Twins are usually born preterm, at 36 weeks on average. A normal vaginal delivery is the primary option. Approximately 50% of twins are delivered vaginally and 50% by C-section. Triplets are born in week 33 of pregnancy on average, usually by C-section.
Multiple pregnancies are delivered in hospitals with the capacity for neonatal intensive care. Very premature babies are usually treated in university hospitals. Approximately 50% of twins and nearly all triplets are delivered by C-section. The average birthweight is 2,500–2,800 grams for twins and 1,900–2,200 grams for triplets.
A midwife attending to the mother, two obstetricians, at least one paediatrician and midwives attending to the babies are present at a multiple delivery. The condition of the mother and the foetuses is monitored closely during delivery in order to detect any problems as early as possible. The method of multiple delivery is always chosen on a case-by-case basis. The factors affecting the choice of method include the foetal presentation, duration of pregnancy, possible complications during pregnancy and the mother’s previous deliveries, where applicable.
In a vaginal delivery, baby ‘A’ is delivered first. The baby is born as the mother pushes during a contraction. If the expulsive stage (second stage of labour) lasts too long, a suction cup may be needed to help the baby out more quickly. The baby’s condition allowing, the infant may be placed on the mother’s breast immediately after birth, while waiting for baby ‘B’ to get positioned in the birth canal so that the second expulsive stage can begin. The positioning of baby ‘B’ in the womb may be guided by manual manipulation of the abdomen. When necessary, the presentation is checked with an ultrasound scan. Sometime the second baby does not end up in the correct position for vaginal delivery, or the baby’s condition deteriorates so that a C-section is necessary. At this point of a multiple delivery, it is common that contractions become less intense. The womb has become so large that it does not have the capacity for sufficient contractions. Therefore, it is often necessary to use an oxytocin drip to stimulate contractions. After the babies have been born, the womb continues to contract and the placenta is usually delivered within an hour. The mother usually pushes the placenta out herself.
The father or other birth partner in the delivery room
Witnessing the birth of his babies is one of the most emotional and memorable experiences in a father’s life. At best, the delivery can be a magnificent, empowering experience that brings the spouses closer to each other. The father or other birth partner can promote a pleasant and safe atmosphere, encouraging the mother to trust her own body and strength and her ability to give birth. Encouragement and support reduce the need for pain relief. Consequently, the delivery takes less time and the mother needs fewer interventions, which makes the delivery a more satisfactory experience.
Should anything unexpected happen during the delivery and a C-section become necessary, it is possible that the father may not be allowed in the operating theatre. The causes for a C-section include foetal distress, weak contractions, and a number of other reasons. If an emergency C-section is necessary, other people are not allowed in the theatre, as the mother will be anaesthetised and the primary concern is to deliver the baby or babies as quickly as possible. The father or other birth partner is almost always welcome to attend a planned C-section.
It is perfectly all right to have two support persons present at the delivery – for example the spouse and a birth partner or a doula. Doulas are support persons who have completed birth doula training. For more information about doulas, contact the Federation of Mother and Child Homes and Shelters (‘Ensi-ja turvakotien liitto’). This can be a good solution for a multiple delivery: the father can concentrate on the baby who comes first, while the other support person focuses on the mother giving birth to the other baby/babies.
video: The father or other birth partner in the delivery room
Premature birth and intensive care of babies
Nearly 50% of all twins and almost all triplets are born prematurely. Today, smaller and smaller preterm babies born in Finland can be treated in high-quality intensive care units.
Premature birth increases the infant’s risk of illness and disabilities. However, it is very difficult to prevent premature births and predict the risk. On the other hand, multiple pregnancies are monitored more frequently than single pregnancies. The monitoring is provided by specialist medical care services. The health care staff do everything in their power to help you to complete as many weeks of gestation as possible.
Treatment in the ICU and a long stay in hospital are demanding for infants and parents alike. In particular, a lot of extra help is needed by families that have other children and are not living in the municipality providing the intensive care.
The treatment of premature babies is always planned on a case-by-case basis, both in the ICU and after discharge from hospital. Follow-up visits to the hospital will be necessary after discharge. In some cases, such visits may be frequent due to the need for various therapies. All this requires efficient scheduling of the family’s life. Extra help and support with household work and child care is also often necessary. It is a good idea to think about this in advance and find out about the availability of help.
Postpartum period and discharge from hospital
The birth of multiple babies is an unforgettable event and the time required for the mother’s recovery varies a lot. The postpartum period is the period during which the mother’s body recovers from pregnancy and childbirth, getting ready to take care of the baby.
The duration of the hospital stay depends on the specific circumstances. It depends, for example, on the health of the babies and the mother, the method of delivery and the duration of pregnancy. The ability to cope at home is always assessed on an individual basis. Whenever possible, the mother and babies are discharged from hospital together. However, this is not always possible. The mother may be discharged before the babies and the babies may be discharged one at a time.
video: Coming home from hospital
Questions and assignments:
What kind of thoughts do C-sections and vaginal delivery evoke in you? Consider how you could prepare for a possible C-section and what you should take into account with regard to recovery or discharge from hospital. Take some time in advance to find out about services provided by your municipality after discharge from hospital. Find out where you can get help at home when necessary. Make arrangements to make your life easier after the babies are born (make food to keep in the freezer, arrange housecleaning help, etc.)
Which hospital is your likely delivery hospital? Visit the hospital’s website or, if possible, pay a visit to the hospital in advance. In addition to the labour ward, it is a good idea to get information on the neonatal intensive care unit, as multiple babies have a higher than average probability of being admitted to intensive care during the first days of their life. Find out about multiple birth coaching in your municipality.
Consider in advance how you will arrange your daily life if your babies have to spend some time in the ICU.