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On episode seven of the Double Happiness Multiplied podcast, we explore birthing options for multiples.
We talk to Maternal Fetal Medicine Specialist Professor Craig Pennell about the types of twins that will require a caesarean delivery and those that can be safely delivered vaginally.
Founder of Rockstar Birth Magazine and Rockstar Birth Radio, Shalome Stone explains why a birthing plan is important.
Hypnobirthing Practitioner and Birthing Doula Elysee Jamieson shares her experience of birthing breech fraternal twins.
And, I’ll tell you why my girls were delivered by Caesarean section.
By the end of this episode, you’ll be armed with all the information you’ll need to make educated decisions about the birth of your babies.
Talking About Birth
Birth. The topic can get as heated as bringing up politics, religion, or vaccinations at a dinner party. There are many people who have incredibly strong opinions on the matter, oftentimes formed on the basis of misguided information.
You’ve probably heard people say things along the lines of, ‘women have been giving birth to babies in the open fields for centuries and they always did fine’, well they often didn’t and the mortality rate was exceptionally high.
However, pregnancy and birth have become incredibly medicalised and it’s often difficult to find a middle ground as such.
So, whether you’re someone who holds dear to your plans of a drug-free vaginal delivery or you surrender yourself to an attitude of going-with-flow, it’s important to be educated on the possibility that your ideal birth plans might need to be altered.
Let’s face it, many multiples wouldn’t cope with the journey down the birth canal and without medical intervention those precious babies wouldn’t survive.
On the other hand, if you have an uncomplicated multiple pregnancy, and under the guidance of a team with experience in multiple births, Professor Craig Pennell assures us that in most cases you can achieve a vaginal delivery.
As Professor Pennell explains there are many things that need to be considered in planning the most appropriate form of delivery for a twin pregnancy.
Type of twins;
Monochorionic Monoamniotic twins will always be delivered by caesarean section,
Monochorionic Diamniotic twins have a high rate of caesarean birth due to common complications,
Dichorionic-Diamniotic – more likely to achieve vaginal births.
Parity of the mother – delivery of twins is technically more difficult for a first-time mum than a woman who has had one or more vaginal births.
Complications in the pregnancy.
Gestation – delivering a set of twins at 24-weeks is very different from delivering twins at 37-weeks.
Location – smaller hospitals might not be equipped to cater for the vaginal delivery of twins.
And, the experience of your obstetrician.
“If you are in the public hospital system in Australia or the United Kingdom, and you have an uncomplicated set of Dichorionic Diamniotic twins, and the first baby is coming head first, then it would be the normal approach to consider a vaginal delivery.”
~Maternal Fetal Medicine Specialist Professor Craig Pennell~
“To put all this in perspective, if you are in the public hospital system in Australia or the United Kingdom, and you have an uncomplicated set of Dichorionic Diamniotic twins and the first baby is coming head first then it would be the normal approach to consider a vaginal delivery,”
“Similarly, in Australia and The United Kingdom if there was severe growth discordance, where the first twin was small and the second twin was large and the mother was unwell, in that situation it’s much more likely that you would have a caesarean delivery,” says Professor Pennell.
When Do You Discuss Birthing Options?
Professor Pennell goes on to say that the discussion about the type of birth you’d like should happen early on in the pregnancy, such that your obstetrician can present you the risks and benefits of each option.
“What everybody’s afraid of is getting the first twin delivered and getting the second one stuck,
“The chance of caesarean section for a stuck second twin is approximately one-to-two per cent, these are small numbers but they are very significant risks,”
The easiest type of twins to deliver is where the first one is head first and the second one is head first, unfortunately once the first baby has come out the second baby’s position changes, which is why it’s always sensible to have an experienced person around with twins, even if they look like they will be straightforward to deliver, according to Professor Pennell.
“If the first twin is breech and the second twin is head first then we would generally not deliver those twins vaginally, because of the risk of the heads getting locked,”
“If both of the twins are breech then it is certainly possible to achieve two breech deliveries,” says Professor Pennell.
Maternal Assisted Caesarean Section
There is a growing trend for women to have as much involvement in their birth as possible and the maternal assisted caesarean delivery has started to be mentioned in multiple births circles. It’s important to consider that although relatively straightforward in a singleton pregnancy, a multiple pregnancy carries increased risks.
