Any data/studies on twin homebirth?

[Emelee]

I just found out yesterday that I'm pregnant with twins. This has come as quite a shock and I'm still grieving over the thought of a possible mandatory c-section and the loss of a homebirth that I really was looking forward to. My daughter's homebirth was a dream and I wanted to repeat that experience.

I haven't called the midwife I was thinking of using (I'm only 9.5 weeks) but I don't think she does twins. I'm also not even sure how safe it would be. All I know is that they are in different sacs which means that I could still possibly have a vaginal birth... if a hospital would even try me.

I would really appreciate it if someone had some informative studies or could point me in the right direction for research... I don't even know where to start! No one in my family has ever had twins nor do I know anyone with twins so this is completely foreign to me. I plan on researching the good and bad because I want to be as informed as possible before deciding to look for an OB or finding a twin birthing midwife.

Thanks for helping me out.

[Mummoth]

I don't have any research or studies to share, sorry! It might be helpful to look on meetup and see if there's a parents of twins support/social group in your area... maybe someone has had an OB who was very natural birth friendly, or even a midwife... it might be a good way to get info specific to your area.

[Buzzbuzz]

My sister homebirthed her first child, and then had a hospital (vaginal) birth with her twins.  As far as I am aware from her research during her pregnancy there are no positive studies out there about the safety of homebirthing twins.  All studies which provide evidence of safety for homebirth have only demonstrated safety for "low risk women" and a twin birth and pregnancy is not a low risk birth and pregnancy.

If you do ultimately go with a midwife, I think you would want shadow care from an OB -- I would want to have someone available that I knew and was familiar with my medical history in case the pregnancy became more high risk (for example, TTTS for identicals, premature labor, etc.).  Many OBs will be extremely reluctant to take over care of a twin pregnancy late in the game.  If you wait now,  you may be stuck with who you can get if you need to shift over to OB care later.

Not to scare you, but there are so many hurdles to consider before the actual delivery in terms of twins -- twins have higher risks of congential birth defects, cerebral palsy and prematurity as well certain "twin specific" conditions (TTTS for identicals) that I feel you are kind of leaping to the end of the process here.

I will check with my sister for book titles she found helpful.

[starrlamia]

the risks are higher for twins, however I do know of people who have done it safely. It really depends on the type of twins and also their presentations at birth. One of the biggest worries is after the first twin is born, there is a higher chance of cord prolapse with the second twin, however again it depends on quite a few variables. I would call the midwife and talk to her, even if she does not do twin births, she could probably point you in the direction of some good research and possibly a midwife who does do them.

Also Try doing a search on google scholar.

[Buzzbuzz]

Yes, that's true.  Twins also have a higher risk of placental abruption and twin moms have a higher risk of post-partum hemmorhage.

OP -- you may be assuming that the OB approach will require c-section wrongly.  The OB said she was willing to pursue either option of vaginal birth or scheduled c with my sister (vertex/vertex di/mo twins).  This was at one of the better (university) hospitals in the state though. 

[jenrose]

You will find individual success stories about homebirth twins, and some tragedies, and zero concrete research on it. 

 

Factors which will be relevant:

 

Gestational age when you start labor. If you're earlier than 36-37 weeks, you're going to need to be at a hospital because the chances are VERY strong that babies will require at least some medical support for breathing.

 

Position of babies. Some practitioners only worry about the position of the first baby, because a skilled practitioner can often reach in immediately after the first baby is born and manually reposition the second one. The old fashioned way to do it was to deliver the first baby vaginally headfirst or frank breech, then reach in and bring the second twin out footling if they didn't immediately present head-first. Once a baby has passed through, there's a TON of room for the practitioner to do it. It's not comfortable, but it's possible... and having had a baby pass through makes entrapment of the head much less likely. That said, it's a dying art. 

