Birth with twins
Giving birth to twins | Pregnancy Birth and Baby
Twins are more likely to be born early, often before 38 weeks, so it's important to understand your birth options. Less than half of all twin pregnancies last beyond 37 weeks.
Because of the likelihood that your babies will be born early, there is a good chance one or both of them will spend some time in special care.
As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or doctor early in your pregnancy.
You should also discuss where you would like to give birth. You will most likely be advised to give birth in a hospital because there's a higher chance of complications with a twin birth.
It's common for more medical staff to be involved in the birth of twins, such as a midwife, an obstetrician and two paediatricians - one for each baby.
While the process of labour is the same as when single babies are born, twin babies are more closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once your waters have broken. You will be given a drip in case it is needed later.
Vaginal birth
About one third of all twins are born vaginally and the process is similar to that of giving birth to a single baby. If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when the mother already has good pain relief.
If the first twin is in a head down position (cephalic), it's usual to consider having a vaginal birth. However, there may be other medical reasons why this would not be possible. If you have had a previous caesarean section, it's usually not recommended you have a vaginal birth with twins.
If you have a vaginal birth, you may need an assisted birth, which is when a suction cup (ventouse) or forceps are used to help deliver the babies.
Once the first baby is born, the midwife or doctor will check the position of the second baby by feeling your abdomen and doing a vaginal examination.
If the second baby is in a good position, the waters will be broken and this baby should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.
Caesarean section
You may choose to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a caesarean section later in the pregnancy as a result of potential complications. You’re nearly twice as likely to have a caesarean if you’re giving birth to twins than if you’re giving birth to a single baby.
The babies' position may determine whether they need to be delivered by caesarean section or not. If the presenting baby - the one that will be born first - is in a breech position (feet, knees or buttocks first), or if one twin is lying in a transverse position (with its body lying sideways), you will need to have a caesarean section.
Some conditions also mean you will need a caesarean section; for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.
If you have previously had a very difficult delivery with a single baby, you may be advised to have a caesarean section with twins. Even if you plan a vaginal birth, you may end up having an emergency caesarean section.
This could be because:
- one or both babies become distressed
- the umbilical cord prolapses (falls into the birth canal ahead of the baby)
- your blood pressure is going up
- the labour is progressing too slowly
- assisted delivery doesn't work
In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if it becomes distressed.
After the birth
After the birth, your midwife will examine the placenta to determine what type of twins you have. Twins can either be fraternal or identical.
If your babies need special care
Depending on where you plan to give birth, you may need to go to another hospital with appropriate facilities if complications in your pregnancy indicate you're likely to have an early delivery.
This may not be near to home, so make sure to check there are enough beds for both your babies in the neonatal unit.
Ask if your chosen hospital has a transitional care unit or a special care nursery. These are places that allow mothers to care for their babies if they need special care but not intensive care. These hospitals are more likely to be able to keep you and your babies in the same place.
You might also want to ask if your hospital has cots that allow co-bedding (where your babies sleep in a single cot), if this is appropriate and if you want your babies to sleep together.
If you have one baby in the hospital and one at home, you will need to think about splitting your time between the two. When you visit your baby in hospital, ask if you can bring their twin and if co-bedding is allowed during visits.
If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is having trouble feeding. You may then need to put the twin who can feed on the breast to encourage milk production in order to get enough milk to feed both babies.
Check if your hospital offers support from a community neonatal nurse, which would allow for you and your babies to leave hospital earlier, for example if your baby is still tube-fed.
When you go to clinics for follow-up appointments, it's a good idea to ask not to be booked into early morning appointments. Getting out of the house with two babies, particularly if one is unwell, can be difficult.
For more information and support, visit Twins Research Australia.
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Giving birth to twins or more
It's important to understand your birth options if you're expecting more than 1 baby.
Twins and triplets are more likely to be born early and need special care after birth than single babies.
Your birth choices with twins
It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.
You'll normally be advised to give birth in a hospital, as there's a higher chance of complications with twins.
There are usually more health professionals at a multiple birth – for example, there may be 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).
For more information on who's who, read about the antenatal team.
The process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.
This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.
Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.
You'll be offered a drip in case it's needed later – for example, to restart contractions after your first baby is born.
Triplets or more babies are almost always delivered by a planned caesarean section.
Can you have a natural birth with twins?
Lots of women think they have to have a caesarean section with twins, but in fact, many twin births are vaginal
If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.
If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.
Find out more about the signs and stages of labour
You're more likely to have a vaginal birth if the first twin is in a head-down position.
But there may be medical reasons why a vaginal birth is not recommended.
If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.
As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.
Once the first baby is born, your midwife or doctor can check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.
If the second baby is in a good position, it should be born soon after the first, as your cervix is already fully dilated.
If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.
Caesarean section and twins
In the UK, more than half of twins and almost all triplets are delivered by caesarean section is a common method used during twin and triplet births.
