twins/placenta question

[reducereuserecycle]

i am not expecting twins...but people keep saying i look like i'm carrying twins...you know, people in the grocery ect.

anyhow, if i do end up having twins (which i do think is unlikely) i want to make sure i have the logistics down. i have researched a little but everything i about having one vaginally then a c-section for the next one...i know people on MDC have uc'd twins...anyhow, here are my question:

i want to do a full lotus...is there any reason why you have to cut the cord when one twin comes out?

what is the normal order? baby, placenta, baby, placenta?

can twins share a placenta?

any other basic info would be helpful-thanks

[Serenyd]

The peeps over in the multiples forum are waay more knowledgable about this stuff. Why don't you try over there? I know that yes, they can share a placenta, but the rest of it I'm pretty clueless on.

[berrymama]

I am by no means an expert in this area, but in the twin births I have seen, usually both are born and then the placenta(s). The first cord was cut and left hanging until the birth of the second twin. Placentas can be separate but grow together. Also depends on if each baby has their own amniotic sack or not.

[fyrebloom]

Twins are MIGHTY complicated. There are a couple different types. The most common is fraternal. They USUALLY have two placentas but sometimes the placentas can fuse together and look like one. This is the lowest risk type of pregnancy because they don't share the placenta and are at lower risk for IUGR and placental complications.

Identical twins (I will call them MZ or monozygotic) usually share a placenta, but sometimes they do not (1% of the time). As with fraternals, a diamniotic/dichoriatic set can have a fused placenta. When twins share a placenta they have a 20% chance of having a condition called Twin to twin transfusion syndrome, which means one baby's blood gets diverted to the other baby. It has an 80% mortality rate if not caught right away and not much better if it is. It really needs to be monitored closely so that some measures can be taken if possible, which include removing amniotic fluid from the bigger baby (reduced risk of PTL from polyhydramos) or using lazers to cauterize the placenta to stop the flow. The babies then need to be monitored after birth because the donor will be anemic and small and the recipeint will have heart probs. 1% of identicals are also monoamniotic. These babies almost always need to be a c-section at about 36 weeks because statistics show most of these baby cord compress after that and kill each other. If they make it full term the first baby will compress the second baby as their cord gets pulled during the birth.

Birth is baby, baby, placenta, placenta. One risk is placentas can shear off the uterine wall prematurely and if the wrong one does it could kill the baby still inside. It's uncommon to happen but more likely then in a singleton birth. Other risks are due to positioning. 60% of babies are both head down, 20-30% are baby a down, baby b breech. Both are fine and safe for Vag delivery. Sometimes they are breech breech (also ok) but sometimes (and in the case of my twins) they are baby a breech and baby b vertex. This can lead to a situation where the babies chins lock and they can't get out. Babies can also end up with transverses in there. As long as baby A is head down then vag birth is very safe, and sometimes with baby b breech it is also safe. I attempted a UC with my twins and ended up needing a c-section. It's just something you have to be aware of when you carry twins.

If you suspect twins I would try to get an ultrasound. I think it's best to be prepared. A lotus birth would be difficult with twins since you would have to labor with the first baby still attached. It can be hours between births and in the case of MZ twins the first can transfuse to the second and cause probs or if you do it with the second the blood supply would be double and might overwhelm the baby.

[MsBlack]

What fyrebloom said is the way I understand twins also, for the most part. As a UC mom I would not want to UC twins without some medical surveillance--at least, an early (as early as possible, which can vary depending upon when twins are suspected) to find out which type of twins, the sac and placenta situation, etc. Also I think I'd have u/s later to be sure that placentas haven't fused, causing twin to twin transfusion--and maybe another at the end to see about babies' positions. In the meantime I'd probably be looking for a mw skilled w/twins at homebirth--just in case I felt it was still safe to be at home, but wanted the skilled support. Sometimes even at a singleton birth it can be good to have an extra set of hands lent by someone who knows something about birth and neonates (whether a skilled mw or sensible UC or hb friend) Can't help but think that twins would present that need for more hands, somewhat more often than singletons.

[MamaRabbit]

My understanding is that TTTS is only for shared placena not fused placentas.

For my twin UC it was baby, baby, placenta. We clamped/cut the cord for Baby A as planned because we were not 100% sure if it was one placenta (risk of acute TTTS at birth) or two fused. We gave her 5 minutes unclamped but then contractions started up again and I needed to pass her off to my mom so I could concentrate on Baby B.

Yes, I definitely needed extra people for my twin UC. My husband, a friend acting as doula/assistant to hand me stuff I needed, photographer, my mom to watch the older two.

[MsBlack]

While TTTS is more common with a shared placenta, it is certainly possible with fused placentas. I know a woman who had this happen--she had the laser cauterization done, problem fixed, had a natural birth in the hospital (with a very natural minded, radical minded perinatologist).

[reducereuserecycle]

it is interesting to hear all about the logistics of twin births. i can't imagine being pregnant with twins and not knowing it...can't you feel that there are 2 in there?

it is sorta annoying the way people start saying it must be twins just because of the size you get at 9 months pregnant...and it has made me second guess myself...because i really don't feel like i'm carrying twins.

[fyrebloom]

TTTS is a physical impossability with a fused placenta. Some cell or blood transfer IS possible with a fused one but the placentas cannot share blood vessels like it can with a single placenta. It is also less severe in Mono/mono MZ twins because of the single sac.... the babies cannot get poly/olgi hydramos. There can be size differences though due to uneven blood flow.

More hands are def important, and I would not have a MZ twin pregnancy without some monitoring due to TTTS or mono/mono. I would do a UP with fraternal twins though. As I said my UC with my twins didn't really work out, and that was partially due to the prenatal care i got and the STRESS they put me under to have a c-section. I ended up with pre-e and my time ran out... so c-section it was. It frequently doesn't happen that way, and since MZ twins are so uncommon you're likely to conceive fraternals if you conceive twins at all.

You CAN have twins and not know it, it wasn't the case for me at all, but each pregnancy is different. I felt much less movement with my twins then with my singletons and they were difficult to palpate because I'm plus sized. If you have 2 placentas they can be tough to feel too, also one baby can lay over the other. The big thing for me was I KNEW I was having twins and I couldn't shake the feeling. Sure enough. This pregnancy I'm carrying a singleton and I measured HUGE because I was so stretched from the previous pregnancy. Alot of factors go into fundal height besides how many are in there. Heck my singleton was 9+ lbs and my twins were about 6 1/2 each. I wasn't really much bigger with them then I was with him, I was just wider because they were next to each other in there. I think if you don't *feel* there are twins it's likly you only have one. They're pretty uncommon and if you're in tune with your body I think it would be hard not to sense it.

[reducereuserecycle]

I think if you don't *feel* there are twins it's likly you only have one. 


that's what i've told the people who commented it must be twins.

i'd love to have twins; it would be so awesome...but i will be more than happy with one