advice

how to cope with twin babies

Giving birth to twins or more can be riskier than with one baby, so it's worth being prepared for things not going according to your birth plan. Maybe you wanted a natural birth, but now you're booked in for an elective caesarean. Or you wanted to manage the pain with a TENS machine or gas and air, but suddenly you're having an epidural. Try to bear in mind that any last minute changes are made with the health of you and your babies in mind.

coping with twin babies

giving birth to multiple babies

You'll be glad to hear that, if you're giving birth naturally, labour with twins or more isn't twice or three times as long… or twice or three times as painful. If you suspect labour has started, contact the hospital straight away and ask to be checked. Things can move pretty rapidly with twins and more, so you want to be in the right place when they do.

The first stage is the same as with single babies but the second stage is different, because you repeat it until all the babies have been delivered. As long as there are no problems, you should be able to have your first baby put onto your chest before the others are born.

Another difference is when you're likely to go into labour. Early labour is six times more common in twins, and 11 times more common in triplets.[1] Bear in mind that full term with twins is 37 weeks, with triplets 34 weeks, and with quads, 32 weeks; yet many babies arrive before that:

  • 30% of twins come before 37 weeks
  • 30% of triplets before 32 weeks
  • nearly half of quads are delivered before 32 weeks
  • you're also more likely to have a premature birth if it's your first pregnancy, or if the babies are in the same chorionic sac, but the good news is that your doctor or midwife will know all about this and will be monitoring you carefully

a natural or caesarean birth

The decision about whether you have a natural birth or a caesarean won't be entirely down to your preference. In the UK, around 50% of twins are born naturally, but the more babies you're having the more likely it is you'll have a caesarean.

This happens for lots of reasons:

  • the babies are lying in positions which may make it difficult for them to turn head down once the first baby is born
  • with more than one baby, there's a greater chance of placenta praevia (where the placenta grows to cover the exit route of the cervix)
  • there's a higher risk of cord prolapse; this is when the umbilical cord drops down in the womb and gets trapped and flattened by the baby's head, so restricting the supply of oxygen and nutrients
  • the babies may be too small and vulnerable to stand the pressures involved in a normal vaginal delivery
  • your midwife and consultant will be aware of all of these factors and in the weeks before the babies are due it's best to discuss this all with them and get their advice; that doesn't mean you just have to do what you're told – it's always worth asking why

What's definite is that even if you finally opt for a natural birth, your labour will be more high-tech than with a single baby. This is partly because the babies have to be monitored separately, so that any complications can be spotted early and treated straight away.

Having twins doesn't rule out a home birth, although triplets may. Discuss your options with your specialist or midwife.

choosing pain relief for twins or more

With twins or more the choices of pain relief are the same as with singles, but many doctors have found that in multiple births an epidural has a lot of advantages.[2] These include being able to turn second or third babies round inside the womb without causing extra pain and being able to quickly carry out emergency caesareans if things get difficult. Also with epidurals, if you do end up having a caesarean you can be awake and your partner can stay with you throughout the birth.

twins or more can mean a crowded delivery room

The birth of twins or more is an exciting event for the hospital too, and so student midwives and doctors may want to watch. This means there can be quite a crowd in the room.

As well as your birth partner, the midwife and the obstetrician there could be an anaesthetist if you're having an epidural, plus a paediatrician for each baby. If this feels like too many already and you don't want students there observing, speak to your doctor or midwife in advance.

after the birth of your babies

Once your babies are born, and provided there aren't any problems, you'll be able to experience that wonderful sensation of having them placed on your chest. Not only will you be able to feel their skin against yours, but you'll get your first incredible look at your newborn children. Depending on the kind of birth you're having, you might be able to put each one to your breast while you're waiting for the next to arrive.

Even if you've had a healthy pregnancy, your babies will probably be a little smaller than most newborns. The average birth weight for twins is 5lb 8oz (2.5kg) each, while for triplets it's 4lb (1.8kg) each, and for quads it's 3lb (1.4kg) each. And don't be surprised if your babies are different sizes. It's quite usual.

The chance of one or more of your babies having to be in the Special Care Baby Unit is quite high. According to a TAMBA (Twins and Multiple Births Association), around 40% of twins and 97% of triplets go into special care.[3] The reasons they're there will dictate how much you can touch and hold them, but you will be able to be with them as often as you want. Ask to have their beds put near each other so that you can easily see all your babies.

It's not easy if one or more of your babies goes into special care but another doesn't. It can be especially difficult if one baby is particularly sick and needs to be in a different hospital altogether. You will understandably feel torn between them.

If your well baby is in the same hospital, ask if they can be moved nearer the SCBU so it's easy for you to pop out and see them. Or take them with you when you go to visit their sicker brother or sister. But if none of this is possible, try to reassure yourself that your sicker baby needs more of your care and attention, and ask your partner or parents to be with the well baby.

how to tell which baby's which

Even if your babies aren't identical, it's going to be difficult to tell them apart at the beginning. Gradually, as you get to know them over the coming days, you'll begin to spot little differences – perhaps one's face is a little thinner, another has an obvious birthmark, or one startles more when disturbed. You'll also soon be able to tell their cries apart. But until that happens, there are some little tricks you can use to make them different so that you and your visitors can easily tell which is which:

  • put a different toy with each baby so that friends and family begin to associate a baby's name with a particular toy
  • give each baby a different bracelet
  • give each baby a colour that's their own, so they'll always be associated with it, then give them a blanket or clothes with that colour in it
    • It's really important to use their names and encourage people to think of them as individuals right from the beginning. This means that as they grow older they can develop their own personalities, and function apart from each other, rather than always being lumped together as 'The Twins' or 'The Triplets'.

feeding twin babies

If you'd like to breastfeed your babies you can. You'll make as much milk as the babies demand, so don't worry that you won't have enough. The difficulty comes in getting into the right position, especially if you have triplets or more. So you'll need lots of help and support, especially at the beginning when you're learning to attach the babies.

If you have twins you can feed them separately or together, but it saves a lot of time if you find a way to feed them together. It may not always be possible, especially if they're different sizes. The most popular position is the 'rugby ball' – the babies' heads towards the middle, their bodies held under each arm. That way you can control their bodies and cuddle each one. But you'll need to find yourself a really comfortable chair, lots of cushions, including a v-shaped one, and some help to pick them up and latch them on until you get used to it.

With triplets and more you might be able to breastfeed two and bottle-feed the others on a rota basis, perhaps expressing your own milk for the bottles. Or you may feed all of them at different times, especially if some are smaller than others and need more regular feeds.

Although the basics are the same as with single babies, breastfeeding more than one is more exhausting and you'll burn more calories. So make sure you rest, have lots of water to drink, and eat well. Getting the hang of breastfeeding can take time, but the benefits are great, especially for smaller, premature babies.[1]

Bottle-feeding allows you and your partner to take it in turns with each baby, and they can feed on their own in the night or before work in the morning. That way they'll feel they’re getting to know the babies at the same time as you. Or visitors can take a turn while you rest or spend some special time with another baby.


References


[1]. How to cope with twins, Emma's Diary [Accessed May 2019]

[2]. Giving Birth to Twins, NHS Direct, November 2017

[3]. Research Rocks, Tamba, [Accessed May 2019]