Saturday, 22 November 2014

BIRTH WEEK: What if it's more than one baby!?

Multiple births account for 1 in 62 births in the UK, with the rising use of fertility treatments and women having children later in life increasing the likelihood of twin pregnancies. Experiences of pregnancy and birth with twins can vary substantially, twins who share a placenta for example are perceived as higher risk than twins who have a placenta each. In this piece, we hear from Mars Lord, who is a mum of five, including one set of twins, and works as a doula in London specialising in twin births.

1. What was your experience of birthing twins?

My personal experience was akin to most twin mums I think. There was an assumption from all around me, including some medical professionals, that it would be a caesarean birth. Despite all I know about birth today, then I knew nothing. I know right? A clueless mother of three. Fortunately I had a Senior Consultant that believed in women's ability to birth her babies. Rather unfortunately I never got the opportunity to birth my babies vaginally.

With sky rocketing blood pressure, I was pre pre-eclamptic and the decision was made to prepare me for caesarean birth. For me it was the coldest and most clinical of my births. With no knowledge of the things that I could do or request, I went happily into a sterile theatre and my babies were taken from my body. Please, don't misunderstand me, I know why it happened and I am grateful that it did, it was just, frankly, the worst of my birthing experiences for me. I felt so detached and absent, and when they handed me my babies, My initial thought was 'meh!'. I realise that it was the lack of oxytocin and my lack of involvement.

With my clients, it is much more of a mixed bag. I have seen some glorious vaginal births, some shocking interventions, some bullying and coercion, some fully supportive health care professionals and some beautiful caesareans. When everyone works together in support of the mother, amazing birth happens. These are not just the 'in a field of flowers with a choir' births, but also the hospital births, the caesarean births.

I have had clients change consultants when they have met rigid walls. Some have even changed hospitals. One client reached out to the head of her health trust who signed off on her birth plan so that she could have a physiological intervention free birth. This client wasn't ignoring medical advice, she simply wanted the chance to birth her babies herself. She stated time and time again that if medical circumstance indicated caesarean, then all bets were off and that is what she would do. Her joy and total delight at her babies entering into the world is one of the moments that has seared itself across my heart. Some clients don't have to fight that hard for a physiological birth. They have consultants and midwives who believe in them. In my opinion, that is key.

2. As twins are perceived as higher risk than a singleton pregnancy, do women pregnant with twins feel that their birth choices are more limited?

Yes, unfortunately I think that many do. We hear the word risk and tend to be automatically risk-averse. We would do anything rather than deal with a risk. What is unfortunate is that the risks on both sides often aren't talked about. So, it is important to find out  the following:

  • What is the risk of going to full/post term with twins as well as the risk of having twins come early? 
  • What are the risks in the birthing choices that you have been given? Caesarean birth risks and vaginal birth risks. 
  • How likely is it that by having a vaginal birth you will end up having one baby vaginally and the other by caesarean? 
  • What are the hospital's percentages of twin vaginal births? 
  • What are the hospital's twin induction rates? 
  • Does the trust have midwives and consultants that are experienced in twin vaginal birth? 

Often the choices that we feel we have to make are the very ones that increase the risk of us not having the births that we want. It is easy to be sent along the elective caesarean route. It is expected by pretty much everyone around us. Some women want to be able to move around freely whilst in labour. This shouldn't have to change because you are expecting twins. Do you want continual monitoring etc? When you labour with twins, you get to 10cm and you have your babies. You don't have to do the entire thing over again. You push for each baby.

You are more likely to have your babies in hospital, but you can birth your twins at home. Independent Midwives are available and, if you are prepared for the long haul 'fight' perhaps you can get a homebirth within the NHS. It is always a good idea to get hold of your hospital's Multiple Birth Policy. This gives you a framework with which to start your conversation with the consultant and the midwives. Be prepared to have to have the same conversation repeatedly. Craft your birth preferences. This is still your body, your babies, your choice. Take on board what the health care professionals are saying and don't be afraid to ask for the other side of the coin.

3. Do you feel NHS maternity services are well set up to cater for twin births?

I don't think that the NHS maternity service is well set up for twin birth. Of course this might just be my London-centric view. This saddens me because I do think that it ought to be and could be. There appears to be a sad loss of experience in twin vaginal birth amongst midwives, in the same way that there is a lack of midwives with breech vaginal birth experience.

We learn more and more that caesarean birth comes with risks that actually don't always make it safer than vaginal birth. Each family are different, each family should make the choices that are right for them. All the options for twin birth should be explored, there shouldn't be an automatic surgical option. I feel heartened each time I hear about another hospital that has helped facilitate a physiological birth of twins.

Of course we have to bear in mind that things don't always go to plan and that some complications in some particular twin pregnancies will necessitate a caesarean and rule out vaginal birth completely. We have these life saving measures for a reason. But we should take lessons from those midwives and consultants that listen to the mother and actually hear her.

I do feel the groundswell movement to give birth back to mothers and a working together of all the healthcare professionals. It is wonderful to have it happen and my prayer is that my children, and their children, benefit from it.

4. What do you think is the most important thing a woman can do to prepare herself for a positive birth experience?

A good birth is an informed birth. Know your options, get the multiple birth policy. Talk to the twin mums that have 'bucked the trend'. Make your plans A, B and C (how you would love it to go, what happens when it doesn't go to plan and the Caesarean section plan). Listen to the stories of twin mums who had positive experiences. The Positive Birth Movement has lots of stories and groups all over the world.

