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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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I was asked by TAMBA to photograph these very special twins. TAMBA is a charity supporting Twins and Multiple Births, now called The Twins Trust. You see, Kiaan and Kush were the world's first twins to be scanned using TAMBA's Twin Pregnancy Growth Charts. These special charts will plot measurements of twin growth in the womb more accurately allowing for the fact that normal for twins is smaller than singletons, and so prevent unneeded early deliveries. More details are on TAMBA's blog about this development they funded.

The most exciting operation in the world in my mind is a c-section. I just couldn't say no to the chance to photograph a twin c-section birth. I was slightly nervous since the only other c-section I attended, 6 years ago, I was at the other end and had a curtain to prevent me peering at my tummy when my twins were born. I don't think I wanted to see it at the time but it certainly gave me a reason to be curious.

A c-section feels so fast, there is just one person being operated on then suddenly there were 2 extra people in the room. Two lives at their very beginnings. The miracle of birth, no matter how it comes about, is amazing.

Here are links to some of the publicity we have received...

Huffington Post: "Cheeky Newborn Twin Sticks His Tongue Out At Caesarean!"

Mirror Online: " I'm over the moon "

Huffington Post: " An extremely important day for foetal medicine"

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Twin birth story - Jenny Burrows - Tiny Shoots Photography

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I was asked by TAMBA to photograph these very special twins. TAMBA is a charity supporting Twins and Multiple Births, now called The Twins Trust. You see, Kiaan and Kush were the world's first twins to be scanned using TAMBA's Twin Pregnancy Growth Charts.

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When I first discovered I was expecting, I was excited to join the ranks of motherhood as a fledgling member. Soon, however, I learned that I was not having a sweet bundle of joy; I was having three. As blessed as we are to have become a family of five so quickly, I found that having triplets made me seem almost un-relatable to other moms.

Here are some things you should know about raising triplets:

1. I often wonder what life with one child is like. Not because I wish I had one child. I am obsessed with all three of my kids. But you know that yummy moment when a newborn finishes eating and curls up asleep in your arms? For me, that moment always meant that it was time to put that baby in a crib and attend to the next child. I used to daydream about what it would be like to hold my child whenever I felt like it for as long as I wanted. I still imagine how it would feel to go to the store with a child and not have people stare, comment, or whisper about my family. I envy your normalcy.

2. Everyone finds my situation fascinating-except for me. Having a family that differs from the norm invites a lot of curiosity and probing lines of questioning-often inappropriate in nature. When people see triplets, they think it gives them a license to discuss a family's very private business of conception. Some try to be covert by asking questions like, "Do twins run in your family?" or "Was it a surprise?" Others go for the jugular and ask, "Are they natural?" or "Did you do The Fertility?" While I am not particularly private about our family's journey with infertility and our subsequent IVF miracles, fielding these questions from people I don't have any connection to feels so invasive. In addition to the barrage of questions from strangers cornering me in the supermarket, I also get loud comments, whispers, and stares from passers-by. Once, I ordered a latte at Starbucks when I had my babies with me and the older lady at the register yelled back to the other baristas, "She must not be breastfeeding, she ordered caffeine!" Geez. Thanks lady. And, of course, there are the cars in the neighborhood slowing to a creep as I push my triple stroller along the sidewalk. There is the rubbernecking and whispers while I stand in line at Target. The loud comments as my children play at the park. I am not a meek person by nature, but I'm also not fond of being the center of attention. These repeated events have made me crawl into my shell and avert eye contact every time I go out. I'm not trying to be rude, I've just been conditioned to act this way.

3. Our normal is different from your normal. Not better. Not worse. Just different. Having three infants is logistically cumbersome. Daily, we have to solve problems that others never needed to consider. What car seats are slim enough to fit three across? Can a triple stroller fit in the back of the car or through a doorway or on an elevator? How do you give bottles to all three when they are hungry at the same time? How will we evacuate the house if there's a fire? Will the doctor allow us to bring three children at the same time? What is the parent-child ratio in this mommy-and-me class? Does this restaurant have three high chairs? These issues are exactly the ones that can make our family seem so un-relatable. Ultimately, we all begin problem-solving the moment we arrive home with a newborn; we just have some different problems to solve.

4. I will never minimize your struggle. Often, you will say things to me like, "I guess I shouldn't complain when I only have one baby." Please complain. Vent. Make me feel human. Being responsible for the wellbeing of a little life is stressful and none of us really know what we're doing. We're on the same team. We're moms. Our struggles won't be identical, but they will be real.

5. In some ways, I have it easier than you do. Having three babies at once isn't necessarily easy, but there are some ways in which it is easier than one. For instance, when I put my kids in bed, they go right to sleep without any coaxing. In fact, they never expect individualized attention for anything. That makes my job easier in lots of ways. As they're getting older, they are starting to play together. A lot. This provides me with a little bit of freedom to get some other things done. I can't imagine having to be a child's sole entertainment all day; that must be absolutely exhausting.

6. I am NOT a Supermom. I hate that term. If you had three babies at once, you know what you would do? You would raise them. Just like I'm doing. Honestly, you would probably do it better.

7. I need you. Having multiples can be lonely and isolating. People sometimes assume that I am too busy or too overwhelmed to do anything else. Or they just want the simplicity of going out one-on-one with a friend and her child instead of taking on the challenges that come with my whole crew. I can't blame them for feeling this way, but please know that I can't do this in a vacuum. I need someone to bounce ideas off and to share stories with. When I get swept up in the chaos, I want to be able to use you as an anchor. And I hope you use me, too.

Related post: Raising One Kid Is A Piece Of Cake

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7 Things You Should Know About Raising Triplets

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When I first discovered I was expecting, I was excited to join the ranks of motherhood as a fledgling member. Soon, however, I learned that I was not having a sweet bundle of joy; I was having three.

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Twins and Multiple Births Association (Tamba)

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Twins Trust - We support twins, triplets and more...

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We’re still here for you...We’re changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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Twins Trust - We support twins, triplets and more...

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We’re still here for you...We’re changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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Home-Start is a local community network of trained volunteers and expert support helping families with young children through their challenging times. We are there for parents when they need us the most because childhood can’t wait.

