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Twin pregnancy

Preparing for a Multiple Birth

Options for giving birth to twins. Some questions answered.

Is it possible to have twins vaginally? Yes it can be possible to give birth to twins vaginally depending how your twins are progressing and how they’re lying in the uterus. If they are progressing well, you and your twins don’t have any medical complications, and one of them has his/her head down and engaged towards the end of the pregnancy, you may be encouraged to try a vaginal birth.
It is likely that you will be encouraged to have an epidural so that should they need to top your pain relief up to full strength during the birth so you can have an emergency caesarean they can do so easily.

However it’s more common for monozygotic monoaminotic twins to be given a caesarean due to possible complications but if you wish to discuss your options with your consultant or midwife then that’s fine. It’s important that you understand the reasoning behind whatever decisions you have to make regarding the birth.
Will I have to have a caesarean with twins? Not necessarily. It depends on a number of factors, including how urgently your twins need to be born, how they are presented (how they are laying in the uterus) and if there are any other medical factors to be considered.

If there are complications, or the babies are in distress, the twins are laying in an awkward position, are monozygotic monoamniotic or are breech, you may be advised to have them by caesarean section.

If you attempt vaginal delivery and the labour does not progress as expected, or if there are any difficulties, or the twins need to be born quickly, you might have an emergency caesarean after attempting labour. I’ve had a caesarean with my older child, does this mean that I have to have another one with my twins? Not necessarily. It can be possible to have a VBAC (vaginal birth after caesarean). If you would like to try this please ask your obstetrician for advice.

How will a twin birth differ from that of a singleton? If you have them vaginally you will go through the pushing stages twice, but the first stage (the dilation) and the third stage (delivery of the after birth) is the same.
With a twin birth the midwife/ obstetrician is likely to want to monitor your twins hearts closely for signs of distress which may limit how mobile you are during the birth.

You may be discouraged from having a home birth, or a water birth. However it is always worth discussing with your health team what options are available to you.

How long does it take to give birth to twins? Around the same length of time as with singletons, the only bit that is longer is the pushing bit. It may only take 10-30 mins longer than giving birth to a singleton.

With a caesarean the babies are lifted out quickly so again it shouldn’t take much longer than with a singleton

.There are lots of junior staff wanting to watch but I don’t want them to, what shall I do?
You might find that you have lots of staff present, particularly senior staff such as a consultant or senior midwife which can be reassuring. However you may also find that you have lots of student doctors and midwives wanting to watch for training purposes. If you would prefer that junior staff are not present for the birth please politely say so at the beginning of your labour. If you are happy for them to stay then that is equally fine but at the end of the day, it’s up to you what you want to happen.

The Birth.
You may spontaneously go into labour, you may have to be induced or for a health concern you may have to have a caesarean, either an elective caesarean on a set date that you’ve prearranged, or as an emergency.

If you are induced this involves them inserting a pessary into your vagina which (hopefully) stimulates labour. You then lay down for about 10 minutes to let it take effect. If the first one does not work they may give you a second one about 12 hours after the first one.Spontaneous labour. This is where you start labour without any medical intervention.

 How will you know if you are in labour?  As soon as you notice any of these symptoms please contact your labour suite for advice. Once you get into hospital you will have an internal examination to see how far dilated you are.

If labour is becoming established you will be monitored, probably offered an epidural and moved to a delivery room. The room you are in is likely to double up as an operating theatre if necessary, just to be on the safe side.

You may be offered other forms of pain relief, including a tens machine, pethidine (an injection) or Gas and Air (entonox). See what you need during the labour, if you need more than one kind of pain relief that is fine, tell your midwife so she can organize it. Will I have to go through labour twice if I am having twins?No.

Once you get to the pushing stage you will do the pushing stage twice, but the rest of your labour is the same as having a singleton (apart from getting two babies at the end, obviously!)  After the birth you will deliver the placenta, the babies umbilical cords will be cut, they will be checked over and then handed to you as long as they have no urgent medical issues. After this you are likely to be given a cup of tea and some toast, and shown how to breastfeed if you’re planning on breastfeeding them.

Having a caesarean.
If your caesarean is elective (i.e pre-arranged) you will be able to plan for the birth. You may be offered a choice of having a general anaesthetic where you will be unconscious (asleep) for the birth or a local anaesthetic where you will be conscious during the birth. A caesarean involves having an incision in the abdomen, both babies being carefully lifted out and the abdomen stitched back up again. This is a major operation and takes a little while to recover from. You will be expected to stay in hospital for a few days to recover.

