No differences in the rates of anal incontinence

The results showed that women in the planned c-section group had a lower rate of problematic urinary incontinence compared with the planned vaginal birth group. The results also showed that there were no significant differences in the rates of fecal or flatal incontinence between the two groups. Fecal incontinence is the inability to control bowel movements causing stool to leak unexpectedly from the rectum. Flatal incontinence is the inability to control gas.

40+0 weeks are considered full term for twins and singletons. However, if you give birth within three weeks prior to this – when you’re 38 weeks pregnant or 37+0 weeks pregnant – your children are considered born at term.

This means that they aren’t considered premature and they’re expected to be delivered without any complications related to prematurity.

Will I give birth prematurely?

About half of women pregnant with twins give birth at term. This means that they give birth when they’re at least 37+0 weeks pregnant. The other half gives birth prematurely.

Whether you give birth at term depend very much on your health, the course of your pregnancy, how your babies are doing, chorionicity and amnionicity.

Chorionicity relates to the number of placentas. Amnionicity refers to the number of amniotic sacs (or membranes). It has to do with your twins being either dichorionic-diamniotic twins (di-di), monochorionic-diamniotic twins (mo-di) or monochorionic monoamniotic (mo-mo) twins.

What is di-di twins?

Di-di twins have individual placentas and a separate inner and outer membrane. Because they’re separated, the risk of pregnancy-related complications is lower.

The babies can’t develop Twin-to-Twin Transfusion Syndrome, Twin Reversed Arterial Perfusion or be at risk of umbilical cord entanglement and compression.

Di-di twins have the greatest chance of being born at term compared to mo-di and mo-mo twins. Fraternal twins are always di-di twins.

About one-third of identical twins are di-di twins.

What are mo-di twins?

Mo-di twins share a placenta and the outer membrane, but each has its own separate inner membrane. As a result of sharing a single placenta, the blood supplies can become connected, so that the twins share blood circulation.

The blood can be transferred disproportionately from one twin to the other. This is called Twin to Twin Transfusion Syndrome (TTTS) and happens to about 10-15 percent of monochorionic twins.

It’s life-threatening in the most severe cases, but treatment is often successful. Mo-di twins can only be identical – be aware though that, in rare cases, placentas can fuse together fooling health care providers into believing that fraternal twins are identical.

What are mo-mo twins?

Mo-mo twins share a placenta and both the outer and inner membrane. The risk of complications is very high. This is because the babies are in the same sac.

That makes them at risk of umbilical cord entanglement and compression during pregnancy and birth. All mo-mo twins are identical twins and are very rare.

About 1 percent of identical twins are mo-mo twins.

Is reaching full term for twins possible?

Reaching full term for twins is possible, but not likely. Many doctors recommend that you get a cesarean section or induction at least 2-4 weeks prior to you being full term with twins.

This is because the risk of stillbirth and other complications increases slightly in the weeks leading up to your due date. Doctors don’t necessarily agree about the timing of delivery.

In monochorionic twin pregnancies recommendations start from 34 weeks up to 38 weeks.* In dichorionic twin pregnancies, it’s from 37 weeks up to 39 weeks.

*This goes for uncomplicated monochorionic pregnancies. If you are carrying mo-mo twins most doctors will recommend that you get a cesarean section around week 32-33.

What does the research show?

A recent study from 2016 decided to examine the optimal gestational age for delivery of twins.  The researchers looked at 32 studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal mortality at various gestational ages after 34 weeks.

Overall the studies included 35,171 twin pregnancies. The researchers found that in uncomplicated dichorionic twin pregnancies, delivery should be considered at 37 weeks’ gestation – this is when you’re 37+0 weeks pregnant.

In monochorionic pregnancies, delivery should be considered at 36 weeks’ gestation. In monochorionic twin pregnancies, they didn’t find any clear evidence to support routine delivery before 36 weeks’ gestation.

Bloody show

A few days or weeks before you are going into labor, the mucus plug that covers the opening of the cervix will pass out of the vagina. It will usually have small amounts of blood in it – this is known as “bloody show.” If bleeding and symptoms of labor is premature, contact your doctor right away because you might be in preterm labour. You may also experience vaginal discharge.

