Ask Your Midwife Elizabeth Stein, Certified Nurse Midwife Ask your Midife Articles
Delivering Twins

By Elizabeth Stein, CNM

Question
I'm pregnant with twins. What can I expect my delivery to be like?

Answer
Twin deliveries may be vaginal or a cesarean section. The route of delivery as well as when to give birth require a complete discussion between the pregnant woman and her doctor.

Twins tend to come a few weeks early (36 weeks) but usually do well. They are mature for their age, probably from the stress of crowding in the uterus.

The route of delivery may be decided by the presentation of the first twin (twin A). If twin A is breech (buttocks or feet first), a cesarean section should be scheduled. If twin A (closest to the cervix) is vertex (head down), a vaginal delivery may be considered. If the second twin (B) is breech, this could make delivery of the second baby difficult, with the chance of the umbilical cord slipping down, decreasing or cutting off its oxygen supply, or having to do a difficult vaginal breech delivery. Sometimes there is heavy bleeding or the baby's heart rate becomes abnormal and a cesarean section is done for the second twin! Sometimes, twin B slides out with ease. If twin B is lying sideways (transverse) when the first baby is delivered, twin B can then slide down vertex or breech!

If both twins are vertex (both are head down) a vaginal delivery is also possible. But sometimes the two heads take up so much space that neither can come out vaginally, and a cesarean section is necessary. Twin deliveries are safely done in the operating room because of the possibility of needing a cesarean. The operating room is usually crowded. Ideally, there is one pediatrician and one nurse for each baby. An epidural would prevent the need for general anesthesia should the need for a last-minute cesarean section arise. A cesarean section is major abdominal surgery done in a sterile operating room. Usually one support person is allowed. Depending on the individual needs of each newborn, the mom and dad may be able to hold or touch their babies. Some babies are very premature and are immediately attached to many wires, tubes, and machines and taken to the NICU (neonatal intensive care unit) with very little interaction with mom and dad. All newborns should be footprinted and have identification bands attached before leaving the operating room.

Sometimes problems with diabetes or high blood pressure during pregnancy complicate the picture. Twin pregnancy and twin delivery are considered high risk. They are safely managed by an obstetrician. The midwife may be involved in collaboration with the obstetrician. If the twins share the same amniotic sac, they should be followed by a perinatologist (maternal-fetal medicine specialist) because of the risk of getting tangled in each other's umbilical cord.

Twins are a double blessing and more than double the work! Please accept all offers of help from friends and relatives. Network and join groups for "doubles" and "multiples" since their support and ideas are invaluable, especially for tips on breastfeeding.


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