Birthing identical twins

AIMS Journal, 2012, Vol 24 No 1

Robyn Hall shares her journey of pregnancy with identical twins

As I was sitting in the waiting room for my 12 week scan I faced a poster advertising our local twins group and thought 'that's someone else's life', so shocked doesn't quite cover how I felt when I saw two little heads on the screen.

That's when I stopped being a mum-to-be and started being 'twin pregnancy' and 'high risk'.

I was told I would be attending the twins clinic but not told why, or given any real information, or even asked how I felt about having twins. Early on I was told that our identical twins would likely be early and, if not, that they should be delivered by 36 weeks and that I could have an elective section if I wanted or I'd be induced, but that most twins are delivered by section so I might as well consider it. I was devastated that my babies' right to choose when and how to be born was gone because they were twins.

When I kicked up a fuss I was told by the doctors that studies show twins stillbirth rate doubled if the pregnancy went past 38 weeks and twins should always be induced early. However, they did not point out that this stillbirth rate is still tiny, only a few perthousand, a tiny percentage. I asked the head midwife if there were other studies that said differently, she said no, but that was a lie. As I was being given so little information, I decided to find out for myself. The two big, healthy and very active babies I was incubating seemed quite comfortable, with no intention of coming early, so the decisions were now mine to make.

The studies I found initially said that if twins were born spontaneously at 38 weeks they fare better than later births, but that the risks of continuing the pregnancy past 38 weeks were much smaller than the risks of induction. Then I found a study that said that, contrary to standard medical advice, twin pregnancies that went past 39 weeks had lower rates of stillbirth, growth restriction and no incidences of respiratory problems at all.

As my pregnancy continued I felt under more and more pressure to follow the doctors' preferences. Every time I attended the twins clinic, people seemed to comment on my reluctance to interfere with nature. 'Have they not delivered you yet?' and 'You'll be getting a section then' from administrative staff and nurses/midwives and one narcissistic male consultant who kept on commenting on my exhausted state and then pouncing with 'have you changed your mind yet'.

Luckily one female doctor and midwife were supportive. As my two were identical, there was also the risk of twinto- twin transfusion syndrome (TTTS) during labour. When I contacted the TTTS Foundation to ask about these risks they said there was no research indicating percentages of this or the outcomes, but that if I felt concerned I could request continuous monitoring during labour, no mention of the word 'section', let alone 'elective'.

My girls continued to grow and were always healthy but once I hit the 39 week mark I was not. I was so uncomfortable that if an elective delivery had only posed risks to myself I would have jumped at the chance, but the idea of risking my babies with no valid medical reason was out of the question.

I ended up in hospital exhausted, anaemic and with rising blood pressure and protein in my urine. My blood tests showed I did not have pre-eclampsia but the doctors did not want to risk waiting as pre-eclampsia can come on very suddenly with twins. I had no problem with the idea of medical intervention for medical reasons but, as the situation was not immediate, I negotiated to have a little time to try natural methods first.

The day I was scheduled to be induced, after three sweeps and three courses of acupuncture, I went into labour myself. It was a long labour and due to maternal exhaustion I ended up in theatre with my first daughter delivered by forceps and my second an assisted breech. The whole time I was monitored, there was never a concern about the babies and I'm confident this was because they had been allowed their own time to grow and develop.

At 40 weeks and three days Ella was born weighing 8lb 4 and smiled up at me from her Dad's arms as I birthed her sister. Cassady was 7lb 13 and needed a puff of oxygen before being given to me, and both my daughters went straight through to recovery with me and fed well shortly thereafter.

I was so thrilled that they were not taken to NICU and therefore did not miss the opportunity to bond and establish breastfeeding.

Yes, twin pregnancies and births carry higher rates of many problems and sometimes interventions are necessary, but that does not mean that all twins are better off being manipulated into this world. There are lots of valid reasons to deliver twins early but, as with any pregnancy, risks should be calculated on an individual basis and the risks of elective sections not minimised, especially the risks to the babies. Twin mothers should be supported in making decisions that they know to be in the children's best interest.

When I look at my beautiful, big, strong, healthy, alert and happy baby girls, I am so proud I refused to be bullied into robbing them of 4 weeks and 3 days of growth and brain and lung development and I'm very grateful for the supportive midwives and doctors we came across and our amazing doula who all helped make our birth possible.