twininfo.co.uk

One baby being born vaginally with the second twin being born via caesarean occurs in only about 3-4% of all twin births. Usually this is done if there is an emergency with the second baby such as a cord prolapse (where the cord comes out with or before the baby, cutting off its oxygen supply), severe malpresentation (like a transverse baby that cannot be moved) or placental abruption (when the placenta tears away from the wall of the uterus prematurely).

Although having twins does increase the risk of you having a caesarean fewer than half of twins are born this way.  Whilst the position of your babies will play a large part in the decision as to what type of birth you will have there are also other reasons for having a caesarean.  These include. placenta previa, placental abruption and labour complications such as foetal distress.  If you give birth by caesarean prior to labour the date will most likely be set around 37 or 38 weeks.  If you go into labour prior to the scheduled date your caesarean will likely happen then.  There is no real difference in the surgery or recovery from a caesarean with twins other than you will be advised to only hold one baby at a time for the first six weeks.  This can be easier said than done, particularly if you are breasfeeding!  The babies are usually born no more than a couple of minutes apart.

More than half of twins will be born vaginally.  The process of labour is the same as with one baby, but the babies will be very closely monitored.   This often means you are unable to use certain facilities available to other labouring mums, such as the birthing pool.  Also, because medical intervention may be required you will almost certainly not be able to deliver your babies in a birthing centre but will have to deliver on the main labour ward.  Some hospitals require that all twin mothers give birth in the operating room, even if they have a vaginal birth. You may be given a drip in case it is needed later and an epidural will often be recommended.  Once the first baby has been born, the midwife or doctor will check the position of the second by either feeling your abdomen and doing a vaginal examination or via an ultrasound.    If the second baby is in a good position to be born, the waters surrounding the baby will be broken and the second baby should be born very soon after the first because the cervix is already fully dilated.  If contractions stop after the first birth, hormones are usually added to the drip to restart them.  This means the second baby is usually born no more than 20 minutes after the first.  The second baby often changes position once the first is born.  If the second baby is breech your doctor may decide to allow the baby to deliver breech, to turn the baby externally or internally or even do something called a breech extraction (pulling baby out by the feet).

When you are having twins more people will usually be present at the birth no matter how you deliver your babies.   There is usually at least one midwife, an obstetrician, and two paediatricians, one for each baby.

Vaginal Delivery of Twins

Caesarean Delivery of Twins

Combined Vaginal/Caesarean Delivery of Twins

Here are the common signs of premature labour.  Contact your doctor if you have any concerns about your pregnancy.

• More than four or five contractions per hour
• Regular contractions that increase in frequency
• Rhythmic or persistent pelvic pressure
• Cramps, similar to period cramps
• Backache
• Diarrhoea or upset stomach
• A change in vaginal discharge
• Vaginal bleeding
• Uneasy or urgent sense that something is wrong

Signs that labour is beginning

Regular contractions
During a contraction, your abdomen gets tight and then relaxes. You may have had these throughout your pregnancy, particularly towards the end.  Before labour, these are called Braxton Hicks contractions.  When you’re having regular contractions that last more than 30 seconds and begin to feel stronger, labour may have started. Your contractions will become longer, stronger and more frequent.

Other signs of labour
You may or may not also have the following signs:

• Backache or the aching, heavy feeling that some women get with their monthly period.
• A ‘show‘ either before labour starts, or early in labour. The plug of mucus in the cervix, which has helped to seal the womb during pregnancy, comes away and out of the vagina. This small amount of sticky pink mucus is called a ‘show’. You lose a small amount of blood with a show, mixed with mucus. If you’re losing more blood, it may be a sign that something is wrong, so telephone your hospital or midwife straight away.
• Your waters breaking. The bag of water surrounding your baby may break before labour starts.  If your waters break before labour starts, you’ll notice either a slow trickle from your vagina, or a sudden gush of water that you can’t control.
• Nausea or vomiting.
• Diarrhoea.