Twin Birth Considerations
Nancy Bowers, a registered nurse, creator of the Marvelous Multiples childbirth class in Atlanta, Georgia, and author of The Multiple Pregnancy Sourcebook, warns that a singleton pregnancy birth plan and a multiples pregnancy birth plan are very, very different. "The greatest difference between a singleton birth plan and a multiples birth plan is the need for expectant parents to be flexible!" Bowers says. "Multiple babies mean multiple chances for things to change."
The first thing expectant parents need to understand is that multiple birth is high risk. Even when there are no known complications, the events of labor, delivery, and recovery can change very quickly. "This is why having a home birth or delivering in a freestanding birth center without surgical facilities is never a wise choice for multiples, even for twins," Bowers says. "However, being high risk does not preclude having options. There are just different options for different situations."
Treatments or interventions that might be optional with a singleton are sometimes required with multiples. Singleton mothers are allowed to walk during labor. But with multiples, the position of the babies and their umbilical cords in the uterus can change as labor progresses, making some maternal activities, such as walking, not possible.
"Another example is labor anesthesia," Bowers says. "While an unmedicated delivery with twins is possible for some women, there are certain situations in which having an epidural can be advantageous, such as when a multiple is turned, delivered breech or if an emergency Cesarean delivery is needed."
Starting the Birth Plan
There are many more differences in a multiples' birth and labor than a singleton's, and Bowers believes that these variables are best addressed in a birth plan. "When everyone is talking on the same level and about the same things, there are fewer surprises and fewer disappointments for all involved," Bowers says. "I strongly suggest couples start talking with each other and with their care providers about this long before delivery. Healthcare providers want families to have a wonderful and memorable birth and are usually very accommodating, when possible."
One of the exercises in Bowers' Marvelous Multiples birth preparation classes use a set of two-sided index cards. Opposite scenarios are written on each side of a card. For example, one side of a card might say "vaginal delivery" and the other says "Cesarean delivery." Another card says breastfeeding/bottle-feeding and so on.
"In my classes, I have each couple work with a set of 12 cards to design their ideal birth scenario," Bowers says. "Then I ask them to select a card to turn over to the opposite side. This means they can't do something they wanted in their ideal scenario, such as having an epidural rather than general anesthesia."
By the end of the exercise Bowers has had them turn over three or four cards. Deciding which cards to turn over helps parents prioritize the times in a birth plan and determine what's really important. In the end, they recognize that safeguarding the health of Mom and the babies far outweighs any "nice to have" options.
Flexibility is Key
While Peggy Willard of Parksville, British Columbia, Canada, didn't have a formally written birth plan, she and her doctor had already been over the particulars. "I was very specific with my doctor about what I wanted and what I did not want," Willard says. "First off, I did not want to have a C-section unless absolutely necessary because I had already delivered my third child breech, so I really didn't think that there was any type of birth that I couldn't 'handle.'"