You may choose to have a planned caesarean, or your doctor may recommend a caesarean, if:
- the first baby is lying feet, knees or buttocks first (breech)
- 1 twin is lying sideways (transverse)
- you have a low-lying placenta
- your twins share a placenta
- you have had a difficult delivery with a single baby before
As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.
In a small number of cases, some women deliver 1 twin vaginally and then need a caesarean section to deliver the second twin.
Video: how can my twin or multiple births be managed?
In this video, a midwife explains what can happen when giving birth to more than 1 baby.
Media last reviewed: 1 November 2019
Media review due: 2 November 2022
Page last reviewed: 31 October 2022
Next review due: 31 October 2025
how to prepare for pregnancy with twins
Pregnancy
Twin birth: how to prepare for twin pregnancy
The birth of twins is a unique experience full of positive emotions, but parents have many questions: discover tips and advice from the experts of the Chicco Children's Research Center.
Birth of twins: a flood of emotions and many questions
First trimester ultrasound came with a surprise: two heartbeats, two babies. Double happiness for future parents, but also anxiety and many questions about pregnancy and childbirth and, above all, how to manage life in the first few months after the birth of babies. From a physiological point of view, pregnancy with two babies has a higher degree of risk and requires extra care and attention, especially in the third trimester of pregnancy. nine0003
Pregnancy with twins: some tips
Rest is crucial: women pregnant with twins should make sure they are not too tired and should be even more careful to avoid stress as they are more at risk of preterm labor . In general, multiple fetuses result in a shorter pregnancy, and for twins, this usually lasts around 36-37 weeks. The option of allowing vaginal delivery instead of caesarean section is evaluated at the end of pregnancy based on the health and well-being of the mother, the growth of the fetus, and the position of the children in the womb.
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Organization is a key factor
As in the case of pregnancy with one baby, the moral and material preparation for childbirth in advance prevents unnecessary stress, especially in the first year of life. Tidying up the house is the first thing to decide: two cribs in the bedroom, a well-equipped changing table with cleaning products , diapers and linen changes, a double bath tub and two high chairs in the kitchen. Not to mention the many pacifiers , as well as bed linen .
Hint: pack maternity bag in advance so that you are ready to go to the hospital at any time and not worry about forgetting something important.
To get out of the house, you need a baby carriage
To get out of the house with two children, you need a set of necessary things, starting with a double or two strollers . The market offers a wide range of models that meet all requirements. You can choose from side-by-side, front-to-back or with fixed or removable seats, in a classic or more sporty style.
How to choose? It's important to take into account your personal needs, from where you live - whether you have an elevator, for example - and your lifestyle.
Expecting twins is a special experience full of emotions. By preparing ahead of time, you can safely approach the upcoming event to fully enjoy this amazing adventure. Follow the advice from the Chicco Children's Research Center to prepare for this incredibly important milestone in your life. nine0054
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Twin birth - Juno
Twin birth: the content of the article
Twin birth: understanding the terminology
Carrying 2 or more children is a multiple pregnancy. It rarely happens - a maximum of 1.6% of expectant mothers. Now there is an upward trend.
Twins are dizygotic twins. They appear when two eggs fertilize two sperm. Such brothers and sisters are not alike. By appearance, you can determine that they are relatives, but the children are not the same.
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Twins are different and same-sex. They may have a radically different character, temperament.
Causes of twins
Researchers have identified a number of factors that increase the likelihood of conceiving two babies:
- Maturity - in a woman at 35 - 40 years old, the level of gonadotropin increases, it increases the chances of becoming a mother twice in one pregnancy;
- Heredity - women on the line of the future mother had twins. She is also at risk; nine0079
- Genetics - the IGF-1 gene is responsible for tissue development, cell division. There is a direct connection between his rise and the conception of twins;
- High levels of IGF-1 protein - observed in women who are overweight and consume a lot of dairy products. Therefore, vegan women are much less likely to have two babies;
- Hormonal therapy - for example, treatment of infertility with gonadotropic drugs;
- IVF - the procedure involves the stimulation of the ovaries, which leads to the fertilization of two eggs.
nine0079 - Nationality - African women most often on the planet give birth to two or more children in one pregnancy.
Scientists from Amsterdam have identified another factor - 2 genes (one or a combination of them). The first is associated with an increase in the FSH hormone, a natural ovarian stimulator for the release of an egg. With a high level of the hormone, 2 eggs can be released.
The second is SMAD3. It is responsible for the reaction of a woman's body to the FSH hormone. If the ovaries are sensitive to it, two eggs can be fertilized. In this case, the level of FSH is not important. nine0003
The first version of the gene increases the chance of carrying and giving birth to two children by 18%, the second - by 9%, their combination - by 29%.
