From Homebirth: A Midwife Mutiny
By Lisa Barrett on July 20, 2008
"When you are carrying twins there are lots of considerations when planning the care and kind of birth you want.
Most twins are born fantastically well when left alone but there are are some extra risks to a singleton and they are greater if the babies are monozygotic. These are putting into context well in an Article by Justine Caines who says “The risk of spontaneous abortion after amniocentesis is 1-2%. This test is routinely offered to women over 35 without any of the trappings of death and injury”
When discussing the care that a woman carrying twin would like, it’s important to consider that hospital care often includes many interventions and a conclusion that term is earlier than with a singleton so induction is a necessity and control often comes in the form of a necessary epidural, jelco insertion and continuous monitoring. In my experience Dizygotic twins tend to carry to term where as monozygotic are more likely to birth early.
Throughout pregnancy, input and information is essential so that birth happens where the woman feels most safe and able to prepare.
If she is planning a homebirth 2 midwives always seem to me to be the best thing. This may come from my own UK background of training. Usually I work alone with the woman, but for 2 babies and a mother it seems to me another midwife is the right thing. I appreciate however than most babies singletons or twins will birth just fine and there are freebirths of twins that work out well. I can only work in the midwifery style I feel to be the gold standard of care for women and their babies.
Homebirth.org.uk has some interesting stories of both hospital and home and a set of guidelines written by Mary Cronk as an indication of how midwives may practice.
I work with the woman to keep her healthy and well, so she feels fit to make great well informed decisions surrounding her birth. At the end of her pregnancy we measured her girth rather than looking at her fundus. This may or may not be significant but a growing girth indicates good health and well being in the baby especially if the twins are monozygotic.
Women can chose to have scans as the babies grow if that’s what they want, mainly these are thought to monitor growth and show position. My clients are free to take up as much or as little interaction with the system that they want during their pregnancy, it’s just my job to inform them of all the pro’s and con’s and then support them in whatever choice they feel is right for themselves.
This video is a twin birth. The woman has a lotus placenta, neither cords were cut and the placenta was born. The babies remained with their placenta (which was fused) until it came away on day 5. There is no reason to interfere in the third stage of a twin birth more than any other. The colour is not great because it was dark in the room. She had also suffered a nasty labial tear previously (with a water birth at a birth centre) so she was anxious for that not to happen this time, we had discussed it prior to the birth, hence me catching the babies.
The second baby was auscultated when the first baby was being born, and I also did palpate after a while to check the second baby was in a longitudinal lie (straight up and down). The second baby is born in the caul and has a cord wrapped around a number of times.
Thank you to this fantastic family for letting me show this (these twins are now 2 years old). They are moving to Canada for a few years and I send all my love. xxx "
To view the video, follow this link:
Twins – A Homebirth With Video