UPDATE - Maybe Twins - HELP!

[greenrootsmama]

I am 10 weeks into my 5th pregnancy. My last baby was a fast and furious UC which was so perfect that there's no way I can imagine birth possibly being any better than that. So, of course, when we discovered this pregnancy it was a no brainer; we're definitely doing another UC. Except that when I palpate my uterus, it feels considerably larger than it should for 10 weeks gestation. My dates are very precise as we were charting when we became pregnant and my cycles are like clock work. I was planning to UP as well until I pulled out my tape measure and discovered I'm measuring 5 weeks ahead (15 cm). So I called up the first OBGYN that my insurance company's website generated and made an appointment for a U/S for the 9th to do a head count. Now I'm nervous. I can't find any info online for UCing or even homebirthing with a midwife when there are multiples. Midwives aren't legally allowed to attend twin homebirths in my state but I'm absolutely petrified to go to a hospital. Further, my last baby was born in 1 hour and 20 minutes. Based on where I live and the time of day there is no way I would have made it to a hospital in time. After having 3 of my births out of hospital, immediately holding and cuddling my sweet baby, still wet and slimy while waiting for the cord to stop pulsating and breastfeeding before the cord was even cut, I just can't imagine it any other way. My first baby was born in a hospital and my relationship with her pales in comparison to my bond with my other children. I wasn't able to hold her for the first hour following her birth because of ridiculous hospital proceedures and low body temp. I'm terrified; I don't want to have to fight with the staff and doctor during labor and birth but I'm concerned about transverse 2nd baby, cord prolapse of the 2nd baby, preterm labor, etc. I really need some help, resources and/or guidance. I know twins have been successfully born at home but I can't seem to find anything online that covers twins at home. Please help. TIA. 

ETA: Update this page.

Edited by greenrootsmama - 3/9/11 at 2:25pm

[ElizabethE]

I have heard so many stories about successful twin UCs. :) Generally speaking they don't seem terribly different from single births. In that sense it is kind of like the fear of UCing breech-- mostly overrated. Once you know what to look for and what the variations of normal there are, you'll feel prepared to handle them as they come.

Here are some links to check out:

http://www.unassistedchildbirth.com/ucstories/tammy.html

http://www.mothering.com/community/forum/thread/1003669/uc-ing-twins-what-should-i-be-aware-of

http://www.twin-pregnancy-and-beyond.com/freebirth-with-twins.html

And if you haven't already, I highly recommend checking into the book Emergency Childbirth. Lots of great and practical info on what to do for emergencies or various presentations, etc.

Do you have any specific questions or concerns with how to UC twins?

[Amanda Williams]

Hello. I do not do UC, but do live close to you and will share my experience with delivering at TMC. I am going to send you a PM.

[greenrootsmama]

Thank you so much. I had a feeling that all the scare tactics were mostly hype. I just don't know anyone IRL who has twins, let alone homebirth or UC. I am just feeling a little panicked and overwhelmed. The thought of twins never even occured to me and now I'm nervous, not just about the birth but also about how to sleep-share and nurse twins (and still get enough sleep). I know that I'll figure it out as always but this is all new and I really had no idea where to begin. I just really want to be as prepared as I possibly can for anything.

I read Emergency Childbirth a while back but I think I could stand to refresh myself on it. Are there any other books that you can think of that might be relavant to my situation? I don't really have any specific questions at this point because I don't know what I don't know (if that makes sense). Thank you again.  

[mylilmonkeys]

I'm not planning to UC our twins, but a lot of the same concerns and questions occurred to me when I suspected we were expecting twins.  If you can borrow a copy of Holistic Midwifery V.2 from someone there is more information in there than any other text I could find.  And it is very matter of fact and not from a fear-based point of view at all.  I tried to research actual stats of prolapsed cords with twins, and it just comes up as one of those "possibilities."  I personally came to the conclusion that it is largely a management problem.  Most of the texts I read recommended immediately breaking the bag of twin B, which obviously risks prolapse if B isn't in the pelvis yet.  For babies positions at time of birth, you'll have to decide what you are personally comfortable with.  You cannot know what position twin B will assume once A is out.  For placental abruption, I did find an article via Google comparing risk of abruption with singleton vs. multiples: http://aje.oxfordjournals.org/content/153/8/771.full.  Hemorrhage hasn't been a personal concern as I am using midwives who carry pit, methergine and cytotec for hemorrhage, as well as aware of non-pharmaceutical methods.  If I was planning UC, I'd have on hand all the relevant homeopathics, herbs, and be ready to eat placenta if necessary. ;)  You can minimize many of the risks, but the size of the uterus is not something you can avoid.  Risk of preterm labor can be reduced by diet.  Twins need at least 120g of protein and 3000 cal per day, good quality calories!  

