What to expect when you're expecting (165 page)

You’ll probably have an epidural. If you’ve had your heart set on one anyway, you’ll be happy to hear that epidurals are strongly encouraged—or even required—with multiple deliveries, in case an emergency C-section becomes necessary to deliver one or all of your babies. If you’d like to avoid an epidural, talk to your practitioner, because practitioner and hospital policies differ on this topic.

You’ll probably deliver in an operating room. Most hospitals require this, just to be on the safe side (and in case an emergency C-section becomes necessary), so ask ahead. Chances are you’ll be able to labor in one of those comfy rooms with the pretty curtains and relaxing prints, but when it’s time to push, you’ll likely be wheeled into the OR.

Twin Timing

Just how far apart will your multiples be born? With vaginal deliveries, most babies are born 10 to 30 minutes apart. With C-sections, it can be just seconds, or up to a minute or two, between births.

Position, Position, Position

Quick … flip a coin. Heads (up) or tails (down)? Or maybe a combination of both? How multiples will end up at delivery time (and how you’ll end up delivering) is anybody’s guess. Here’s a look at the possible ways your twins may be presenting and the likely delivery scenarios for each situation.

Vertex/vertex.
This is the most cooperative position that twins can wind up in on delivery day, and they wind up in it about 40 percent of the time. If both your babies are vertex (heads down), you’ll likely be able to go into labor naturally and attempt a vaginal birth. Keep in mind, however, that even perfectly positioned singletons sometimes need to be delivered by C-section. This goes double for twins.

Vertex/breech.
The second best-case scenario if you’re hoping for a vaginal birth for your twins is the vertex/breech setup. This means that if Baby A is head down and well positioned for delivery, it may be possible for your practitioner to manipulate Baby B from the breech position to vertex after Baby A is born. This can be done either by applying manual pressure to your abdomen (external version) or literally reaching inside your uterus to turn Baby B (internal version). The internal version sounds much more complicated than it is; because Baby A has essentially warmed up and stretched out the birth canal already, the procedure’s over pretty quickly. If Baby B remains stubbornly breech, your practitioner may do a breech extraction, in which your baby is pulled feet first right out the door.

Breech/vertex or breech/breech.
If Baby A is breech or if both your babies are bottoms down, your physician will almost certainly recommend a C-section. Though external version is commonplace for breech singletons (and can work in the above-mentioned vertex/breech multiple pregnancy), it’s considered too risky in this scenario.

Baby A oblique.
Who knew there were so many positions for babies to lie in? When Baby A is oblique, it means his or her head is pointed down, but toward either of your hips rather than squarely on your cervix. In a singleton pregnancy with oblique presentation, a practitioner would probably try external version to bring the baby’s head where it needs to be (facing the exit), but that’s risky with twins. In this case, two things can happen: An oblique presentation can correct itself as contractions progress, resulting in a vaginal birth, or more likely, your practitioner will recommend a C-section to avoid a long, drawn-out labor that may or may not lead to a vaginal birth.

Transverse/transverse.
In this setup, both babies are lying horizontally across your uterus. A double transverse almost always results in a C-section.

Here’s what you can expect when delivering your twins:

Vaginal delivery.
About half of all twins born these days come into the world the old-fashioned way, but that doesn’t mean the birthing experience is the same as it is for singleton moms. Once you’re fully dilated, delivery of Baby A may be a cinch (“Three pushes was all it took!”) or a protracted ordeal (“It took three hours!”). Though that latter scenario is far from a given, some research has shown that the pushing phase (stage two) is usually longer in a twin delivery than in a singleton delivery. The second twin in a vaginal delivery usually comes within 10 to 30 minutes of the first, and most mothers report that delivering Baby B is a snap compared to Baby A. Depending on the position of Baby B, he or she may need some help from the doctor, who can either reach in and move the baby into the birth canal (internal version) or use vacuum extraction to speed the delivery. The possibility of this kind of intervention is yet another reason why many doctors strongly recommend epidurals for multiple moms. (An arm reaching up into your uterus to pull out a baby isn’t pretty without pain meds.)

Mixed delivery.
In rare cases (very rare cases), Baby B must be delivered by C-section after Baby A has been delivered vaginally. This is usually done only when an emergency situation has come up that puts Baby B at risk, such as placental abruption or cord prolapse. (Those all-important fetal monitors tell your doctor just how well Baby B is doing after Baby A’s arrival.) A mixed delivery is not fun for mom; in the moment, of course, it can be very scary, and after the babies are born, it means recovery from both a vaginal birth and major abdominal surgery, a big double ouch. But when it’s necessary, it can be a baby-saving procedure, well worth the added recovery time.

Planned C-section.
A scheduled C-section is discussed with your doctor in advance and a date is set. Possible reasons for this plan include a previous C-section (a VBAC is not common practice for multiples), placenta previa or other obstetrical or medical issues, or fetal positions that make vaginal delivery unsafe. With most planned C-sections, your spouse, partner, or coach can accompany you into the operating room, where you will probably be given a spinal block—a pumped-up version of the epidural used to block pain in a vaginal birth. You may be surprised by how fast it all goes after you’re numb: Baby A’s and Baby B’s birth times will be separated by anywhere from seconds to just a minute or two.

Recovery from a Multiple Delivery

Besides having your hands twice as full, your recovery from a multiple delivery will be very similar to that of a singleton delivery, so be sure to read through Chapters 17 and 18. You can also expect these postpartum differences:

It’ll likely take longer for your belly to return to normal size (it was stretched out more, after all). You’ll likely have more extra skin to contend with, too, after all that stretching.

You may experience more lochia (vaginal bleeding) for a longer period of time. That’s because more blood was stored up in your uterus during your pregnancy, and it all has to go now.

Getting back into shape will take longer—mostly because you were probably pretty inactive for the last three months of your pregnancy (no matter how physically fit, or not, you were before your pregnancy).

You’ll be achier for longer because of all the extra weight you carried around during pregnancy. Not to mention all the extra carrying around you’ll be doing after delivery.

Breastfeeding for Two Is Good for Mom, Too

You probably already know that breastfeeding is the best for your babies (see
page 447
for tips on breastfeeding multiples). But did you know that it also does your postpartum body good? Breastfeeding releases hormones (oxytocin) that help your uterus contract to its normal size (and remember, yours was especially stretched). This in turn will also stem the flow of lochia, so you’ll lose less blood. And if you’re concerned about losing weight, just consider those little nurslings to be nature’s liposuction machines: Breastfeeding two babies will burn fat and calories twice as fast, which means you’ll also have license to continue eating more. Nurse three (or more) and the calorie bonuses multiply.

If your newborns are in the NICU, you probably won’t be able to nurse them directly at first, but they’ll benefit greatly from the ideal nutrition only you can provide (especially if they’re preemies). So cozy up to an electric pump (they can likely be fed with the expressed milk), and continue pumping until they’re released and ready to cozy up to your breasts.