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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Follow three mothers as they share their tips on the joys and challenges of feeding twins.

The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole:

From Bump to Breastfeeding

From Bump to Breastfeeding extra films

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At Best Beginnings we believe in the power of collaboration to create and provide quality-assured and evidence based information for families. All of our content is co-created with parents and healthcare professionals and vetted by external Healthcare bodies and parents. Read more

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Follow three mothers as they share their tips on the joys and challenges of feeding twins. Vimeo Video http://www.vimeo.com/11739595 The rest of the DVD can be viewed by clicking through the links below. While they work very well as stand-alone films, From Bump to Breastfeeding is best viewed as a whole: From Bump to Breastfeeding 1.

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It's important to understand your birth options if you're expecting more than 1 baby.
Twins and triplets are more likely to be born early and need special care after birth than single babies.

Your birth choices with twins

It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

You'll normally be advised to give birth in a hospital, as there's a higher chance of complications with twins.

There are usually more health professionals at a multiple birth - for example, there may be 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).

You'll already have met your obstetrician and midwives to discuss your baby's birth beforehand, so they will not all be strangers.

For more information on who's who, read about the antenatal team.

The process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.

This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.

Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.

You'll be offered a drip in case it's needed later - for example, to restart contractions after your first baby is born.

Triplets or more babies are almost always delivered by a planned caesarean section.

Can you have a natural birth with twins?

Lots of women think they have to have a caesarean section with twins. In fact, more than 40% of twin births are vaginal.

If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.

If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.
Find out more about the signs and stages of labour
You're more likely to have a vaginal birth if the first twin is in a head-down position.

But there may be medical reasons why a vaginal birth is not recommended.

If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.

As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.

Once the first baby is born, your midwife or doctor can check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.

If the second baby is in a good position, it should be born soon after the first, as your cervix is already fully dilated.

If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.

Caesarean section and twins

In the UK, more than half of twins and almost all triplets are delivered by caesarean.

You may choose to have a planned caesarean, or your doctor may recommend a caesarean, if:

the first baby is lying feet, knees or buttocks first (breech)

1 twin is lying sideways (transverse)

you have a low-lying placenta

your twins share a placenta

you have had a difficult delivery with a single baby before

As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.

In very rare cases, some women deliver 1 twin vaginally and then need a caesarean section to deliver the second twin. This happens in less than 5% of twin births.

Finding out if your twins are identical

After the birth, your midwife will examine the placenta to check that it's all there and look at the membranes.

If your babies have a single placenta with 1 outer membrane (chorion) and 2 inner membranes (amnion), they must be identical (monozygotic).

Otherwise, the only way to tell if they're identical is through DNA testing. This is not available on the NHS.

For advice on how to find out if your twins are identical, you can phone the Multiple Births Foundation on 020 3313 3519 or email them at imperial.mbf@nhs.uk.

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It's important to understand your birth options if you're expecting more than 1 baby. Twins and triplets are more likely to be born early and need special care after birth than single babies. It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

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In this article

Will I have to give birth in hospital if I'm expecting twins or more?

Nearly all women expecting twins or more give birth in a consultant-led hospital unit. Your obstetrician and midwife are likely to advise you that this is the safest place for you to have your babies. However, much depends on your circumstances and how your pregnancy is going.

Your hospital will have worked out its own policy on twin births, taking into consideration national guidelines. These guidelines recommend a planned (elective) birth for twins or more.

A planned birth is one where:

(NCCWCH 2011b, NICE 2011, RCOG 2008)
Hospital is the only place where you can have these types of birth.

A planned birth also means that your obstetrician will recommend a date for your labour to be started or for your babies to be born by c-section. She should discuss the timing of your babies' birth with you early in your third trimester.

Your obstetrician will take into account whether your twins share a placenta (monochorionic) or each one has their own placenta (dichorionic) when recommending a date for them to be born.

National guidelines recommend a planned birth for:

Dichorionic twins from 37 weeks.

Monochorionic twins from 36 weeks.

Triplets from 35 weeks. Mums expecting triplets will be offered a course of steroids to help their babies' lungs develop before they're born.

It's safest for babies who share a placenta to be born in hospital, where specialist medical care is at hand. And even if your twins have their own placentas, there are still potential risks that could make birth difficult (McAslan Fraser 2012, NCCWCH 2014, NHS 2014).
In any birth of multiples, there's a greater likelihood of heavy bleeding for the mum after the birth (NCCWCH 2014). Newborns often need immediate help after birth too. Just under half of twin babies and nearly all triplets need to spend some time in special care (NHS 2014, Tamba 2012).

All these reasons point to why you're most likely to have your babies in hospital. But, ultimately, the decision is yours. Talk to your midwife or obstetrician about your birth options, in the context of how your pregnancy is going. You could also make an appointment with the head of the labour ward or the supervisor of midwives or midwifery advocate at your hospital to discuss your preferences.

If you opt for a hospital birth, check out these ways to make your room comfortable for labour.

Do I have to have a planned birth with twins?

Despite hospital policies and national guidelines, it's up to you to decide where and when to give birth.

If your twin pregnancy has been without complications, and your babies don't share a placenta, it is possible to wait for your labour to start naturally. This could also open up the option of giving birth at a birth centre or at home. You'll need to plan this well in advance with your obstetrician and midwifery team.

National guidelines recommend planned birth for all twins because, in complicated pregnancies, it reduces the risk of one or both of the babies being stillborn.

However, for uncomplicated twin pregnancies, it's not clear whether planned birth by induction or caesarean is better for mums and babies than waiting for labour to start naturally (Hofmeyr et al 2011, NCCWCH 2011a).

If your babies are healthy and growing well, and you want to wait for labour to start naturally, your obstetrician should support you. It's an individual decision, and some parents consider a wide range of issues when weighing up what to do, including:

how well mum is coping with the pregnancy

how they feel about interventions during labour and birth

how likely it is that a caesarean will be needed

whether opting for a planned birth would affect the mum's chosen place of birth

If you decide against an induction or planned caesarean, you'll need weekly checks with your obstetrician to ensure that you and your babies are healthy.

