delaying cord clamping in twin hospital birth

[AnaMom]

Hello mamas. I am working on my hospital birth plan. What can you tell me about possibility of delaying cord clamping in a twin birth? How does it all work, and is delayed cord clamping a possibility with twins? If you delay clamping, do you have to forgo having baby on your tummy while you are waiting for cord to stop pulsing (because cord may be too short to make that possible)? Can you just run through the mechanics of this process for me with twins? Thanks!

[Dena]

Well, I don't know the mechanics, because we haven't gotten there yet, but I spoke to three OBs who said it was possible and that they would respect my wishes to do it. I did ask one about holding the baby, and she said she could usually manipulate positions so that it was possible while the cord was still attached - it is just a matter of being creative.

Good luck to you!

[Novella]

Dr. George M. Morley has all kinds of fantastic information about delayed cord clamping and his writings are available on several sites.

He advocates delayed cord clamping in twin deliveries.

In our fervent plans for delayed clamping, the OB kept giving stories about how it wouldn't be possible because she'd be busy with Twin B and wouldn't have enough hands to hold Twin A.

Obviously, like so many other bith issues, attendant WILLINGNESS is the biggest obstacle. With the large crew of medical personnel that most hospitals insist on for twin deliveries, it seems ridiculous that there's suddenly a "shortage of free hands" for something as important as this (and that's assuming Mom is too busy labouring with Twin B to hold Twin A herself).

I had writtten to Dr. Morley about the delayed clamping because our twins were mono-chorionic, di-amniotic, so thus at risk of TTTS which can (in rare cases) occur suddenly right at delivery (Acute TTTS versus Chronic - which builds throughout the pregnancy).

Dr. Morley had even discussed a case where he had to deliver twins by c-section, but did delayed cord clamping of both.

Mechanics: If you are "permitted" to birth your twins naturally, a woman's body often has a lull between Twin A and Twin B. (Mine was 17 minutes). So this would certainly allow time to cuddle Twin A on your abdomen as long as the cord was long enough. If it's short, someone else would have to hold babe, just as you mentioned. Once the contractions intensify for Twin B, I imagine it would be too difficult to keep holding Twin A (I had to give my little guy away temporarily). Then Twin B born and resume cuddling.

I think a lot of docs don't like it b/c they want a totally clear view for episiotomy or any of that other monkeying around that they do. But I don't think it makes that much of a difference. Meaning that: even if they clamp off Twin A immediately, you still have a cord hanging out of you when birthing Twin B.

I send you many fervent wishes that your attempts to delay cord-clamping suceed. It is the biggest regret that my husband and I have in the births of all of our children. We always requested delayed clamping. We never got it. We just weren't strong enough / clear-headed enough in those seconds to persist. Good luck to you!

[AnaMom]

Thanks, ManitobaMom for the very thorough reply and for sharing your experience. Very helpful. My perinatologist said that if she personally delivers the babies, she would be willing to delay clamping if there is sufficient interval to do so as long as she can personally hold baby A. But she could not guarantee if other docs would be willing to do it. And its a total crap shoot who my doc will be that oversees the delivery. This hosptial uses residents supervised by attending physicians and I found from my brief stay recently (preterm labor) that the residents were often quite reluctant to veer from "the book" at all. They are extremely risk averse, of course. Not that delayed clamping is really a risk. Anyway, your post prompted me to do some more research and there is plenty of good info out there. A midwife in my area has compiled quite a list of info: http://www.gentlebirth.org/archives/cordIssues.html. And my search on pubmed revealed pretty much only benefits to delayed clamping. So I would certainly like for us to be able to influence delayed clamping, but I must say I'm less than optimistic that we'll be able to pull it off.

Anyway, thanks very much for the reply!

[MamaRabbit]

I just asked about this in the Birth Professionals forum...off to find that link.

ETA: Here's the link

[michellyn]

I don't know about the hospital aspect of it, but I'd read an article that encouraged delayed clamping as a way to reduce hemorrhage. My midwife's experience in delivering twins was that the risk of hemorrhage is greater in twin births (thus, she planned to administer pitocin after the births to help reduce chances of an after birth hospital transfer). Because our twins weren't at risk for TTTS, we delayed, clamping after about 7 minutes, mostly because the second twin appeared to be arriving soon. My midwife was so amazed at how little bleeding I had--less than many singleton births she's assisted at. I highly recommend it in cases where the risks of it are okay.

I don't know about the laying on stomach parts either since I had a water birth.

[michellyn]

I forgot to mention that my midwife never did end up giving me Pitocin after the twins were born since things were going so well.

[MamaRabbit]

So did you delay for much longer after the second one?

Can you post the article?

I'm planning a UC for this and am trying to find out as much as I can about the clamping part.

[michellyn]

The article I read is here: http://www.radmid.demon.co.uk/twins.htm
Look near the end under "Keeping Twin Birth Normal."

I honestly don't remember how long we waited with Cate. I'm guessing it was close to the same--mostly just waiting until the cord stops pulsating. It could have been slightly shorter since the midwife wanted to check me (I was in the tub, where I gave birth; my labor progressed so quickly that my first twin was born just before she arrived; also, I think she wanted to keep an eye on the hemorrhage situation since in her experience, twin moms have had a much greater degree of hemorrhage--and hospital transfer--than singleton births).

You are a much braver woman than I. I would have been petrified to have a UC with my twins (though, inadvertantly, the first twin was a UC).

Michelle

[Raneysmama]

mono/di twins and clamping

I'm a little confused about this cord clamping thing. I know it's great for a singleton, but what about monochorinic twins? Everyone says they clamp the first baby's cord quickly to reduce the risk of acute TTTS, but wouldn't that make the extra blood go to Baby B? So wouldn't waiting to clamp be safer, especially in that situation...I don't know how acute ttts happens at birth really.

[birthjunkie]

Hey, Raneysmama! I *know* you from Twinstuff (over there, I'm mom23cuties).

Anyway, I have a friend who could probably give you some advice. If you PM me, I can tell you where she hangs out.

[Novella]

Originally Posted by Raneysmama

I'm a little confused about this cord clamping thing. I know it's great for a singleton, but what about monochorinic twins? Everyone says they clamp the first baby's cord quickly to reduce the risk of acute TTTS, but wouldn't that make the extra blood go to Baby B? So wouldn't waiting to clamp be safer, especially in that situation...I don't know how acute ttts happens at birth really.

I know EXACTLY what you mean - had the same questions ourselves. According to Dr. Morley (I'm pretty sure I'm remembering the source correctly), if Twin B were subject to Acute TTTS, that could happen EVEN AFTER Twin A was delivered and clamped. Just as you said: extra blood from Twin A in the placenta due to premature clamping and that blood could suddenly go to Twin B. So the (minute) risk is only truly over once both babies are born and clamping has occured. Goes back to the benefits of delayed clamping (which applies to all babies) versus the risk of possible Acute TTTS for mono-chorionic twins.

One thing that was never clear to me was the idea that in a singleton delivery, with delayed cord clamping there can be a regulated "back and forth" of blood between baby and placenta to optimize blood volume in the baby. This made me wonder: If you delivered twins with both cords left intact and DID have Acute TTTS, why wouldn't the remedy to that simply be to continue leaving the two cords and placenta all intact, so this "regulation" could occur?