Hi all

I've been thinking recently about the upcoming birth of our twins (yes, quite a while to go yet) and wondering a few things.....

• Epidural - did you 'have' to have one?
• Continuous foetal monitoring - were you able to have intermittent monitoring?
• IV cannula -
• Drip after first twin born - heard this is often policy
• Cord clamping - were you able to delay clamping till pulsing stopped?
• Management of third stage - were you able to have a physiological third stage?
• Staff in labour room - how many were in there?
• Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?
• Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?
• Positions for labour - were there any limits imposed on you?
• Options for vitamin K - were you able to do this orally instead of injection?

I'm sure I'll think of more lol

DD2 was a planned homebirth and we were going to have a homebirth again for #4 but DH is less than impressed with the idea of having twins at home so looking into options for making a hospital birth as much like nature intended as possible

I was induced at 36+5 due to one baby having IUGR and not growing/fluid level dropping so that dictated a lot about my labour but here are my answers:

• Epidural - did you 'have' to have one?
My OB wanted me to have the line put in, drugs were up to me. I was happy to have the epi so didn't ask if he'd give me a go without it.

• Continuous foetal monitoring - were you able to have intermittent monitoring?
Because twin 1 was the one with IUGR and there were concerns about her ability to handle labour I was continuously monitored

• IV cannula
• Drip after first twin born - heard this is often policy
I was induced so had the drip in to start with. Once twin 2 was in position the drip was turned up (I think, it's a bit of a blur)

• Cord clamping - were you able to delay clamping till pulsing stopped?
I didn't ask.

• Management of third stage - were you able to have a physiological third stage?
I ended up with a manual extraction of the placenta. I held twin 1 for a few minutes before her cord was clamped and cut and she was whisked off for assessment. Things were more relaxed with twin 2.

• Staff in labour room - how many were in there?
During labour a midwife was usually in there, or popping in and out to keep an eye on the monitoring. Once labour was established she stayed there and there was usually a student as well. The OB arrived around 20 minutes before twin 1 was born, by the time she arrived there was a resiscitation team from NICU waiting (thankfully not needed) and another (smaller) team waiting for twin 2.

• Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?
My Ob was happy as long as twin 1 was cephalic, the position of twin 2 didn't matter.

• Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?
He mentioned once that he preferred to have twins delivered by 38 weeks. He was very happy to let singletons go to 42 weeks though so I suspect he'd have considered leaving twins longer if all was going well.

• Positions for labour - were there any limits imposed on you?
The many cords, tubes and leads kept me confined to the bed. this didn't worry me really as I'd hated moving around with my previous singlton births.

• Options for vitamin K - were you able to do this orally instead of injection?
I know it was an option if requested

• Epidural - did you 'have' to have one? From my experience, most people do. I chose not to, due to the fact I had low blood pressure, and previous experience had me fainting with one in
• Continuous foetal monitoring - were you able to have intermittent monitoring? Initially I had intermittent. It was continuous in the last 1/2 hour however, but since they didn't argue about the epi, I consented to this!
• IV cannula - I chose to have the cannula, again a small concession to no epi.
• Drip after first twin born - heard this is often policy No drip here
• Cord clamping - were you able to delay clamping till pulsing stopped? Not, not in my case
• Management of third stage - were you able to have a physiological third stage? After much reading, I chose not to with identical twins.
• Staff in labour room - how many were in there? I honestly have no idea. I ended up with a group of student midwives (3 from memory?) who had never seen a twin birth before, the OB, 2 peads, 2 midwives. Could have been others, I didn't care!
• Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic? twin 1 cephalic, twin 2 started labour in breech, ended in transverse, was internally repositioned by the OB
• Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well? I had a fantastic OB, who listened to my wishes, and she knew I wanted a vaginal birth, and that I birthed fast. There was no mention of a caeser, She nevered suggested induction however my twins were born spontaneously at 35 weeks
• Positions for labour - were there any limits imposed on you? I tried lots of positions, including shower/bath. But the most comfortable for me was laying on my back in the bed. No idea why, its the most illogical!
• Options for vitamin K - were you able to do this orally instead of injection? I honestly can't remember!

