Birth options for twins

Hello all,

I'm due with twins in June.

They are in separate sacs with separate placentas which is apparently the best 'kind' of twins to have when it comes to birthing - the lowest risk type of twins.

Anyhow, I am going with a private ob, L ionel S teinberger who is very pro-vaginal birth, happy with breech, and is willing to discuss all options.

Here comes my dilemma

The 'recommended' birth plan for vaginal birth of twins is to have an epidural with the labor of twin 1. This is so that after twin 1 is born, if twin 2 decides to do somersaults, turn transverse or decide to try and hide in my ribcage, the OB can get in to my uterus and move twin 2 without me protesting too much. Twin 2 deciding to do weird things is relatively common (cant remember the stats I read but maybe 40% IIRC?). Let's assume for arguments sake that I'm healthy, twins are healthy.

I don't know if I want to have an epidural. I would prefer to labor naturally, be able to move, use gravity, keep my pelvis open etc etc. However, I don't want to put twin 2 at any unnecessary risk either. I have a secondary appointment with the OB in a few weeks and would really like to be informed as possible to discuss my options with him.

So the way I see it there are a few options
1. No epidural. Run risk of C/s if second twins goes AWOL. Run risk of injury to second twin due to delay of getting under general etc.
2. Epidural. Labor on back, continuous monitoring.
3. ???? Are there are other options - is it possible to have epi inserted but no anesthesia administered. That way if things go belly up, I'm cutting 10-20 minutes off any delays because it doesn't have to be inserted, just administered? I know there are self administered epi pumps - does anyone know if this is an option in this case?

I'm really stressed about this. I'm finding it very hard to give up on the idea of a natural active birth, but neither do I want to place my babies at any unnecessary risk. Homebirth is not an option for me for twins, I'm just not comfortable to do that. I would go public if my options there are better (would be the Angliss). However, then won't I just get whoever is on for the day, and if one of the twins is breech they'll insist on c/s anyhow? bleurgh.
Bloody twins! :p

I know plenty of people have popped out twins vaginally with no issues but instead of birth stories I would prefer if people have experiences about options for Option 3 or if they have any evidence/articles/books I could read regarding stats/issues that I can educate myself on!

Thanks in advance. My head is going round and round and round!

Congrats Dollyroux! We have a couple of other twin mums-to-be in my HBing group ATM. Due to our m/ws guidelines, both will be delivering in hospital with m/w support and a cooperative ob (a couple of the IMs have visiting rights).

They have had the same discussions it sounds like you have had. Both have (independently) refused an epidural and are negotiating on other things (one has refused continuous monitoring, for eg), due to the risk that both twins will be c/s if not allowed to labour naturally. Good birthing support is just as applicable with twins as it is for any other birth. I know you were considering HB before you found out you were having twins, have you considered speaking with an IM to still provide the prenatal and birth support role for you, albeit with the care of an ob as well?

All the best for your pg and the birth! Twins is just another variation of normal and (statistics aside) women have been successfully birthing twins for just as long as singletons.

Thanks for your response Jennifer13. I was considering homebirth before I found out it was twins. As I am going private ATM, I can't afford a m/w and the ob :/. I am looking at hiring a doula though...

I think i just need more information on the pros and cons....

Just a random thought - do you watch One Born Every Minute? There was a twin birth on the last episode... You can catch it online... She went through the exact same thing, whether or not to have an epidural... She manages without and delivers both vaginally.

My mum had my sis and I within 12 minutes of each other with no epidural 29 years ago!

I'm going totally against the grain here but the epi is put in place for a reason. I didn't have my twins naturally but had no issue with the epi for the reason you've outlined above. I ended up getting pre eclampsia and needed a csection so that's a perfect example of the many twist and turns twin pregnancies can tack. My following two singletons births where medication free VBACS and I did push for them because I felt the risks where much lower. My personal opinion go with what feels right. From what I've heard your OB is FANTASTIC. Good luck and hoping your twins arrive with minimal intervention. Xx

For our twins an epidural was placed and a low dose administered just to ensure that it would function if/when needed. It was then left in place but not used from that point on. It was put in place for the exact reasons as stated. OB was happy to deliver both naturally providing the first was head down, the second could have been breach and that was okay. They were only concerned about twin A's position to begin the labour and then twin B would be dealt with during.

