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Twin Pregnancy and Birth: Image

Self Directed Twin Pregnancy & Freebirth

published 16 November 2021

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Twin pregnancy and birth

“There are two things in life for which we are never really prepared: Twins.” - Josh Billings

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In 2019 in Australia, 4,446 pairs of twins were born. In 2016 11,949 sets of twins were born in the UK. And in 2019 in the USA 120,291 twins were born. The world is at an all time high of twins being born, reaching 1.6 million twins per year. So if you find yourself, or suspect yourself to be a part of that statistic, then you’ll be wanting to know some details about twin birth and pregnancy!

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What causes twins
They don’t know exactly what causes twins, but having twins is more likely, (not guaranteed!) if: 

  • You’ve had twins before or are a twin yourself 

  • You’re over 35 

  • Used IVF or fertility drugs to conceive 

  • Had many babies already

  • Family history of hyperovulation (releasing 2 eggs at once)

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How to tell if you're carrying twins

“No, your closely spaced children are nothing like having twins, but thanks for trying to relate” 

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  • The only definitive way to tell is ultrasound. But this isn’t 100%. A mother’s surprised face went viral after her midwife assisted homebirth, obstetrician consulted pregnancy became unexpected twins!  If you choose to get an ultrasound, the easiest time to tell it’s twins is 10-12 weeks of pregnancy. This is usually when your medical care provider can say for sure how many fetuses, placentas and amniotic sacs there are. But Ultrasounds have risks and you may like to wait, or get none at all. https://sarahbuckley.com/ultrasound-scans-cause-for-concern/  

  • Fundal height measuring ahead consistently after 20 weeks

  • Extra or more pronounced symptoms such as severe nausea, weight gain

  • HCG levels (when tested early and often)

  • Palpitation and Bellymapping https://www.spinningbabies.com/pregnancy-birth/baby-position/belly-mapping/ 

  • Heart beats, plural: if you listen with a doppler, ultrasound, stethoscope, or fetoscope, you may hear more than one heart beat. Be sure to check the speed and volume - it’s easy to hear your own through the artery in your stomach and mistake it for an additional baby. (The average fetal heart rate is between 110 and 160 beats per minute. It can vary by 5 to 25 beats per minute. Adults are 60-100bpm)

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Types of twins

“Sometimes miracles come in pairs”


Now that you know you’re carrying twins, you may like to explore further and find out what types of twins. Blood tests and ultrasound are the only way to tell though you could make an educated guess about how many placentas with an experienced fetoscope user.


Di/Di (Diamniotic dichorionic twins)
If the egg splits before the placenta has formed, within three days of fertilisation, each baby will have their own placenta, chorionic sac and amniotic sac.


Di/Mo (Diamniotic monochorionic twins)
If the egg splits after the placenta has formed, after the third day following fertilisation, then the babies will share a placenta and chorionic sac, but will have their own amniotic sac. Monochorionic twin pregnancy is more common where assisted reproductive technology has been used.


Mo/Mo (Monoamniotic monochorionic twins)
Monoamniotic twins occur when the egg splits after the amniotic sac has begun to form, around nine days after conception. As a result, both babies share an amniotic sac. Many monoamniotic twins lie very close to, or on top of, each other and early ultrasounds cannot tell if they are separate babies.
Monoamniotic twins are often misdiagnosed, especially at early scans. They are higher-risk than other diamniotic twins, but babies do survive. If you want to know more, the Monoamniotic Monochorionic Support Site, at http://www.monoamniotic.org, looks like an amazing support network and has a bulletin board with mo-mo mothers around the world.


