SIL is having twins: how can I best support her?

[morganlefay]

My SIL recently found out she is pregnant with twins We were talking the other night about birth. The pregnancy is her first, and it's unplanned but welcome. She's definitely not "crunchy" like I am, but she's heard me talk about the problems with over-medicalized birth and I think some of it rubbed off on her. (I had planned a homebirth and ended up with a natural hospital birth, btw) She also knows I aspire to be a doula someday. Her OB was chosen quickly and seems pretty mainstream. I'm wondering how best to give her advice and support, since my knowledge and resources on natural birth don't seem to apply completely since twins carry a higher risk. Is she basically guaranteed an induction/c-section? Are there any resources I can point her to that deal specifically with twins or high risk situations? I think she wants (and deserves) to be informed but I don't want to scare her, since she's pretty nervous already.

[sanguine_speed]

[AmyKT]

My SIL is also pregnant with twins (36 weeks) and although I think it is very common for docs to talk induction and C/S with twin mamas, I'm amazed that her OB is content to let nature take its course. There are, however, several contributing factors to that attitude, I think.

1) There have been no complications along the way.
2) The babies have both been head down for weeks.
3) SIL previously gave birth to a 9-pounder at 38.5 weeks, spontaneous labor. The doc had wanted to schedule a c-section because of suspected large baby, but luckily, she came too quickly for that. So now SIL has "proven" herself.

I'd be having a serious what-if talk with my dr, if I were your SIL.

[klocke]

Coming from someone who is currently 35 weeks and a some change pregnant with twins I think the best thing you can do for her is to be understanding and non judging. I am a very natural momma, maybe not completely crunching but definitely not main stream. I have had 3 vaginal births with my last being a home birth. Twin pregnancies are not like singleton pregnancies. I'm not saying expect complications because I have had a completely non complicated pregnancy but what I mean is that at 25 -28 weeks she very well could be as big as a full term mom with a singleton. This brings on many issues earlier such as back ache, pelvic pressure, sleepless nights and a whole list of other things that get over exaggerated. This is by far the hardest pregnancy I have experienced maybe even the hardest thing physically period. Having a supportive ear when you are experiencing those things so early and then having to endure them for so much longer is priceless.

Now about the birth. She will probably have a hard time finding an OB who will let her delivery vaginally since it is her first. Most (and I mean nearly all) OBs require that Baby A is head down at the very least with a good majority requiring both babies being head down. Since this only occurs in 40% of twin pregnancies you have a much higher rate of c-section. I originally had a midwife for this pregnancy until 20 weeks when we learned it was twins. Since then I have gone through 3 OBs to find the one I have now. I am having to have a c-section because both babies are transverse but he is willing to let me go to 38 -39 weeks before doing the c-section. A lot of Dr's. don't do this so you need to start asking now at what point do they schedule? I found in my search a ton who wanted to do c-sections at 36 -37 weeks which is understandable if there are true problems but doesn't need to be routine. It also depends on the type of twins she is carrying. Identical twins generally carry higher risks than fraternal. She will most likely at some point in her pregnancy be required to see a high risk specialist to have some u/s monitoring done. Even in my case of fraternal twins (lowest risk) I have still been required to see a perinatologist every 4 weeks since 28 weeks. This is the farthest between visits that they schedule and I'm considered the lowest risk category. It can be a little overwhelming because high risks Dr's. can be even more medicalized than regular Obs. Just make sure she understands and feels comfortable with anything the Dr's. want to do and and an occasional reminder that not everything Dr's. say can be taken at face value doesn't hurt either. I know even with all the information I know from my past three births and attending several midwifery conferences it still can be intimidating to start hearing all this medical jargon from Dr's. Sometimes you just have to take a step back and remember what perspective it is coming from.

[wbg]

Congrats on the news. Have you checked out the parenting multiples forum on MDC? Lots of wise twin Mamas with wisdom to share.

[RedOakMomma]

Definitely post in the twins forum.

I had a natural birth in a hospital with my twins (one breech) eight years ago. I had an OB and it's not some hippy-dippy, crunchy hospital. No midwives, no birthing pools...I had to push in an operating room (which really, wasn't a big deal).

Your OB selection is really important when you're carrying twins. You'll want to know his/her rates of induction, c-section, their beliefs about delivering twins, etc. Your OB is going to be your biggest advocate (other than yourself) when it comes down to what really happens at birth.

If your sister wants a natural birth,or just one with few interventions, it's probably best to do a few things:

1) find out if her OB is on board (have her write a birth plan, discuss it with him/her, and see how supportive he is and if he gives her the confidence that she can do this)

2) If her OB isn't on board, or doesn't see her wishes as realistic, find other care.

3) hire a doula.

4) read-up, educate herself, and educate her birth partner on birth.

The reality is that OBs and the medical establishment in general is a little intervention trigger-happy with twins. They just are. So you need to be really, really careful about the medical professionals you surround yourself with. They need to be on your side, and supporting you. They need to be believers in women and natural birth.

I didn't have interventions or a c-section. Labor was natural and wonderful. It can be done!

[Gena 22]

No matter what your SIL's preferences for birthing, she will need an experienced caregiver. Lots of OBs think they're experienced, but twins are something special and it's worth finding an expert.

Support her by paying for her membership to in her local twins club. There is a national moms of multiples site which lists local clubs. Most have online list servs and expectant moms meetings. She can get good, personal BTDT advice and ask around for the best OBs.

Second to that, know and let your SIL know that being a mom pregnant with twins, especially for your first pregnancy, is going to require a thick skin. She will hear so many scary stories. OBs, even well meaning ones, will likely scare her silly with talk of what could happen. The problem is that there are not nearly as many twin studies out there. So much less is known. So even healthy twin pregnancies seem like a crisis to many caregivers. Every ache becomes preterm labor in the mom's mind. And even if she takes perfect care of herself, it is possible she'll have problems. The best thing is to stay positive.

Here's my current favorite study:
http://www.uptodate.com/home/content...=labordel/5122

And my favorite blog post about carrying twins full term:
http://www.lookydaddy.com/weblog/200..._that_mos.html

But as a PP mentioned, just be an ear for her and support whatever choices she makes.

And make lots of food for her when her twins are born!

Best wishes!

[morganlefay]

Thanks for the responses, everyone. I feel a little more informed now Gena, thanks so much for the links. I found a local twin club and will encourage her to check it out. And I will definitely look at the Multiples forum as well.