Were you able to move around Abigail?

Thanks Zap - it's great to get the different responses!

OP - I haven't watched it but ill seek that out. Thanks :)

I'll find the link and post it, but I follow a mum in YouTube who gave birth vaginally and drug free, she's American so that's a pretty big deal over there too. Twin B was in a funny position after twin A came out, the doctor did put his hand in there to help bub, and Twin B was happily delivered breech. She didnt have an epi and it did seem painful, but not to the point that you'd go wow, she 100% should have had that epi. Might be a good vlog to watch back, she documented her whole twin pregnancy and the care she was getting, including the birth :)

The twins on 'one born every minute' twin 2 was breech and delivered ok.

Although I don't have 'twin' experience, I do know some hospitals do a low dose or half dose epidural. If you ask either your Ob or the hospital. (I had hoped to have a half dose with my DS3 but the major public hospital I went to didn't do that type)

I was offered the chance to have an epidural sited just in case it was needed but declined because of the risk of complications from the epidural site, with the full understanding that this meant I was more likely to need a general if I needed a CS for twin 2. In my case twin 2 did do somersaults but the midwives held him in place once he was longitudinal with the understanding that if a bum presented I would flip onto all fours and deliver him that way, but he was head down so I stayed kinda on my back which was the comfiest position after I had already had one baby. I did need a painful internal which would have been nicer with an epidural, but it only lasted 30 seconds and I appreciated the chance to use the pool for labour more than I would have that experience being less painful.

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I'll find the link and post it, but I follow a mum in YouTube who gave birth vaginally and drug free, she's American so that's a pretty big deal over there too. Twin B was in a funny position after twin A came out, the doctor did put his hand in there to help bub, and Twin B was happily delivered breech. She didnt have an epi and it did seem painful, but not to the point that you'd go wow, she 100% should have had that epi. Might be a good vlog to watch back, she documented her whole twin pregnancy and the care she was getting, including the birth :)

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I follow her too, definitely give her birthing vid a watch, it is amazing!

And I watched the OBE ep too with the twins. Twin 2 there also needed help to turn into a right position, it hurt the mum for 30secs or so but then was over and twin 2 was delivered awesomely.

I have no experience at all with twin deliveries, but I do wonder: If twin 2 presents in an odd position, can they move them from the outside ... and ECV is it? Could there be time to do that rather than doing it internally? Obviously I have no idea lol, but I have wondered this before in my little musings of if I ever had twins hahaha ;)

(Oh and as an aside, I had an epi with DS but it wasnt full strength. I could still move my legs, although they were numb, and I was able to weight bare an hour or so after his birth despite the numbness. No idea if I could have when it was first done itms, but perhaps a really low dose one could be put in if you wanted so you could still move around?)

Have a look at the Australian Multiple Birth forum, or even their facebook page which is fantastic. I think someone posted a similar question on the FB page recently. I had an epi for mine, mainly because it was a VBAC. My best friend birthed her twins 2 weeks before me with no pain relief at all. And I've also heard your OB is fab too :)

In our area the anaethetist will put in the epidural but it is a patient control administered epi, so you are the one who decides how much you want to administer (if any) during your labour.

He said they do it that way so if you have something start going wrong with the delivery of the second twin then you already have the epi catheter in place which thay can hit you with to manually deliver twins 2 or if you need a c/s then they will dose it up big time for a c/s so you can be awake instead of having a general.

Maybe this is something you could discuss with the anaethetist as you are the one controlling the epi's use but it is there to give the ob an option as well if things go wrong.