Seeking support online – pregnant with twins

Pregnant women are increasingly turning to social media for information support, especially when feeling pressure to accept medical intervention “just in case”.

This is the story of Lisa, pregnant with twins after 2 cesarean sections and one vba2c. Lisa sent a call-out for support via Facebook in the weeks and days before a booked induction date:

“I need some advice. I’ve made it to 38 weeks with mono-di twins. Not a single problem or cause for concern at all in the whole pregnancy. However, my Dr wants to induce me at 38+3 as they don’t recommend twins going much past 38 wks “just in case” the single placenta deteriorates (1:69 chance). I desperately want to avoid medical induction but don’t want to risk my babies’ lives. Any advice, info, stories, encouragement would be greatly appreciated. Thanks in advance!”

Because of her twin pregnancy, Lisa was considered high risk. Her conundrum was whether to accept the medical advice or decline the induction – but then feel solely responsible for any adverse outcome.

Lisa shares the advice she was given to accept an induction of labour with her twin pregnancy:

“There has been absolutely no problems whatsoever this pregnancy, except the fact that these twins are mono-chorionic aka “identical” (which means they share a placenta) but that appears to be functioning perfectly with no sign at all of problems. The Drs just believe that by not inducing me at their preferred time they are entering “uncharted territory” & they don’t want to take the risk that something “could” go wrong even though there is no cause for concern yet. It makes me feel very nervous to be going against medical advice but at the same time I don’t want to fall into the “cascade of interventions leading to a C-section” after getting induced. It’s a real tough call because I would hate for one of my babies to suffer or God forbid pass away because I went against the Drs advice, but at the same time I don’t want unnecessary C-section. I’m just so anxious about this but I’ll be ok I’m sure. Just have to go with my instinct and have faith.”

In Lisa’s case, she and her babies were perfectly healthy. Her assessment was that she was in a prime state for giving birth. While naturally concerned for her twins, Lisa was also worried about the risks  associated with pre-emptive interventions and technological control of her labour.

Inducing twins before 39 weeks was explained by her doctor to avoid the risk of the placenta failing – Lisa quoted them as saying there was a one in 69 chance.

Virginia from Homebirth Access Sydney described the issue Lisa was facing: “It sounds like your Dr is downplaying the risks of induction (and not carrying the babies to their own natural full term) while overstating the “risk” of leaving well alone – an all too familiar story unfortunately.”

(Overstating the risk of ‘expectant management’ and understating the risks associated with ‘active management’ is a complex and important issue in maternity care)

You will be thrilled to learn Lisa went into spontaneous labour and gave birth to her twin girls – two days before the induction date.

Crystal (l) and Jasmine (r)

Lisa wrote on Facebook:
“I gave birth to our beautiful identical twin girls Wednesday 27th at 12:48pm & 1:21pm. Crystal Rose was 8 pounds even, & 52cm long, Jasmine Faith was 6 pounds 8 oz & 50.5cm long. Both safely delivered vaginally after vba2c & 2 previous c-sections. Thank you to everyone for their amazing encouragement & support! It helped more than you could ever know!”

You can find Lisa’s birth story here

In the spirit of sharing information and support, Lisa was happy to share her story and the support she received online, including responses from well-known Australian midwives and researchers Rachel Reed and Carolyn Hastie.

Women expecting twins and the people supporting them may appreciate the honesty, care and encouragement in these responses too!

• I would ask the Ob for the research that says 1:69 chance of placenta deteriorating. Then when they can’t produce it, (because there isn’t any) she can just keep being pregnant. To avoid medical induction all you have to say is thank you but no thank you. I attend a few [twin births] a year and have never had a client go in for induction. They have all birthed AFTER 38 weeks with no problem. Nobody can do anything to your body that you don’t consent to. An induction means approx 65% chance of a section. Good luck

• So much fear about twin babies. Ask the woman to talk to the children heart to heart. She needs to feel safe about them both, to especially make sure she connects with the second one – that’s the baby the doctors really wave the shroud about – they are so much creating self fulfilling prophecies. I have had lots of experience with twins and even before they used ultrasound to diagnose twins – when they would pop out unannounced they know how to be born. I’m happy to talk to the woman – she can ring me

• There is probably not much info re. real risk about the alternative (ie. not inducing) because so few women avoid the pressure to [induce]. I know a mother on the Sunshine Coast who resisted and birthed full term twins without intervention. The standard approach is induction before term + epidural so that the OBs can manage any complications. Of course induction and epidural create complications for mother and baby. The risk of a twin birth alone is difficult to separate from the risks associated with the routine interventions carried out during a twin birth. If she wants to birth physiologically she will need to trust herself and have a strong birth plan + support people… or not birth in hospital.

• Lisa any medical intervention carries risk, not least when it is not medically indicated – “just in case” is not a medical indication. Inductions will at least double your chances of caesarean which carries risk in itself, for you and for your babies. You need to bear in mind that you can say no to the induction, as it is your right to make an informed choice about what happens to your body and your babies. It sounds like your Dr is downplaying the risks of induction (and not carrying the babies to their own natural full term) while overstating the “risk” of leaving well alone – an all too familiar story unfortunately. There are 2 birth stories of full term twins in our Autumn issue of Birthings “Safety & Risk”which is available to buy or download on our website. I wish you all the best.

• I don’t have any info to lend other than an old co-worker just had a c-sec on her healthy twins @ 38 weeks and they’re both still in the NICU a week later….

• Best resource I can give is a book called Having Twins and More by Elizabeth Noble. It is a hugely thick book but it was my bible for my twin pregnancy. I kept them in until I went into spontaneous labor at 40 weeks 5 days.

• I had my twins at 39 weeks at home. Labor was spontaneous, placenta was gorgeously healthy and full of life. I’m a huge proponent of letting twins go until they are ready unless there is a warranted health concern. I second the Elizabeth Noble book, she normalizes twin birth.

• One of my ladies refused an epidural [doula client]. She was told that there was a risk that she would need a crash section to get the second twin out if he went into trouble. The lack of epidural meant that she has the freedom to move about and therefore allow the babies to descend for a vaginal birth. She did it all on gas and air. She did her research about birth and decided that they were not allowed to bully her into the birth of THEIR choice.

• There is a growing body of evidence that babies born prior to 39 weeks (38 completed weeks) are more likely to have problems transitioning and need to spend some time in special care nursery. Has the OB given a reason for induction? There is no reason to treat a twin pregnancy any differently than a singleton (unless they share a placenta). [Lisa’s babies did share a placenta but this midwife was not informed of this at the time]

LINKS THAT WERE SUGGESTED BY MIDWIVES AND DOULAS:

• Romi’s empowering vaginal birth of twins (Brisbane, Australia)
• High Risk Birth – Defined by Whom by Justine Caines~ article
• Why at least 39 weeks is best for your baby~ webpage article
• Australian Multiple Birth Association~ website
• Having Twins and More – Elizabeth Noble~ book
• Natural Childbirth of Twins and Triplets~ YouTube video
• Twin Birth at Home?~ webpage from Homebirth UK website
• Mary Cronk Midwife – Guidelines for Care (natural twin birth, home or hospital) ~ webpage article
• Collection of Twin – Multiples birth stories