Wrapping your head around the fact that you are having a baby can be hard, whilst there’s excitement and joy, there’s also fear and anxiety as to what lies ahead and how your life will change.  Imagine then that you’re not expecting one baby, but two, or more!! Along with the trials and tribulations of a single pregnancy, come additional concerns, more decisions and the potential for more complications.

One Born Every Minute: Expecting Twins? by Professor Mark Kilby and Jane Denton, has just arrived on bookshelves all over the UK. A guide to the road through pregnancy and your babies’ first year, it covers everything from how twins are conceived, how they are born and how to cope with double trouble (a phrase that will start to grate with you before you reach the end of your first trimester!!).  Not only that, but the writers and publishers have kindly shared some of their wisdom with NowBaby and we’re kicking off with how a twin pregnancy can affect the options to you surrounding the where you give birth to your babies….

Expecting Twins: Birth Options

Twin pregnancies present risks for both mother and babies, so once you know you are expecting more than one baby, there will be different factors to take into account concerning where you give birth.

Even uncomplicated, ‘low risk’ twin pregnancies are still ‘high risk’ compared to singleton pregnancies, so the safest option for twin pregnancies is to give birth in a dedicated obstetric unit within a hospital, where operating theatres and full emergency facilities are available if needed. Depending on where you live, you might have the choice of more than one such hospital, in which case you should spend some time deciding which one is best for twin births.

If you do have a choice and if you already had a hospital in mind before you knew you were expecting twins, you may wish to reconsider – indeed, the medical staff may recommend you do so. As all twins are more likely to be born early and may need specialist medical care, you should find out what level of care the hospital’s neonatal unit (NNU) is able to provide. However, this needs to be evaluated alongside your antenatal circumstances: you could be attending hospital every two weeks for scans, and so ease of access at this stage is important.

Levels of neonatal care

There are three levels of neonatal care, but not every NNU is equipped to offer them all. The level of care needed by premature babies depends on how early you go into labour and the health of your babies at birth.

  • Special care is routinely provided for babies born at 34+0 weeks and more, those of low birth weight (below 2 kg) and those with moderate health problems.
  • High-dependency care is for babies who need continuous monitoring and includes those born at 28–33+6 weeks and/or with short-term complex care needs (e.g. need help with breathing, intravenous feeding or weigh less than 1 kg). This, as well as all other levels of care, is provided in a Local Neonatal Unit (LNU), although babies needing long-term complex/intensive care are transferred to an NICU.
  • Intensive care is for babies born before 28 weeks and those with very complex problems. A neonatal Intensive Care Unit (NICU) provides constant monitoring and (usually) mechanical ventilation.

Questions to ask your hospital

Listed below are some of the questions you may want to ask about your hospital. You can also access data on all hospitals and maternity units via the Care Quality Commission’s website.

The birth

  • What is the hospital’s approach to twin births: how are they monitored and delivered?
  • Is there a specialist multidisciplinary team for multiple births?
  • What are the recommendations for using epidurals with twin deliveries?
  • What level of care does the hospital’s NNU provide? Where will your babies be transferred to if they need a different level of care?
  • What is the attitude towards birth plans, specifically for twins?
  • If you think you may use it, what is the policy on nonpharmacological pain relief, such as acupuncture and reflexology?
  • Will you be able to eat and drink during labour?
  • Can you wear your own clothes?
  • Can your partner cut the umbilical cords?
  • Can anyone else attend the birth (check policy on how many people are allowed in the delivery room)?

Postnatal care

  • How many beds are there in the postnatal ward?
  • Are there any amenity rooms (single rooms with en suite facilities, for which you pay a fee)? If so, how are they allocated and how much do they cost?
  • What is the average length of stay after a vaginal and after a Caesarean birth?
  • In what ways are mothers of twins helped after the birth?
  • Do the babies remain with you at all times?
  • Are partners allowed to stay overnight?
  • What are the visiting hours and do these apply to partners as well?
  • Is there a breastfeeding counsellor and any additional support for mothers breastfeeding twins?

This is an edited extract from One Born Every Minute: Twins? by Professor Mark Kilby and Jane Denton, published by Quadrille, £25.