 

Skill of midwife. The last thing you want is a midwife who's willing to "try" but has never done it before. Experience matters. And likely they will want to have at least three midwives present, one for each of the babies and one for you. At least one of those midwives needs to have had experience delivering twins, preferably several times.

 

Distance to hospital. I live 7 minutes from a regional transfer center with a level III NICU and a special program of backup docs who specifically volunteer to accept homebirth transfers. This is neither accidental on my part nor common anywhere in the country. But the fact that my midwife practices legally, has good relationships with the hospital AND the perinatologist who handles the medical side of my risk factors, and knows her own limits makes me FAR more comfortable than I might otherwise be making the choice to homebirth as a high risk mom. If you live 45 minutes away from a hospital... that has a huge impact on how long it would take to intervene in the event of problems. Some families will go so far as to rent an apartment or hotel room near the hospital they would transfer to, when homebirth is important but transfer is more likely than for the average low risk mom. My risk factors happen to be such that hospital birth actually increases my risk levels... my highest risk period actually starts around the time they send most women home after birth. (Clotting issues, I'm only pregnant with one baby).

 

And then it just comes down to how your body handles a twin pregnancy. One of the reasons I stay comfortable with the idea of homebirth is that my blood pressure never gets high, my glucose is NEVER high, and while I dislike pregnancy extremely, my body is pretty dang competent with the whole "growing a good sized baby and birthing it" thing. 

 

Many, many of the things that go wrong with twins start showing red flags early. Babies sharing a sac. Poor growth due to placental issues. High blood pressure due to placental issues. Malpositioning. Preterm labor. Hyperemesis.

 

Even for women who plan homebirths for twins, there needs to be a clear realization that in order to birth twins at home, you need to grow good-sized babies and carry them to term, and they need to be in a good position. And all the skilled midwifery care in the world can't guarantee that (nor can a doctor, for that matter). So realistically you have to know that your chances for needing transfer are much higher than they were last time. BUT... if all other things are going well, yeah, homebirth is possible. I actually know two moms who've had triplets at home. It all depends on what risks you're willing to live with. 

[AlexisT]

IMO, they will never do a decent study on twin home birth. Forget the politics for a second, or getting it through an IRB. You'd need to find enough twin mothers who wanted a home birth, and midwives with experience doing them (otherwise, you're going to get the same problems as the Hannah TBT). Then you'd need enough of them to make it to delivery without risking out for another issue. Twins have higher rates of all kinds of complications, as jenrose mentioned, plus the positioning issues. It's very rare to find provider who would voluntarily deliver a breech twin A--apparently this is more of a problem than a breech singleton. I know, we've all seen the Psalm and Zoya video, but no OB will touch it and few midwives will. So, in the end, you'd have a tiny number of women--not enough to draw any valid statistical conclusions.

I can tell you that twins are risked out on the NHS and in the Netherlands. I don't know the exact guidelines for Canadian midwives. So you won't find an international study, either.

[BroodyWoodsgal]

I've got nothing for you that's not anecdotal, I know a few people who have very successfully birthed twins at home and one who had a perfect twin UC. I have heard of bad outcomes (vary degrees of "bad") on the internet, but never known anyone with a bad outcome personally. I have not been able at any point to find research, pointing either way, I felt comfortable with because it just hasn't been done.

As for what **I** would do:

- I would plan to HB.

- If I couldn't find a MW who would attend me in my state, I would look in another state close to me.

- If I couldn't find anyone who would attend at home, but would attend in hospital for a vaginal birth, I would look into their actual rates and find out if they were ACTUALLY supportive of a vag birth.

- I would UC before I went to the hospital for a c/s if I couldn't find a MW who would attend me and couldn't go vaginally in hospital.

HOWEVER, I would also invite WAY more testing, ultrasounds, etc into my prenatal plan and I would sincerely work to make sure that I was doing everything in my power to birth as safely as possible. If a test or ultrasound showed something that made things "less than perfect" for HB...depending upon what it was, I would proceed or schedule the c/s. There are some things they could find that I would be OK with at home and there are some things that I would NEVER ever risk.