Conjoined twins (also called Siamese twins)
If the egg splits later than 12 days after fertilisation, and does not split completely, then conjoined twins occur. https://multiples.org.nz/types-of-multiples/more-about-different-types-of-twins/ 

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Identical and non-identical. Identical (monozygotic) twins are formed when one egg is fertilized by one sperm cell, which then divides into two separate embryos. Each shares the same genetic components and identical genetic structures. 
With non-identical twins, it works slightly differently. They form from two separate eggs being fertilized by two separate sperm cells. These twins share no more genetic composition than siblings with the same parents.
This podcast episode is really interesting and talks about hyperovulation, superfetation, and how twins can be conceived from different fathers https://fertilityfriday.com/episode-269/


Types of placenta in a twin pregnancy 
A single (monochorionic) shared placenta. 
2 separate (dichorionic) placentas.
When there is one outer sac (chorion) around both twins, and one separate inner sac (amnion) each, this is called diamniotic.
If the twins share both the outer and inner sacs, this is monoamniotic 
Monochorionic diamniotic and monochorionic monoamniotic twins are always identical 


Sex of the twins 
Finding out the sex can help you know if they’re identical. An alternative to ultrasound is blood test but it has its limits.
“The Harmony Prenatal Test can be used in twin pregnancies to test for trisomies 21, 18 and 13 and fetal sex chromosomes. The test can tell whether both twins are girls or whether at least one of the twins is a boy. It cannot tell if both twins are boys, or if there is one boy and one girl.” 

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Should you freebirth twins? 
This is up to you. There are certain situations that some mothers would be comfortable with, and others that you may not be. Only freebirth if you are happy with the choice you’re making and confident in your ability.
Some mothers might choose a midwife assisted homebirth when they hear they’re having twins. Some might choose a caesarean if they learn they are having breech twins.
There are no right or wrong ways to birth your babies. An empowered, woman-centered birth can be achieved in any situation provided the woman is informed and supported in her choices.

The important thing to know is YES, freebirthing twins is 100% possible, and a very valid option.
Ultimately you decide the risk for yourself. https://www.pregnancy.com.au/high-risk-birth-defined-by-whom/ 

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https://www.bellybelly.com.au/birth/twins-doesnt-always-mean-c-section/

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Twin Pregnancy

“Double the giggles, double the grins, double the trouble when you’re blessed with twins”

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  • Body Changes: You may put on more weight, gain extra stretch marks, and grow a bigger tummy with two babies taking up more space. This can be disconcerting or change how you feel about your body for some women.

  • Nutrition: This is so important. You’re not just “eating for two”, you’re actually eating for 3! To keep all of you growing well and avoiding preterm labour, you will need lots of protein, salt, and fluids. Weston A Price, Sally Fallon, and Dr Brewer have twin protocols for their pregnancy diets/books. (Brewer Facebook group https://www.facebook.com/groups/1582949685279015) 

  • Support: You may need extra support for your rapidly growing belly, such as a belly support band. Seeing a chiropractor or going swimming often may help reduce the strain on your body and the accompanying muscle aches and pelvic pain.

  • Twin to Twin Transfusion Syndrome: This is where in 2% of twin pregnancies, or in 10-15% of monochorionic twin pregnancies, one twin takes more blood than the other through a placenta anomaly, causing heart issues to one twin, and organ failure in the other. If your twins are diagnosed with this between 16w and 28w using information from echocardiogram and ultrasound exam, then there is a low survival rate for one or both. They usually need treatment in the womb and this will be a complicated path for you to go down. https://fetus.ucsf.edu/ttts/ 

  • More TTTS info http://www.multiplebirths.org.uk/MC%20Pregnancy%20%20Version%2012%2017%205%2010.pdf 

  • Balance and position: Spinning Babies techniques for twins will give you comfort in pregnancy and also help position best for labour. Seeing a chiropractor regularly for adjustments can also be beneficial https://www.spinningbabies.com/pregnancy-birth/baby-position/twins/  

  • Pregnant Mother: in your twin pregnancy, you are more at risk of things like pre-eclampsia, preterm labour, and excessive amniotic fluid. After birth, you’re more at risk of things like bleeding excessively. Following a diet like Dr Brewers will help prevent a lot of these issues, like their emergency protocol for preeclampsia. 


How twin birth differs from singletons

“Twin problems #4: Who was born first?”

