How is a Twin Labor and Delivery Different?

Preparing for birth has been a big part of both of my pregnancies. I started a lot earlier last time and prepared a bit more (which makes sense since it was my first time), but as I come into the home stretch of my twin pregnancy, I’ve spent a lot of time thinking about how my twin birth may (or may not!) go. I started writing this as one blog post but it was getting so long so I decided to break it into two parts. The first part will talk about how twin labors and deliveries are different than singletons. The second part will talk about my personal wishes/desires/hopes for my own twin labor and delivery. Every woman is different and that every birth is different. Whatever you choose for yourself is the right choice in this extremely personal decision.

Let’s start with some facts on twin births. There are some differences from a typical birth that many may not realize. When we saw those two little bubbles on our 7 week ultrasound, I had no idea how exactly my pregnancy and labor would be different, but I knew it would be.

How Are Twin Births Different From Singleton Births?

Here are some facts about twin births compared to singleton births based on research and discussion with my doctors. (The facts may change depending on which study or article you read. All sources are linked.)

• Full term for twins is generally considered 37 weeks, as compared to 40 weeks for singleton pregnancies.
• 60% of twins are born prematurely (before 37 weeks). The average twin pregnancy lasts 35-36 weeks (this seems to vary depending on where you read it).
• Identical twin pregnancies with one placenta are generally shorter, largely because doctors will induce/schedule a c-section at 37 weeks compared to 38 weeks with a di/di (two separate placentas and sacs – which is usually fraternal but not always). My girls are di/di & fraternal.
• The average single baby weighs 7 pounds at birth, the average twin weighs 5.5 pounds. Twins grow on the same growth curve as singleton babies until 28 weeks; after that point they often grow more slowly.
• Preeclampsia occurs in roughly 10 to 15 percent of women carrying twins, two to three times the rate of women carrying one baby.
• Pregnancies with delivery of twins cost about five times more than singletons.

How is Labor and Delivery Different With Twins?

• Many states will not allow a home birth with twins and many midwives will not deliver twins at home (though it does happen!).
• Most practitioners will schedule induction or c-section no later than 38-39 weeks gestation – there is some proof that the placentas at this time are similar to a 42 week placenta with a singleton, which means they may not be as effective in supporting your babies (which increases the risk of stillbirth).
• At least one study found that twin moms generally have a shorter first stage of labor (yahoo!) than singleton moms. Second stage was the same length (despite two babies coming out).
• Having twins does NOT mean you need a c-section. Generally doctors will allow babies to be born vaginally if both are head down. Some doctors (mine included) will deliver vaginally if only Baby A is head down, even if Baby B is breech or transverse (they will try to flip Baby B from the inside OR deliver breech – my doctor will do both). Some women opt for a c-section even if both twins are head down because they are afraid that Baby B will flip and their doctor won’t be wiling to deliver breech, which would require a c-seciton after vaginal birth, or a “double whammy” as it’s nicknamed.
• Twin births in most states must take place in the operating room – including vaginal births. Women may labor in a normal room but must push and deliver the babies in an operating room in case of an emergency c-section (the riskiest part of a twin birth is once Baby A has been delivered). There are usually about 12-14 people present when the babies are both – a doctor (or two), a NICU team for each baby, an anesthesiologist, and several nurses.
• Both babies are born before the placenta or placentas come out.
• According to a Baby Center article, about 10% of births are a double whammy, but according to the data in the “Got Twins” Baby Center group (which includes surveys from over 1,000 moms) only 3.3% of births were double whammy. The article states that if Baby A is head down and Baby B is breech when labor starts that you have a 25% chance of needing the double whammy. Obviously if your doctor is willing to deliver breech, you have a much better chance of avoiding the double whammy (which most moms consider their worst nightmare). The Baby Center survey shows that if both babies are head down the double whammy only occurred 0.8% of the time.
• Some doctors require the epidural when delivering twins in case of an emergency c-section.
• Many hospitals require constant fetal monitoring during twin labor and delivery.

You probably know more than you ever wanted to know about twin labor and delivery if you followed me through all that! It’s a lot of information isn’t it? And a little scary. At least that’s how I have felt and I’m working on moving past those fears. I know that all of these differences are precautions and it doesn’t necessarily mean that I can’t have a normal, complication-free birth. Its important to recognize the risks and mentally prepare for what could happen, but also to stay positive.

I’m looking forward to sharing how I’m preparing for my twin birth in another post next week (and let’s hope the twins don’t come before I finish it!).

What preconceived notions did you have about twin births? Did you learn anything new by reading this?