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Delivering Twins

Frankston Hospital, baby, delivery

Two semesters down, only one to go! The nerves are definitely increasing as I creep closer to finishing my Postgraduate Diploma of Midwifery, yet the ever exciting experiences I continue to have on my placement days makes me so eager to finish the course and see where my nursing and midwifery career takes me. 🙂

There have been many firsts this year of both the highs and the lows that a midwife may experience: first time taking a newborn screening test; care given to a terminated baby; baby requiring phototherapy and most recently the delivery of non identical twin boys. I felt mixed emotions in the twin delivery – excitement for the mother and father and nervousness in hoping that the birth would go smoothly.

The mother first let the midwife and I know what her birthing plan was. Birthing plans are a great way of letting the midwife know what the woman and her partner wish during their labour and birth, but also keeping in mind that some things may not go to plan depending on various factors including maternal and infant wellbeing.

What made me most nervous, having learnt at university about twin births and complications that can happen when delivering the second twin, was her wish of having a normal vaginal birth and refusing pharmalogical pain relief. At Frankston Hospital it is practiced to give an epidural to women delivering twins due to the increased morbidity and mortality of the second twin, and the requirement of intervening efficiently through the use of instruments or caesarean. It is so difficult to position my feelings in this situation about her birth plan, where I feel so happy that this woman has made this decision in the hope that everything will go as planned, yet the other side I think of is the what ifs.

What if the second twin alters position after the first twin is born? What if the second twin becomes distressed? What if there is an umbilical cord prolapse of the second twin? What if premature separation of the placenta occurs prior to the second twin’s birth?

Labour and birth I have learnt is honestly about being able to go with it, see how it plays out, and respond efficiently and appropriately in any situation that may arise. This is what the midwife, obstetricians, paediatricians and I were going to have to do with the twin delivery.

As a nurse and soon-to-be midwife I always want the best outcome for all of my patients. As each situation differs with every person it so important to take in the whole picture and identify any concerns, as medical conditions and risk factors can change the ‘smooth running’ of labour and birth.

After the obstetrician artificially ruptured the membranes surrounding the first twin, the woman went into labour naturally, contracting strong and regular and eight hours later with non-pharmalogical pain relief including showers, walking, squatting and position changes on the bed, the first twin was born. What a wonderful moment, seeing the first twin boy crying and handed over onto mum. Things were going well. 🙂 

Determining the position of the second twin needed to be done in a timely manner. An ultrasound completed by the obstetrician confirmed a cephalic presentation (the baby was still head down and was not breech). That was such good news!!

The obstetrician ruptured the membranes of the second twin and he was born 20 minutes after the first. A wonderful and happy experience to be a part of, as well as the relief that everything went well for the mother, father and twin boys.