Vaginal Birth of Twins – Positive Experiences
I have just been privileged to be present and assist a woman giving birth to twins actively in a hospital. It seems awful to relate that nearly all my previous experiences of twin birth as a midwife have been negative with ARM, continuous monitoring and quite frequently a traumatic (as I see it) and hurried (pushed on) delivery of the second twin.
My previous experiences have filled me with such horror that I find myself in the position of feeling that if I were to be pregnant with twins I would be scared stiff of how I would cope with the labour and all that it entailed. I didn’t think it was possible to get a positive birth in a hospital — until this week.
I cared for a woman (I’ll call her Mary) who came in while I was on night duty. 38+ weeks, twins, both cephalic, both felt a good size. Mary came in and was in early labour, (cervix 3cms dilated) and wanted to use the bath, did not want continuous monitoring, wanted to be free to adopt different positions with no unnecessary interventions.
I ran a warm bath for her and she stayed in there for an hour and got out when the contractions began to dictate frequent position changes and settled onto the bed with a beanbag in an all-fours position.
The doctor on call would have preferred a CTG trace (electronic monitoring of babies’ heartbeats) but it was difficult to monitor both babies adequately with Mary in this position and in any case I had no concerns about the size or condition of them. I listened in intermittently and both babies seemed to be coping well with the labour. He would equally have liked an ARM (artificial rupture of membranes) and FSE (foetal scalp electrode) attached to Twin 1 but I told him this was out of the question and as far as I could see there was no need to interfere.
This non-intervention was very important to Mary and she had already swapped hospitals in her pregnancy to increase her chances of a normal delivery and it was important to me to only interfere if it was really necessary.
Two hours after admission and Mary was experiencing urges to push, membranes of the first twin ruptured spontaneously and 15 minutes later he was in the world and yelling healthily. With Mary’s permission I performed a VE (vaginal examination) to assess presentation of the second twin. Head down still and just above the spines. Twenty minutes later he arrived to join his brother.
This birth has restored my faith in the maternity services although I think it also had something to do with the ethos of our unit. While the doctors were very “quivery” and nervous, the other midwives were not, and I received good support from them. In my last unit the situation would have been very different and both I and Mary would have been given a very hard time in trying to meet her wishes from both doctors and midwives.
In fact, even our doctors did not put huge pressure on Mary or me regarding intervention – I know they have very different experiences and mean well in their approach but in this case their intervention was not needed. I feel that I was able to apply our guidelines regarding care of a labouring mother with twins without being absolutely rigid, and without my colleagues waving them in the background and predicting dire outcomes if they were not followed.
Mary said afterwards that the birth had been very positive for her and that she had so worried about routine intervention. I am just glad she birthed her babies with us and not in a huge and medicalised obstetric unit (like my last unit, where she would have been just another in a long line of women to be processed).
I didn’t think until this week that it was possible for the mother of twins to give birth so positively in a hospital. I am glad to be proved wrong. This posting is long-winded, I know, but I just feel so pleased with this outcome.
Midwife Jane was awaiting home birth twins. Well, she waited and waited with their mum. They have now been born, two boys – both over 3kgs at home in the space of 3 hours and are happily growing on their family’s love and mother’s breast milk. They were born at 11 days plus dates.
Medicalising of twin pregancies is one of the examples of the pathologising of childbirth in this country. Years ago, my clever old midwifery tutor was born at home with her also clever twin sister born 24 hours later. Her mother was attended by a midwife and a G.P.. All of them slept over the night after the first baby was born and then woke up ready for the next labour. This story has always inspired me. As I understand it, having twins used to be a normal home birth event in the UK.
Nutrition as with all pregnancies surely must contribute to these healthy twin outcomes, but ..I’ve heard stories from retired UK midwives where even smoking and poor diets haven’t seemed to cause any problems.
Inductions, epidurals, c/s for twins are now almost the norm I believe. Only the women who challenge this and are well-supported by midwives get to avoid being messed with, like someone Jane has as a client.
This has prompted me to write about the birth of my second twin Amelia. My girls presented as vertex (presenting twin) and transverse from about 28 weeks and didn’t budge. I’d rejected the care of the secondary care clinic, a multidisciplinary team managing all level 3 pregnancies, and stayed under the care of my midwife Sandra.
