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Labor and Delivery
By Kristy Zurbrick
Months have gone by. You've gotten used to having two babies inside you.
Now, as your due date draws near, you must think about how you and they
will make the transition to meeting face-to-face-to-face. Labor and delivery
with twins can present some unique decisions and challenges. The best
thing to do, as they say in the Boy Scouts, is to "be prepared".
1. Learn the signs of labor.
Typically, you're not far from labor when the baby's head drops into the
pelvis, the mucous plug dislodges, your water breaks, and you experience
stronger, regular and more frequent contractions. For women who are expecting
one baby, these signs crop up around the 39th week of pregnancy. For those
with twins, however, labor usually occurs much earlier; the average twins
are born at 36 weeks.
Recognizing the symptoms of labor isn't always a clear-cut process, especially
when the signs show up earlier than expected. "Compounding this problem
is that some women do not trust their own intuitive feeling that something
is wrong and therefore fail to act on it," says Dr. Barbara Luke,
author of When You're Expecting Twins, Triplets or Quads (1999). "So
remember, at whatever point in your pregnancy you experience any symptom
of labor, call your physician. He will most likely instruct you to get
to the hospital for further evaluation."
2. Know your pain relief options.
Once labor begins, there are various methods available for relieving the pain that comes with it. Beyond relaxation techniques and breathing exercises, you may consider receiving medication for the pain. The medication comes in two forms: analgesia, which decreases the pain but does not eliminate it, and anesthesia, which numbs you and may involve unconsciousness. Discuss these options with your doctor ahead of time.
Dr. David A. Ruedrich, an obstetrician who specializes in multiple births, often recommends epidurals to his patients. As the most common method of labor pain management, epidurals allow medication to be inserted through a catheter into the lumbar space beneath the spinal cord. In addition to allowing the mother to stay awake and alert during the birthing process, this medication also helps in the case of emergencies.
"You have to be prepared for complications if one or more of the
babies isn't doing well," Ruedrich says. "The epidural allows
us to transition from a vaginal birth to a c-section if an emergency arises.
This transition can be made more easily and safely if pain medication
has already been administered."
Expectant mothers of multiples may be happy to know that their labor pains are usually comparable to those of mothers delivering single babies.
"Patients are always relieved to hear that labor is generally no
more painful with twins than with a singleton baby," says Luke. "You
need to go through the first stage of labor, including transition, only
once, even though you are giving birth to two babies. While you do go
through the second stage twice, this usually proceeds more rapidly with
baby number two."
In some cases, the second baby arrives within a couple minutes of the first. Most of the time, however, the second baby comes 20 to 30 minutes or more after the first one.
3. Vaginal vs. c-section delivery
"The biggest thing we talk about with multiples is route - whether
they will be delivered vaginally or by Cesarean section," says Ruedrich.
The chance of either is roughly 50 percent. Approximately 40 percent of
the time, both twins will be born head-down. In these cases, Ruedrich
says, obstetricians will try to deliver the babies vaginally. It's when
the babies present themselves in different positions that the route may
change.
"Other presentation combinations, such as one baby being head-down
and the other breech (feet or buttocks first), can lead to c-sections,
somewhat depending on the desires of the parents, the obstetrician and
the gestational age of the babies at delivery," he says.
The main deciding factor in delivery method is the position of the baby closest to the cervix. If the first twin is breech or sideways in the womb, a c-section will likely be scheduled.
If the first twin is born vaginally and the second one is breech or sideways,
the obstetrician may move the second twin into a better position by pushing
on the mother's abdomen externally or perform a breech extraction. If
these methods don't work, a c-section may be necessary.
"In all of these combinations, you have to weigh the risks to the
babies and to the mother," Ruedrich says. "Beforehand, mothers
should be emotionally prepared to handle a c-section, since about half
of twin births are delivered this way."
The more you know about the possibilities, the better you will navigate the ups and downs of labor and delivery with twins. No matter what challenges present themselves the end result is a miracle times two.
Kristy Zurbrick is a freelance writer working with Twinshelp and an editor of a weekly newspaper in Columbus, Ohio.
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