Epidural - did you 'have' to have one?
Request one d that was the original plan, but labour progressed faster than expected and missed out.
Continuous foetal monitoring - were you able to have intermittent monitoring?
Once my water were broken I was on continuous monitoring
IV cannula -
Inserted at the time my waters were broken
Drip after first twin born - heard this is often policy
Already in
Cord clamping - were you able to delay clamping till pulsing stopped?
Sorry didn't ask
Management of third stage - were you able to have a physiological third stage?
Yes
Staff in labour room - how many were in there?
8 in total, OB, NICU team, 3 midwives
Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?
Twin 1 and 2 cephalic, I wouldn't have been allowed to deliver naturally if Twin 1 was breech.
Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?
Would have been induced at 38 weeks, but went into labour at 36.4
Positions for labour - were there any limits imposed on you?
Had to lie on left side, most comfortable anyway as Twin 1 was also posterior.
Options for vitamin K - were you able to do this orally instead of injection?
Sorry can't remember

Epidural - did you 'have' to have one?
I was originally told that if I wanted to try a VB, I would need one just in case T2 had complications. When I went into spontaneous labour, I begged for one & due to the fast progressing labour, I was only just able to get one.

Continuous foetal monitoring - were you able to have intermittent monitoring?
Again due to the fast progressing labour & also due to previous complications during pregnancy, I had continual monitoring.

IV cannula - Drip after first twin born - heard this is often policy
An IV was put in when I arrived at labour & delivery & a second was put in as well, but nothing after T1 was born

Cord clamping - were you able to delay clamping till pulsing stopped?
I didn't ask.

Management of third stage - were you able to have a physiological third stage?
I don't really understand this.

Staff in labour room - how many were in there?
For us it was like AFL Grand Final Day at the MCG. We had a premature birth, so we had paeds & NICU staff for both twins, there were 3 OB's, numerous midwives... From the birth of T1 to after T2's birth it went from standing room only to silence. I was left with 1 midwife.

Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?
N/A as mine were both cephalic

Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?
N/A

Positions for labour - were there any limits imposed on you?
I gave birth lying on my back.

Options for vitamin K - were you able to do this orally instead of injection?
I'm not sure

HTH.

for us if twin 1 was breech that was it, dr was not willing to risk a vaginal birth (i was fine with this, i had read the pros and cons for both and trusted my dr)

when we were planning our natural birth it was decided i would have the epidural in but not use it unless needed (this was incase they had to go in after the 2nd twin and help maneuver her out).

i was not going to have any drip unless it was decided i needed it as i found it got in my way alot when birthing ds1, and we were going to have intermittent monitoring.

it was up to us if we wanted them to have the vitamin K shot and hep B etc. as for positioning for labour, we unfortunately didnt get to discuss this but im sure you could do it whatever way was most comfortable for you.

if all went to plan we were going to let nature take its course and let the twins come when they were ready, but at 34wks i developed obstetric cholestasis so they wanted them out as soon as i hit full term.

mc/da id twins

Epidural - did you 'have' to have one?
yes - hospital protocol, though it wasn't inserted until 3hrs into labour then turned off for 4hrs so i could get the urge to push

• Continuous foetal monitoring - were you able to have intermittent monitoring?
induced via synto so internal probe for t1, external for t2

• IV cannula -
i had one in due to minimal insulin gdm - nothing went through it though

• Drip after first twin born - heard this is often policy
i had the drip in until the end

• Cord clamping - were you able to delay clamping till pulsing stopped?
we had no choice, t1 in some respiratory distress

• Management of third stage - were you able to have a physiological third stage?
it wasn't cord traction but due to the epi i was told when to push as i couldn't feel anything

• Staff in labour room - how many were in there?
too many to count - i had them vaginally in theatre so theatre staff plus teams for them and me

• Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?
t1 had to be cephalic for vb

• Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?
i was induced at 37+3 due to gdm and iugr for t1 otherwise they would have left me go

• Positions for labour - were there any limits imposed on you?
i was stuck in the beetle position due to constant monitoring and the epi

• Options for vitamin K - were you able to do this orally instead of injection?
same as singletons

I can tell you how things are planned for us and what I'm "allowed" or have negotiated. No idea how it will all eventuate but this is how things stand at the moment. Being a midwife has given me a bit more freedom with helping make some of these decisions but really these options should be open to anybody. I actively sought an obstetrician who was geniunely flexible on these issues and most of these things were negotiated somewhat in our first visit at 11 weeks. My twins are Di/Di.