Hope that helps you find a little direction!  It is maddening trying to figure out real quality information, even in texts.  I have UC'd previously and have accepted a small possibility of UC'ing our twins, by virtue of being so far from my midwives and short labors, like you.  I think it would be fine if I had them on my own, but I really prefer my midwife that I have come to really love over my past three pregnancies.  But, I have one of those ideal twin pregnancies where the babes have completely separate placentas and sacs, so no possibility of twin-to-twin transfusion, and one baby went head down pretty early and both have been head down since 33 weeks.  I'd have more to think about if A was breech or they had other risk factors.  

[greenrootsmama]

I really don't have any concerns about developing any problems. I know I need to up my intake of healthy calories. I have nearly always enjoyed a pretty healthy dairy-free diet but I think I might switch my prenatal to one that contains more folic acid (my current vit only has 400mcg). I think my biggest fears lie in the propaganda that I can't seem to avoid in my search for information. After my appointment next Wednesday I should have a better idea of what I'm up against although I think I'll definitely be reconsidering my decision to UP. Thanks for all the great info. I'm going to head up to the library next week and see if I can get my hands on some good resources.

[dayiscoming2006]

I was seriously convinced I was having twins at the beginning of this pregnancy and it came out to be just one little one. So, you can think about it, but you may want to find out officially. 

If it were me, I'd try to go on with an UC and read up on UC and midwife attended homebirths with twins. There are some really neat stories in the birth stories section that I read back when I suspected twins. Almi is the most recent UC twin birth I know of and her story I think is in the UC section somewhere. You could ask her where if you have trouble finding it. It was a good story. One of the babies was small (I think 4 lbs) and was still healthy and nursed just fine. 

HTH 

[greenrootsmama]

I was on MDC a few years ago when I was pregnant with my 3rd but haven't been around much since then. When I came back everything was different and I'm having some difficulty navigating the site. I'm still trying to figure it out but when I do I'll be sure to check the UC birth stories.

I was concerned enough about the measurement of my fundal height that I called and made an appointment for next week to have an ultrasound just to be sure. I don't want to go through the whole birth preparing for and thinking there are twins only to find out that there's only one. Not only that but the outcome of my upcoming appointment will significantly influence how I proceed with my pregnancy (UP or OB).

[Mamatoabunch]

My first pregnancy was twins, conventional care. I always wonder about twins since, but singles since my first pregnancy. By 20ish weeks I always know if there is one or two by feeling and intuition. I knew w/ my first pregnancy there was 2 around 16 weeks. Remember it is probably one and the measuring ahead is just many pregnancies. I have always measured ahead. You have plenty of time, nothing needs to be decided today.

[Logan]

If you go to the UC forum page and then scroll down and click through the first 5 or 6 pages, I did that a few days ago to read some previous topics and there were several posts from people who were planning to or just had UC'ed twins, so you don't have to go far at all to find them  Hopefully a few of them will check in here for you, if they are not too busy enjoying their babies.

[greenrootsmama]

I'm starting to come down out of the rafters. That initial shock reaction had me petrified, thinking the worst. Now that I've had time to breathe and think about it rationally I just need to know what preparations have to be made and considered that differ from a singleton birth. I realize that preterm labor is an increased risk with twins but that with a good diet I have a pretty good chance of making it to 40 weeks (not to mention avoiding a lot of other serious complications as well). I've already UC'd so I have a pretty good understanding of common complications and how to handle them should they arise. I was planning to UP this time but now I'm thinking that it might be better to have at least some of my prenatal care through a provider for tests and at least a couple of ultrasounds, first to determine if they are identical or fraternal and second to be sure the babies are in a favorable position for vaginal birth. I'm still a little nervous but I think that with time it will go away and I'll be ok.

[douladianne]

A little info regarding twins...If your ultrasound shows two babes, it still might leave you with a few questions. An ultrasound will determine a few things regarding twins: If there's definitely only one placenta, then you know they're identical. If they are boy/girl, obviously fraternal. If there is two placentas and both are the same sex, they can still be identical. I am always surprised by some in the medical profession when they automatically assume that if there's two placentas, that they aren't identical. If the egg splits before day 4, they each develop their own placenta and sac. There are higher risks associated with identicals sharing a placenta that as a parent of twins myself, wouldn't be willing to risk by doing a UC.

Looking forward to your ultrasound results next week!