As Professor Pennell explains with this procedure the mother is prepared for her caesarean section in the normal manner, however, her arms and hands are prepared with surgical scrub, gown, and gloves such that when the head comes out the mother can reach down and put her hands around the baby’s shoulders and complete the delivery by herself.
“The important thing to realise is that in a twin delivery if the first baby is coming head first this procedure is certainly possible, but in terms of a breech delivery, these are technically challenging in caesarean and vaginal delivery,”
“So, it’s not possible for a mother to bring her arms down and grab the baby’s legs and deliver that baby safely,” says Professor Pennell.
Do your Research
Hypnobirthing Practitioner and Birthing Doula Elyse Jamieson did exactly what Associate Professor Pennell advises, she did her research and got a second opinion to find a birthing team she was happy with to deliver her non-identical twins.
“So, for me, I was absolutely preparing for a vaginal birth of my babies if everything was safe for me and them,”
“But I soon found when I turned up to my hospital in order to have that, there were a lot of protocols in place, things like having an epidural in place, which I wasn’t personally comfortable doing,”
“I discussed that with the hospital I was preparing to birth at and felt that for me in the public system where you’re at the mercy of who’s on, on the day, it wasn’t the best option for me to stay in that system,” says Elyse.
Elyse set out to do some research and found an obstetrician who was happy and comfortable for her to birth without the epidural. He was also skilled in twin births and skilled in breech birth, which worked out really well considering that both of Elyse’s babies ended up in the breech position at term.
“I wouldn’t be going in willy, nilly or blind to a birth and expecting to have a vaginal breech birth without having a care team who were confident and skilled in that area.”
~Twin mum, Elsye Jamieson – founder of Somabirth~
“I wouldn’t be going in willy, nilly or blind to a birth and expecting to have a vaginal breech birth without having a care team who were confident and skilled in that area,”
“The first baby came out frank breech, so he came our bum first,”
“Twelve minutes later the next baby came out, he came out double footling with his arms over his head like Superman,” explains Elyse.
Elyse says although there were lots of people in the room for her twin birth, it felt a lot more calm, safe, and quieter than when she gave birth to her singleton. She believes the reason it went so well is that she trusted everyone in the room.
“For me, it was a very straightforward double breech vaginal birth, which is uncommon but I am very, very grateful that it panned out in that way,”
“There was no pressure after the first twin was out, he had delayed cord clamping and was put on my chest and we had a bit of a nuzzle and snuggle before I started bearing down for the second twin,” says Elyse.
Now, Elyse did have a birthing plan and because she had already birthed a singleton she knew there were certain standards she’d accept the second time around. Although, a birth plan was part of her preparations for the birth of her twins she was also realistic about the outcome.
This same approach is advocated by the founder of Rockstar Birth Magazine and Rockstar Birth Radio, Shalome Stone.
“When we talk about birth plan there’s a sense of definitiveness about that as if you could write down your ideal birth wishes and that they would, therefore, all come true, and we all know birth is not like that,”
“There are untold twists and turns in every birth journey because it’s a dance of two people, there’s you and there’s your baby and sometimes they decide how they want to be birthed,”
“But what you do when you’re creating a birth plan is that you’re putting some thought into how you would like your birth to unfold,” explains Shalome.
Shalome says it’s not about being prescriptive, it’s about putting some research into what’s available to you. And, asking yourself questions, such as;
What feels right to me?
How would I like my birth to unfold if it were to flow smoothly?
How would I like it to unfold if it doesn’t flow smoothly?
What interventions would I be happy with?
How mobile would I like to be?
What type and level of motoring would I be comfortable with?
Is delayed cord clamping important to me?
If a caesarean section is recommended, will I be interested in assisting the delivery?
“It’s not about researching every medical paper and writing a ten-page birth plan, it’s about getting to the point that you feel comfortable with where you’re at.”
~Shalome Stone – founder of Rockstar Birth Magazine and Rockstar Birth Radio~
“It’s not about researching every medical paper and writing a ten-page birth plan, it’s about getting to the point that you feel comfortable with where you’re at,”
“I’d encourage women when they are pregnant to feel into their intuitive side, there is a knowing that comes with pregnancy, there is a heightened sense of intuition,”
“As you’re crafting your birth plan and you’re thinking about your options, really tap into what feels right to you,” says Shalome.
