Is every twin birth inherently 'high risk'?

[mamabutterfly]

Is giving birth to twins in inherently a high risk event? Or is it more correct to say that the kinds of things that elevate risks to babies happen more often with twins, & need to be watched for more closely?

I'm especially interested in links to good articles/books/sites with evidence based research on childbirth with twins, addressing this question.

Background: As a new doula, I've been asked to attend a twin birth. The mom has given birth before (vaginally, with a midwife) - but it was suggested by other moms of multiples that she go with a 'high risk' ob this time, at a hospital that is pretty not-mother&baby-friendly (but has a well-reputed NICU). She wants to be somewhere that is able to deal well with emergencies, but also wants to prepare for childbirth that may go smoothly with no complications at all -- and this hospital doesn't seem to be considering the possibility that a twin birth could happen without complications.

Anyway, I consulted my library of about 10 pregnancy & birth books (Simkin, Balaskas, England, Klauss & Marshall, Kitzinger, Sears) and found very very little info about preparing for twins! :( So are there some best books or websites to consult? I'll cross post this in the Multiples forum...

Thanks!

mamabutterfly

[fourlittlebirds]

It depends on how you define "high-risk". I mean, most OBs would automatically label me high-risk because I am 38 and overweight. This is of course because statistically older women and overweight women have more problems. So it's an appropriate label for a group, maybe, but not necessarily for an individual. (I do not NOT consider myself even remotely high-risk.)

Likewise, I think most OBs would automatically look at any twin pregnancy as high-risk. I, though, would not even think of labeling a twin birth high-risk if it went to term and both babies were head-down.

Ack, gotta go, but quickly, I believe there's a section on twin birth in Kitzinger's The Complete Book of Pregnancy and Childbirth.

[pamamidwife]

Elizabeth Noble's Having Twins is excellent.

In today's environment, every pregnancy is viewed as being on the verge of turning into a horrific disaster. :(

Sad, yes. Logical? No.

[mommy2twinboys]

I had a ultrasound at 5 weeks confirming that I was carring twins. As I was walking out of my ob's office I looked at the paperwork he had just given me and I was marked high risk. I was 26, in great health, nothing other then the fact that I was carrring twins made me high risk.

[mamabutterfly]

Thanks for the book suggestion, pam! That was the one I was thinking of after browsing the multiples forum. :) So it's good to have it confirmed.
I did look in Shiela Kitzinger's book, blueviolet, but it's just a two-page section, lol.

mommy2twinboys - thanks for sharing your experience. Did you find that your ob went on to expect complications at every turn, or were they open to the possiblity of a normal pg & birth? The sense I get from my client's hospital is that they don't have much confidence that things *might* go smoothly, but rather that they are preparing (only) the worst.

Aside from the increased likelihood of preterm labor or low birth weight & complications from that, what are the primary risks considered?

I understand that some of her options will be determined by babies' positioning/presentation - but presuming optimal positions, what are they most concerned about for the birth itself?

thanks, ladies. :D

mb

[Artisan]

I think in nearly every case she would be considered high risk. I know my midwife is unable to do high risk deliveries, and twins automatically fit the protocol. I think it is hard to even get an OB to give someone a chance to birth vaginally... they use scare tactics about having a vaginal delivery for the first baby but a crash C-section for the second, etc.

I believe moms carrying multiple babies are also at higher risk for hypertension/pre-eclampsia.

[mommy2twinboys]

My Ob really didn't even give me the option of a vaginal delivery and I have to say at the time I didn't question him either. My thinking at the time was that he was the doctor and he knew what was right so I had C-section scheduled. I went into labor early though. Both the babies were breach, so I would have ended up having one anyway. He said that he would not attempt a vaginal birth when the babies were breach. Since that time I have discovered Mothering and I am much more informed. My boys are also circumcised. I didn't give much thought to that decision either. I just thought everyone did it. I have learned so much at MDC. :p

[Defenestrator]

Not all high-risk obs are non-mother-friendly. I work as a doula with a group of high-risk obs whom I prefer to the local ob group. One of them is a radical feminist who just had twins herself and has been researching mother/baby conflicts of interest in the childbirth arena. One is a doctor from Holland who still bears the imprint of the medical system there. One other is a super-nice guy who seems to bond really well with the teen moms who get referred to him.

I find that when they actually have moms who are classified high-risk that they overreact less than the traditional OBs. If I were having twins in the hospital, I would want to use a provider who assists in twin births all of the time, not someone who is going to be panicking if something happens out of their comfort zone. That said, when I thought I was having twins, I was planning a home birth. If I needed to be at the hospital, it would be with the perinatologists, though.

As far as choosing a hospital based on NICU goes, I would try to find one with the best and most mother-friendly NICU. I have found as a doula who often works with high-risk moms that the hospital in my area with the biggest, best established NICU tends to treat babies in a more sophisticated manner, both producing better outcomes, but also not overtreating or keeping babies admitted longer than they need to be.


Good luck!

[magentamomma]

I had my twins at home, and my delivery went very well. The highest practical concern I believe is a very real risk of post partum Hemmorage. I did bleed much too much, but my midwives were skilled in herbs. I don't think I would have bled so much if I hadn't been left in the herbal bathso long. Breech birth is also a practical consideration, but I think practitioners should have more training and that more breech presentations should be delivered vaginally. I have noticed that most the midwives I come in contact with are scared off of breech births, but it used to be the norm. Any way, I would tell any one pregnant with twins, that they are still safer in the home as long as they make it to term-38 wks with twins.And don,t let people freak you out, because my thoery on many cases of prematurity is all the mind:censored :cuss that occurs between people and pregnant moms:soapbox

[pamamidwife]

In my state, homebirth midwives are legally able to attend twin deliveries.

In my opinion, twins does not always constitute high risk.