22-23 weeks – twins antenatal class

Last week we were away for half term with family, which was a lovely time for us all, particularly for me to rest as well as do some swimming – non-weight-bearing exercise is good. There wasn’t much to write about in terms of pregnancy. I’m continuing to monitor my blood pressure – it is staying at around 105/65 at home, and it went up a little to around 110/70 last week when away, but it’s back down this week. This is still pretty low for me personally and for being pregnant with twins.

23 weeks

There’s more to write about this week at 23 weeks. On Sunday Tom and I attended an all-day twins antenatal class. The twins specialist midwife, whom I’ve seen every time I’ve been to twins clinic, had invited us and said that it was focussed on specifically twin labour, delivery and early postnatal care in hospital, rather than general things you’d learn about at antenatal classes, which as third time parents we really don’t need. We’d done the NHS classes in Cambridge when pregnant with Andrew, and found them rather useless – nothing I hadn’t read about already and the assumption that birth should be medicalised. I’d also done an NCT antenatal refresher course when pregnant with Joel, which was more useful in a non-medicalised approach for us, though I mainly did it to meet local mums with toddlers who were having another baby around the same time as me, from a social perspective.

The twins antenatal day also included a tour of the delivery suite (including the entrances to the operating theatres and SCBU, and the transitional care ward) at the Birmingham Women’s Hospital. This is what really sold it to me, because I have never given birth in a hospital room, and not in this hospital at all. Andrew and Joel were born in the midwife led birth centre in Cambridge – with lovely homely rooms that look nothing like a hospital, with no monitoring equipment, a birth pool, a normal bed, low level lights etc. Well actually, Joel was nearly born in the reception area, but we just made it into a room! I found it very reassuring to see where I will be giving birth this time.

Before we found out it was twins, I’d decided we would stay at home for the birth, because I’d only just made it to the birth centre last time, and having done labour twice before with no pain relief or complications, I now had confidence that my body can do it. Both my labours have followed similar patterns – some sporadic, irregular, non-painful but uncomfortable tightenings/Braxton Hicks for a few hours, then a sudden gushing of the waters breaking, followed by a quick ramp up in strong, painful and regular contractions until pushing and then delivery. The time from waters breaking to delivery was about 3 hours with Andrew and about 1 hour with Joel. However, twins is automatically considered “high risk”, so I’m “not allowed” to have a home birth or go to the birth centre. Though actually, as the home birth coordinator midwife pointed out to me when I rang her to tell of the twins news and that I’d no longer need to meet with her, there’s no legal reason why I can’t ignore the doctors and have a home birth, it is ultimately my choice. I just feel this is one step too far in going against medical advice, so we will try to get to the hospital. I wouldn’t be at all surprised though if we ended up with an accidental home birth, because quite frankly I’d rather have a home birth than a car birth!

This is, however, assuming that twin 1 is in a head down position by around 32-34 weeks, after which point they are unlikely to turn due to lack of space. At the antenatal class the midwife showed us a diagram of the various permutations of twin positions. There were 6 in total, and only for 2 of them would I “be allowed” to attempt a vaginal delivery, the other 4 would automatically mean a planned c-section. Basically twin 1 has to be head down, and twin 2 can be bottom down or head down – twin 2 is likely to move anyway once twin 1 is born and he/she suddenly has half a womb’s more space to spin about in! If twin 1 is bottom down, or if either/both of them are transverse (lying horizontal instead of vertical), that would mean a c-section. So I am hoping that twin 1 gets head down at the right time, though if not I will do my own research on the risks of attempting a breech (bottom first) birth, particularly with my good delivery history, rather than simply going along with what the doctors demand without question. They seem happy enough that twin 2 can have a breech vaginal birth, just once twin 1’s head has paved the way. I asked what would happen if twin 1 was bottom first and I went into a spontaneous and fast labour before a planned c-section date – the answer was an immediate emergency c-section, which would be a race between doctors and babies I think.

When we were hearing about these birth options in the class, the midwife posed the question – who decides how the babies will be born? I answered “me!”, because ultimately I know it’s my body and my decision, and I think she already knows from seeing me in clinic that I’m going to be “one of those” who doesn’t just go along with what the doctors say without question. They talk of what is and isn’t “allowed” – but what they really mean in most cases is what is and isn’t advised in their professional opinion, and even that can differ between individual doctors. What she actually was trying to get at though is that the babies themselves determine how they will be born, depending on their position before and during labour. I see her point, and I’m not against having a c-section if it ensures that the babies and I survive any threat to our lives. Of course I’m glad that medical intervention exists when it is needed. But I am aware that it does come with risks itself, not to mention the recovery from surgery.

I did feel a little on my own amongst the mums at the class for really wanting to have a vaginal twin birth. We were all carrying “DCDA” twins – two placentas and two amniotic sacs, so the least risky in terms of likelihood of complications, and the only kind for which we are “allowed” to attempt a vaginal birth at this hospital. Three had already chosen a planned c-section – because they had had one with their older singleton, and even I’m not sure I would want to attempt a twin VBAC (vaginal birth after caesarean). One was a first time mum and was still unsure what she wanted, and one had previously had an emergency c-section and a VBAC with her two singletons, so was probably going to attempt a second VBAC since the first had gone well. It made me very aware of how blessed I’ve been with uncomplicated labours and deliveries, which sets me up well, both mentally and physically, for doing it again with twins. I’m also aware that all of these thoughts about birth are based on my pregnancy staying uncomplicated and the twins not arriving early or needing to be delivered prematurely for whatever reason. I’ll write more about that next week, along with what happens in the case of the other extreme of timing – potential induction of labour if the twins arrive “late”.

As well as the information from the midwife about labour and delivery at the hospital, she had invited three families with twins of different ages to come along and chat to us about their experiences. All of them only had the twins, no older or younger singletons. It was interesting to hear from them, but a lot of what we ended up talking about I either knew from having had babies before, or I’ve seen from other twin mums online in the twins groups on Facebook that I’ve joined. For example – the lack of knowledgeable breastfeeding support from the NHS and the fact that babies don’t sleep for very long at a time. Some of their tips were of a different parenting style from ours, so they weren’t something I would take on board. And I think Tom felt a bit left out when the dads were discussing the pros and cons of different brands of double pram, as we aren’t getting one!

I think that’s probably enough writing for one week. Next week I will write more about the potential timing of birth that we discussed in the class, as this is related to the fact that 24 weeks is an important milestone in any pregnancy – it is the point at which a foetus is thought to be “viable”, with just over 50% chance of survival if born in the 24th week, providing there is intensive medical care available.

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