Twin Birth Plan: Pain Management & Birthing Environment

by admin · Published 16. January 2019 · Updated 16. January 2019

A twin birth plan can cover different aspects and stages of labor. It’s a good way for pregnant women and their partners to talk about what kind of birth experience they would like. It can also help ensure that the hospital staff knows what you prefer and help ensure that your expectations are met – or at least addressed. We’ll add more examples of twin birth plans continuously.

Twin birth plan – VBAC twin birth

This twin mom gave birth in the UK in 2008 to identical di-di twin boys. She did a vaginal birth after c-section (VBAC) at home. She made the twin birth plan in case she wouldn’t be able to deliver at home.

Notes

I am very short sighted, so please be aware that I do not want my glasses taken away from me at any time. I have no spares, and I cannot see at all. If necessary give them to my partner for safekeeping.
I spent time in ICU for Meningococcal Septicaemia 12 years ago, and I am very wary of being helpless in a hospital attached to lots of equipment. This happened to me again in my first birth, and it’s why I generally wish to avoid interventions and monitors unless necessary. Please help me to make this a more relaxed experience for me, my partner and both our babies, we’ll remember you well for it.
I am a fish eating vegetarian. No allergies.
My authorised spokesperson during labour is my independent midwife. My partner is to be allowed access at all times.

Going into labour

Spontaneous commencement of labour and VBAC.
If I am still pregnant at 38 weeks I would like to discuss my options at that time, and take decisions day by day. I may consider elective repeat caesarean, ARM or monitoring and waiting depending on how I feel when that point arrives. I will not make an advance decision on this.
No prostaglandin gel, I have a previous caesarean scar.
No induction or artificial augmentation to labour as I have had a caesarean section previously. I had a very bad experience of this before and I will not consent to it again.
Repeat Caesarean in preference to induction.
If I am overdue, then I will have regular CTG to ensure babies are OK.

VBAC – normal birth plan

If I arrive at hospital in established labour with no problems, I would like to be admitted under midwifery-only care. I would like this to remain the case unless there are any problems identified.

The Birthing Environment

I want to use the bath.
I want to use a birth pool
I want privacy and quiet. I want to keep the number of people present to a minimum: I understand there may be more people needed at a twin birth, but I would like them to wait outside until necessary. I am not happy to have curious onlookers or students present.
I do not wish to give birth in an operating theater.

Labour

I have an independent midwife supporting my birth. Please respect her role, make her feel welcome, and make use of her knowledge of me and my pregnancy.
I am a VBAC labour but I do not want to be treated any differently from any other labouring woman. I have studied and am aware of the risks and do not need to be reminded.
Freedom of movement at all times. Facilitation of movement in the event of monitoring (I will not lie back on the bed for any length of time as I did this my last labour and do not wish to repeat).
Please note when my last labour stalled (6cm) and support me to get past that stage in this labour.
Drinking and eating as requested by me.
No routine cannula; please see note at top, I have spent long weeks attached to multiple IVs and it’s something that causes me a lot of stress. Please only cannulate when needed. If cannula is necessary please consider placing it at wrist rather than back of hand.
Vaginal examinations only as agreed or for specific medical reason.
Fetal stethoscope/pinnard/sonicaid doppler for intermittent fetal monitoring – no CTG or fetal scalp monitoring.
Spontaneous rupture of membranes – no amniotomy. Please note this was done without permission in last labour (and most painful moment of entire labour). This has made me very wary of VE indeed so please take care.
No time limits on the stages of labour.

Pain Management

Use hot shower/bath and hot water bottle (I will bring).
Labour on all fours, standing, walking, beanbags.
I have learnt self-hypnosis and will be using this method of pain relief.
TENS machine.
Please give me lots of reassurance and encouragement. I need to hear that everything is going fine and that I am doing well.
I would like to use Gas and Air.
I would like to be supported to labour without chemical pain relief.
I do not want pethidine.
I do not want an epidural as I feel it especially important to move around to give me the best chance to VBAC both babies. I did not need an epidural last time even though induced on a drip for 17 hours and OP baby.

The Birth

Presence of my partner/midwife at all times.
No time limits for birth or between twins. I wish to be led by real assessment of situation not artificial rules.
After first baby is born, if the 2nd baby is well, wait for spontaneous contractions and urge to push.
No coached pushing.
Physiological third stage if birth has gone without intervention.
I wish to avoid an episiotomy.
Forceps or ventouse only in an emergency and after consultation and discussion with me and my partner. I would prefer repeat section to instrumental delivery (ventouse in preference to forceps, no routine episiotomy).
Birth in an upright position, no stirrups.
As long as babies and myself are happy and healthy, I want no time limits placed on third stage.
On delivery I want babies to be placed onto my abdomen/chest.
Umbilical cords to be clamped after they have stopped pulsating if possible.
Babies not to leave my view, or if extra care is required then partner must go with babies.
I would prefer a small tear to heal by itself without suturing.

After the Birth

I want to see my placentas.
Delay routine checks for the first hour.
I do not want babies to be washed. I did not see my first baby until he was cleaned up and wrapped up and it is important to me to see the babies as they came out.
Immediate breastfeeding after birth.
Carry out checks of babies whilst on my abdomen.
Babies to be exclusively breastfed.
I would like lots of support with breastfeeding.
No formula feeds for babies or supplemental feeds without discussion.
Babies to be examined by any health professionals only with parents’ authorisation and in our presence.
If there is any concern about babies, we want to know without delay.

Caesarean Birth

Caesarean Section can only be with consent.
I need to know that all options have been exhausted before the decision to have a Caesarean is made.
I do not want the catheter to be inserted before anaesthesia.
I want someone to be there and comfort me if I am having contractions whilst the epidural/spinal anaesthesia is being inserted, apart from the anaesthetist.
I want my independent midwife to come into the theatre.
I would like someone to take photos of babies before cleaning and as checks are made. This is very important if a GA is necessary.
I want to see babies ASAP especially as they are lifted up and before they are cleaned/wrapped up: I missed this before and it is very important to me, however brief.
After I have held babies, please place skin-to-skin with father: this was the only positive in previous section.
I want to be kept informed about what is happening to me during the caesarean section at all times.
I wish to remain awake for the caesarean.
If I need a general anaesthesia then I want my partner to be given our babies as soon as they are born.
If I need a general anaesthesia then I want my partner to be present/waiting just outside the operating theatre.
My partner must go with babies if they need to be taken to special care. If only one needs this, then he should go and my midwife should keep the other near to me.
I wish to have skin to skin contact with babies, please leave one arm accessible/unrestricted.
I want suture of my incision, not staples. Dissolvable stitches please.

After A Caesarean Birth

I want to breastfeed babies as soon as possible.
I want my babies’ health checks to be conducted within my full unimpeded view.
I want to see my placentas.
I want to drink and eat as soon as I feel the need.
I want the IV to be removed as soon as possible. I find them distressing and it impeded breastfeeding last time.
I want to know how my pain will be controlled after the operation. Please do not give me only paracetamol as this caused me great distress after previous section.
Please anticipate anaesthetic wearing off and give me appropriate pain relief before it becomes so painful that I need Morphine. I wish to avoid Morphine as it made me feel unsafe with my baby last time.
I want to be helped into breastfeeding positions, but please no putting of nipples into babies’ mouths, I will do this (sorry – previous bad experience).
I want the obstetrician who performed the operation to come and see me and explain what happened in detail.
I want to be helped to get up after the operation when ready. Please no repeat of last time when forced out of bed at 6am with no pain relief.