A (Hospital) Birth Plan for Twins

I don’t think I ever shared my birth plan here back in the day, but thought I would since I know how interested I was in this kind of thing when we were thinking and preparing (as best you can!) for the birth of our twins.

38 weeks 2 days, day before birth

I will start out saying that while I lean towards the “crunchy” and natural end of things, generally, in terms of birthing I’m only a little left of center.  Though I value everyone having the option and love the idea of it, homebirth was never something I considered in my case (this slideshow featuring tons of natural and homebirthing twin mamas still makes me cry, however! Love it!).  After all the medical interventions and angst we went through trying to conceive the first time around, I was fairly comfortable and reassured by the hospital setting.  At the start of my second pregnancy, I felt more confident about things and opted to see midwives (who worked with a local hospital), but once we found out it was twins, they kicked me out of the practice.  There were a few “twin” midwives unconnected to major hospitals that I were recommended by various folks, but at that point I wanted the medical monitoring again, and wanted to be birthing in a hospital with a good NICU.

My girls were monochorionic (shared placenta) diamniotic (two sacs) identical twins, so while it was not the very riskiest of situations (if they shared a sac, for example), it still carried some concerns, especially with regards to TTTS (which was on my mind a lot, since I was following another Seattle family’s heartbreak regarding this at the time).  At our first appointments  with the perinatologists (for the NT scan, and a subsequent followup ultrasound) there were notable differences between the girls measurements that made our doctors suspect TTTS. We had ultrasounds every other week from then on out to follow that, though it ended up, thankfully, resolving on its own.

For many months leading up do the delivery, I talked, questioned, and negotiated with the doctors in my clinic (all perinatologists) to see how naturally would agree to allow me to labor and birth.   I wanted to do it as naturally as I could, without interventions, without meds, without an epidural (barring complications, of course). They were fine with most of that, strongly advocated vaginal delivery over a C-sections in most situation (unlike many OBs I have heard about, regarding twins) but DID — across the board — want me to at least get an epidural in place before delivery.  They also admitted they could not force me to do anything: these were just their (sometimes strong) recommendations.

Their reasoning about the epi: in their experience, we had the best chance of a vaginally delivering a the second baby, no matter what position they flipped into, if they were able to get in and turn/manipulate her without my being in the kind of pain which might make it harder or impossible for them.  Also, if baby B went into distress after baby A was born, and an emergency C was needed, I would have to be put under general anesthesia if I didn’t have the epi.  I know midwives deliver twins all the time without epidurals, and perhaps the pain during manipulation thing is not as big of a deal in the moment with all that is happening then (or there are more gentle ways to move them, with movement and positioning the mother).  And also, that all these complications are rare.   But, after much pondering, I decided I did feel I was in good hands and was okay with the epidural plan, as long as we didn’t have to do it before it was truly needed (I ended up getting it during transition, as they were prepping for the birth).

Back to the pregnancy! Once the possible TTTS resolved there were no other complications, though I did end up with preterm labor at 33.5 weeks.  A few nights in the hospital and a few weeks on meds and modified bedrest at home did the trick.  The girls were born at 38.5 weeks, and it went very smoothly (here’s the official announcement, and here’s the birth story, with lots more info on how some of these things actually worked out).  The doctor did have to do a lot of manipulation to get Delia, who had turned sideways, heading in the right direction (“diving in up to his elbows” was mention, ug).  At that point, and after when I realized the extent of what happened there — while I was fairly obliviously watching Lonnie with Elsie — I was pretty glad I had ended up with the epidural…

Anyway, here’s the birth plan, which for the most part worked for us!  Much of this was taken (and edited to our needs) from a form I found online.  We were birthing at a large hospital with a huge labor and delivery department — our doctors were the hospital perinatologists — so some of this takes those specific details into account.

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Birth Plan for _________________
mono/di twin girls

Parents: ____________________  & ____________________
EDD: __________________
Drs: ___________________

We are excited to meet our new girls and know we are in good hands here at _______________!  While we realize twins and possibly prematurity may add many unknowns, we do hope to have as natural and normal a labor and birth as possible. We really appreciate you doing all you can to help us with this goal.

Labor:
Our doula, _____________, will be a part of our labor team and we want her with us throughout labor, in the laboring room and OR, and in recovery or postpartum rooms.

We prefer as little medical interventions as possible, as long as labor is progressing naturally.

• I would prefer intermittent and/or remote monitoring to allow for as much mobility as possible
• I am GBS positive, but would prefer to not be attached to an IV after the meds are in. I would prefer a Hep Lock to a standard IV
• I want to have the option to walk and labor in various positions, have access to a birth ball and the shower/bath if at all possible
• I would prefer to manage pain naturally and without meds as long as possible. I am okay with having an epidural placed prior to pushing stage, and would ideally like to have that placed & tested early in labor and then turned off until needed.
• I had a bad experience with epidural placement at my previous birth (1st attempt was not successful, 2nd was “tricky”) and prefer the most experienced anesthesiologist available to work with me this time.

Birth:

• I DO NOT want an episiotomy, unless absolutely necessary.
• I would like each baby to be placed on my chest immediately after birth, unless surgical birth or health issues rule this out.
• My husband (______________) would like to cut each baby’s cord.
• If general anesthesia is necessary for a surgical birth, I would prefer the type and dosage be given in a way that allows me to regain consciousness as quickly as possible.
• If needed, I prefer post-operative pain medication that allows me to remain alert and able to interact with my babies

Post birth baby care:

• We prefer that treatment of the babies’ eyes with drops or ointment be postponed until an hour or two after birth, so they can see clearly during early interaction.
• I expect to keep any stable, healthy baby in my room with me from birth or as soon as possible. (I understand that the degree of rooming-in depends on both the babies’ and my conditions after birth.)
• We prefer that any physical examinations, tests, etc. of the babies take place in my room.
• We would like to decline the hepatitis vaccine at this time for both babies
• We prefer no artificial infant formula, bottles of any kind or pacifiers be given to either baby, unless found medically necessary and after consultation with us.
• Pediatrician: __________________________ Phone: _________________________

NICU:

• Kangaroo Care: we would like to initiate skin-to-skin contact as soon as possible.
• Co-bedding: If both of our babies require NICU care, we would like them to be co-bedded in a single crib as soon as two are medically stable.

Feeding/Breastfeeding:

• Breastfeeding is extremely important to us. I want to attempt breastfeeding as soon as possible, within the first hour of birth if the babies health permits it.
• If babies are unable to nurse, I would like access to a pump and want to start pumping as soon as possible after the birth. I had issues with milk supply in my first pregnancy and want to take all efforts to bring in a strong supply as soon as possible.
• My husband has a severe dairy allergy, and their sister was intolerant to dairy until 18+ months. We would like to avoid any formula supplementation or breastmilk additives for this reason unless deemed medically necessary, and want to discuss the issue thoroughly with a doctor before any decisions are made.
• If the babies cannot feed effectively at the breast at first, we would like to avoid bottles & artificial nipples, and would like to try alternatives such as cup or syringe feeding, finger feeding, or use of a supplemental nursing system.
• I would like early and frequent assistance from a lactation consultant to establish effective latch and suck, and to ensure early breastfeeding success.

Thank you!!! We appreciate all you do to help our family at this special time!

 

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Hope somebody out there finds this useful!   At the time I was searching for it, I felt like there was a lack of info out there on attempting & navigating a “natural” (or close to that) birth of twins in a hospital setting.  I’d love to hear more stories, though!  If you had twins, what kind of birth did you have?  Do you have any suggestions or ideas for people hoping to do something similar?

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