Recovering from a twin birth
Whichever method you use to give birth, you will need time to recover afterwards. Rest is important as is eating well and drinking plenty of fluids. Taking short walks even if it is just up and down the corridor in the hospital is a good idea too as soon as you’re able to.

If you have stitches from an episiostomy ( a cut to your perineum) you may be sore for a few days. If it hurts whilst you urinate (wee) try soothing the area with some warm water and drink plenty, this will dilute your urine and make it sting less.

If you have a caesarean you will need extra help picking up your twins for feeding /changing etc. You will also be monitored to make sure you are recovering after your operation and have your dressings changed and your wound checked.If you’re feeling particularly sad or unwell please contact your health team for advice.

After the birth you will bleed (a bit like a heavy period) for 4-6 weeks. This is known as lochia. If you notice large clots of blood, are very heavy or notice an offensive smell, please contact your hospital immediately.

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What to pack in your hospital bag if you’re having twins

 

Pack the following for yourself:
• An old baggy t-shirt or nighty for the birth.
• Breast pads
• Tissues
• Your toiletries bag with soap, shampoo, conditioner, moisturiser, toothbrush, tooth paste, deodorant, comb, brush. Buy travel size bottles of shampoo, deodorant, etc rather than full size ones. Saves you lugging your whole bathroom cabinet with you!
• An old flannel
• 2x hand towels
• Maternity Pads (or heavy flow sanitary towels)
• Old knickers (not g-strings or anything very skimpy. Big granny pants are best) or disposable maternity pants
• Dressing gown
• Slippers
• Fresh nighty/ Pyjamas. Pyjamas will be fine even after a c-section because they sit higher up than your scar.
• Maternity/Nursing bra
• Mobile phone and/ or camera
• Socks

For the babies
• 2 packs of newborn nappies (if they come in a double pack already one pack should be enough for now!) It’s important not to over do it, because sometimes twins can be surprisingly big/small and need a different size of nappy to what you might think!
• 4 pairs of scratch mitts
• 12 body suits (vests)
• 12 baby grows (sleep suits)
• 2 baby hats
• 2 towels
• 2 cardigans
• Nappy sacks
• Sensitive wipes (check they are suitable from newborn)
• Pleat of cotton wool
• Baby soap, shampoo etc (check if suitable for newborn)
• 6 bibs
• Muslin squares (optional)
• Carrier bags to put dirty clothes in.

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Twin Pregnancy ~ what to expect when you’re pregnant with twins

You may be feeling like you’re on an emotional roller coaster right now, one minute feeling delighted, the next in floods of tears not knowing if you’ll be able to cope with one (more) baby let alone two! This is perfectly normal and totally understandable. This feeling usually passes after a while, especially when you find out more information and arm yourself with useful tips and advice from other twin parents’ who have already been there and done that! If it doesn’t, please see your GP or midwife for advice.

How will I know if I am expecting twins? The main way is to have an ultrasound dating scan  (’sonogram’) which will also tell you how many babies you’re carrying. Many women ‘just know’ they’re having twins, even before they get sent for a scan.
Signs that you *might* be pregnant with twins include:
  • Feeling very tired,
  • Extremely irritable,
  • Weepy,
  • Having very sore breasts,
  • Severe morning sickness,
  • Looking big for your dates.

Some people find that they have very severe pregnancy symptoms, but others have either very mild symptoms or none of the above. The most accurate way of telling if you are pregnant with twins is via a scan. If you think you have a likelihood of having twins, please see your GP to discuss having an early scan.

 
How long does a twin pregnancy last? Twin pregnancies are said to be ‘term’ at 37 weeks. Triplets  are said to be ‘term’ at 34 weeks. So a multiple pregnancy can be shorter than a singleton pregnancy. However, some twins do go to 40 weeks.
 
