Does Metroplex Midwifery support twins?
Yes! We have experience with twins at home, and make evidence based recommendations to you regarding the care of you and your babies during pregnancy and birth. Both fraternal and identical twins can be born at home. We recommend monitoring by both our practice and a maternal-fetal medicine specialist we work regularly with. In most ways, a twin birth very much resembles a singleton birth. 2-3 midwives instead of one will be present, as well as additional students to help out. Please read our twin stories to hear more!

Can Twins be born vaginally?
Yes! It is a safe option to deliver twins vaginally. “The chance of needing a cesarean delivery is higher when you’re pregnant with twins than when you’re pregnant with one baby. However, you have a good chance of having a normal vaginal delivery if the presenting twin (the one nearest to the cervix) is in a head-down position, there are no other complications, and you are at least 32 weeks pregnant.” Breech twins can be born vaginally as well, which is a topic we will discuss if that becomes relevant so you can make an informed choice on how to proceed.

Vaginal twin birth is even an option for VBAC! The American College of Obstetricians and Gynecologists (ACOG) states: “[clients] with two previous low-transverse cesarean incisions and women carrying twins may be considered appropriate candidates for a TOLAC.”iiiWhat screenings are recommended?

Ultrasound examination is the only safe and reliable method for definitive diagnosis of twin gestation. Early ultrasound assessment also provides accurate estimation of twin gestational age, which is important in all pregnancies, but particularly important in management of twin pregnancies because of the higher risks for preterm delivery and growth restriction. Amnionicity and chronicity, in very basic terms, identifies whether your babies each have their own sac within the womb, or if they share. It is paramount to safe management of twin pregnancies that chorionicity and amnionicity be determined. This can only be determined by ultrasound.

There is a great deal of trust between the client and/or family, and the midwifery team, because management of the twin birth requires continued discernment. There should be convincing and compelling cause to intervene within the twin birth, but when indicated, these interventions may require immediate response with little prior warning. This is especially true for the second twin if fetal well-being is in question. In the hospital, vacuum and forceps are options; however, in the home setting, conversion to longitudinal (vertex or breech), and delivery by extraction is preferred.

We hope this has been helpful to help inform you of your options and what out of hospital twin birth looks like! We look forward to assisting you however you elect to proceed. Contact the midwife for additional information!

iACOG Bulletin. Multiples: When It’s Twins, Triplets, or More

An Evidence-Based Approach to Determining Route of Delivery for Twins

iii New VBAC Guidelines: What they mean to you and your patients