If you are pregnant with twins you will almost certainly be advised that a twin pregnancy carries higher risks than a singleton pregnancy. What is often not explained is that much of this risk is dealt with before you get to term. The main increased risks are pre-term birth and pre-eclampsia. The possibility of going into labour early need not deter you from planning a home birth: you can always go into hospital if you’re not happy labouring at home for any reason. One could argue that, as with pre-eclampsia which is usually detected prior to labour starting, this is not something you need to weigh up when deciding where to give birth.
It is important to eat well during your twin pregnancy. Research has shown that mothers who gain sufficient weight in the second trimester (i.e eat enough!) have a lower risk of pre-term birth and of having low birth weight babies. High stress levels, including pregnancy-related stress, are associated with pre-term labour. This means you’ll need to weigh up the benefit of any tests you may be offered against the potential stress of undergoing the test and any interventions you may be offered as a consequence. Do remember that, as with any pregnancy, tests are not compulsory and can be declined if you wish.
There are other concerns that your midwife and consultant may express. It’s worth remembering that the evidence base for twin pregnancy and birth is patchy and research often doesn’t tell the full story. For example, a study currently underway is aiming to find out whether planned c-section or vaginal birth of twins has better outcomes. But the study looks at the highly medically managed vaginal birth that is normal for twin mums in hospital, not the physiological, active home birth you may be planning.
In terms of the actual labour and birth, the most common complication is one or both babies being breech. Turning the baby manually by External Cephalic Version (ECV) is not attempted for twins. If the first baby is breech your consultant is likely to recommend an elective c-section, though of course you can refuse this. Hands-off breech birth is an option, but the challenge you may face is that many midwives no longer have experience of vaginal breech birth due to most women in this position choosing to have an elective C-section.
Whilst many twin pregnancies can and do end with a completely uncomplicated, normal birth, it is worth thinking through carefully your options for the various birth scenarios and writing it all down in your birth plan / care guide. For example, if you have a c-section, what for you would make this a better experience? Or if you plan for a ‘hands-off breech birth’, what do you want to happen if labour does not progress: would you opt for a breech extraction, or would you want to go straight to c-section? These are the sorts of questions you might want to consider when planning your birth preferences.
So what sort of twins are you having? In terms of birth choices, whether you are having identical or non-identical twins is less important than whether they share a sac and placenta, are in separate sacs but share a placenta, or have separate sacs and placentas. If you do decide to have scans, it can be worth establishing whether your babies share a placenta and a sac (it’s easiest to tell this in the first trimester), as this may influence where you plan to give birth and whether you decide to accept certain other interventions.
You may wish to consider hiring a team of independent midwives who are experienced in breech birth and preferably twin birth to look after you. While it is not easy, it is possible to negotiate an NHS home birth of twins, and in some areas independent midwifery practices are able to offer care under the NHS.
It may be helpful to talk to the Supervisor of Midwives, Head of Midwifery and/or the consultant obstetrician early on in your pregnancy to give enough time for a care package to be worked out for you – this may be different from the standard home birth rota in your area. If there is a Consultant Midwife in Normality at your trust, they will be a good person to talk to. You may need to be persistent in asserting your right to choose home birth for your twins. Seeking additional support from other like-minded mums of twins can be helpful. Those who have had or have planned home births, or who have negotiated for less medicalised births in hospital are a good source of information.
‘In general those who know about privacy as a basic need in labour are not scared by this sort of birth. It is the art of doing nothing. First you wait for the first baby. Then you wait for the second baby and finally you wait for the placenta. The point is to make sure that there is not too much excitation around after the birth of the first twin, so that the mother is not distracted and has nothing else to do than look at her baby in a sacred atmosphere. The same after the second one, while waiting for the placenta […]. Those who don’t know about the importance of privacy are so scared of twin births that they create a cascade of interventions… if they have not chosen the easy way, that is to say a caesarean section. Today many practitioners are right to prefer a caesarean section. Giving birth without any privacy among scared people can be dangerous.’
~ Michel Odent ~
Having Twins And More: A Parent’s Guide to Multiple Pregnancy, Birth, and Early Childhood by Elizabeth Noble and M.D. Sorger
AIMS Journal articles on twin birth:
Written by Joanne, mum of 3, all born at home including twin girls