• Epidural - did you 'have' to have one?

No I don't have to. Nobody has to have something like this inflicted on their body if they don't want it. Do thoroughly research WHY they want to give you one though and negotiate to have one placed without medication so it can be used in hurry if needed. I was told it was "hospital policy" where I am delivering but when I asked the nurse unit manager of birthsuite she simply said "it's between you and your Ob".


• Continuous foetal monitoring - were you able to have intermittent monitoring?

My option is to have intermittent monitoring in the event that we have a good reactive trace on admission. After having some CTG monitoring last night and having a lot of issues with getting into the right position to monitor both at the same time, I just cannot see it as a reasonable option for birthing. My tummy is huge and the transducers slide around - even without the hardening of contractions it was very difficult and I had to sit very still and hold both of them. Not ideal for labour.


• IV cannula -

I have agreed to this on the basis that there is a higher risk of PPH after twins. I will get it put in up my arm so it's not in the way of bending my wrists and being on all fours (I've got good veins so this should be fine). I don't see that it interferes with my ability to birth and it seems to be a sensible option.



• Drip after first twin born - heard this is often policy

Do you mean syntocinon? This is an option I've agreed to if the second twin doesn't follow within an hour.

• Cord clamping - were you able to delay clamping till pulsing stopped?

My Ob has agreed to this. I've negotiated to also have any minor resus done with the baby on my chest, still attached. I think people forget that babies are still getting oxygenated blood through the cord in those minutes. In most hospitals facial oxygen can be extended to anywhere in the room for the baby. This is widely practised in hospitals where late cord cutting is valued.


• Management of third stage - were you able to have a physiological third stage?

I have agreed to Syntocinon to be used AFTER the second twin's cord has ceased pulsating. I have refused routine use of Syntometrine unless a PPH is happening.


• Staff in labour room - how many were in there?

Our request is that there are as few as possible. I know how easily a twin vaginal birth can turn into a circus spectacular so I've put some measures into place to prevent that happening.


• Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?

I think everybody prefers Cephalic/cephalic but I think a twin delivery requires an Ob who is proficient and confident with breech as even a cephalic second twin can flip breech down after the birth of the first twin. My Ob is happy to deliver the second twin breech and we've discussed this at length, including positioning and what we expect of each other in this situation.


• Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?

I'm right at that stage at the moment. My Ob said it was routine to induce at 38 weeks but he was happy to continue with the pregnancy as long as cord doppler flows and amniotic fluid volumes continued to be good. So at this stage we are past 38 weeks and have no plans for induction.


• Positions for labour - were there any limits imposed on you?

Only in relation to a breech delivery. Once the babies breech is on the perineum he prefers the lithotomy position in stirrups. This is the position he feels most confident doing a breech delivery in so I agree that this is the safest way for us to go. I can labour actively if I want to in order to get the baby to that stage.


• Options for vitamin K - were you able to do this orally instead of injection?

This is not really an Obstetric issue but a paediatric issue. I have chosen oral Vit K to be given only after the first breastfeed. I am sure you are aware that it's three doses when given orally. Research has shown that it actually gives a higher level of Vit K for longer when given like this so it's a bit difficult for people to argue against the practice! If you do decide to give it this way it's important to ensure that all three doses are given as the third dose will be given by you at home (unless your babies have extended SCN stay).


I hope that helps! I have some specific requests surrounding a caesarean delivery if that should eventuate too. I think it's important to be flexible with a twin delivery because it's simply a higher chance of requiring intervention or a surgical delivery. All we can do is focus on what we want and hope that it all follows.

I was told at 20 weeks it would be a c-section, no ifs or buts.
Delivered by a great caesar at 30 weeks. Previously I have had 2 vaginal births.
Like others have said, do your research, but keep an open mind.
(Mine were mcda and had some complications)

Fertilewoman, you must be counting down the days, I'm getting excited for you!

Di/Di Frats

Epidural - did you 'have' to have one?
I was supposed to have one, policy at the hospital was that you at least had to have it in, just in case of manual assistance was needed for Twin 2. I didn't have one at all in the end, I delivered both babies just under an hour after arriving at the hospital so there just wasn't time.


• Continuous foetal monitoring - were you able to have intermittent monitoring?
Twin 1 had the scalp monitor, I also had two trace monitors for each heartbeat strapped to my belly that were constantly needing repositioning.