Vaginal bleeding

When you approach your due date, minor vaginal bleeding may be a sign from your body that it’s preparing going into labor. If you’re also having contractions, this is a good indicator that you’ve started dilating. If vaginal bleeding is as heavy as a normal menstrual period, however, contact the hospital immediately.

Contractions

Another sign that you are going into labor is braxton hicks contractions increasing in duration and strength. When you begin to feel pain or that the contractions have a regular, consistent pattern, call your midwife and discuss the situation with her. Learn when the contractions have a regular, consistent pattern, by reading our twin birth guide.

Breaking of water

Some women experience the breaking of water prior to having contractions. Even though you are not having contractions, call the hospital. They’ll want to examine you to make sure that the umbilical cord hasn’t prolapsed. A cord prolapse occurs when the cord slips through the cervix and into the birth canal prior to the baby. If the cord is squeezed, it can cut the blood and oxygen supply, suffocating the child. It’s very important that you lie down after your water has broken to take pressure off the cord, if it’s prolapsed. Once the midwife has checked that it hasn’t, you’re free to walk around. If you’re not getting contractions after a few hours, the hospital staff will induce labor. This is done via pills or a drip. The twin closest to the cervix needs to face head down in order for you to have a vaginal birth – otherwise a c-section will be required. Read about c-section and twins.

Abdominal pressure

If you feel sudden abdominal pressure, sometimes in combination with braxton hicks contractions, you may be in early labor. It’s heavy to carry twins in general, but intense abdominal pressure is often a strong sign that you’re going into labor. Contact your midwife immediately if the abdominal pressure suddenly becomes very pronounced.

Different articles related to:

Pregnancy
Use our twin pregnancy week by week guide and stay updated throughout your pregnancy. Find out how twins are formed and know the difference between the many types of twins. Get insight into the feelings and emotions associated with being pregnant and how you deal with them.

Birth
Be prepared for the birth of your twins. Get advice from midwives and be informed about pregnancy complications and early labour. Also read our twin birth stories and get advice from other twin mothers. Learn how to take care of yourself, your partner and your twin babies.

Babies
Having twins means dealing with two babies at once. Find out how to handle this and learn more about nursing, breastfeeding and sleep.

Toddlers
Two active toddlers are a joy, but can also take a toll on you and your partner. Learn tips to cope and receive information about potty training, parenting and other subjects relevant for parents having twins.

Children
Your twins are getting bigger and may be starting school or on their way to college. Read about twin scholarships and the joys and challenges of having twins, who are maturing.

Family
A strong family foundation is a strength, especially when you’re having twins. Read about parenting and how to develop or maintain a thriving family. Read about how other families are handling having twins and what you can do to make sure that you, your partner and your children stay connected emotionally.

How will the position of my babies affect delivery?

If you’d like to have a vaginal twin birth, hope that both babies – or at least baby A – is in a head down position.

Both babies are head-down

If both babies are head down, you’ll be advised to give birth naturally in many countries. However, if you have health problems, or one or both of your babies are struggling in some way, you might be advised to have a c-section. Also, in some cultures, c-sections have become a symbol of status, which might also influence the advise you’ll be getting.

Baby A is head down – baby B is breech or transverse

Baby A is the baby closest to the birth canal and the one who’ll be born first. He or she needs to be head down in order for the vast majority of doctors to recommend a twin vaginal birth.
If twin B is in a breech or transverse (sideways) position, some doctors will recommend a vaginal birth, whereas others will recommend a c-section. It depends quite a lot on the doctor you’re seeing, and the culture in the country you live in.

Baby A is breech or transverse

The vast majority of doctors will recommend that you get a c-section if baby A is in a breech or transverse position.

What’s the safest way to deliver twins?

There has been controversy regarding the safest method for the delivery of twins at or near term. A policy of planned cesarean section for the delivery of twins gained support after the publication of the Term Breech Trial – a study done on singletons. It showed that planned c-section is better in the case of a full-term pregnancy when the baby is in a breech position. Further support for planned c-section has come from large cohort studies of twins showing a reduced risk of a poor outcome for twins born with elective c-section as compared with vaginal twin delivery or emergency c-section. Nevertheless, a large study, published in the The New England Journal of Medicine in 2013,* found no benefits of planned cesarean section compared to planned vaginal delivery for the delivery of twins between 32 and 38 weeks of gestation, if twin A was in a head first position. In the study, the researches point to the fact that their findings are generalizable only to centers that can provide the obstetrical management specified by the protocol, including the ability to perform an emergency c-section within 30 minutes if necessary.

