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Archive for the ‘Twins’ Category

Checking my stats I discovered that ‘Risk factors for a home birth with twins’ was a search someone had started which had caused them to visit my blog. It’s interesting how these things must function as individually ‘risk factors’, ‘home birth’ and ‘twins’ would definitely all feature in my musings but I feel sure that I haven’t ever put them all together, and definitely never in a format suggesting that I would encourage a home birth for twins.

  • There are midwives who will disagree with me on this one, they are brave, I am tremulous. I look at the risk  factors during and following the labour and plump firmly for the ‘birth units attached to an obstetric unit are lovely’ attitude.
  • There are midwives who will disagree with me on this one too, they would rather the obstetric unit.
  • There are midwives who will disagree with them on that one, they would rather an elective caesarean section.

So, there are 4 viewpoints on how the birth of twins should be managed. How would each group have reached their opinion? Most often the answer is experience, a bad experience of one method and a good outcome with another. To be honest, there are very few, currently practising, NHS midwives who will have experienced a planned homebirth of twins therefore we haven’t got any experience, be it positive or negative, on which to base our judgement. What we have to do is consider the twin births we have witnessed in hospital, read any evidence about outcomes at twin home births and weigh up the risk factors (I’m not even going to include Trust guidelines, policies and protocols here as they would completely bar a homebirth of twins). 

Let’s consider the risk factors during labour. Immediately there is a difference between identical, one egg, twins and fraternal, two egg, twins. This arises because the identical twins will share a placenta and sac, whilst the fraternal each have their own home and placenta. I could scribe for ever if I muse about each so I’ll mention it when pertinent. So, Mum has gone into labour, twins will often come early, has the pregnancy reached 37 weeks? Before that there is a risk of one, or both babies, having breathing difficulties. I think  that everyone would agree here that the birth should be in an obstetric unit purely for the paediatric support. Then, how are babies lying? Are they behaving themselves? Ideally both babies will be coming head first, if they are then risk regarding the birth immediately decreases, this is when I muse about a birth centre environment, as long as it stands along-side an obstetric unit. 

First one, head down (cephalic) with the second breech? Gosh. How big are these babies? Is the first one larger than the second? Even though the research on vaginal breech births being a no no has been rubbished obstetricians, and midwives are still hugely wary, at this juncture many professionals would advise an elective caesarian section. I say many, not all. If one of my women was pushing for a vaginal birth with T1 cephalic and T2 breech I would have a long discussion about the problems which may be encountered due to breech presentations but, if they were fraternal, ultimately I would support her with her desire for a vaginal birth in an obstetric unit. Identical twins, more problematic, it’s that one placenta worrying me, is it going to start separating before the 2nd baby is born? The breech may deliver with no difficulty, so hopefully there are only a few minutes between babies, it may take it’s time though, or decide to stick a leg down and then require more manoeuvres to help it out or the cord may snake down, I’m weighing it up, placenta might separate = lack of oxygen, baby might take longer to be born, certainly there is higher risk for a poor outcome with the second twin, my feeling, obstetric unit and possibly an epidural. Many, many people and some midwives would disagree with me, I’ll put a couple of links here, Emma Barker’s twin birth and Homebirth org which have a more relaxed stance than me. Both babies breech, obstetric unit and, in my world, whether fraternal or identical, elective caesarian section.

Why all this worry? After all it’s just giving birth to two babies rather than one. Unfortunately it really isn’t that simple, and the second baby really does fare less well than the first baby. Several reasons, mainly due to the extra space available once number one has been born. Even if the second baby was coming in a good position, be that cephalic or breech prior to its sibling leaving the womb, that can change as soon as room has been created for it to move around. Routine at twin births is stabilising the second twin as soon as number 1 is born. An assistant will, externally, attempt to ensure that wriggly twin 2 doesn’t perform celebratory gymnastics. There is also the risk that the cord will present before baby, someone will check this and, if it there and baby is in a good position plus already striving to come out s/he will be assisted in their endeavours but, if baby is still high, or the part the examiner is feeling is a leg , shoulder or arm then the safest way forward is a caesarean. If T2 is behaving then generally, after a short rest, contractions will continue. This isn’t always the case though and, due to the uterus contracting down following the 1st baby, there is a risk that the placenta will start to separate, causing number 2 to suffer with a lack of oxygen so some units will routinely put up a syntocinon IV to ensure that contractions can be stimulated if necessary. It’s also handy to have the syntocinon hanging around for the third stage, that time when the placenta, or placentae are coming away. There is much talk in this entry about the uterus, and it’s size and during the third stage is when it can cause the mother more problems. With one baby there is a much smaller area where the placenta was attached, with two it is really quite large, and in essence this is an open wound which can bleed quite impressively if the uterus doesn’t contract down really quickly, and then stay contracted down. Following a twin pregnancy all the associated tissues and muscles have been hugely stretched so the chance of an atonic, non-contracted uterus, is more probable, therefore the strong  possibility of a postpartum haemorrhage is something to be kept in mind. This is where the syntocinon IV comes in handy as it may well be required to help a reluctant uterus to contract.

