Expectant twin mums, depending on where they are in the globe, are usually proposed one or two major medical interventions during their first hospital appointment.

  1. You’ll be required to have an epidural “just in case”…
  2. You’ll have to give birth in the OR (operating room or theatre) “just in case”…

The reason for the “just in case” is usually to do with the second twin, Twin B or Twin 2…”just in case Twin B requires manual extraction”, or, “just in case Twin B requires an emergency caesarean”.

This is a pretty standard approach, and unless you’ve found yourself a truly supportive care provider (thanks again Unicorn Ob), you’ll usually face a whole barrage of “rules” and protocols in order to even attempt a vaginal birth.

Humour me for a moment, and let me tell you a little story.

Imagine you are preparing for a family road trip. Everybody is SO excited to be going on this road trip. You’ve never been on a road trip before, so you’re planning to make it a great experience for you all. The day for you to set off on your wonderful adventure has finally arrived. You load all of your luggage into the car. You fill the car with petrol. You ensure that all of your children are properly harnessed in child safety seats, and you put your own seat belt on. Oh, and one final thing…you deploy all of your airbags, “just in case” you have an accident.

Twin Birth Intervention

You soon realise that you can’t really use the steering wheel anymore. You can’t see out of the windscreen. Your reversing camera screen is completely covered. You were certain there were mirrors to assist you, but they’ve completely disappeared too!  In deploying the air bags, what you’ve actually done is increased your chances of having an accident. This isn’t how you wanted your trip to go at all. But, oh well, off we go anyway, as we’ve done all of this preparation and were told that the airbags are there for our safety, “just in case” of an accident.

Can you see where I’m going with this? Do you see how this little story relates to the “just in case” interventions proposed to the vast majority of twin mamas around the globe?

What does the evidence say?

The evidence suggests that epidurals can lead to an increase in further intervention, including assisted birth, and caesarean section. The medication from the epidural crosses the placenta, and enters our babies bloodstream. An epidural limits your ability to stand and move around, but the evidence shows that upright positions can help facilitate vaginal birth and actually increases the size of the pelvis by up to 20%!1

When we give birth in the OR all of the lights are on, and there are lots of people watching what’s going on. You feel observed, but the evidence suggests that feeling unobserved and being unhindered in a dark place actually helps to facilitate safer birth, for you and your babies (think of where a mother cat might go to give birth…). In the OR, you have care providers who are waiting for something to go wrong. You are surrounded by medical equipment. This isn’t helping you to feel very calm and safe, which is another evidence-based thing that leads to safer birthing2.

By insisting that women have an epidural or give birth in the OR “just in case”, it might be argued that what care providers are actually doing is increasing the chances of that “just in case” scenario, actually happening.

An Intervention of Choice?

Now, I know that some women will choose to have an epidural (for many good and valid reasons), and some women will choose to give birth in the OR (because they actually DO feel safer there), and that is okey dokey by me…I LOVE it when women have choice. BUT, when these interventions are presented to us as the ONLY way that we are “allowed to attempt” a vaginal birth, well…that’s when I get my cranky pants on.

It makes as much sense to have an epidural or give birth in the OR “just in case” of [insert reason here], as it does to deploy the airbags in your car “just in case” of an accident.

A final word

So twin mama, I urge you to do your research and make your decisions based on your unique set of circumstances. If an epidural is recommended “just in case” of a breech extraction, it might be worthwhile questioning how common a breech extraction is for your care provider? Or, if a hands off breech birth might be an option? Or, what percentage of the twin mums they see have a vaginal birth?

When you make informed decisions and make choices from a place of knowledge rather than fear, you can feel comfortable and positive about your birth, however you choose to bring your babies into the world.

Wanna get into the nitty gritty? Book a one-on-one skype consult with me today.

You too, can Rock Your Twin Birth.

Elyse Jamieson – Birth Doula, Educator, and Twin Mama



1 https://sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby/

2 http://www.nationalpartnership.org/research-library/maternal-health/low-stress-birthing-environments.pdf


* featured image by Angela Gallo.