What are my chances of having a vaginal birth with twins?

If both your twins are growing well and you've had no complications during your pregnancy, you may be able to have a vaginal birth (MBF 2010, RCOG 2008). About four out of 10 twins are born vaginally (NCCWCH 2011a, Redshaw et al 2011).

Some hospitals insist on a mum giving birth by caesarean if she's carrying identical twins who share a placenta (RCOG 2008).

Ask your midwife or obstetrician what your hospital's policy on twin births is, and whether any of the maternity team has experience of vaginal twin births. Ask them to explore thoroughly the risks and benefits of vaginal birth with you (Hofmeyr et al 2011, NCCWCH 2011a), taking into account your circumstances (MBF 2010, RCOG 2008).

The position of the twin that's likely to be born first will have a big influence over the type of birth you have (NCCWCH 2011a, RCOG 2008). If your first twin is in a head-down position, you may be able to have a vaginal birth (NCCWCH 2011a).

It's likely that your second baby can then be born vaginally too. Once your first baby is born, there'll be more space in your womb (uterus). So if your second baby is in a breech position or lying across your cervix, your obstetrician can turn her into a head-down position.

Your obstetrician may move your baby by palpating your belly in a manoeuvre called external cephalic version (ECV). Alternatively, she may be able to insert her hand through your fully open cervix to reach your second baby.

Attempts to turn a second twin are usually successful. In less than five per cent of cases, the second twin needs to be born by caesarean (NHS Choices 2014, NCCWCH 2011a).

What's a vaginal twin birth like?

Because you're giving birth to more than one baby, there'll be more health professionals in the room than there would be for a singleton birth.

The medical team may include two midwives, an obstetrician and, as your babies' birth approaches, two paediatricians and possibly two neonatal unit nurses, one for each baby (McAslan Fraser 2012, NHS 2014).

Your midwife will offer you pain relief such as gas and air and pethidine.

It's likely you'll also be offered an epidural or to have one set up, along with a needle in a vein in your arm (a drip). Having an epidural and a drip set up means you can have your pain relief topped up quickly if you need an assisted birth or a caesarean later on (NHS 2014).

It's worth discussing your pain relief options with your midwife during pregnancy. You can then include your preferences in your birth plan (McAslan Fraser 2012).

Keep in mind that labour and birth are unpredictable, though. Your midwife or doctor may recommend a course of action at any time that isn't what you'd hoped for, but which will always be in the best interests of you and your babies.

During labour, expect to have your babies monitored with electronic fetal monitors (EFM) (NHS 2014). This is standard practice for multiple births.

Your midwife will strap a belt with sensors attached to wires around your belly. The sensors pick up your babies' heartbeats and the intensity and frequency of your contractions. You will need to have two belts to pick up each twin's heartbeat.

Once your waters have broken, your midwife may ask your permission to attach a wire to the top of your first twin's head. At this stage, your baby's head will be showing through your widening cervix (McAslan Fraser 2012, NHS 2014). The wire is called a fetal scalp electrode, and it's a clearer way to measure your baby's heartbeat.

When you're ready to push, your obstetrician may ask to move you to the operating theatre (McAslan Fraser 2012), in case you need an assisted birth. Some hospitals have a policy of carrying out assisted births in a theatre setting (McAslan Fraser 2012, NCCWCH 2011b). You'll also be in the right place in the unlikely event you need a c-section to give birth to one or both of your babies.

Once your first baby is born vaginally, your midwife or doctor will check the position of your second twin by:

feeling your tummy

asking your permission to do a vaginal examination

carrying out an ultrasound scan (McAslan Fraser 2012)

If your second baby is in a good position to be born, your midwife or obstetrician will break the waters surrounding him. Your second baby is likely to be born very soon after your first, because your cervix is already fully open (dilated) (McAslan Fraser 2012, NHS 2014).
If your contractions stop after your first twin is born, your midwife will add hormones to the drip to restart them (McAslan Fraser 2012, NHS 2014).

Once you've given birth to your babies, you'll deliver the placenta or placentas. This is the third stage of labour. Your midwife will recommend that you have a managed third stage, when delivery of the placenta or placentas is helped along with a injection that helps your womb to contract strongly.

Your midwife will give you this by an injection in your thigh or via an intravenous drip, soon after you've given birth to your second baby. The hormone helps to protect you against heavy bleeding. There's an increased risk of bleeding when the placenta is larger, and because your womb has been stretched by two babies (McAslan Fraser 2012, NHS 2014).

It should still be possible to have delayed clamping of each umbilical cord, whether your babies are born vaginally or by caesarean. Delayed cord clamping means that your babies can benefit from the extra blood that pulsates from the placenta (Liu et al 2017, Ruangkit et al 2015). Ask your midwife or doctor if this is supported at your maternity unit and add it to your birth plan if you want to ensure it happens.

Why might I have to give birth by c-section with twins?

Your babies will have to be born by caesarean if the placenta or one of the placentas is covering the opening to your cervix ( placenta praevia) (NCCWCH 2011a). Placenta praevia is case where a vaginal birth is not possible.

In addition, you may be advised to have a planned caesarean if:

You've had a caesarean before (McAslan Fraser 2012, NCCWCH 2011, RCOG 2015).

You've had a difficult or complicated birth before (McAslan Fraser 2012).

You've had a complication during your pregnancy, such as one or both of your twins are not growing as well as expected (MBF 2010).

Your twins share a placenta and an amniotic sac (monochorionic monoamniotic). A caesarean is recommended because of the risk of your babies' umbilical cords becoming tangled during vaginal birth (MBF 2010, RCOG 2008).

You may go into labour, but still need to have an unplanned caesarean if:

There is a complication with your labour, such as your twins moving into an awkward position (McAslan Fraser 2012).

One or both of your babies have become distressed during labour (McAslan Fraser 2012).

Your labour is slowing down (McAslan Fraser 2012, NCCWCH 2011a).

You have high blood pressure or pre-eclampsia that doesn't respond to treatment (McAslan Fraser 2012).

The cord falls through your cervix ahead of your baby or babies (prolapse) (McAslan Fraser 2012, NHS Choices 2014).

