Re: [ozmidwifery] Homebirth of twins

[Sue Cookson]

Hi again Yvette and others, These babies weren't identical at all, although by ultrasound they were monochorionic diamniotic twins. My twins book says all monochorionic are identical so I am confused. My guidelines for twins at home have always been first baby head down, of even size and 37 weeks plus. This is the fourth set I have had prime care of - all have arrived head/head, after 37 weeks and pretty even in size. I am sure that setting clear guidelines to all involved makes a huge difference. Perhaps I sure try a time guideline as well!! This mum had an early u/sound, then chose to have another at 35 weeks to check for above criteria. (Totally her choice tho as I was quite clear of their position). The placenta, as attached, was very round - not obviously fused, but had a very thick fusion of membranes running down the centre. The cords were very different in size and length, and the placenta on baby#1 side was thick, and on baby#2 was thin and different coloured. I can't answer the question about the cervix - I only checked once and that was purely to stop my hair going greyer whilst I worried about position - I really didn't want a shoulder presentation... The assessment I did was about 5 hours after baby #1 and the cervix was nearly fully dilated. I guess I felt it was probably always at about that dilation. The contractions really didn't stop completely at any time, just weren't so strong for many hours, and definitely picked up in intensity whilst and after breastfeeding. The books say the intensity changes with the stretching and pressure of the presenting part coming into the vagina, so although she didn't exhibit transitional symptoms for all those hours, I think her cervix probably didn't alter much, but others may know more... As far as sharing the placenta goes, watching the mother's uterus reform around the second baby and placenta was pretty amazing and very obvious. It no doubt helped her uterine muscles to contract to the right size for the remaining one baby and large placenta. After baby # 2 was born, it then had less effort to contract again to expel the placenta whihc it did very efficiently, with minimal blood loss. I can imagine a very different scenario if baby # 2 was either forced through by oxytocin if her labour wasn't considered effective enough, or membranes broken and baby extracted by the end of the first hour ( or have we heard a much lesser time allowed between first and second babies?). This management would surely predispose a big bleed considering the enormous effort the uterus would have to make to contract quickly down around the now empty uterus.... always much to learn with every birth. Justine, you're amazing!! We'll look forward to your amazing story unfolding over the months. Just remember to really rest up and eat and drink well. Optimum health is a must for twins. Yvette, birth is a truly amazing journey each time. Birthing two can be a simple as one if you believe, prepare and have a solid team around you. Good luck and you are welcome to email me privately. I have attempted to post some pictures of the twins and their placenta, but it isn't working. I'll get my son onto it! Sue