Opinion: Double the hugs with twins

Morgan Wise with her twins David (left) and Ingrid at home in Waipukurau. Photo / Warren Buckland

Janine Gard is a diploma qualified birth educator and founder of Bellies to Babies. She has taught more than 2900 parents to feel confident, informed, supported and prepared. This week she talks about twins.

Every year in New Zealand around 1000 couples find themselves expecting twins, triplets or occasionally even more babies. Multiple births are more common than they were years ago, due to the advancing average age of mothers and the associated rise in assisted reproductive techniques, in particular the use of fertility drugs.

Twins account for more than 90 per cent of multiple births. There are two types of twins – identical (monozygotic) and fraternal (dizygotic). To form identical twins, one fertilised egg (ovum) splits and develops two babies with exactly the same genetic information. Identical twins are always the same sex, so if your twins are identical, you'll have two girls or two boys and they'll look very alike. This differs from fraternal twins, where two eggs (ova) are fertilised by two sperm and produce two genetically unique children, who are no more alike than individual siblings born at different times, this is more common than identical twins and your babies may be the same sex or different sexes. Contrary to popular belief, the incidence of twins doesn't skip generations.

Some women are more likely than others to give birth to twins. The factors that increase the odds include women in their 30s and 40s having higher levels of a hormone called oestrogen than younger women, which means their ovaries are stimulated to produce more than one egg at a time; the greater the number of pregnancies a woman has already had, the higher her odds of conceiving twins; a woman is more likely to conceive fraternal twins if she is a fraternal twin, has already had fraternal twins, or has siblings who are fraternal twins and assisted reproductive techniques – many procedures rely on stimulating the ovaries with fertility drugs to produce eggs and, often, several eggs are released per ovulation.

Having twins (or more) is considered a higher risk, you can still have a midwife if you choose, but will usually mean you will have other specialists involved such as an obstetrician and a paediatrician - one for each baby, most women will be able to have continued care with their midwife as well (yay!).

Twins are more likely to be born early, often before 38 weeks, so it's important to understand your birth options. Less than half of all twin pregnancies last beyond 37 weeks. Because of the likelihood that your babies will be born early, there is a good chance one or both of them will spend some time in special care (SCBU). As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or doctor early in your pregnancy. You should also discuss where you would like to give birth. You will most likely be advised to give birth in a hospital because there's a higher chance of complications with a twin birth.

While the process of labour is the same as when single babies are born, twin babies are more closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once your waters have broken. You will be given a drip in case it is needed later.

About one third of all twins are born vaginally and the process is similar to that of giving birth to a single baby. If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when the mother already has good pain relief - but this is your choice.

If you have had a previous caesarean section, it's usually not recommended you have a vaginal birth with twins but this should be decided after a conversation with all your health care providers. If you have a vaginal birth, you may need an assisted birth, which is when a suction cup (ventouse) or forceps are used to help deliver the babies. Once the first baby is born, your LMC will check the position of the second baby by feeling your abdomen and doing a vaginal examination. If your second baby is in a good position, your second baby should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.

You may choose to have an elective caesarean from the outset of your pregnancy, or your LMC may recommend a caesarean section later in the pregnancy as a result of complications. You're nearly twice as likely to have a caesarean if you're giving birth to twins than if you're giving birth to a single baby.

The babies' position may determine whether they need to be delivered by caesarean section or not. If the presenting baby - the one that will be born first - is in a breech position (feet, knees or buttocks first), or if one twin is lying in a transverse position (with its body lying sideways), you will need to have a caesarean section. Some conditions also mean you will need a caesarean section, for example if you have a low-lying placenta or if your twins share a placenta. If you have previously had a very difficult delivery with a single baby, you may also be advised to have a caesarean section.

Even if you plan a vaginal birth, you may end up having an emergency caesarean section. This could be because one or both babies become distressed during labour, the umbilical cord is in front of your baby, your blood pressure is going up, your labour is progressing too slowly, assisted delivery doesn't work and in very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if it becomes distressed.

After the birth, your midwife will examine the placenta to determine what type of twins you have. If your babies need special care, you may need to go to another hospital such as in Wellington that has appropriate facilities if complications happen during your pregnancy or one or both of your twins requires specialist care. These hospitals are more likely to be able to keep you and your babies in the same place. If you have one baby in the hospital and one at home, you will need to think about splitting your time between the two. When you visit your baby in hospital, ask if you can bring their twin and spend some time holding and caring for them together. If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is having trouble feeding.

Remember - you will have double the love, double the hugs, double the chubby cheeks and squishy baby kisses, double the grins and double the blessings!

■ For information about antenatal classes near you, check out From Bellies to Babies www.hbantenatal-classes.co.nz or phone 022 637 0624. I'd love you to join me, sign up today!

Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.