What can I do to avoid a caesarean?

Try to stay as fit and healthy as you can during pregnancy, as this will help you to cope with labour when the time comes (NHS 2015). Try to stick to a gentle exercise programme throughout your pregnancy.

Be as active during labour as possible. Keeping mobile may improve your chances of avoiding a caesarean (Lawrence et al 2013).

However, this may be a challenge in a twin birth, as fetal monitoring can restrict you physically. Some hospitals have mobile monitors that allow you to move around freely.

Having a birth partner to give you continuous support while you're in labour may reduce your chances of having an unplanned caesarean (NCCWCH 2011a). You'll need good, solid support from the moment your labour starts. You could ask your partner, a friend, a relative, or a doula to take the role.

Have a look at this infographic, which summarises the risks and benefits of giving birth by caesarean section if you're expecting twins.

References

Hofmeyr GJ, Barrett JF, Crowther CA. 2011. . Planned caesarean section for women with a twin pregnancy. Cochrane Database of Systematic Reviews (12): CD006553. onlinelibrary.wiley.com [Accessed October 2015]

MBF. 2010. Monochorionic twins: information for parents when twins share one placenta. Multiple Births Foundation. www.multiplebirths.org.uk [Accessed May 2016]

Lawrence A, Lewis L, Hofmeyr GJ, et al. 2013. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews (10): CD003934 onlinelibrary.wiley.com [Accessed May 2016]

Liu et al. 2017. Use of delayed cord clamping in preterm dichorionic twin gestations. Obstet & Gynecol 129

McAslan Fraser E. 2012. Expecting twins, triplets or more: the healthy multiple pregnancy guide. Tamba (Twins & Multiple Births Assocation). www.tamba.org.uk [Accessed May 2016]

NCCWCH. 2011a. Caesarean section. National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. London: RCOG Press. www.nice.org.uk [Accessed May 2016]

NCCWCH. 2011b. Multiple pregnancy: the management of twin and triplet pregnancy in the antenatal period. National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. London: RCOG Press. www.nice.org.uk [Accessed May 2016]

NCCWCH. 2014. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health, Clinical guideline, 190. www.nice.org.uk [Accessed May 2016]

NHS. 2014. Giving birth to twins or more. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2016]

NHS. 2015. Exercise in pregnancy. NHS Choices, Health A-Z. www.nhs.uk [Accessed May 2016]

NICE. 2011. Information for the public: antenatal care for women who are pregnant with twins or triplets. National Institute for Health and Clinical Excellence. www.nice.org.uk [Accessed May 2016]

RCOG. 2008. Management of monochorionic twin pregnancy. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 51. www.rcog.org.uk [Accessed May 2016]

RCOG. 2015. Birth after previous caesarean. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 45. www.rcog.org.uk [Accessed October 2015]

Redshaw M, Henderson J, Kurinczuk JJ. 2011. Maternity care for women having a multiple birth. Oxford: NPEU. www.npeu.ox.ac.uk [Accessed May 2016]

Ruangkit C, Moroney V, Viswanathan S, et al. 2015. Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - a quality improvement study. J Neonatal Perinatal Med 8(4):393-402.

Tamba. 2012. Tamba twins & multiples healthcare survey: making progress. Twins and Multiple Births Association. www.tamba.org.uk [Accessed May 2016]

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In this article Nearly all women expecting twins or more give birth in a consultant-led hospital unit. Your obstetrician and midwife are likely to advise you that this is the safest place for you to have your babies. However, much depends on your circumstances and how your pregnancy is going.

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Multiple pregnancy: antenatal care for twin and triplet pregnancies

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This guideline has been updated and replaced by NICE guideline 137

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It's important to understand your birth options if you're expecting more than 1 baby.
Twins and triplets are more likely to be born early and need special care after birth than single babies.

Your birth choices with twins

It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

You'll normally be advised to give birth in a hospital, as there's a higher chance of complications with twins.

There are usually more health professionals at a multiple birth - for example, there may be 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).

You'll already have met your obstetrician and midwives to discuss your baby's birth beforehand, so they will not all be strangers.

For more information on who's who, read about the antenatal team.

The process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.

This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.

Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.

You'll be offered a drip in case it's needed later - for example, to restart contractions after your first baby is born.

Triplets or more babies are almost always delivered by a planned caesarean section.

Can you have a natural birth with twins?

Lots of women think they have to have a caesarean section with twins. In fact, more than 40% of twin births are vaginal.

If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.

If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.
Find out more about the signs and stages of labour
You're more likely to have a vaginal birth if the first twin is in a head-down position.

But there may be medical reasons why a vaginal birth is not recommended.

If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.

As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.

Once the first baby is born, your midwife or doctor can check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.

If the second baby is in a good position, it should be born soon after the first, as your cervix is already fully dilated.

If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.

Caesarean section and twins

In the UK, more than half of twins and almost all triplets are delivered by caesarean.

You may choose to have a planned caesarean, or your doctor may recommend a caesarean, if:

the first baby is lying feet, knees or buttocks first (breech)

1 twin is lying sideways (transverse)

you have a low-lying placenta

your twins share a placenta

you have had a difficult delivery with a single baby before

As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.

In very rare cases, some women deliver 1 twin vaginally and then need a caesarean section to deliver the second twin. This happens in less than 5% of twin births.

Finding out if your twins are identical

After the birth, your midwife will examine the placenta to check that it's all there and look at the membranes.

If your babies have a single placenta with 1 outer membrane (chorion) and 2 inner membranes (amnion), they must be identical (monozygotic).

Otherwise, the only way to tell if they're identical is through DNA testing. This is not available on the NHS.

For advice on how to find out if your twins are identical, you can phone the Multiple Births Foundation on 020 3313 3519 or email them at imperial.mbf@nhs.uk.

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It's important to understand your birth options if you're expecting more than 1 baby. Twins and triplets are more likely to be born early and need special care after birth than single babies. It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

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Feeding will take up a lot of your time in the first few months of your babies' lives.
Whether you breastfeed or formula feed, you'll need to create a routine that suits you and your babies.

Some mothers can feed 2 babies at the same time, while some prefer to feed 1 after the other.

