Twin or multiple pregnancy and birth: what you need to know
Discovering that you are pregnant with twins, triplets or more, can cause a huge range of emotions - from delight to despair, and anywhere in between. Navigating a multiple pregnancy can be complicated, with lots of new information to take in and some big decisions to make. But remember that at The Positive Birth Company, we are here to support you to keep calm and relaxed, and give you a toolkit to navigate any situation like the total boss that you are!
You may have always thought there were two kinds of twins - identical and non-identical - but if you are pregnant with twins (or more!) you are going to learn some new language at your appointments. Your team will identify if your twins are dichorionic diamniotic (DCDA) - each has their own separate placenta with it’s own inner membrane (amnion) and outer membrane (chorion); monochorionic diamniotic (MCDA) - sharing a single placenta with a single outer membrane and two inner membranes or monochorionic monoamniotic (MCMA) - sharing both the inner and outer membranes. MCMA twins are the most unusual at only 1 in 100. All non-identical twins are DCDA and a third of DCDA twins are identical.
“I was very shocked to find out I was carrying twins. I was overwhelmed with lots of emotions and fears, including the worry that I probably wouldn’t be able to have the birth experience I had hoped for.” - Tara, Birthing The Future
If you are pregnant with MCDA twins, you can expect extra scans and close monitoring, as these twins have more chance of Twin to Twin transfusion - a placental abnormality. You may be offered a referral to a fetal medicine specialist for some of your scans and appointments.
If your twins are MCMA, you will also be offered extra scans as there is a chance of cord entanglement which can cause complications for your babies.
DCDA twins are more common, and the chances of complications arising is much lower. You will be offered scans every 4 weeks to monitor their growth - measuring your bump doesn’t give us reliable growth information on multiple pregnancies because we cannot tell what each individual baby up to!
You or your friends and family might have assumed that twins are always born by caesarean birth - but actually around half of twins are born vaginally. Most twins are born prematurely, and the position of the first twin is often the deciding factor on the advice your team will give you. If Twin 1 (the baby closest to the cervix) is in a head down position, and there are no other complicating factors that would suggest that a caesarean birth might be the safer option, then you will be supported in a vaginal birth if that is your preference. If your twins are not born prematurely, you will be offered an induction of labour, or planned caesarean birth, before your estimated due date. The timing of this will depend on the type of twins you are carrying, and your whole pregnancy and medical picture.
If you know anything about us, you know that we love to use our BRAIN! Consider the Benefits, Risks, Alternatives, your Intuition and what if i do Nothing. Having a decision-making framework like this can really help you to make an informed choice around your birth. We are socially conditioned to follow the advice of professionals unquestioningly, often we can hear recommendations as orders “as you have DCDA twins we will scan you every 4 weeks”. Remember that you have to give informed consent for all care pathways and appointments. Every time you hear something that sounds like an order, remind yourself that it is a recommendation and an offer - and that it is down to you to gather as much information as you feel you need to make the right choice for you and your family (side note - most of you will happily go along with the advice, but being engaged in your care will increase your feelings of autonomy and control in pregnancy and labour, and that in turn will improve how you feel about your pregnancy and birth experience).
Search out positive stories and videos of other multiple births, and start to visualise your own experience based on real events - always strive to avoid ridiculous over the top Hollywood births which bear little (or no) resemblance to real life birth. Find your positive birth tribe - multiple pregnancy support groups and charities are out there, and The PBC community has lots of twin families who will encourage you too.
Because multiple births are more likely to end prematurely, it might be a good idea to try to have a tour of the neonatal unit or meet some of the team who work there to get an idea of what your experience there might be like. Around 40% of twins require some extra support in a Special Care Unit or Neonatal Unit. Although this can feel worrying, studies have shown that twins mature more quickly that single babies born at the same gestation, and many twins only require a short stay with little medical support. Whether your babies can stay with you on the postnatal ward, or need extra support from the neonatal team, it is really important to remember that you need to take good care of yourself too.
Written by Senior NHS Midwife, Hannah O’Sullivan
Useful links / resources:
Read Tara’s Story from our #BirthingTheFuture Campaign
Royal College of Obstetricians & Gynaecologists Information for You; Multiple Pregnancy
Trust Birth Preferences
https://twinstrust.org/let-us-help/pregnancy-and-birth/preparing-for-birth/birth-preferences.html