Mars Lord (MammyDoula) is a mother of five, including twins.  She is a birth and postnatal doula, specialising in twins, who works in London. An avid theatre goer and drinker of red wine, Mars is often found de-briefing mentored doulas in her favourite theatre cafe.  Her passions also include reading, dancing and all things birth. Follow Mars on twitter @mammydoula. 

Are you pregnant with twins or a mum of twins? Have you felt supported in your birth choices? Would be great to hear your experiences!


  1. Yes risk is mentioned a lot. Until 19 weeks we thought the boys were mo/mo the highest risk category which we were told was early delivery and c section as there was a strangulation risk in each others cords. Personally I always felt happy with my consultants risk analysis and didn't feel I had to argue. She was also pro vaginal birth so from the start it was agreed as long as the presenting twin wasn't breach I could have a vaginal birth. My dream birth would have been a water home birth and I will be forever sad I've never experienced this but I have 2 happy healthy toddlers which outweighs that.

    I think communication could be better. My first birth was at the birth centre and I chose to stay 2 nights. With ds 2 and 3 I didn't know until the day that they wanted me to birth in theatre just in case. It wasn't a problem but it was a surprise on the day. Epidural was a choice but one I took so that if there was a problem I would still be awake during a section. In the end these things were an advantage as after the vaginal delivery I had a huge haemorrhage. My midwife was great. Keen to deliver the second baby as well as the first but the registrar insisted on being responsible for the second. Both were great in terms of the care they gave. We ended up staying in for a week which I hadn't expected and wasn't emotionally prepared for. I was then told it was normal after twins. Please tell people this first, especially with an older child waiting at home.

    1. Yes. It would be wonderful if there were more communication. I do believe that informed choice allows us better births.

      I'm sorry that you didn't get your dream waterbirth. Perhaps with your fourth!

  2. Although I felt looked after during my twin pregnancy (scans every 2 weeks, consultant appointments etc) I was definitely unprepared for the birth, which was unfortunately pretty horrific. There was no real plan for my care, just a "wait and see" approach as both babies were head down. My labour was mismanaged from the start, and I ended up having an emergency caesarean 78 hours after my waters broke. Both babies were then taken away to special care and they didn't come back for 36 hours. Unsurprisingly I didn't even feel like they were mine by then! I wish there had been one person who was properly in charge of my pregnancy and birth - perhaps a specialist midwife? Who knows if it would have made any difference, but I would have felt more in control and less like an experiment

    1. Mrs R...I am so sorry that that was your experience. I have no words and wish that I did.

  3. I had my twins four years ago in Belgium. My gynecologist told me that a twin pregnancy meant more risks, but never spoke about a caesarian. The pregnancy did not go well, at 27 weeks they discovered that our twins probably would come earlier. I had to stay lying on the couch from that day on. But it was well worth it because they stayed in my belly untill 37,5 weeks!

    The birth happened how I wanted it. I did not want an epidural, that was ok, but I had to let them put a catheter in my back, just to make sure that was already there if an emergency caesarian would be needed for our second baby. The birth was a normal birth, on a bed. My husband could pull the second baby out of me, something I still find very special. The only thing I would have seen different is the moment after birth. I only got them on my chest for 20 seconds before they were taking away for a check up (in the same room so I could see them). The check up only lasted half a minute and then I got them back on my chest. But it didn't feel natural that they were taken away and touched by other hands then mine and my husband.

    I did not want to stay long in hospital because I wanted to be with my elder child. I stayed for two nights (if I remember it well) and had to convince them to let me go home. They rather wanted me to stay a little bit longer because the iron level in my blood was very low. But I really stressed out in the hospital and wanted to go home (strange enough I liked being in the hospital with my fourth one...).

    I think the key part in my positive birth experience was the trust I had in my gynecologist and the support from my husband (who actually wasn't allowed to say or do much because I was living in my own little bubble). I had my birthplan I shared with the staff and I knew that my gynecologist would do everything to make the birth going like I wanted to. And everything that wouldn't go by plan, should be because she thought it was necessary.

  4. How wonderful. Trust is a key component. So glad that you had that and such a positive experience.

  5. Hi Mars, It's really interesting reading your blog and the replies :) I am 25 weeks pg with di/di twins and the hospital I am booked into (C&W) has a 'vaginal birth policy' for twins (or at least, they definitely steer you down that route unless there are any complications). At first this worried me as I wanted choice, but i now feel that this is a good thing - it means hopefully that they will try to enable me to have a vaginal birth if everything is going to plan. I have also decided to hire a doula :) and I'm really excited that I will have someone there with me to support my wishes and help keep the communication channels clear.

    I'm very scared of going against the hospital's advice (we've waited a LONG time for these babies), but equally would like to have a say in how my twins are born and at the moment it's unclear where that line is drawn.. I feel that having a doula will help me through the decision-making process (and also tell me when I need to do what the hospital recommends!)

    I'm also hoping that my husband will be able to enjoy the process when it happens rather than feel like he's responsible for me, the birth plan and the babies all at the same time... I think it might send him over the edge which won't help me!!

    Most of my twin-pg friends already have their elective C section dates.. it feels very strange being in limbo about my babies' births.. but i'm hoping over the next few weeks I'll be a bit more sure about what I'd like.

    Thanks for sharing your experience :) x