Others feed whenever their babies seem hungry (on demand).

If 1 baby is smaller and needs to feed more often, you will not be able to feed them at the same time at first.

If you want, you can work towards bringing their feeding routines together as your babies grow.

If you have any concerns about your babies' growth, you can take them to your local baby clinic to have them weighed and measured.

Your health visitor can tell you where to find your nearest baby clinic.

Some health visitors will visit you regularly at home to keep an eye on your babies' progress.

Breastfeeding twins or more

It's important not to be put off breastfeeding because you're having more than 1 baby.

Breastfeeding is a great way to soothe your babies and helps you build a strong bond with them.

It's perfectly possible to breastfeed twins, triplets or more. Lots of twins are breastfed until they start eating solid foods.

You may like to try a few breastfeeding positions to see which suits you best.

You'll get support with breastfeeding at the hospital and also when you take your babies home.

The benefits of breast milk for your babies are the same as for single babies.

But as multiple babies are more likely to be born prematurely, there are extra benefits.

Breastfeeding premature twins

Breast milk is better for premature babies as their gut is immature and it's easier for them to tolerate and digest.

Breast milk also contains proteins and antibodies to protect your babies against infections.

If your babies are very tiny or sick when they're born, you may need to express your breast milk to begin with.

Your expressed milk may be fed to your babies through a thin tube that passes through the nose and into the stomach.

Visit the Twins Trust website for more information on breastfeeding twins or more.
Watch videos of mums talking about breastfeeding more than 1 baby

Formula feeding multiples

You may need to combine formula feeding with breastfeeding if, for example, you have triplets or more, or you may choose to only formula feed your babies.

Formula feeding is more expensive than breastfeeding when you have twins or more.

But it does mean that other people can help with feeding your babies.

As with breastfeeding, you'll need to decide whether you're going to feed your babies together or separately.

Bottles need to be freshly prepared for each feed. This can be quite time consuming with twins or more, so you may want to ask your partner or someone else to help with this.

As with breastfeeding, formula feeding your babies can help you build a close and loving bond.

Hold your babies close during feeds, look into their eyes and talk to them.

Learn to notice their cues when they want to be fed and when they have had enough.

Visit the Twins Trust website for more information on formula feeding twins or more.

Weaning twins on to solids

When your babies are around 6 months old, you can give them their first solid foods.

It's not unusual for 1 baby to be ready to begin solids before the other.
Find out more about your baby's first solid foods
If your babies were born prematurely, your health visitor can give you advice on the best time to start solids.

Unless 1 of your babies has a serious infection, it's safe for them to share spoons and bowls.

Visit the Multiple Births Foundation website for more advice on all aspects of feeding twins, triplets or more (PDF, 5.96kb).

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Feeding will take up a lot of your time in the first few months of your babies' lives. Whether you breastfeed or formula feed, you'll need to create a routine that suits you and your babies. Some mothers can feed 2 babies at the same time, while some prefer to feed 1 after the other.

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Find out what causes twins, how to find out if yours are identical, and where to go for support if you are having twins or more. Plus facts and myths about twins.

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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Fertility treatments and the fact pregnancies are happening later in life has made multiple births more common.

Different types of twins

One-third of all twins will be identical and two-thirds non-identical.

Identical twins

Identical (monozygotic) twins happen when a single egg (zygote) is fertilised.

The egg then divides in 2, creating identical twins who share the same genes.

Identical twins are always the same sex, so if your twins are identical, you'll have 2 girls or 2 boys.

Non-identical twins

Non-identical (dizygotic) twins happen when 2 separate eggs are fertilised and then implant into the womb (uterus).

These non-identical twins are no more alike than any other 2 siblings.

Non-identical twins are more common. The babies may be of the same sex or different sexes.

Are you carrying twins?

You might think you're carrying more than 1 baby if:

you seem bigger than you should be for your dates

twins run in your family

you have had fertility treatment

It's usually possible to find out if you're having twins through 12-week scan.

At the scan, you should be told whether the babies share a placenta (meaning they're identical) or if they have 2 separate placentas (meaning they can be identical or not).

If this is not clear from the first scan, you should be offered another one.

What causes twins?

Nobody knows what causes identical (monozygotic) twins. Everyone has the same chance of having identical twins: about 1 in 250.

Identical twins do not run in families. But there are some factors that make having non-identical twins more likely:

non-identical twins are more common in some ethnic groups, with the highest rate among Nigerians and the lowest among Japanese

if you're pregnant and over 35 you're more likely to have non-identical twins because you're more likely to release more than 1 egg during ovulation

non-identical twins run on the mother's side of the family, probably because of an inherited tendency to release more than 1 egg

IVF can increase the chance of twins, as more than 1 embryo may be transferred.

How can I tell if my twins are identical?

The most accurate way to tell if twins are identical is through a DNA test. This can only be done after your babies are born.

The placenta could also provide clues. If your first ultrasound scan is done before 14 weeks, it should be possible to tell accurately what kind of placenta your twins have.

Otherwise, the placenta can be examined after your babies are born.

For more information on this and birth options, read about giving birth to twins.

Read more about the different types of twins on the Twins Trust website.

More detailed information on DNA testing and how to find out whether twins or triplets are identical is available on the Multiple Births Foundation website.

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Fertility treatments and the fact pregnancies are happening later in life has made multiple births more common. One-third of all twins will be identical and two-thirds non-identical. Identical (monozygotic) twins happen when a single egg (zygote) is fertilised. The egg then divides in 2, creating identical twins who share the same genes.

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I am expecting twins, can I use the same Spinning Babies techniques for my pregnancy and labor?

Yes! Spinning Babies approach works well for multiples. If you can, start early. Otherwise, start today. You may need to add professional bodywork help to balance uterine ligaments.

Ask your doctor or midwife if there is any medical reason not to do any of these activities ( inversion, particularly).

When to start Spinning Babies approach in a Twin Pregnancy?

I typically suggest 20 weeks for a singleton. With multiples the start of daily balancing activities might begin earlier, for instance, 16 weeks... Start gently, pace yourself, and be steady rather than athletic, please!

