You had your game plan in place for having your baby -- until you found out you're having babies -- as in, twins! Now you're not sure where to start with your birth plan; including details for two babies will be more complicated than for just one, you might think. Actually, it really won't be. The same birth possibilities exist for both singleton and twin births. You have a increased chance of having a Cesarean birth or other complications, but you can still ask for options that cover the most likely contingencies.
How Twins Change Things
A twin pregnancy is higher risk than pregnancy with one baby, for several reasons. In a twin pregnancy, you have twice as many chances for the baby to be upside down or sideways, necessitating a Cesarean delivery. In the United States, 75 percent of twins were delivered by Cesarean in 2008. Twins are also more likely to deliver prematurely, before 37 weeks. Twins pregnancies are more often complicated by gestational diabetes, pre-eclampsia or placental abruption, along with other complications that can throw a monkey wrench into your birth plan. It's important to remain flexible and realize that having twins means more than twice the likelihood of problems arising that will put road blocks in the way of your prefect birth.
If you're having a vaginal delivery, your birth plan labor requests won't really differ from those you would make if you were having just one baby. Labor requests in birth plans often center on location: do you want to labor in the bed, the birthing pool or strolling the halls? Pain medication is another typical mention in birth plans: do you want the option or do you want anyone who mentions the word epidural banned from your room? Other common options include fetal monitoring -- how much, how long, when and where? Your doctor might be less likely to leave the fetal monitors off if you're having twins, since twins are at higher risk of getting tangled up in each other's cords and going into fetal distress. If he insists on an intravenous infusion, ask if a saline lock, which gives immediate access to a vein, would do.
Even if you're having two babies, there's no reason you can't ask to hold or nurse both right after birth, as long as they're not too premature or having any respiratory or other complications at delivery. Because both babies don't come out at the same time in a vaginal delivery, there's also no reason why you can't request that your practitioner not do an episiotomy.
Pushing in an upright position or squatting or pushing in the birthing pool likewise should be no more problematic when you're having twins than when you're having just one, except for the difficulty of monitoring baby number two when you're giving birth to number one.
The only difference in making a birth plan for two if you're having a Cesarean delivery is to ask to have two arms free during the surgery, one for each baby. You might also want to think of what you want done if one baby has to go to the neonatal intensive care and the other doesn't, or what you would like done if both babies need observation. If they're in stable condition but just need extra warmth and monitoring, you might want them both in the same isolette or warmer. If they need intensive care, this might not be possible, since keeping two sets of tubes and wires in place could result in errors or accidents.
If your babies are big enough, both can stay in your room. Your birth plan can also discuss common issues, such as whether or not you want your baby boy circumcised or whether you want to avoid supplemental feedings, vitamin K administration or antibiotic eye drops. If both your babies need procedures done, you can certainly request to have them done at different times so you can be present with both either during or right after the procedure. Nursing twins can be trickier than nursing just one baby, so ask for help from the hospital lactation consultation or your nurse as soon as possible, so you get nursing off on the right foot with both babies.
Since twins can come quite early, talk with your doctor about where you want to deliver well ahead of your due date. It's ideal if you can deliver at a hospital with a level III nursery, which means they can handle the sickest babies if your babies come very early, but your doctor might not have privileges there. It's easier to transport you to the hospital before the babies are born and less traumatic than to transport them after delivery. If your babies need transport, or if one does and one doesn't, the receiving hospital may or may not be willing to accept you for transport as well. Talk to your doctor about your transport wishes, including which hospital you prefer your babies to go to. Some ambulance companies will not let you or your partner accompany the babies during transport.
Suzanne Robin is a registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology. She also has extensive experience working in home health with developmentally delayed or medically fragile children. Robin received her RN degree from Western Oklahoma State College. She has coauthored and edited numerous books for the Wiley "Dummies" series.