Features of pregnancy
Bearing several fruits is harder than one. After all, the body of the expectant mother works in an increased load mode: the uterus grows, the diaphragm and internal organs are displaced and compressed.
The heart works harder, the urge to urinate becomes more frequent, the woman suffers from shortness of breath and a feeling of lack of air. More weight gain negatively affects the spine, legs, and veins. nine0003
Higher risk of preeclampsia, hemorrhoids, varicose veins, intestinal disorders, heartburn - few pregnant women are lucky to avoid these troubles.
Probability of complications during pregnancy and childbirth of twins
We will determine the risks for the future mother.
Preeclampsia. Diagnosed five times more often. It proceeds more severely, against its background, acute pyelonephritis develops.
Anemia. It develops as a result of iron deficiency - it is consumed in large quantities. nine0003
Gestational diabetes. It occurs more often than when carrying a single child.
pathology of pregnancy. Bleeding, placenta previa, premature birth, miscarriage, abnormalities in labor activity.
Wrong position of children.
Low position, breech, foot or mixed presentation complicate the birth of twins.
Postpartum complications. After the first birth (older twin), the uterus may begin to contract - this leads to placental abruption and a threat to the life of a younger brother or sister. nine0003
Massive blood loss. An overstretched uterus can contract poorly after the birth of children. For the mother, this is fraught with blood loss, uterine atony.
Complications for children
Among the risks for babies, doctors point to the following:
- Body weight less than normal by at least 10%. In most cases, the weight does not reach 2.5 kg;
- Developmental delay. The mother's body is not able to saturate two children at the same time with nutrients and oxygen. Therefore, twins are born small and immature; nine0079
- Unpreparedness for birth. Babies are born prematurely, often severely premature. Even if one baby is ready to meet his mother, then the chances are high that the second one will be less ready for this.
Due dates for multiple pregnancies
In most cases, pregnancy ends at 35-36 weeks.
The birth at 32-33 weeks is assessed as premature. Both or one of the babies may not be ready. The consequences are a lag in physical development, low body weight and height. This is an indication for a caesarean section. nine0003
At 35 weeks, it is advisable for the expectant mother to be hospitalized in the maternity hospital. From now on, a meeting with children can happen at any moment. At 36 weeks, independent childbirth is possible.
The appearance of children at 37 weeks is considered optimal. Usually around this time this happens. They are as ready for the event as possible: healthy, strong. Weigh less than single peers. In the absence of previously identified pathologies, everything proceeds without complications.
At 38 weeks, twins appear extremely rarely. This is the best outcome.
How to calculate the due date of twins
The reference point is the first day of your last period.
Subtract 3 months from this day and add 7 days. Here is the expected day of delivery. This method is more suitable for women expecting one child.
It would be more correct for you to subtract 2-3 weeks from this date. If this is your second birth, twins may be born even earlier. nine0003
Duration of twin labor
The birth process includes 3 stages:
- Cervical dilation - from irregular contractions to full dilation;
- Expulsion of the fetus - from attempts to birth;
- Postpartum - from the appearance of the child to the release of the placenta.
The duration of these stages does not depend on the number of fruits. The state of health of their mother plays a role.
The duration of childbirth - the period of exile - is longer than with uniform gestation. This is due to the successive exit of the children. For most women, this step takes 15 minutes. nine0003
The kids go out one after another on average with an interval of 13.
5 minutes.
Method of delivery in multiple pregnancy
Expecting twins is not a reason for operative delivery. With good health of them and their mother, easy bearing and no contraindications, the woman in labor can handle it herself. An important condition is the cephalic presentation of both children, the normal location of the placenta.
In case of complications, pathology of pregnancy, contraindications on the part of the mother or babies, surgical intervention is indicated. nine0003
Natural childbirth
First, the harbingers of an imminent meeting with babies come.
The stomach drops - mom breathes easier. With repeated births, the stomach drops shortly before an important event - in a couple of days, with a third it may not fall.
Liquid stool is the second harbinger. Substances are more actively released to start the contractile activity of the uterus. They also irritate the intestines.
Increased urge to the toilet "in a small way.
" The uterus presses on the bladder - urination becomes more frequent. nine0003
Decreased activity in children. The symptom is not typical for everyone.
Pain. The sacrum, lower back aches - twins can appear from day to day or even in the next few hours.
In first-born mothers, these signs are more pronounced.
Start of the birth process
It starts with contractions - this is how the uterus opens. They are accompanied by severe pain, regular and growing.
The birth process proceeds according to the standard scheme. Some stages are specific. nine0003
The sequence is:
- Neck fully open;
- The eldest child is born: the waters break from the bladder, and the child is born;
- Pause;
- The youngest child is born. By the same principle;
- Sequence out.
If the water does not leave, the fetal bladders are pierced - an amniotomy is performed.
Delivery of twins by caesarean section
In some maternity hospitals, patients are given the opportunity to choose the method of delivery.