• IV cannula - - I had this put in as they madly prepped me for the epi that never happened, nothing was done with it until later though.

• Drip after first twin born - heard this is often policy
Didn't happen for me but I don't actually recall the policy from my hospital on it to be honest.

• Cord clamping - were you able to delay clamping till pulsing stopped?
I never asked, to be honest it was a blur of so much activity and it wasn't something I'd really thought much about prior.

• Management of third stage - were you able to have a physiological third stage?
I'm not sure what this means exactly either, going off the responses of PP's I'm assuming its got something to do with placenta delivery? If so, I was able to deliver the placenta on my own, my body seemed to go into 'shoot em out' mode, two babies and a placenta in under 30 minutes, what a machine, lol

• Staff in labour room - how many were in there?
During labour there were 3 midwives the entire time and the obstetrician on duty. When I felt the urge to push and they realised Twin 1 was crowning, the occupancy rate in the room doubled. Each baby had two staff, the anaesthetist turned up at this point as well , and we had someone from SCN come across in the midst of it all, plus the original three midwives and doctor who were with me.

• Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?
Twin 1 cephalic was the only way they would entertain vaginal delivery at my hospital. Mine were cephalic/breech, twin 2 was born breech and did not turn, she was delivered bottom first in one push without any intervention and we did not attempt to get her to turn.

• Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?
I was able to go to term if all went well, post 39 weeks was not recommended at the time, however, and I was more than happy to be induced between 38 and 39 weeks if it came to that. As it was I went into spontaneous natural labour at 36w4d though.

• Positions for labour - were there any limits imposed on you?
Yes, due to it being such a short labour though I don't know if mine would be reflective of what most or many birthing multiple mums would experience in a longer labour. Most of the time spent in the actual labour unit was fiddling with those blasted monitors strapped to my belly and prepping me for the epidural I never had, lol!

• Options for vitamin K - were you able to do this orally instead of injection?

I didn't ask the question to be honest.

Epidural - did you 'have' to have one?
The OBs couldn't stress to me enough how much they advised it but they always acknowledged that it was my choice and the wonderful midwife there with me was absolutely determined to both me and the doctors on they day that it was all about my choice. As it so happens, my choice was to have one inserted and to play it by ear as to whether or not I'd have it turned on (although they were going to test it with a mild amount even if i opted not to have it turned on). I had been quite scared of having an epidural as I'd had one once before and it was a nightmare. I never wanted another one. Then when faced with the prospect of birthing twins I needed to reassess my view of the matter. My choice to have one came down to the fact that if I did ended up with an emergency c/s for any reason I did not want to risk being under a general anesthetic when birthing my babies and all that I would miss out in those early moments if I was, I did not want to be dealing with the after affects of a general whilst becoming aquainted with my babies, I did not want to leave DH in a position where he'd feel torn between being with his wife in recovery or being with his new babies. So, epidrual it was. I did have it turned on because I wasn't coping with the pain (I was shuddering violently after each contraction) and had no recourse to get away from it or work with it in any way because I had a head clip monitor on Twin A who was showing signs of potential distress.

Continuous foetal monitoring - were you able to have intermittent monitoring?
I didn't know I could even ask for it and had I known I would have. I was on constant monitoring from the outset as a matter of course (or so it seemed), which totally sucked as there was only 1 position I could recline in and it was incredibly uncomfortable and frustrating. As mentioned above I ended up with a head clip on Twin A and so obviously from then it was constant but if I had've been up and about in the earlier stages maybe we never would've gotten to that or at least I would've only been tied down from that point instead of for the entire time.

IV cannula
Yep, I was induced so obviously no way around it plus with them planning the epi they had it ready to go for the fluid. With my previous epi my blood pressure crashed in a big way and so they were on the watch for that and ready to pump the saline into my veins.

Drip after first twin born - heard this is often policy
Definitely depends on the hospital and your situation. If your twins are not sharing a placenta they'll likely be more lenient with this and allow things to take their course more. At my hospital that was the case. They were happy to give you an hour before intervening if all was going swimmingly and each baby had their own placenta but for me, they were sharing so they are more cautious due to the risk of the placenta thinking it's time to come away after the first baby was born. As it was I had the drip in anyway so they just continued it.