For the record, I'm a 28 year old in good health, never had a pregnancy or birth related complication and easily handled two natural childbirths with no help from anyone. Those things all factor in for me.  If I started to have blood pressure problems or even if I was just getting gut feelings like maybe things were turning fishy, I would try really hard to let go of feeling "Steadfast" and would open myself to the possibility of selective sectioning. I don't worry about positioning, or even things like cord prolapse or rupturing. In my mind, those are actually lower end risks and for things like positioning, there are ways -very old and tested ways- to safely welcome babies in all manner and position. Prolapse just isn't a big enough risk for me...again, there are ways to try and avoid that and the risk, in my mind, is less "spooky" to me than the risks associated with c/s.

BUT when you start talking TTT, mono/di cord questions etc etc....or any indication that there is a problem with one or both babies that MAY require immediate care...well, then I start feeling spooked. I think twin pregnancy is pretty normal. I think the chances of things going wrong are still fairly small. But I do feel there are subtly elevated risks. I am normally a WAY minimalist when it comes to prenatal care...but with twins, I would insist on closer monitoring of the pregnancy, would want more ultrasounds, etc and would be much less attached to my homebirth plans.

Sorry that's so much. Look, I'm a fierce homebirther. I stand by homebirth completely. I stand by UC completely. I stand by HB and UC for women even in situations that I wouldn't HB or UC. I believe in birth choice. I can only think, off the top of my head, of a few pretty rare circumstances under which I would sign up for a c/s selectively. But they exist....and I think that knowing they exist and preparing for both ways (or any number of other options) is important.

It's interesting to me, to re-read this post and realize that after my DDs birth or even after my DSs birth...I wouldn't be writing a post like this. My post would have been absolutely ragingly 100% pro-homebirth. But you know, I've been blessed with two completely perfect births, two completely perfect outcomes and two completely perfect, healthy kids. And those facts lead me to feel MORE cautious about birth. Over the last three years, I've had these amazing births, fallen in love with these two amazing kids and have come to realize where my priorities lie. This life I've built is so precious and seeing them growing so fast and perfect in front of my eyes has made me realize that I don't want to take this for granted for even a moment.

If my first pregnancy or even my second, had been a twin pregnancy, I would have fearlessly charged forward with a planned homebirth...with or without a MW and wouldn't have been fearful about something going wrong. If I were to find out that this pregnancy was twins, I would be much more committed to very thorough prenatal monitoring and would do whatever I had to, to feel comfortable that I was going into my birth, wherever it ended up happening, with open eyes and good information.

[Ellie'sMom]

You should post this over in the "Parenting Multiples" forum. You will get more info over there.

When I had my twins 5 years ago, there were no studies which included multiple births for all the reasons cited above. Just for point of reference, I will tell you what my criteria were to homebirth. I definitely don't mean to imply this is right for everyone. I should start off by saying that if I had had the option of a midwife attended hospital or birth center birth, I would have probably chosen that. I would have had to birth with an OB, push in the OR and have an epidural in place. That just wasn't for me. I had also had a wonderful birth center birth with my dd, so I felt confident about unmedicated labor and birth. 

I found a midwife with lots of twin experience (with the Amish). I think we were her 22nd set. She carried oxygen, pitocin, etc. She was certified in neonatal resuscitation and brought 2 apprentices for the birth. 

I got shadow care from a supportive OB who knew I was planning a home birth.He was actually a high risk OB.  I was very lucky to find him. I chose to do all the standard ultrasounds, etc. This gave me lots of peace of mind. He knew that I wanted straight talk regarding his opinion on the safety of my birth. 

As far as the pregnancy: I wanted to be at least 37 weeks (went to 40+3), Baby A was head down (he was engaged for weeks, so we knew this was the case), I had no comps with the pregnancy: good blood pressure, no anemia. I was in an urban area with quick access to an excellent children's hospital. 