Ultimately the choice of where a woman gives birth to her baby, however many, is her decision. That choice should be informed though. There are risks with a twin birth, and they are higher than for just one baby. The highest risk, prematurity has been passed with a planned home birth but there is still risk at term, particularly for the second baby. Professionals can advise, and on the whole we err on the side of caution so, if you are expecting twins and want to really know your options and the risks, read, read, and then read some more but make sure that what you are reading comes from safe sources.  

Great article about twins – e.Notes.com

American discussion about twin births with international references

Postscript – (declaring an event which may make me biased)

My daughter had twins, by an elective caesarean section at 36 weeks. This was her 2nd pregnancy. The first ended with an induction of labour at 41 weeks and 4 days, failure to progress, cervix never more than 4 cms dilated after 15 hours on syntocinon, progressed to caesarean section and the birth of a 9lbs 12ozs baby girl.

The twin pregnancy was identical twins and was uneventful. Daughter was happy with the plan to deliver the babies at 36 weeks, I concurred as T1 was cephalic, T2 was breech, the history of the previous section and a close family history of twin-to-twin transfusion resulting in both babies dying. The babies weighed 6lbs each but T2 suffered breathing problems and spent the first 2 days of his life in NICU, he is fine now. In retrospect I would have encouraged waiting until 37 weeks, but hindsight is a wonderful thing.

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Twin transport

This post is unsponsored and is entirely my own, unsolicited opinion.

I have been the proud owner or user of several pushchairs designed to be used by twins. The twins are now 3, they started off quite small, 6lbs and are now chunky lads of 2 stones 5lbs

Before daughter discovered that she was growing 2 babies instead of the 1 I had a Cosatto Kiwi side-by-side double buggy, advertised as being from birth. It had all the bits, raincover, footmuffs, sun-shades but was rather wobbly and it felt as if the handles may snap at any moment. This was with a 1 and 2 year old in it, so once I felt I no longer needed a buggy which would take 2 I donated it to the local charity shop. Major mistake, so I thought, when just a few months later the twins were discovered on scan.

Daughter is someone who investigates thoroughly before making a decision so every avenue was explored before she decided upon which pushchair she would buy for the boys. After much debate she made a decision, she was going to get the Jane Twin Two plus 2 rebel car seats.

She made a great choice. Lightweight, folds neatly, takes two newborns and performed problem free. The car seats slot easily onto it and are a generous size but really, really light. Very important when you are struggling to carry one in each hand.♥

I went for the side-by-side option, the Bertini Bidwell. It should have been great, but I hated it. It was huge, with the hood up I couldn’t see the front of it so was always rear-ending innocent pedestrians. Despite the 4 by 4 steering it was clumsy, and boy was it heavy and very bulky to store. Looked good, definitely eye-catching but, ultimately for me a poor choice.

Bertini

By the time the boys were 6 months I had given up on the Bertini, I sold it on E-Bay and traded it in for a MacLaren Twin Techno.

I was really pleased with it, It felt sturdier than the Cosatto. It looked comfy, had two good sized shopping baskets and wasn’t too difficult to fold or store, it’s freestanding. I could manoeuvre it quite easily but I could have done with the handles not being so far apart, it’s probably better if you’re taller, I’m only 5ft 3ins. It was good when daughter went abroad on holiday as it went in the aircraft. Problem though, once the boys got to a year old I was having to run at kerbs and then jump and push down hard on the handles to get up on to the pavement, and all this with my arms wide apart. I started dreading going out for walks but then fate smiled on me, the Mum who lives opposite asked me if I wanted her Out & About Nipper, free!