Come labour at 40 weeks they were still in the vertex/transverse position. I had previously decided that if they were not both head down by term I wouldn’t have a homebirth, but would go into the hospital to give birth. So in we trotted and met Sandra who directed us to the new flash labour/delivery rooms with lazy boy chair and big deep tub ( big whoop). Rose was born first (7lb 2oz) fairly easily and caught by Sandra.
Amelia continued to float high and transverse so in came the obstetrician( who we had managed to avoid thus far) to do what I had been dreading more than a C/section, an internal version. He couldn’t reach her despite using his other hand to perform external version at the same time. With the next few contractions she moved to the oblique, the Ob had left in a panic to call the anesthetist as Sandra had put a light epidural in prior to the version ( the anesthetist had set it up and left the anesthetic for Sandra to top up when needed) and he wanted to put a full one in so I could go to theater.
When he came back in and saw she was at the oblique and FHR (by hand held Doppler) was good, he decided we could have a while longer to get her right around. Before he left he wrote in my notes in big letters “Patient wants a normal as possible birth” – when did I become a patient??? I digress.
Between contractions (which were very far apart because of the epidural) I kept my hand on Amelia’s rump keeping up pressure so she wouldn’t slip back. Nearly an hour after Rose was born Amelia made her grand entrance face up and weighing a pretty decent 8lb 7oz.
I am so pleased I kept my midwife as my lead maternity carer as I am sure I would have ended up with a C/section (or worse, vaginal birth and C/section) had I gone under the care of the ‘team’. I am eternally grateful to her for her commitment to my babies and myself. It was no picnic for her either – she was under pressure to relinquish my care, and if anything had gone wrong she most likely would have lost her access agreement with the hospital..
Regarding ‘Can a Twin Birth be a Positive Experience?’ by Jane Evans:
I found what she said about gravity very interesting, for me my twins were stacked and Milly had been transverse since 28 weeks, so birth position didn’t account for much there, but once Rose was born getting upright (as much as you can just after giving birth and breastfeeding that baby to assist the birth of the next) assisted in her tipping down. Also pushing was very different with trying to birth the first twin, all my pushing efforts went onto Milly who was on top, and rose got this weakened second hand push to help her out, needless to say it took much longer than I was used to, to birth her.
Andrea’s twin birth story for Rose and Amelia is online.
Does the genetic tendency to have twins run on the female line, or is there some male involvement?
The husband and his family history would have no bearing on whether his wife released more than one egg and thus conceived fraternal twins. However I did read in Elizabeth Nobel’s book (I think) ‘Having Twins’ that there can be a genetic tendency for some sperm to predispose an egg, once fertilized, to divide. It could be an enzyme that certain sperm carry, who knows, but some fertility specialists are doing research into it after discovering a high number of monozygotic twins developing after early embryo transfer during IVF. So he may have an ever so slight influence, but on the whole no, the husbands family history has nothing to do with the wife’s ability to conceive twins.
And just to confuse you even more, there is thought to be a third type of twinning, a blend of mono and dichorionic twinning, although it’s very hard to prove. It’s thought that the ovum goes through a third meiosis creating an original and daughter germ cell which are then fertilized by two different sperm. There is one animal, I think it’s the hippopotumus or Rhino that always twins in this way. But like I said it’s hard to prove in a human, but does explain why some fraternal twins are more alike than others.
I’ll just plug our new web site www.nzmba.org, the web site of the New Zealand Multiple birth association. Linked to the site in browser form is 20 years of Multiple birth statistics kept in the form of a data register on thousands of multiple births in New Zealand. This data is only accessible to those doing research and you need a code to access it. Because it’s now browser-based, researchers, including midwives, can access it from anywhere in the world. All you have to do is have your research passed by a university ethics committee and the NZMBA. One researcher has already found the diabetes gene and its link to low birthweight babies, from using our register.
Andrea, Mum of 9
On Other Sites:
Twins – Twice, by Beverley Beech (AIMS). Natural birth versus caesarean section.
TAMBA (Twins and Multiple Births Association)
Multiple Births Foundation for parents and professionals
AH updated 2 January 2001