[Mamatoabunch]

There is no way to definitively tell one placenta by an U/S. The only definitive answer to identical or fraternal is by a blood test after the babies are born, unless someone does an amnio or CVS probably. It can tell you if the babies are in one sac or two usually. I personally had routine a twin pregnancy experience and U/S's caused more concerns, troubles, worries than they eliminated. I have skipped them since to determine one or two. Also, now that I have more time, fundal is unreliable before 20 weeks in mulipara moms. 

[labortrials]

Actually, I knew pretty early on that my girls were fraternal - seperate sacs and seperate placentas (one anterior, one posterior).  The problem is that seperate placentas can fuse, and therefore look like one.  Additionally, it can be difficult to tell if the chorion layer is shared or not.  Top it all off with disagreement among the experts as to the varying degrees of identicality, and your head can start to spin.

If it's twins, the MOST desirable thing is for them to be in their own sacs.  If they can be in their own sacs with their own placentas, that's even better.  (Wait, I forget - if they're in their own sacs, I think that means they have their own placentas . . . I think.  Fuzzy.)  But, I've read tons of UP/UC stories where mamas & papas didn't know any of this at all until the babies were born, and everything was fine.  Personally (meaning, for me) it was good info to have, especially because I was considering UC for the twins.

[greenrootsmama]

I've been reading about the differences between identical and fraternal and I think I've decided that if it turns out to be unquestionably identical twins then we'll have to take our chances with the hospital. Fraternal or singleton, I'm staying home (providing we don't end up with a transverse baby). Although, I have to admit that now that I've begun looking into it and visualizing having twins, I think I'm going to be a little disappointed if there is only one. KWIM? Not to say that I won't still love the idea of having a single baby. I just never thought in a million years that I would ever have twins (I don't know anyone IRL who has twins) and now that it's staring me in the face, in between the confusion and fright, I've grown to look forward to it. Thanks again ladies for your insight. I really appreciate it.

[greenrootsmama]

UPDATE: I had my U/S today and we only saw one beautiful little cutie. The doctor suggested it could be a fibroid but said she wouldn't bother checking because there's nothing that can be done about it anyway. She confirmed that I'm measuring at about 14 weeks even though I'm only 11. The baby is measuring 3 days ahead but that doesn't account for the difference. I'm relieved but slightly disappointed at the same time. It helps to have a little picture of my sweetie because I'm so in love that the disappointment is fading quickly. Thanks for everything ladies.

[dayiscoming2006]

Originally Posted by greenrootsmama 

UPDATE: I had my U/S today and we only saw one beautiful little cutie. The doctor suggested it could be a fibroid but said she wouldn't bother checking because there's nothing that can be done about it anyway. She confirmed that I'm measuring at about 14 weeks even though I'm only 11. The baby is measuring 3 days ahead but that doesn't account for the difference. I'm relieved but slightly disappointed at the same time. It helps to have a little picture of my sweetie because I'm so in love that the disappointment is fading quickly. Thanks for everything ladies.

Yeah, also, from researching back when I suspected twins (and was wrong), I found out that the fundal height is unreliable until 20 weeks. And that it is normal to measure as much as 3 weeks ahead in consecutive pregnancies. At least you know now and you have that nice little picture to enjoy, :)
 

[Almi]

Just wanted to put in my two cents, even though you're just having one. :3

When I found out I was pregnant for the second time (first ended in m/c), I knew I wanted to have a UC.  Then came my first prenatal appointment with my OB.  I was 15.5 weeks, and he concluded that I did indeed appear to be 15.5 weeks pregnant.  Then came my first ultrasound - two beans!  One of my very first thoughts was the fear that I would no longer get my dream birth.

But I researched and researched, and I became more and more at peace with the idea.  I decided we would play it by ear, and as long as everything went well (as far as the pregnancy and the twins' presentation), then we would still plan on an unassisted homebirth.  I was very thankful for my prenatal care, because it helped me to assess my own pregnancy.

Soon I was 8 months pregnant, both babies were vertex, and I had no complications.  At 35.5 weeks, my intuition told me that my babies' lungs were ready.  Exactly one week later, the first baby's water broke.  I had a beautiful, easy, uneventful birth.  My birth story is posted here:

http://www.mothering.com/community/forum/thread/1284198/they-re-here

[greenrootsmama]

That's wonderful. After reading several homebirth and UC stories anywhere I could find them, I started to think that I could do it too. I even started to look into the potential complications of twins and found that there aren't many which differ from a singleton birth. So I think that if I had been pregnant with twins I would have been able to find the security and confidence to still have my UC. I was even a little disappointed when I only saw one little peanut on the ultrasound because I was becoming excited at the thought of UCing twins. After the first day I wasn't feeling quite as sad because even though I know I could handle the birth, I think I would be overwhelmed trying to take care of two babies at the same time.