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Plain Talk About Twin Births
May 2009
Twin pregnancies don't always culminate in cesarean birth. But a twin pregnancy does put you at a higher risk for complications. In general, the method of delivery is determined by the position of the baby or babies inside the womb.
Best Position
The head down position (vertex) is the best position for a vaginal birth. The baby's head is the largest part of him. If the head makes it through, you know the rest will follow with ease. But aside from this fact, the head is malleable and can be angled in a number of positions to help move the baby down and out of the birth canal.
A baby that presents facing up, known as the occiput posterior position needs more room in the pelvis than the baby who is facing down (occiput anterior). If the pelvis is roomy, face up position is no problem. It may even be possible to turn the head to the face down position as the head is descending. On the other hand, a narrow pelvis with a baby who won't turn is going to necessitate a cesarean delivery. Other presentations which may need a cesarean delivery include, hand first, arm first and shoulder first.
If a baby is known to be breech (buttocks or feet first), many doctors will opt for the cesarean, assuming the baby can't be turned or repositioned. A transverse presentation (crosswise) will almost always require a cesarean section, since there are many complications associated with this type of presentation, including prolapsed cord.
Twin B
All babies risk these presentations and may need a cesarean delivery, but in the case of twins, the second baby (Twin B) is at a higher risk for a complicated presentation. Of course, it sometimes happens that a first twin is born vaginally, and the second by cesarean. This would be a difficult scenario to take in on many levels, but it's a realistic possibility.
Another factor to consider when determining the method of delivery is the length of the babies' gestation. Premature babies risk intracranial bleeding when subjected to a long labor and delivery. If it is suspected that the babies will be premature, a cesarean may be their best chance for a safe delivery, and twins are at an increased risk for premature delivery.
There are other conditions that may affect the method of delivery. Preeclampsia is a condition that endangers both mother and babies. The symptoms of preeclampsia include high blood pressure, protein in the urine, visual disturbances, and headache. Regular labor and a vaginal delivery in such a case may bring on seizures and death. A cesarean is often the preferred delivery route when a mother has preeclampsia.
Less Tolerant
Other complications that may lead to a cesarean delivery are gestational diabetes, intrauterine growth retardation of at least one baby, and placental insufficiency.
When the mother experiences complications, the baby tends to be less tolerant of routine labor and delivery and more prone to signs of fetal distress. It's not uncommon for a pregnancy that fits this scenario to end in a cesarean delivery.
The main thing to remember is that prenatal care has come a long way and health care providers have more tools at their disposal than ever to give you the safest pregnancy and delivery possible. Even if you end up needing a cesarean, it's not the worst thing that can happen to a girl. It may be just the ticket to two healthy babies and a healthy mom.
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