Multiple Pregnancies and Labour
In multiple pregnancies, the method of delivery is usually decided on the basis of the first baby’s presentation.
In around 70% of multiple pregnancies, the first baby comes head first so that its delivery proceeds very much like for a singleton. If the first baby is breech, external cephalic version is not possible as it is in singletons, and a Caesarean section during childbirth is usually advised.
As there are two babies and because they are more likely to be small, both babies will be monitored continuously with a cardiotocograph (CTG) each.
It can often be difficult to predict the position of the second baby, and the fact that one of the babies in such a pregnancy has been delivered vaginally does not necessarily mean that the next baby/babies will be positioned in the same way.
After the first baby is born, the position of the second baby will be checked by examining you internally or externally. If head first, or coming down the canal as a breech, then the baby can come out relatively normally. However, a breech second twin will still need to be delivered by a doctor just as with a singleton breech. If the baby is lying transversely, then the obstetrician will turn the baby around, usually by inserting a gentle hand inside the birth canal to bring the baby’s foot down into the birth canal. Because this may need to be done urgently, or because it may be painful, an epidural is recommended for all twin deliveries and should be in position and working prior to the first baby being born.
Babies in a multiple pregnancy also tend to be born prematurely since labour can start early due to excessive stretching of the uterus, which may stimulate uterine contractions.
A multiple pregnancy can cause maternal and/or fetal problems in labour, and therefore induction or a caesarean section may be necessary. A Caesarean section is usually required more often in a multiple pregnancy than in a singleton. This applies both to elective Caesareans done before the onset of labour, and to emergency Caesareans done for complications arising during labour. A common reason for a caesarean before labour starts is if one twin has not grown properly so that it is less likely to withstand the stress of labour.
If one of your babies is lying in an abnormal position, or if your labour is premature, it may also be advisable to have a Caesarean section to deliver the babies. This procedure is also recommended if your first is breech, and is most likely to be undertaken in cases where you are having three or more babies. Otherwise, if your babies are to be delivered normally, a number of healthcare professionals will be in attendance, your babies will be closely monitored electronically, a drip will be set up and epidural anaesthesia recommended.
Once the first baby is born, the position of the second will be checked and, if he/she is in a good position, the waters surrounding that baby will be broken to allow immediate delivery. In some cases, it may be necessary to turn the baby manually to the correct presentation.
If contractions have stopped after delivery of the first baby, an infusion of the drug syntocinon using the drip that has been set up will be used to get them going.