Things to consider for your birth
How do you want it to feel?
What do want the room to look like?
Who do you want to be present?
How do you want to be supported?
Do you want the word pain excluded from your birth plan?
Shalome suggests women explore the level and depth of the content they want in their birth plan, and also look at creating an alternate plan to turn to if things don’t unfold as expected.
“So, you had hoped to birth your babes vaginally and something has taken a left turn when you thought it was going right, and now your team are talking about needing to do an unscheduled caesarean birth,”
“Instead of fearing that as an outcome, and not wanting to put any attention to it for fear that you might actually manifest it, have a think about getting comfortable with that option,” says Shalome.
Things to consider for your alternative birth plan
Would you want a gentle or family centred caesarean birth?
Would you want the drape to be dropped if possible?
Would you like to have a clear drape?
Would you like immediate skin-to-skin contact?
Do you want delayed cord clamping?
Your birth plan should be short and easy to understand in the event that someone new to your team will be able to quickly scan it and know what you want.
“So, you had hoped to birth your babes vaginally and something has taken a left turn when you thought it was going right and now your team are talking about needing to do an unscheduled caesarean birth. Instead of fearing that as an outcome and not wanting to put any attention to it for fear that you might actually manifest it, have a think about getting comfortable with that option.”
~Shalome Stone - founder of Rockstar Birth Magazine and Rockstar Birth Radio~
There were no birthing plans, or in fact, any expectations for the birth of my twins. You see, the idea that I was actually having twins was still sinking in when it was discovered there were serious complications in the pregnancy. The Intrauterine Growth Restriction diagnosis meant that the girls wouldn’t survive a vaginal delivery. And it was very clear they would be born prematurely.
So, at 28-weeks’ gestation when the sonographer informed us it was time to deliver the girls, I had no idea what would unfold.
It turned out that the girls and I didn’t cope with the epidural and there were times when I remember feeling like my heart was stopping, and I was about to simply drift away. Also, I could tell there were significant concerns for my smaller twin, Aasha, with her vital signs dropping.
Eventually, we were stabilised and I was wheeled into the operating theatre to be met by what seemed like such a large number of people.
I could feel the pressure of the scalpel and I was trying so hard to be strong for what lay ahead. It was a complicated delivery. When twin one’s sac was ruptured to get her out, twin two’s sac also burst due to some kind of fusion between them.
The girls weren’t well enough for me to hold, and one by one they were held up for me to see, Bella was a dark purple colour, which really shocked me even more so than her size, and Aasha, she was so tiny. They were both quickly whisked away by the Neonatal Intensive Care team.
The girls had barely left the room when I could tell there was something wrong, I could feel everything. The small amount of epidural that got me through the birth had worn off. Then everything went black.
I woke up shivering and had no idea where I was. I couldn’t stop my teeth from chattering and I felt an extreme sense of anxiety. I drifted in-and-out of consciousness for the next hour or so and eventually was wheeled back to my hospital room.
It wasn’t until later that night that I could get down to the NICU to see the girls.
My birth story wasn’t ideal. However, it saved my girls’ lives.
It’s important to be under the care of a team that specialises in multiple births.
If you’re not happy with the care you’re being provided, you have the right to get a second opinion.
Put some thought into how you’d like your birth to pan out.
Create an alternate plan in the event things don’t go to plan.
Having multiples doesn’t always mean a caesarean delivery.
Thank you for listening to Season One Episode Seven of Double Happiness Multiplied.
Coming up on Episode Eight … we’re talking with Consultant Neonatologist Doctor Patricia Woods from King Edward Memorial Hospital in Western Australia about what to expect when you have babies in the NICU.
Mum of quadruplets Jannelle Snaddon walks us through her NICU journey.
Psychologist Monique Robinson offers practical advice about taking care of your emotional wellbeing when you have babies in NICU.
Also, I’ll share my NICU story with you and I’ll read a moving letter from a micro-premmie mum written to other parents of premature babies.
Until next time….
I wish you Double Happiness … Multiplied.
Double Happiness Multiplied - What you need to know about having Twins, Triplets, & Quads book:
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Double Happiness Multiplied
Hypnobirthing Australia™ Practitioner & Doula, Soma Birth
Rockstar Birth Magazine & Rockstar Birth Radio
Podcast music by:
Catherine Ashley Harpist