Can I be having twins, there isn’t a history of twins in the family? Absolutely! It is possible to have twins without there being a strong history of twins in the family. Especially if you’ve had assistance in some way to get pregnant, like IVF etc. However if you do have a strong history of dizygotic (non-identical or ‘fraternal’) twins in the family you do have a stronger chance of having twins.
Why am I so big for my dates?
This is because twins grow at the same rate as singletons for the first 26 weeks of pregnancy! This rate will start to slow down after 26 weeks.
I’m frightened, everything seems so daunting! Help! You can ask questions on the Twinsonline Facebook Page  and via Twitter www.twitter.com/twinsonline_uk Here you can get informal, friendly advice from other parents and adult twins that have been in a similar situation to you .
Please note if you have any medical concerns please go see your GP or contact your Midwife or Antenatal clinic urgently..

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How will my twin pregnancy differ from a singleton pregnancy?

Pregnant WomanYou will find that you will usually get bigger quicker, wear maternity clothes sooner than with a singleton pregnancy.
You may have more severe pregnancy symptoms (although not all twin mums do) You will be scanned more frequently than with a singleton, especially if you are expecting monozygotic (’identical’) twins who are sharing a chorion.

You’re more likely to be seen by a consultant. Twin pregnancy is also usually slightly shorter than a singleton pregnancy. You may need to go on Maternity Leave sooner than if you were having one baby. However it largely depends on how your pregnancy is progressing and how strenuous your job is.

What happens next? Once you’ve established your pregnant you normally get invited to a ‘booking in’ appointment where you meet the midwife at around 10-12 weeks. In this appointment you will have your blood pressure checked your urine sample will be tested and your weight checked.

Your midwife will take a blood sample to determine what blood group you are and if you are rhesus positive or negative.

You will also be asked about your family medical history and about any previous pregnancies. You might find out very early on that you are pregnant and have quite a wait before you go to your booking in appointment. If this is the case and you have questions for your midwife in the mean time please don’t hesitate to contact him/her or your GP.

If you have any health worries at all, go to your GP, midwife or A&E if appropriate. If you have vaginal bleeding, severe morning sickness, severe or prolonged headaches (especially after 20wks), any sign of swelling seek medical attention urgently.

It can be useful to buy a small notebook to jot down any questions you might have for your health team about your twin pregnancy. Make sure you leave plenty of space to jot down the answers to the questions and take a pen with you!

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Feeling your twin babies move.

When did you feel your twins move for the first time?
When did you feel your twins move for the first time?

Feeling your twin babies move.

When will I feel my twin babies move?

If it is your first pregnancy you might feel them move for the first time from around 17-18 weeks, maybe a little later. If you’ve already had children you might feel them move sooner than this ~ from around 14 weeks. It is not unheard of for you to not feel them move for the first time until 20+ weeks. It can be hard when it says in pregnancy and parenting books that you might feel them move from around 17 weeks but you haven’t felt yours move for the first time until later. If you’re worried at all please contact your midwife for reassurance.

How will I know if what I am feeling is my twin babies moving?

When you feel your babies move for the first time it may feel like a tiny ripple or even a slight touch of wind or perhaps a mildly fizzy feeling. You may at first only feel a gentle fluttering or it might take you a few attempts to realise that what you are feeling is them moving inside you. Eventually it will get more obvious as to what is happening and you might even be able to see the movement as you look at your abdomen. As time goes on the kicks will be more prominent and there’s nothing more rewarding than snuggling up to daddy and allowing him to feel them kick him too. (Why should he miss out on all the ‘fun’? :D)

Their movements may form a pattern, soon you’ll establish what a normal days movements is like for you.

You may also start to notice a pattern emerging. They might have times when they’re awake and active, and other times when they’re less active or you don’t notice their actions so much. Figure out what is ‘normal’ for you and your babies.

I’m not sure if my twin babies are moving or their movements have changed, what should I do?

If you find that you’ve not noticed your babies moving for a little while (especially if you’ve been busy going about your day) you might find it helps to lie down for a short period of time and drink a cold drink and see if that helps. If you don’t start noticing movements after a lie down and a cold drink contact your midwife or delivery suite for advice.

If you notice any changes to the amount or way that your babies are moving or you’ve not felt them move for a while get in touch with your midwife, antenatal clinic or delivery suite.  Sometimes when you notice a change in movements it can be that they’re kicking inwards or lying facing away from your front but it’s important not to assume that this is the case, always get checked out to be on the safe side. It also can mean that the babies are in distress or need help so it’s always important to ring and ask for guidance. Your midwife/ delivery suite may want to get you in for monitoring.

For more information check out this article from the Royal College of Obstetricians and Gynaecologists https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-your-babys-movements-in-pregnancy.pdf

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