Start now

Is it too early?

Linda writes:

I have a mom 22 weeks pregnant with twins. Right now, it appears they have their own sac and placentas. Should we be worried about getting them head down this early on?

Linda (I attended your workshop in Florida.)

Gail responds:

It's not about getting them head down this early, Linda. Its about getting more Balance for the mom now for:

Comfort as her body grows

Optimal blood circulation

So the uterus has the most room on the day the babies decide to go head down - so that they can move head down when gravity and the weight of babies' heads unite for that moment to happen.

Balance first; a head down fetal position (at 28 weeks and beyond) is the first signs of balance - but not a sure sign. Optimal fetal position isn't so much the goal of the activity as it is the result of optimal balance.

Is it too late?

These sleepy twins were breech at 40 weeks and then, with one Forward-leaning Inversion flipped head down in time for a stress-free vaginal birth.

Spinning Babies gentle techniques work for twins, too!

Balancing the womb means to help the womb be more symmetrical by releasing tension, twists or torsion in the uterine ligaments. These are the supporting "ropes" that can get tight and spasm. Most women do not feel discomfort from the spasm. While others feel jabbing pain or just discomfort.

Balance Means "Make Room For Babies"!

Balance is achieved with pregnancy activities, such as the activities on this website. Professional bodywork also helps overcome torsion or tensions from accidents or and I suggest myofascial release and chiropractic adjustments to correct any misalignments of the pelvis.

Misaligned pelvic joints pull the uterus off center and can, at times, effect fetal position. Women with loose ligaments may need to wear a pregnancy belt, beginning in midpregnancy (or as soon as you learn about pregnancy belts).

Alignment of the uterus with the aligned pelvis will help baby A to flip head down.

What is specific to twins in fetal positioning?

We don't know how the twins are going to effect each other with movement. Think of multiple sized marbles filling a jar. You want to get one more in, so you jiggle the jar a little bit. The marbles shift some. You add water and jiggle, now the marbles accommodate each other more easily. Let's think now about multiple babies in the womb.

Two babies may be lined up like two little compact ovals next to one another or they may be curled facing each other, a bit like a puzzle. More amniotic fluid (normal, or up to a high normal amount) gives more room for a big position change. Drinking 3 quarts or liters is about right for the average pregnant person. Add more if you are doing athletics or live in a hot, dry climate.

After using Rebozo Sifting is a gentle jiggling of the abdomen to relax the broad ligament (in the style shown in the photo). Please don't be over vigorous. You aren't trying to force a baby to move. This is a physiological change you are seeking and a deep relaxation of involuntary muscles. We can't do that with over excited sifting!

I notice that twins moms who do several Forward-leaning Inversions in one day (not day after day!) may have babies go head down afterwards. It really surprised me that it worked for these two twins held in their advocate's arms. Their mother did only one Forward-leaning Inversion and that was at 40 weeks! The both immediately went head down. Its more usual that a twins mom would do 7 or more in one day and then two days later the twins might be head down.

When time is of the essence, for example, you are 32-34 weeks or more, you need to attend to your pelvis and ligaments with professional help.

Hi Gail,

I am a Doula in the UK, I use your techniques all the time, most recently at a lovely natural twin birth in a midwife-led unit. I use Rebozo sifting and [Forward-leaning Inversion at every visit and use many other techniques in labour!

Thanks for all your good work!

-Selina

PS: More info on the twins here

http://deverra.blogspot.com/

http://www.magicalbirth.co.uk/ 6.html

What if twins are lying sideways?

Hi, Gail-

I took your workshop in [Massachusetts] earlier this year; loved it and have been making great use of the pelvic release [ Sidelying Release] & the [ Standing] sacral release techniques, esp.

Last week spent some time with a doula client of mine who's G2P1, and was 35+3 with transverse twins. We did the [Side-lying Release] and the Standing Sacral Release, some good heart-to-heart talking, moxa, and the next morning Baby A was confirmed vertex by U/S! Exciting.

Many thanks for your teaching....do you ever stop & just smile thinking of how many uncountable c/s you've prevented with your teaching???!

Michelle L'Esperance

Certified Professional Midwife, N. American Registry of Midwives
WarmWelcomeBirthServices.com

Should I have a cesarean?

If you are facing a cesarean because one or both twins are breech (bottom first) or one or both are sideways, you may like to try the activities listed above and below. They may help. It depends on why the baby is breech. If it is because there is a twist in your lower uterine segment, then these "balancing activities" may work very well.

Here and there, there are still Obstetricians and trained midwives (homebirth in the US) who are specially trained in breech birth complications. If you find one that is comfortable with breech, you may still be supported in a plan for a vaginal birth even if the first twin is breech. Second twins often do well with a vaginal breech birth- the gate is wide open!

Choose a doctor with skills to support this common twin birth scenario. If you have to travel for your birth, remember how you birth sets how you will live. While not all intended natural labors continue with a vaginal birth (some have cesareans because the baby or babies aren't lined up to come into the pelvis or because of mother or baby health reasons). So many women could have empowering twin births.

Personally, I find twin births to nutritionally well fed and healthy women go quite amazing!
More important than how babies are born is how babies are grown.
You may have to find good advice yourself about diet and rest during a twin pregnancy. Here's a good start: Midwife Mary Cronk of the UK gives Guidelines for Twin Pregnancy. And in the US, the late Dr. Tom Brewer's diet on http://www.blueribbonbaby.org/ helps twin moms go full term. If you are well nourished and healthy, and stay healthy through good nutrition for your needs, you are likely to go full term.

Eat about 6 protein servings a day, including an egg unless sensitive; with 3 quarts of water; salt-to-taste; dark greens daily and other fresh veggies; one Vitamin C source such as fruit or hibiscus tea; and a couple of servings of whole grains, not so much bread as whole cooked grains such as slow cooked oatmeal, brown rice, quinoa, bulgar, buckwheat groats (high in iron). Tom Brewer recommended a baked potato with its skin (wash it well before baking and avoid the green ones!). I'd add to make one quart of the water a pregnancy tea of bulk sourced Red Raspberry Leaf Tea (1 part) and Alfalfa (1/4 part). Other additions in the tea can attend to other needs, such as 1 part Nettles for iron. Steep 5-15 minutes and drink hot or warm.