*2804 women at 106 centers in 25 countries were included in the study. 

Will I give birth prematurely?

You are at higher risk of giving birth prematurely when you are carrying twins as apposed to a singleton. About half of women pregnant with twins give birth at term. This means that they give birth when they’re at least 37+0 weeks pregnant. The other half gives birth prematurely. There are debates in the medical community regarding what the optimal gestational age for twins is. Read more about this. Depending on the point of view of your doctor, you might be advised to get an induction or c-section before you go into labour naturally.

How does a twin vaginal birth progress?

Midwife Ditte Toft Heskjær is no stranger to a twin birth. She is employed at a Danish hospital in a team designated to women pregnant with twins and women suffering from birth anxiety. She gives an insight into how a vaginal twin birth progresses, and how you can conduct yourself during birth in order to get a positive birth experience. Also read her advice on how you can prepare for giving birth and about having a c-section with twins.

The latent phase

The procedure until the uterus is 10 centimeter dilated is the same as when giving birth to a singleton. The latent phase lasts until the uterus is 3 centimeter dilated. We advise women to stay at home as long as the contractions are irregular in strength and duration. When dealing with a singleton birth, we advise women to go to the hospital, when the contractions are of five minutes interval and has a duration of 60 seconds. When it’s a twin birth our advice is 5-7 minutes. The latent phase will last approximately 8-12 hours.

The active phase

The active phase is when your uterus is dilated 3-4 centimeters and lasts until it’s 8 centimeters dilated. Most women go to the hospital during this period of time. During birth it’s a good idea to move around and take various positions that’ll help your children’s rotation. I’ll run a CTG* once in awhile, but when I’m not, you’re free to walk around, take a shower or use a bathtub – be aware that not all countries allow the use of bathtubs during birth. I encourage that you create a good atmosphere in the delivery room and bring whatever makes you feel safe and comfortable. This could be your own pillow or music you like. I also advise the pregnant women’s partners to take of their shoes, so they feel more grounded. The mother often looks at her partner as well as the midwife to check that everything is okay, and it’s important to radiate calmness. The active phase will last about 4-6 hours. Usually the birth takes longer when a woman are in labour for the first time.

*Cardiotocography (CTG) is a technical means of recording the fetal heartbeat and the uterine contractions during pregnancy.

The transition phase

Now your uterus is dilated 8-10 centimeters. This is when the contractions are most painful. Use the strategies you’ve practiced, for instance different breathing techniques. It’s important to listen to your midwife, be cooperative and use the techniques, she suggests, even though it may feel unmanageable.
This transition usually lasts about an hour. When your cervix is fully dilated, you’ll need to lye or sit down on the bed, so the midwife can run a CTG and follow the curves continually. I’m very focused on ensuring that both twin babies are doing well at this point, as this is a time with strong contractions and the children are under much strain. Be aware though, that it’s good for them to feel a bit of stress. The heartbeat is allowed to decrease, as long as it’s within the norm. The adrenaline from the stress ensures that their bodies are awakened and prepares them for having to breathe once they’re born.

The pushing phase

You are 10 centimeters dilated and the babies will start to descend down your pelvis. You may begin to feel an urge to push. This phase usually lasts 60-90 minutes for the first twin and 15-20 minutes for the second twin. During a twin birth, many women will get a drip to stimulate the contractions. This enables them to give birth to the second twin faster. I’m usually alone with the woman and her partner, until I assess that there’s 5-10 contractions left until the first twin is born. Then I call in a standby team consisting of doctors and midwifes, who will assist in the delivery of the babies. When the first twin is born, I examine the position of the second twin, as it may have shifted during the birth of the first twin. The baby needs to lye with his or her head or buttock downwards. If the baby lies across (transverse), I’ll try and lead the baby in place during the contractions. If i’m not successful, a c-section is necessary. Read more about twins and c-sections. When both children are born, the placenta(s) will follow shortly after. This is usually not painful.
There is an increased risk of bleeding more than you normally should during labour, when you are giving birth to twins. This is due to the fact that the uterus has been very large. You’ll get an IV-drip, which causes the uterus to contract.

Read about having a c-section with twins.