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  • Time: There is a belief that after 1 twin comes out, the other must come out very shortly after. However time does not seem to be of essence unless they share a placenta https://about-twins.com/birth/inter-twin-delivery-interval/ 

  • Breech: One or both twins may be breech. Some Drs refuse to do twin birth if the first baby is unlikely to come out cephalic. This is because the twins are smaller, and exert less pressure on the cervix so can get caught. But there is only a slightly increased risk in twins being breech than a normal birth. Breech delivery is the same as for a singleton, and you should be prepared on how to deliver breech, no matter how babies are positioned leading up to birth. We have a whole page on it with recommended resources. 
    Breech twins can also get caught on each other, “head entanglement” so that is something to research. https://www.researchgate.net/publication/332180849_CASE_REPORT_OPEN_ACCESS_A_maneuver_for_head_entanglement_in_term_breechvertex_twin_labor 

  • Cord prolapse: There is a chance that after the first twin, the cord of the second twin will come out. This is bad because the cord takes air to the second baby, and if it occurs, the second baby will need to have it’s cord returned to the uterus and you transfer for a csection, or you will need to birth twin B within 3 minutes of cord presentation.

  • One/Two placentas: In cases where the twins share a placenta or it is fused, the placenta coming out before the second twin is really bad. That is twin B’s oxygen source, and baby needs to come out ASAP. I did hear of a story where the placenta came out before twin B, and twin B was chilling high in the uterus, so the midwife reached up inside, grabbed twin B, and pulled him by his feet out as far as she could safely, and the mother then pushed him the remainder of the way out. Her quick actions saved baby B’s life.

  • After the birth: Lend some thought to how you will feed twins. Extra cushions and support for the first few days.

  • Small babies: twins are often smaller than singletons. This means you will need to keep them warmer, and potentially they may have issues feeding if they are premature and  have tiny mouths, and you will need to syringe feed if they cannot latch.

  • Other complications: Can be the same as most single vaginal births. Research postpartum hemorrhage, shoulder dystocia (rare in twins), neonatal resuscitation.

  • Mary Cronk, famous for twin and breech midwifery: http://www.homebirth.org.uk/marycronk/marytwins.htm 

  • Allowed: Often women will be told they aren’t “allowed” to do a vaginal breech birth, or vaginal twin birth. It’s not your Drs decision. It is YOURS. https://www.chilledmama.co.uk/post/women-do-the-allowing  

  • Most important: Plan for 2! have a third adult person there. This means that someone will always be able to look after you and both babies if anyone needs resuscitating or you’re haemorrhaging. They can hold baby A while you do things to birth baby B or manage complications. And you still have hands spare to pass you items or call 000, or take photos.

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Premature Birth 
One particularly common thing for twin pregnancies is preterm birth. Less than half of twin pregnancies go beyond 37 weeks.
Premature babies depending how early they come, will cope differently. A lot of singletons at 36w are fine, with only 5% ending in the NICU. But up to 30% have some form of respiratory distress. Male babies are more likely to have issues than girls born early, and twins, because they are smaller, are also more likely to need a little help.
Many women don’t know exactly when they ovulated and conceived. With medical pregnancy dating going off of LMP (last menstrual period), women can easily be a week or more behind, so instead of 36w you may only be 35w. This means I would advise you to be very sure on dates if staying home in preterm labour.


Twin Birth

I believe that planning a Twin birth truly requires the "twins" of intuition AND knowledge. It's up to you to decide how much you need of each.

Reading and watching other women's twin stories can be inspiring and can help you learn valuable tips too. Join freebirth Facebook groups and read birth stories and wisdom from the women in there. 
I hope your self directed twin pregnancy and freebirth go smoothly and that you are able to tune into your womanly intuition and both your babies to see what birth benefits all 3 of you!


Positive Twin Birth stories 


Resources

Twin Pregnancy and Birth: Text

Thanks for reading! If you have more questions about unassisted birth and how to resolve common complications, you may like to check out our FAQ page.

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