out by the feet!

I was very happy to be at a hospital with a neonatal icu just in case. I was a resident at the time and a physician now. I would never have been able to get past the guilt if there had been any complication that hurt my baby that would have been possibly preventable. I understand why people want to home birth but having worked with kids with cerebral palsy and other complications, I encourage you to take advantage of the experience of the hospital. For example, I loved having the lactation consultant help me get going with twin feeding while still in the hospital. I wish you great luck on your big adventure! I had postpartum elation! Happy at the hospital

My advice is to give birth in the hospital. I know that many births turn out OK at home, but I believe it is too risky. I had visions for delivering a natural birth (in Alta Bates). While in labor the baby's heart rate suddenly plummeted and he was delivered through emergency c-section in 8 minutes. It seems that when my son suddenly descended into the birth canal, his head blocked his umbilical cord (or something like that). Even if we could have learned of the problem during a home birth, in the time we would have rushed to a hospital, he would have died or been severely brain damaged. I am so grateful to the skilled phsyicians & nurses at Alta Bates and that pesky heartrate monitor that everyone (including me before this happened!) complains about. Since you are so much more likely to have complications with twins, I say, be in the hospital. There is so much you can do to still make it your own experience while there. Grateful mother of a healthy son

I have to 2nd the responses about not being worth the risk with twins to attempt a home birth against the advice of your doctor. I am pregnant with twins right now, & after the birth of my first would never consider a home birth. My son was stuck for a while in the birth canal. My doctor wanted to vacum him out, but I wanted a natural birth. In the last minutes of pushing the scapal monitor fell off & no one knew that the cord had also tightened around his neck. He was completely blue & lifeless when he came. Nurses rushed to revive him and he only had an AGAR of 3 at 1 minute. Years later it still causes me pain to remember the feeling of laying there, not knowing if he was dead or brain damaged, thinking I should've just let them vacum him to get him out faster. He was rushed to intensive care and put under warmers. It was hard not to get to hold him for a couple of hours, but the advice everyone has given you is true. It's just a few hours out of an entire lifetime and my bonding with him was in no way hampered by not getting to hold him immediately. Later a doula had the audacity to tell me that had I been allowed to hold him immediately he would've revived on his own from getting to smell me. Insane advice considering he couldn't even breathe, let alone smell.

I also appreciate the fetal monitors on at the hospital. Both my sister and I had the experience where the monitors showed the babys' heart beats dropping dangerously low (70 beats/minute) due to the cord around the neck. All it took was rolling over on our sides to get it back up. If you're at home, you don't get these monitors. Someone wrote about a video of a woman birthing alone in the bathroom. That woman was very fortunate that there was no cord wrapped around the baby's neck, or meconium in the amniotic fluid, something that even a midwife at home would send you to the hospital for.

I also have several friends that work at Children's Hospital, and have heard about cases of newborns that are there because of a delay in receiving emergency care due to having to rush from a home birth to the hospital, treatments that would've been available in seconds had they been born in a hospital. anon

Go to a hospital with a good NICU. There is a reason twin births are ''high risk''. Many OBs (including MFM trained) get stressed with multiple deliveries. I understand that many people would like to deliver vaginally, but really, what is important here? the delivery or 2 healthy babies. (ie is it the wedding or the marriage). For me, there was no question: 2 healthy babies. My babes were born 2 months premature, but I had a discussion with my perinatologist about what I wanted should I make it to ''term'' and what my options/risks/benefits were if they came early. Thus, I and my husband were educated and knew what to expect and were able to make the urgent c-section the best moment of our lives. My ob team also knew what we would like. And just because you deliver your babes in a hospital, who says you will have a c-section? I know plenty of MOMs who delivered vaginally. Having 2 beautiful babies is a blessing. sue

How to make childbirth with twins as natural as possible

April 2000

Can anybody recommend a doula or midwife who specializes in delivering twins? We had a wonderful home birth for our daughter, and although that might not be possible for the twins I'd still like to make an effort to make their entry into the world as natural as possible.

As I'm sure you know, having twins at home may not be possible. You really can't tell what position they will be in until the ~ 30th or 32nd week, and if they are in a number of unfavorable positions you will require help in a hospital. Even if they both position correctly, I'd personally feel more comfortable in a setting where an OB could step in in case of problems. Our second child had difficulties in the birth because her umbilical cord was shorter and it started to pull the placenta from the uterus wall during birth. This caused her to bleed, a dropping heart rate, and a need to get her out quickly. Having not only an OB who was on top of the situation, but also a waiting family physician who was able to ensure good breathing and everything else once she was out, was really great for us scared parents. The short umbilical cord was not something that could have been seen on an ultrasound. Anyway, I'm not trying to scare you, but if you do plan a more natural birth setting, I would also plan for several contingencies. Good luck with the pregnancy and congrats again! Michael

A woman named Patti Sala has been recommended to me from a woman in my group. She is not a trained doula, but experienced in helping postpartum families and also does night time care. Most there now are doulas and charge accordingly. Her rates are lower. Sherry

For person wondering whether a doula is a necessity if no family is around. I also didn't have family close by but I had twins! For me the doula was a lifesaver but I also consider myself lucky to be able to have had this help. I know people with twins that manage without help and many of my friends with one baby also didn't have family and got through the first weeks just fine. I'd say a doula is a luxury but absolutely worth it if you can budget it in. Our doula was a present. If family back home ask you what you need have them chip in for the doula. Our doula was Carol Egan. (Feb 2000)

I delivered twins at Alta Bates by C-Section 8 months ago and was surprised to find out that the recovery was not nearly as bad as I expected. A lot of people I know with vaginal deliveries had more discomfort and pain afterwards than I did! I was not able to hold either baby right after delivering, but the doctor did hold each of them up for me to see and talk to right away, and the anethesiologist took pictures of my husband and I with each of the babies minutes after they were delivered. Of everything I went through, I think not being able to hold them and stay with them right after birth was the hardest emotionally. But, my husband was with them every minute and brought them to me in the recovery area. It wasn't until I was in my room that I was able to hold them. I think the most important piece of advice I can give you is to walk as soon as you are able and to walk as much as you can. I was so overwhelmed with trying to deal with two babies that I didn't walk as much as I should have and as a result ended up with terrible gas pains. No one warned me about that, and the gas pain was worse than any of the other C-Section related pain. I liked having the babies room in with us, but relied on my husband to do all the diaper changing and to bring the babies to me for nursing. I didn't really experience incision pain with nursing, although I've heard that can be an issue. That may be because I mainly used the football hold for nursing, so I didn't have the babies resting on my tummy. Once I got home, I was definitely more active than what the doctor recommended, but I didn't know how that could be avoided -- we live in two story house, and I had two babies to tend to. I don't want to be irresponsible for saying this, but I've always felt that my recovery was quicker, because I was walking around a lot and going up and down stairs. (Both things I was told not to do!) Lastly, I would highly recommend getting a private room and staying at the hospital as long as you can. Good Luck! Chris (May 2001)