The only complication I was not prepared for was hemorrhage. I wish I had just gotten some pitocin after the birth. Of the twin homebirth moms I know from these boards, several of us bled heavily (big placental attachment site + stretched out uterus), so I think this should be managed proactively. Neither my life, nor my babies were ever in jeopardy, but I think the blood loss effected my initial milk supply and just left me really weak for the first week or so. 

Not the hard data you are looking for, but I do not think you will find any research to support twin home birth. As with anything, we all have to decide what level of risk we can handle. 

Congrats on your pregnancy!! 

[loveneverfails]

I would absolutely pursue vaginal birth, but not home birth for twins.  Baby A almost always gets out fine.  It's baby B where you run into problems, and things can go downhill fast.  Twins at home are against the regulations for home birth in most countries that have good home birth track records and training, and I would be guided by that.  

[Emelee]

Sorry to not respond for so long, internet has been down for several days. I really appreciate your replies but I have had little time to do any real studying. I still intend on doing that extensively! The good news is the midwife who I was thinking of using has an OB who comes to her birth center and he is willing to actually come to my house and be the primary for a homebirth if he sees everything going well! He will even allow breech because he has dealt with that before! Then the midwife would be his assistant as well as another midwife that I would have to choose on my own. Obviously nothing is certain until closer to time but I was so grateful that I now have options. I would have hated having to go with a midwife that I didn't trust completely or who had to fly under the radar making the event of a transfer difficult. Even if I am risked out of homebirth because of complications to the babies or myself, I can use this OB at the hospital and he will let me try natural there.

I am really feeling much relieved to have choices

[BroodyWoodsgal]

Originally Posted by Emelee 

Sorry to not respond for so long, internet has been down for several days. I really appreciate your replies but I have had little time to do any real studying. I still intend on doing that extensively! The good news is the midwife who I was thinking of using has an OB who comes to her birth center and he is willing to actually come to my house and be the primary for a homebirth if he sees everything going well! He will even allow breech because he has dealt with that before! Then the midwife would be his assistant as well as another midwife that I would have to choose on my own. Obviously nothing is certain until closer to time but I was so grateful that I now have options. I would have hated having to go with a midwife that I didn't trust completely or who had to fly under the radar making the event of a transfer difficult. Even if I am risked out of homebirth because of complications to the babies or myself, I can use this OB at the hospital and he will let me try natural there.

I am really feeling much relieved to have choices

YOWZA mama, that is some smokin' hot AWESOME news!! An AWESOME place to start....that sounds like an awesome option!

Sorry about your power being out, we were some of the lucky ones. Usually we're the first to lose it and the last to get it back, but it was only like 36 or 40 hours that we were without this time.

[jenrose]

Originally Posted by Emelee 

Sorry to not respond for so long, internet has been down for several days. I really appreciate your replies but I have had little time to do any real studying. I still intend on doing that extensively! The good news is the midwife who I was thinking of using has an OB who comes to her birth center and he is willing to actually come to my house and be the primary for a homebirth if he sees everything going well! He will even allow breech because he has dealt with that before! Then the midwife would be his assistant as well as another midwife that I would have to choose on my own. Obviously nothing is certain until closer to time but I was so grateful that I now have options. I would have hated having to go with a midwife that I didn't trust completely or who had to fly under the radar making the event of a transfer difficult. Even if I am risked out of homebirth because of complications to the babies or myself, I can use this OB at the hospital and he will let me try natural there.

I am really feeling much relieved to have choices

That's absolutely amazing. ANYTHING that makes the process smoother in the event of transport is good, and having a doctor working together with midwives in a home environment? That almost never, ever happens, anywhere, and if it's available to you for a twin homebirth? Color me astonished. I'm living in one of the more liberal places in the US for homebirth, and even here there are no doctors I know of who will touch homebirth with a 10 foot pole. They'll take transfers graciously, but actually going out to a home to do a birth? I'd fall over in astonishment if that happened here. 

