If you are about to give birth to twins, triplets or other multiples, you'll almost definitely find that your labour and delivery experience is a lot different from women who have given birth to single babies. Everything from where you give birth to the number of people present during your delivery can change with multiple child birth, so it is a good idea to know what differences to expect.
Some of the more common differences to expect with twin and multiple births are..........
Place
The place in which you actually give birth may be radically different from where you would have given birth with a single baby. Because of the high risk that multiple births involve, the chances arethat you will have to give birth in hospital. You may also be required to give birth in an operating room, surrounded by lots of machines and lights, especially if you are experiencing labour complications. This is not to say you won’t be able to give birth to your twins at home or in a birthing center but you will find that most health care providers will advise you to give birth in hospital, in case of an emergency.
People at the Delivery
You might also find that you have a lot more people with you in you delivery room than is usual with a single birth. Because you are about to give birth to two babies, it's necessary to have more people available to help care for the babies once they are born. You may have up to two obstetricians and two midwives on hand for the delivery. There will also need to be an anaesthetist there, should you require a caesarean section. Your partner will also be in the room, along with a paediatrician. Some hospitals also allow students to look on during multiple births, as long as you have no objections.
Medication
It is not unusual for staff to strongly encourage having an epidural instead of 'going for' a natural birth when it comes to giving birth to twins or multiples. Though you won’t feel any more pain during a multiple birth than you would during a single birth, multiple births are more likely to be delivered via caesarean section. Should a c-section be required, an epidural will enable you to make the transition much more easily.
Vaginal Birth or Caesarean Section ?
Women who are expecting twins/multiples often wonder if they will be able to have a vaginal birth, or if they will have to have a caesarean. Well, as long as your labour is uncomplicated, it is possible ,and in fact it is usually recommended, to deliver both babies vaginally. However, because multiple births can be so unpredictable, caesarean sections are often needed to help deliver twins and multiples safely. On average, about 50% of multiples are born vaginally, while the other 50% are born via caesarean section.
Birth Presentation
The major factor in determining whether or not you will need a caesarean is the position of your babies in your uterus. Unlike most single babies, who are typically born head-down, multiple babies can be born in various presentation combinations. This can make vaginal deliveries more complicated, particularly if one or both of the babies is breech or transverse (sideways).
If the first baby is head down, you will likely deliver this baby vaginally, unless you are experiencing other complications. Once the first baby has been born, you and your health care providers will then try to deliver your second baby vaginally, as well. This is typically possible if the second baby is also head-down, however, it may be impossible if the second baby is breech or transverse. Your midwife/obstetrician will try to move the baby by pushing on your uterus, but this is not always effective. If your second baby remains in a breech or transverse position, you will probably have to have a caesarean section.
If the first baby presents in breech or transverse position, it is unlikely that you will be allowed to proceed with a vaginal delivery. Most health care providers feel uncomfortable delivering breech babies when caring for a multiple pregnancy. In this case, both babies will be delivered through caesarean section.
Other Complications
Other complications that can arise during labour and delivery may mean that you will have to have a caesarean delivery. Caesarean deliveries are often performed if:
 ....you are suffering from pre-eclampsia
....you experience placental abruption
....labour is not progressing
....one of the babies is too big to fit through the birth canal
....one or both babies is showing signs of distress
Dealing with Twin Labour and Delivery
If you are expecting twins/multiples, there are a few things that you can do to help everything go as smoothly as possible.
Make your birth plan well ahead of time. This will give you and your health care provider the opportunity to become familiar with the plan of action on delivery day.
Learn what to expect. Though anything can happen, you will be able to deal with it better if you become familiar with all aspects of birthing twins.
Read up on both vaginal and caesarean births, so you will be able to deal with anything that may happen.
Be flexible. It is difficult to predict the course of a multiple birth, so try to roll with the punches a little and don’t worry to much if things don’t go as planned. However, if you are concerned or unhappy about what your health care provider is doing, be sure to speak up.
March 2008
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