What can I say? It’s easy to manoeuvre, it’s light, it fits in the boot of my hatchback, none of the others did, and folds down quite compactly.  I can zoom through woods and up and down hills. It has two baskets, not as generous as the MacClaren but large enough for bits and bobs, a potty does fit in them. Downside is that I get punctures, luckily Hubby is good at repairing them. The handlebar has foam padding which has split on the corners, purely cosmetic though, I’ve repaired it with duck-tape. ♥

Meanwhile, daughter had decided that the Jane twin two was no good for cross-country hiking so she traded it for a secondhand Jane Powertwin. (She chose Jane again as her previous one was so reliable).

It is smaller than it’s counterpart, the Twin Two, and is good for older babies or children of different ages, it can only be used for newborns with the car seats. It was certainly easier for going ‘off-road’ but the boys had less room and the one in the back found it easier to grab his brother’s hair! The front wheel gradually adopted a jaunty angle which made it difficult to manoeuvre, I refused to be left in charge of it as the twisted wheel made it go to one side so you had to fight it constantly. Daughter persevered with it until one day I returned from work and found that my beloved Nipper had gone walkabout, she had borrowed it. No way was my pushchair disappearing, EBay was searched and within the week I had another Nipper. DIL has now bought a Nipper, she has pronounced it better than her Phil and Ted’s!

So, from my experience the Nipper comes out on top.

If you find that you have twins on the way – 

  • Try out all the pushchairs. How easy are they to put up and then collapse?
  • Does it take two newborns? 
  • Remember they will not be small for very long, how easy is the pushchair to push with toddlers on board?
  • Is there enough capacity for all the bits and bobs which accompany two little people?
  • Will it fit in the car?
  • Where will you store it? Is there enough room?
  • Will it fit through doorways?
  • Shop around.  

P.S I’m not advocating Kiddicare, it’s just that they provide a video demonstration, as I said ‘shop around’.

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Last week I wrote about how chuffed I was that Tamba had sent me a certificate as a ‘small token of our appreciation for the valued support‘ I have given to one of their families, also giving me free membership and welcoming me to their community. I was all excited (yes, I am that sad), as it meant that I would be able to take the boys to a playgroup geared toward multiples so I  went to the website and tried to activate my membership, unsuccessfully. I emailed them, but received no response, so yesterday I phoned them and today I’m well p****d off. Basically I’m not entitled to my free membership as my daughter, who nominated me, has let her membership lapse so, unfortunately, I will not have ‘help to continue providing valued support to the family who nominated’ me. Now, if this were a manufacturer, store or advertising company who had misled and disappointed me in this way I would at this moment not be whining away here, well I probably would but I would also be composing a letter of complaint and suggesting that they were guilty of misrepresentation. I have read and reread the letter and no where at all does it state any conditions or refer in any direct way to daughter’s membership, it only alludes to her presumed membership by calling them ‘one of our families’. Apparently 79% of midwives recommend Tamba, not sure how that figure was arrived at, certainly I have never been asked. Perhaps they asked the parents of multiples, whatever. I shall continue to tell expectant parents of multiples about Tamba for want of an alternative, but I will always be a gutted grandmother.

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Workbound

Every few weeks my work/homelife pattern dictates that I have one ‘rest day’ and ten working days, tomorrow is the final day in this pattern and I’m bushed. In the middle of it I went to a lovely homebirth, once again it was a rush to get my gloves on and there was no time at all to call the second midwife, beautiful baby girl, everything wonderfully quick, easy and natural. Mum and Dad very happy with their third baby and her relaxed arrival into the world.

I received a Certificate of Appreciation from Tamba . It was because daughter had nominated me for it as I provide her with support, it’s my job, I’m her Mum and her children’s Grandmother, I should support her. Still it is lovely to have a certificate and, even better, it gives me free membership of Tamba so the boys and I can start going to a twin group. That will be wonderful as it will be somewhere which is set-up to cater for multiples, I’m  hoping to be able to go somewhere with the boys and to actually enjoy myself and relax…..slightly!

Due to the glorious weather I have been able to get out and garden for a couple of hours in the evenings, such a wonderful way to unwind after a ‘heavy’ day. Now I’m just keeping my fingers crossed that the rain holds off until Saturday as I haven’t managed to mow the grass yet.

