Birth Plans for Twins—or More!

Willard also wanted to nurse her twins as quickly as possible, though she knew that might be more difficult with twins. "I wanted my doctor to know what I wanted so that he would be aware of my expectations," Willard says.

As is often the case with multiples, Willard's expectations did not match up to the reality. "When I wound up having a C-section, I have to honestly admit that I was upset with my doctor," Willard says. "But at the same time, I had to trust that he truly knew what was best for my girls."

If Willard had to do it all again she would create a more flexible birth plan. "I would also better prepare myself for that plan to fail and simply remind myself that the only thing that truly matters is the health of my babies and my own health," she says.

For Denise Archambault, childbirth educator for Women & Infants Hospital in Providence, Rhode Island, flexibility is key. "It is important for families to be flexible, as no one can predict how the birth experience may unfold," Archambault says. "When everyone knows that the goal is a healthy mother who births healthy babies, it can be a positive experience."

Archambault believes it is the loss of control that affects the parents of multiples the most. "Many families have used assisted technology to conceive these precious babies, adding to their stress," Archambault says. "The dream of the entire process happening naturally versus the reality of all the technologies that may have been necessary to create healthy babies for healthy mothers may disillusion some families about having any control or plan."

A flexible birth plan can help parents feel a sense of control while still reminding them that anything can happen. It's important to write down and make known the things that are most important for them to experience, such as being able to hold their babies soon after birth, for Dad to cut the cord or to be able to put their babies to breast as soon as is able.

"Families feel a loss of control when they do not have options or are not part of the decision-making process," Archambault says. "Medical circumstances may supercede the family's wishes and plans."

Bowers agrees. "Remember that a birth plan is a tool, not a contract," she says. "If you lock yourself in to one hard and fast mindset or you don't understand the high-risk nature of multiple birth, you are likely to be disappointed if and when your plans don't match the outcome. I encourage expectant parents to develop a plan with realistic options, rather than a fantasy birth scenario."

4 Tips for Developing the Birth Plan

• Remember to include basic information—even if the hospital and doctors already have it. Information such as your full-term due date, your birth supporter's name, your obstetrician's name, and how many babies you are having should all be immediately available at a glance.
• Spend some time mapping out the plan with your partner. Are you going to have a doula? How do you want to record the birth? Do you want pain medication? Does your partner want to cut the cords? Are you breastfeeding?
• Make sure you give a copy of your birth plan to your labor support people, your birth attendant, your childbirth educator, and your birthing center or hospital nursing and admissions staff.
• Make sure you think of the issues that might arise if you go into preterm labor, which is very common with multiples. If at all possible, tell them you wish to be transferred before delivery to a hospital with a neonatal intensive care unit (NICU) offering the highest level of care. It is better to deliver at a hospital that can give the appropriate care than it is to have the babies moved after delivery. Or perhaps you want your partner to go with the babies into the NICU rather than stay by your side. You'll want to make sure these things are known ahead of time.