Cord clamping - were you able to delay clamping till pulsing stopped?
Again with the whole shared placenta thingy and their desire to keep things moving to get Twin B out, they preferred not to wait. Would've been a whole different ball game if my babies had separate placentas.

Management of third stage - were you able to have a physiological third stage?
Not sure what things would have looked like had I not been induced but as such they just kept feeding the drugs through until it was all over.

Staff in labour room - how many were in there?
I had 1 midwife and a trainee midwife (so 2 people) pretty much up until it was action stations with the OB popping her head in every so often to say hi and see things were going. Once we hit pushing time there was an extra midwife ready to take the care of Twin A, the OB, and a paed. So, a total of 5, which didn't feel over the top or too crowded or anything. It was a pretty big room so we weren't all squished in.

Breech presentation – twin 1 breech/twin 2 cephalic, twin 1 cephalic/twin 2 breech, twin 1 breech/twin 2 breech - were you 'allowed' to deliver anything other than cephalic/cephalic?
So long as Twin A was cephalic they were happy for me to birth vaginally. Given the propensity of Twin B to shift around during and after Twin A's delivery they were pretty much completely disinterested in her position until after Twin A was born. As it turns out she was cephalic prior to delivery and stayed that way. But then I had told her she had to so of course she did!

Where you told that you would need an induction at 38 weeks? or were you able to go to term if all was well?
I was told they take this case by case depending on how both mum and babies are faring as they near/reach 38 weeks. For me, I'd had a previous still birth and they were keen to get my babies out ASAP. I wasn't prepared to be induced prior to 38 weeks so 38 weeks it was. In the independant research I did I found that it was deemed ideal for twins (especially those sharing a placenta) to be birthed somewhere between 38-39 weeks. Obviously earlier than 38 weeks they are generally quite small and potentially not fully mature but post 39 weeks the instance of still birth in Twin B does start to steadily and dramatically climb and mum's ability to nourish them appropriately starts to steadily decline (simply not enough space left to get the amount of food in that you need to give them all they need so becomes almost better out than in).

Positions for labour - were there any limits imposed on you?
Yes. Those damn monitors!

Options for vitamin K - were you able to do this orally instead of injection?
Wasn't given any other options. Didn't know there was an oral version.

Thank you all so much for replying!!

Doing a lot of reading and research into my options and what I'm willing to compromise on and push for/against.

Great to hear so many have vaginal births with twins!

I have been thinking of you, Kabailz, and this topic. I had, before falling pregnant, hoped for a lovely water birth in a birthing centre somewhere and never ever wanted to see another epidural in my life. The discovery of twins and the knowledge that not only was my waterbirth out the window but that I would likely have to fight to keep things as natural as possible was disappointing to say the least. For myself and a few others in the expecting multiples group at the time, we really wrestled with this throughout our pregnancy.

When I sit back and look at the cold hard facts of my delivery and on the scale of lots of intervention to no intervention for a vaginal delivery (regardless of how many babies) mine was way up there in the scale of intervention (e.g. synto induction, constant monitoring incl. fetal headclip by the end, no option to move around or change positions during labour at all, epidural, episiotomy) and if I'd known when I first set out that I would be ticking all those boxes by the end I would've been quite upset.

That being said, what I REALLY wanted to tell you was that I had THE most wonderful, wonderful birthing experience that I ever could have hoped for. Seriously. After suffering a stillborn with my first and having such horrendous memories of giving birth (and not just because she was stillborn, other stuff went down that made it even worse) I was so determined to have some nice memories of a vaginal delivery (hence my longed for lovely calm water birth) and even though it looked amazingly different to what I pictured, I got what I wanted. I had a great time giving birth to my baby girls, epidural, episiotomy, fetal head clip and all. I really cannot stress just how fantastic a time I had and I treasure it for everything that it was and wasn't. So, I wanted to encourage you that even though you are now facing the prospect of something that looks different to what you had hoped and planned for, it doesn't have to be bad.

ECB - you are so right! A birth with lots of intervention does not have to be a negative experience at all. I've been involved in lots of difference scenarios with women coming out with the opinion that they had the best possible birth experience. For some women that is an elective caesar at 38 weeks and for others it's a natural drug free labour where they caught their own baby at home. Then every other combination of scenarios in between. Everybody is so different in what they expect and are happy with.