[deni bronson]

Twins definitely do take a lot out of you. I had to have a c-section with mine because twin A was breech(she needed a hip sonogram a little after because they always check that with breech babies). Homebirth is easier with singletons but much riskier with twins. My Dr instructed me to start taking iron up to my due date because of more blood loss in multiple births. I did hope to deliver vaginally, but the girls did not want to cooperate and flipped throughout the whole pregnancy until twin A ended up breech when the time had come. There's an increased risk of preclampsia in multiple pregnancies as well. So not too many doctors or midwives would touch twin home births for those reasons and the reasons already stated. I did ask about that even though I didn't actually want to do that, I just asked just in case I went into labor at home they advised me of those risks and that probably no Doctor or Midwife (where I live at least) would do it.I did find something a bit vague where I'm unsure if it's speaking of the twin births or not... here. I would talk to your OB and see if you are able to have that as an option when taking age, position of the babies, and overall health into consideration.

[BroodyWoodsgal]

Originally Posted by jenrose 

That's absolutely amazing. ANYTHING that makes the process smoother in the event of transport is good, and having a doctor working together with midwives in a home environment? That almost never, ever happens, anywhere, and if it's available to you for a twin homebirth? Color me astonished. I'm living in one of the more liberal places in the US for homebirth, and even here there are no doctors I know of who will touch homebirth with a 10 foot pole. They'll take transfers graciously, but actually going out to a home to do a birth? I'd fall over in astonishment if that happened here. 

Yeah. I'm still doing mind cartwheels over this! OP...AWESOME.

[Emelee]

Thanks AverysMomma and jenrose! I'm still in shock that it might bean easy process getting this prenatal and labor care from the OB/midwife team. The midwife I spoke with says that the doctor was interested in attending homebirths to learn more about them, in particular twins! I am no longer dreading this journey but actually getting excited about it all. It has been difficult to find studies especially any that are recent. The best I've come up with so far are just individual birth experiences whether good or bad.

Ellie'sMom, I will definitely post over there as well. I've read a little but is seems mostly to be about actually raising multiples (a whole different set of challenges!!). Congrats on your homebirth with twins! It is definitely inspiring and the ultimate dream for me at the end of this journey. I only hope that my body and the twins cooperate! I hope for both to be vertex but only time will tell. At least the nearest hospital is maybe a seven to ten minute drive at the most so not too far.

[~Adorkable~]

there is a running pregnant with multiples thread over on that area and many ladies that are preggo and would love the company, congrats and may you have a smooth uneventful full 10 months!

[Ellie'sMom]

Originally Posted by ~Adorkable~ 

there is a running pregnant with multiples thread over on that area and many ladies that are preggo and would love the company, congrats and may you have a smooth uneventful full 10 months!

I had to re-read this 3 times to realize that you didn't mean a thread for moms pregnant with multiples who run for exercise. I kept thinking, "Holy C#$p! That is hard core!"  

[greenmama66]

FWIW i had my twins at home- first pregnancy, both head down, 41 weeks and 3 days term, 4.5 hour labor, first twin even came out posterior- second twin born 1 hour and 10 minutes later, identical girls- 7.6 and 7.8 pounds. I DID have a PPH- midwife was totally expecting this and prepared for it.

My placenta was huge! Girls are now almost 21 years old and the first born is studying to become a midwife herself. I did not have an OB backup, I just visualized a peaceful healthy birth with daily affirmations (have done this for all of my pregnancies) and ate well (ample protein, green superfoods, etc). I found out I was carrying twins at about 7 months along which we had confirmed by an ultrasound.

17 months later I assisted a friend having her twins at home- both footling breech- babies were fine. Some midwives will attend homebirths with twins but it's not something spoken about very often. Of course it depends upon the client and situation.