Other Techniques for Twin Pregnancy Fetal Positioning

Body Balancing (Myofascial Releases)

Myofascial work on your sacrum can return a folded or twisted sacrum to its ideal angle and release the twist it would cause in the lower uterine segment. A symmetrical, or balanced, womb will allow the baby to turn and face the mothers right hip or back more easily.

Sidelying Release is the Queen of Balance. More than sidelying, you are addressing 30 or more muscles that effect pelvic alignment and comfort. See the instructions, it's tricky!

The Standing Release is a gentle Myofascial bodywork. Your partner can learn to "release your sacrum" after car rides, etc. In a car, your sacrum is tilted back and liable to wrinkle a bit, like a rug irritating baby's nose (so to speak). The main problem is that the twist in the sacrum distorts the womb and the baby has a more difficult time lining up with the pelvis and cervix during the birth. This makes the birth longer. See Spinning Babies; Parent Class Video Download for how to do it.

Diaphragmatic Release is a technique of myofascial workers, craniosacral therapists and Chiropractors (some) which amazingly helps the tissues relax around the womb. It effectively releases the round ligaments which can be so tight they hold a baby's forehead in front.

The diaphragmatic release, also called Abdominal Release, will accomplish emotional release as well. The whole person approach resolves deep tension quickly.

Protect the body balance you have just enhanced with Rest Smart positioning while you sit or lie down:

https://spinningbabies.com/learn-more/techniques/rest-smart/

Chiropractic

Chiropractic adjustments can help the various soft and bony structures of the body relating to the womb. (Seen here, at right) One well known release is called the Webster maneuver. It is the same as for helping to flip a breech baby. It works well for a posterior. And can be used safely for twin pregnancies.

Here is a lovely case study on helping breech twins flip head down spontaneously after Webster's Manuever on the Chiropractic Journal of Pediatric, Maternal & Family Health: Resolution of a Twin Breech Presentation with the Application of Webster and Diversified Chiropractic Technique, by Danita Thomas Heagy, D.C Read the full article here.

Overview of Maternal Positioning for Twin Pregnancy

Once you balance the womb and supporting ligaments, more room will be available within the womb, the sides will be softer and more flexible. A single baby will be able to sort herself out with gravity and movement. If the twin babies themselves aren't blocking each other, then they, too, will move into place.

Techniques to use in a twin pregnancy

In order:

1. Jiggling (Manteada, Chunging, sifting...) This can be done by your partner or friend.

2. Forward-leaning Inversion-Reasonable for every twin-carrying mother in the first two trimesters. But inversion may not be for every twin mother in the third trimester. Each woman is different and has different tolerance for being upside down. How many and how long? Once a day for 30-seconds each with head down twins. Breech? Keep scrolling down!

3. Maternal positioning is more effective following the balancing techniques. Gravity follows balance. Arrange pillows to Rest Smart. Hips higher than knees, belly lower or equal to spine 24/7 Mind your posture always.

4. Movement - gentle swimming belly down may be a good way to use the counter pressure of water to help the babies into position.

5. After 36 weeks, avoid squatting and other things to engage baby until baby turns to face your right hip or is definitely LOA. Once labor is underway, especially as baby gets to "0" or +1 station," then see if squatting is helpful for any fetal position.

Labor helps the posterior baby into position:

Uterine contractions help head down babies rotate from posterior to anterior (if necessary), so use Balance, Gravity and Movement in early labor, especially.

Ask your nurse or doctor, "Is there anything about my situation that I should avoid getting upside down?"

Balance the mother and the baby will turn.

Another arrangement of Spinning Babies techniques could be:

Forward-leaning Inversion; and

Standing Sacral Release,

Abdominal/Diaphragmatic release (both Myofascial) and

Chiropractic adjustments of the pelvis, and neck, regularly.

Moxibustion at 33 weeks or later, particularly 2x a day for 20 minutes each on the outer (and upper) little toe nail (bladder 67) for the weeks 34-35 of gestation

Acupuncture with professionals very well experienced with pregnant women. I'd feel comfortable with student or new acupuncturists myself, but I want to save you time and money. Be efficient and see the best. Find a community acupuncturist to reduce costs and get several appointments for for the cost of one visit to a "regular" acupuncturist.

Relax involuntary muscles and relax the broad ligament with Rebozo sifting (Manteado) as well as the:

Abdominal (diaphragmatic) release.

Maya Massage. Once the flow is returned full force to the womb the babies may even grow more symmetrically.

Use a Sidelying Release in late pregnancy or any time in labor when Baby A is entering the pelvis in a difficult position, labor is not progressing in spite of strong contractions or serious back labor.

Doing only maternal positioning isn't likely, by itself, to help a breech twin turn at 32 weeks or later gestation. This is a subjective claim, however, success depends on many factors!

Here are the links for more information to make sense of these instructions:

Breech Twins

Frequently, I get emails from mothers or their doulas asking if one or more of the techniques is safe for them to use to try to get their breech twins into a head down position.

Forward-leaning Inversions several times in one day and then at least once daily may help give you a pelvic adjustment and release spasms/tension/twists in the cervical ligaments. This allows the lower uterine segment to become symmetrical and "make room for the babies" to get head down.

How often for breech twins? Once a day before 26-30 weeks. Then on one day only if after 30 weeks, you might try the Forward-leaning Inversion 7-14 times in one day for 30-seconds each, followed by the breech slant board (breech tilt board). Then, when babies are head down, do one FLI a d day.

Doing head stands in deep water (for those who feel safe doing so) may be quite helpful, especially after doing balancing techniques.

Avoid a manual version

In what's called a External Cephalic Version (ECV) a doctor or midwife manipulates the baby around through the abdomen to a head down position. It's not considered safe to do with twins.

Add balance and the babies will follow. At least if they can navigate past one another. Gravity pulls, so if there is room for the heavy head of the baby to settle towards the bottom of the womb it will.

The second baby lying cross ways or breech is not uncommon and may not be nature's issue. If the space is available and then gravity follows the birth of the first baby (stand up), the second baby usually turns head down.

