Birthing Options and Management of a Twin Pregnancy

Knowing about your twin pregnancy could come as a surprise and may make you feel both excited and nervous at the same time. With these mixed feelings of joy, excitement and shock you might be worried about a lot of things. Does twin pregnancy need some special care or treatment? Will my babies be born healthy? Is a Caesarean required or normal childbirth is possible? Your list of questions will go on.

Depending on how your babies are positioned in your uterus, your birthing method will be decided. You can discuss it with a midwife or an obstetrician who will guide you well. Your babies could be in any of the following positions when you go into labour:

Vertex / Vertex:

Both your babies will be in a head-first position. If you are expecting to have a vaginal twin birth, this is the best position.

Vertex / Breech: 

This is when your first baby is in head-first position while your second baby is either in buttocks or feet-first position. This position could possibly be the second best position if you are expecting a vaginal twin birth.

Your first baby is born normally while the second baby will turn on its own or could be turned inside of you to be born vaginally as well.

Breech / Vertex or Breech / Breech:

Your first baby is in buttocks or feet-first position while your second baby is either in head-first position or in the same position as your first baby.

There is a chance that this combination can lead to a risky vaginal twin birth and you have to opt for a caesarean twin birth.

Transverse / Any position:

In this position, your first baby will be lying sideways i.e., horizontally in your uterus. Your obstetrician will probably recommend a caesarean no matter what position your second baby is in.

About vaginal twin birth

Approximately one-third of all twins are born vaginally and the process is similar to that of giving birth to one baby. An epidural for pain relief is usually recommended when you are opting for a vaginal twin birth. This could be because that if any problems arise it is easier and quicker to assist your childbirth when you already have good pain relief.

Sometimes while you are having a vaginal birth, you may even need assisted birth to deliver your babies in which a suction cup or forceps is used. In a vaginal twin birth, if everything goes smoothly your second baby usually comes out within 10-30 minutes after your first baby is born.

Conditions that could favour a normal twin birth:

  • Head-first position of your baby
  • The position of your second baby
  • Pregnancy without complications i.e. when your babies are free from all the complications that can make a caesarean necessary.

About Caesarean twin birth

From the onset of your twin pregnancy, you may choose to go for an elective caesarean or your obstetrician may recommend you to go for a caesarean later on as a result of potential complications. Overall a caesarean is safe, but it may not be needed in every case. The positioning of your babies will determine if they need to be delivered by caesarean or not. You may have to go for a caesarean if your first baby is in a breech position or one of your babies is in a transverse position.

Sometimes the second twin is born by caesarean after the first twin has been birthed normally. This is mostly if your second baby is having a risky position that may cause a problem.

You may be advised to go for a caesarean under the following complications:

If the umbilical cord prolapses –

If it falls into the birth canal in front of your baby, a vaginal birth won’t be possible.

Non-progressing labour –

If your labour is not progressing because your cervix is not opening and the babies are showing a sign of distress, a caesarean is administered.

If you have placenta praevia –

If you have a low-lying placenta that covers your cervix.

One or both your babies become distressed –

It can occur if your baby is deprived of oxygen due to umbilical cord compression, placental abruption, etc.

If you have pre-eclampsia –

If you are suffering from severe pre-eclampsia, decreased oxygen level and blood flow your obstetrician will ask you to opt for a caesarean.

If you have special pregnancies –

If you have monochorionic monoamniotic twin pregnancy (MCMA) of if you have more than 2 babies i.e. triplets.

Management of your twin pregnancy

  • You should go for frequent antenatal visits to check for any complications and for monitoring the growth of your babies carefully.
  • All your nutritional needs must be addressed to meet your babies needs for their nourishment.
  • Frequent fetal assessment should be done by ultrasounds and by monitoring your babies heart.
  • Monitoring your and your babies health is important to identify any pregnancy complications.
  • Increased rest also could be advised to you in case of any complications.

After the birth of your babies, they might need special care so you need to choose a hospital that offers that care and has a neonatal unit. At the end what matters to you is the health of your babies and that you recover faster. Recovery from a caesarean usually takes longer than recovery from a vaginal birth.

It is important that you select a hospital with appropriate facilities so that if any complications arise during your labour they are taken care of by the experts. Complications can appear at any point of time during your twin childbirth and may not always be predicted earlier.

Make sure you are well nourished and hydrated throughout your pregnancy to recover faster. If proper care is taken during your pregnancy there are minimal chances of complications. You should be in touch with your midwife or obstetrician and discuss the pros and cons of your normal twin birth or caesarean twin birth. Being pregnant with twins can be a lot of work for you, but the reward will be an exciting one.

“Sometimes miracles come in pairs”

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