It can be frustrating when you’re pregnant with twins, because some of what you read in pregnancy books or are told in antenatal classes about labour and birth won’t apply to you. You can feel left out, unless your hospital offers multiple pregnancy specific classes, or you choose to attend a multiple pregnancy antenatal course or workshop privately. If you’re interested in the latter, Tamba and the Multiple Births Foundation offer good ones.
Remember, although you're expecting twins, you have a right to ask your health professionals to talk you through your options as early in the pregnancy as you like. And rest assured you will still have options. Although giving birth to twins does carry more risks, you may not experience any complications at all. Also, just because you’re carrying twins, it doesn’t mean that labour will be twice as long or twice as painful!
How close to your due date will you go into labour with twins?
It’s important to know that twins often come early, and Tamba suggests you have your hospital bag packed from 26 weeks. A survey carried out in 2008 found only 43% of pregnancies with twins lasted over 38 weeks. And 44% of all births involved one or both babies spending some time in neonatal care.
The normal term for a twin pregnancy is 37 weeks although it’s not unusual to go to 40 weeks. If your doctor decides it’s not advisable for the health of you or your twins to go past 38 weeks, they may decide to induce labour. This is usually done with a hormonal pessary or gel and, if necessary, artificial rupture of your membranes (breaking your waters) and a hormonal intravenous drip.
What kind of birth will you have with twins?
Every birth is different and yours will depend on factors such as:
- Your twins' health
- Your twins’ size
- The position of your twins
- Your wellbeing
- Your hopes for the birth
- Hospital procedure
A twin birth is higher risk, so your birth may be more medicalised than mums you know who had a single pregnancy.
Do you have to have a caesarean?
Intervention, in the form of a caesarean, forceps or ventouse, is more than twice as likely as with a single pregnancy. Over half all twin babies in the UK are born by caesarean. However, a vaginal birth is certainly possible if there are no complications that mean your doctor advises against it. Many twin mums successfully deliver their babies this way.
Whatever is suggested to you, either prior to or during the birth, you and your partner are entitled to ask why, and if there are any alternatives.
Your doctor may want to schedule an elective (planned) caesarean before you go into labour for various reasons. For example:
- The first baby is in breech or transverse positions
- You’ve previously had a baby by caesarean
- You have placenta previa (where the placenta/s covers your cervix)
- You’ve previously had a difficult vaginal birth
- You understand the risks but decide you would prefer to have your babies this way
During labour, an emergency (unplanned) caesarean may be necessary for various reasons, including:
- The baby being delivered moving into a difficult position
- Foetal distress
- Compressed or prolapsed umbilical cords
- High blood pressure
- Slow progress
- Failure of assisted delivery (ventouse or forceps)
Occasionally - in about 5% of cases - the first baby is delivered vaginally but a caesarean is required for the second baby.
If you opt to deliver your twins vaginally you should be watchful for the first signs of labour. The signs your in labour will be the same as for a single pregnancy, but the chances are you’ll experience them earlier.
What will labour be like with twins?
Labour in a twin pregnancy follows the same pattern of first, second and third stages. However you’ll need closer monitoring than in a straightforward single labour, due to a higher risk of complications. Because of this, it’s unlikely doctors will support midwife-only, birth centre, water or home births and most likely you’ll give birth in hospital.
You’ll be asked to wear a CTG monitor to keep tabs on your babies’ heartbeats and your contractions. A CTG monitor is a belt with sensors worn around your bump and one attached to your first baby’s scalp, via your cervix. While you’ll still be able to move around and adopt different positions, this monitoring will restrict your ability to move and travel around the hospital.
During labour, you’ll be offered all the normal pain relief options - gas and air or pethidine, for example. You’ll probably be advised to have an epidural due to the higher-than-normal risk of an emergency caesarean or assisted delivery.
It’s important to understand what all these methods of pain relief involve, to discuss your wishes with your midwife or doctor, and include them in your birth plan.
When you’re ready for the second stage of labour (pushing your twins out), many hospitals require multiple births to take place in the operating theatre. Expect to see more medical professionals present than with a single birth, as you’ll need two midwives and two paediatricians – one for each baby – and there may well be junior staff and/or students who wish to observe a twin birth. If you’re uncomfortable with this, you can ask for all non-essential staff to leave.
You may be encouraged to deliver your twins lying on your back but different positions may be possible with your midwives’ support, so do discuss your wishes in advance.
What happens after the first of my twins is born?
After your first baby is born, the doctor will check the position of the second baby and, if necessary, attempt to move it into a head-down position. The second baby is usually delivered within 20 minutes and delivery is often quicker and easier as the birth canal has already widened.
Natural delivery of the placenta (third stage of labour) is not usually recommended due to an increased risk of bleeding with twins. A hormone drip will be used – while you coo over your brand-new bundles of joy!
However you and your healthcare team plan to deliver your twins, remember you have a right to discuss your wishes and ask questions at every stage. Ultimately, it’s the wellbeing of you and your twins that will form the basis of all decisions.