Can I have a vaginal breech twin birth?

Breech twin birth can be nearly as safe as head down twins if you have a couple of skilled attendants. Whether twins or singletons, every breech baby deserves a provider who knows how to rotate stuck arms out and how to bring the nape of the neck into view before helping the head out.

The first twin opens the way for the second twin. So if only the second twin is breech, then many doctors and some midwives who do twins will have the skills to support a vaginal birth (if not their peer support). Read about breech vaginal birth elsewhere on this website.

There are still skilled doctors and midwives accepting parents late in pregnancy to help avoid a cesarean if vaginal birth is a healthy possibility for those parents.

Most doctors today lack skills for natural breech births and that includes twin breech births. It is considered medically safe for the regularly skilled doctor to pull out the second twin if breech vaginally. Fewer let the second twin be born spontaneously, and the safety in spontaneous 2nd twin depends on how the second twin is doing. Monitoring is called for, and most 2nd twins do quite well but some don't like to be left behind and Mama's loving push and some need a gentle hand to guide them out along with that push.

Many parents don't know of this challenge to their birth plan until the babies are within a month or weeks of birth. The time to bring better balance into the body to encourage head down babies in early in pregnancy. The second trimester is a key time for body balancing. Still, some women can help their babies be head down later in a twin pregnancy. Continue the balance techniques (without the breech tilt, which is not in this category of techniques) until birth.

An email:

...She really wants a vaginal birth. She is with a very good OB now, but he is not comfortable doing Baby A as a vaginal breech. There are other options she is pursuing. I just wondered if doing techniques such as the ones you describe or for example, the Webster's Technique or moxibustion would be safe seeing as how it's twins....

My answer was something like this:

I can answer with my opinion.

Non-invasive techniques such as the two you mention seem compatible with multiples as well as singletons.

More importantly, let's acknowledge the woman with a breechling who desires a natural birth or VBAC and has a doctor who doesn't/or can't support her desires. She desires her original birth plan strongly. She realizes her doctor isn't on board with that but he/she is so good in other ways, and the relationship is already established.

Change seems more alarming than continuing with the original doctor, even if the cesarean plan is causing distress. Trying to get twins to flip, which does happen, becomes the only way to keep the established relationship with the doctor and continue the hope for a natural birth.

The chances of natural birth are diminished with this approach. Changing providers may lead to an empowering vaginal breech birth.

Meanwhile, I'd suggest self care or professional myofascial body balancing and pelvic alignment. a craniosacral therapist and a Chiropractor certified in Websters make a good team approach. Moxibustion and Acupuncture have some success as well.

I think more is better than one modality. We don't know which a particular body might respond to, but time is of the essence and flipping is less likely without increased balance of the soft tissues and pelvic joints.

All pregnant mothers benefit from increased balance, even pregnant mothers of twins

Always talk to your babies. Have your partner talk to the first baby directly by putting a tube (paper towel roll or clean vacuum hose) to the lower right side of your belly and talking heart to heart to get baby's attention. This will encourage your baby to look to the sound and get his/her head in an LOT position, the ideal start position.

The most important thing is love.

Watch a slide show on a twin HBAC (home birth after cesarean), click here.

"My Doctor wants to induce me at 37 (38) weeks."

Using the late Dr. Tom Brewer's diet on http://www.blueribbonbaby. org/ twin moms are going full term with healthy 7-8 pound babies. It never hurts to eat green leafy veggies, plenty of lean protein and a gallon of water a day, with salt to satisfy your taste in your food.

35-38 week-old twins will nurse almost hourly each, with a 2-3 hour break while sleeping; while 40 week twins may go 2 hours more often, and 3 and sometimes 4 hours when sleeping.

Babies born early are at higher risk for health problems and death in the first year of life. If we can prevent premature birth we can reduce risk. Why work hard to keep the babies in the womb and then induce, or even surgically remove them, before 40 weeks? Where is the evidence of safety with that plan?

Some attitude

March of Dimes is giving obstetrics the dickens for causing an epidemic of premature babies when they are induced or sectioned before they are due. Some twins may need to be born early for specific health-related reasons, such as a significant twin-to-twin transfer, but that is the exception, not the routine.

Ask your doctor if the induction is "just in case," or do you have a specific risk for continuing to go to term? An aggressive doctor or midwife might say, "You have a live baby today, I can't guarantee that tomorrow!" (I've heard this a number of times!) Its one thing if one baby is slowing down and/or the heart rate is not variable or one baby isn't growing, but the argument that your womb will get too big to work properly is bonkers. Eat well and get your iron and protein intake up.

Full term is full term, twins or singletons. Placentas and wombs aren't time bombs, but beautifully designed organs for safe gestation.

Feed your placenta so it is healthy enough to do the work for nine months. Don't smoke or eat junk, and unless you have a preexisting liver ailment or other unusual situation your placenta should be happy to continue to nourish your babes. Discuss any decisions you make with your doctor and midwife.

Pay attention to a good pregnancy diet for twins:

Eating 6 servings of quality protein (lean proteins, not a lot of peanut butter). Eat 100 to 150 grams of protein each day you are able to get it and keep it down;

3-4 quarts of water a day, including up to a quart of Red Raspberry Leaf Tea (make sure you are drinking non-caffeinated tea and its not flavored black tea! Try and get the leaf bulk rather than bagged.);

Leafy green vegetables, like raw spinach, Spring Mix salads, broccoli and cooked kale with lemon, eat a green leafy every day;

A yellow fruit or veggie a couple times a week or more; and

Whole grains, not white breads. Brown rice or quinoa grain makes a lovely addition and are good for digestion, nutrition and energy levels.

Add Omega oils, such as Nordic Naturals cod liver oil in a capsule or oil. Eat happy fats such as avocados or a tablespoon of butter, not margarine, each day.

Salt to taste, which means, to me, a bit of salt on your food.

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I am expecting twins, can I use the same Spinning Babies techniques for my pregnancy and labor? Yes! Spinning Babies approach works well for multiples. If you can, start early. Otherwise, start today. You may need to add professional bodywork help to balance uterine ligaments.