twins
VOb Approach to Twins Please sign downloadable pdf.
We are so pleased you've entrusted your twin pregnancy care to us at Village Obstetrics.
We have a great deal of experience with twins, even successfully delivering twin VBACs. That we can repeatedly achieve safe vaginal delivery of healthy twins is testimony to our approach. Our aim is to provide you with a happy pregnancy and birth experience while maximizing safety and success.
A few specifics to form a basis for our approach. Twins are at risk for growth problems in utero. Sonograms are advised every 4 weeks to keep track. Placental function may diminish earlier in twins than singletons so weekly Biophysical profile sono testing from 36 weeks makes sense.
At delivery the contractions need to be regular and frequent especially for twin B. Long intervals between delivery of twin A and twin B are not so good. Typically after delivery of twin A, the uterus stops contracting. This is best prevented. This area means utilizing oxytocin (pitocin) appropriately.
In labor, epidurals can interfere with labor if administered too early, we suggest letting your labor be more active before obtaining an epidural. IV medication is best used if you need pain relief before you get the epidural in early labor.
Monitoring the fetal heart rate is important too. In early labor (to allow ambulation) we support intermittent monitoring in a fashion of 30 mins off monitor, 30 mins on monitor. We request that anytime you are in bed or not walking far from monitor (ie rocking or leaning at beside or using birthing balls) that you remain continuously monitored. We also utilize internal fetal heart monitoring when the water bag has broken or at about 5 cm to help ensure that we are getting information on each twin not the same twin.
The above implies that things do need to be watched, so labor is best done in the hospital. This means asking you not to have significantly long labor at home, but to come and stay in the hospital from early onward.
We should discuss the mode of delivery for twin B. We suggest a vaginal breech delivery is best (so long as the size is similar to A).
Finally please keep in mind that many twins are best delivered by cesarean section. For example, twin A might not be head first and so we wouldn't even have an opportunity to have normal labor. It is our experience that couples who have actively planned for their c-section have had extremely positive experiences of their cesarean birth.
Please be assured that we do not over-react to monitor information. We do not utilize medications to speed things along. We have no predetermined timetables. We are full committed to vaginal delivery of twins when our patients want it. We share the above information because our years of experience tell us that doing these things helps achieve safe deliveries for both mom and babies.
Drs. Mussalli and Worth