Tomorrow is Jack’s 5th birthday. It is terryfying how quickly time passes, I can still remember in minute detail the day he was born and I became a grandmother, it was the most emotional day of my life. Now he is a little school boy who constantly amazes me with his knowledge of dinosaurs and the solar system.

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Twin trials

Today has been a bad one with the boys, even though the sun was shining. I had been really looking forward to being able to spend a day outside with them and I had thought that it would be so much easier, more space, lots to do, I could not have been more wrong, they would have tried the patience of a saint, and I am definitely not one of those.  Jamie and Louis are nearly 20 months old now and, so far, life with them has become easier in some respects, but more difficult in others. Easier, well they feed themselves, they can negotiate the stairs themselves, they will amuse themselves for short periods. There is possibly more but in my present frame of mind I am hard-pushed to think of any! More difficult, they are mobile. Yes, that makes life easier as I don’t have to carry them around but to go out anywhere, children’s play areas, the woods is so fraught with the ‘how can I keep an eye on, and retrieve two toddlers’ dilemma that I have to really psyche myself up for it. I have discovered one soft play area where I can go and it is so geared toward toddlers that it is a safe as I could wish. However, it’s the school holidays now and everywhere is heaving with little people, when you are trying to keep track of two adventurous little boys it is an absolute nightmare. When daughter first discovered that she was having twins other parents of twins warned her that she would have to buy two of every toy, she assimilated the advise, I scoffed at it, fool that I am. It’s true. If you want to avoid arguments, screaming, fighting, biting then you have to have 2. Cars, shape-sorters, books, not similar, no that won’t do, they have to be duplicates, otherwise carnage ensues. To be fair Louis is less likely to want what Jamie has, and even if he does he stops short of violence but Jamie, well he is a nightmare. In the garden I have 2 ride-on cars, not identical, Louis was unceremoniously pushed off. I have one child’s lawnmower, that caused a huge tug-of-war plus screaming. In the one wendy house there is a little tikes kitchen, I looked through the window just in time to see Jamie bite Louis’ stomach because he wanted to stand where his brother was. By the time Jamie had pulled his brother off the plastic climbing cube thingy I was ready to lock him in the shed. By now it was 4pm so, instead of that, we came indoors, I put  ‘In the Night Garden’ on and gave them both a biscuit. Peace reigned.

At this stage with the other grandchildren we were starting to take short walks with them holding my hand. If I needed to go to Homebase, or Comet. no problem. In to the car, get there, park, get out of the car and off we would walk into and around the store. If I needed to buy several items no problem, I would use a trolley. Grandchild would walk with me, or if they started playing up they would be put in the available seat. Try ‘popping’ out with toddler twins, it’s an exercise just getting out of the house but then, once you get to the retail park what then? There are no twin trolleys but if you use a pushchair then you have no free hands to carry anything. I invested in a set of twin reins, fab thing. Harness goes around my waist and then the boys are clipped to me. I dare you, just try it. Borrow 2 toddlers, put them in the car, drive to a superstore and then try to get from your car into the store with the babes on reins. It seems like hours but is possibly only 20 minutes. By the time you have made it to the store you will be seriously doubting the wisdom of entering. The journey across the car park will have elicited the usual toddler behaviour of stopping to examine everything, car wheels, cigarette ends, drain covers and the usual tripping over etc. No, don’t scoff, imagine that at least trebled. Twins are not double trouble, they are far, far more than that. By the time you have stopped one from sticking his fingers up an exhaust pipe, ‘Don’t. Hot. Burns,’ the other one will have run around your legs and be picking up a half full, soggy packet of crisps. You grab it off him and he throws himself down onto all-fours, you can’t pick him up because his reins are wrapped around your legs and anyway, by the time you have untangled yourself and righted him the other one is sitting in the only puddle for 6 miles. I do have a remedy, hard on the arms and shoulders, but less stressful, I grab the harnesses and carry them so they dangle at the end of each arm like a shopping bag. This causes disapproving looks from other pedestrians but I am becoming impervious to other people’s opinions, especially those who comment helpfully with observations like ‘Rather you than me’.  I am determined to get them functioning well on reins as it will, eventually, make our time together so much nicer. With Amy we would go out for wanders, through the woods, feeding the ducks, mini-expeditions and I really miss the recreational side of looking after a toddler, the fun things. Oh yes, the fun things like painting, play-doh, puzzles, just use your imagination and you may be able to guess why none of these activities rank highly on my ‘to do with the boys’ list. Uncontrollable mess probably sums up the first two, fights just about covers the last. Oh the joy of twins.

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Work is manic at the moment. One of our team is off sick with………..chicken pox and another 2 are on annual leave. I have been finishing over an hour late everyday, getting home and then spending another hour making phonecalls and doing all my paperwork.

The couple whose little girl was stillborn were having an especially sad day today as it was today that their baby was ‘due’. The results of the postmortem are expected on Monday, I’m visiting them on Sunday but then I’m off until Friday so I’ve given them my mobile number, just in case they need a chat when they have received the results, if there are any. I know that sounds strange but that’s how it is sometimes, there is no reason found as to why baby did. I suppose that there are different ways to look at a ‘non’ result like that. It could. perhaps should be seen as positive as there was no abnormality found with the placenta or any problem with baby so it would not indicate any reason as to why the next pregnancy should not result in positive outcome. However, a different perspective from the parents point of view may be that it happened for no apparent reason before, why not in subsequent pregnancies? I do know though that, if they go on to have another baby, they will be hugely anxious as they approach and enter the weeks when their first baby stopped moving in the womb.

Last weekend Nanny and Grandad had Jack, Amy and Izzy to stay. I was anticipating bedlam, instead I had a wonderful cuddly time with 3 really angelic (most of the time) grandchildren. On Thursday I took the twins, Jamie and Louis, to a local open farm, it was a messy, glorious affair! I’ve invested in a set of twin reins, they go around my waist and then the boys are attached to me, rather like 2 huskies pulling a sledge, I think we provided an interesting side-show for the other farm visitors.

Jack has, finally, developed chicken-pox. He has taken so long about it that we thought that he may have immunity, we were wrong. His Mummy reported that he had said he was really tired this evening, and then when he had his bath 10 spots were spotted :). When they told him he had the pox he slowly took himself upstairs, got into his bed and announced that he was ‘very poorly’. What a man.

twinrein_011

Not me, or ‘the boys’.

We had all, including son, though that his ulcerative colitis was a thing of the past following his total colectomy and ileostomy, this isn’t the case though. What none of us had appreciated was that a short length of bowel is left behind and, obviously now we know, that is still affected by UC. Son doesn’t go into great detail but from the comments he has made it was starting to cause him discomfort, so he is back on medication. Nasty, nasty disease.

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Catching

 

 

cp_0304_chickenpox_002

Hot off the press, Amy has chicken pox. Essentially this is good news, until I think more upon it. Amy cannot go to nursery, her Mummy cannot go to work; it is virtually guaranteed that the boys will catch it from their sister, but not necessarily at the same time since the incubation period is anything from 11 – 20 days, the average being 14,  so the having unwell kiddies around could go on for a long, long time!

Tomorrow is Izzy’s 2nd birthday party, Izzy and Jack haven’t had varicella so tomorrow is now a ‘Chicken Pox Party’. Unfortunately Evie’s Mummy doesn’t know if she has had this childhood illness so they will not be attending the party as it wouldn’t be good news for DIL to develop CP whilst trying to care for a little baby and, if she hasn’t had the pox, Evie will not be receiving a passive immunity via breastfeeding, so she could develop it as well.

Back to little Izzy’s birthday. I had a text from her Mummy last night “This time last celebrity big brother I was pushing a little Izzy out! Ah, that makes me feel extremely emotional! x”. Reading the text bought back the memories of her homebirth and how perfect, and quick, it was. The other day I was chatting to Jack about when his sister was born and he remembers when he woke up in the morning and went into his Mummy and Daddy’s bedroom and found a ‘tiny’ Izzy snuggled in their bed, it is obviously a happy memory for him. He has never really displayed any jealousy or resentment toward his sister, she’s just his little sister. A couple of weeks ago I asked Amy’s Mummy if Amy had ever questioned why there is only one of her but two of the boys, I wondered if she might feel ‘lonely’. Her Mum reported that Amy had never shown any appreciation of the boys being twins, or expressed any feeling of being deprived by not having a sibling of her own age. This week though she said to her Mummy that she wished she was like all her friends and only had one baby brother, so she obviously recognises that her brothers are unusual. Things should get easier for her though as they become less demanding.

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