Yes! My beloved friend and contributor Pam actually delivered twins as a student midwife. What a lucky duck!!!!
Twins are tricky when it comes to birth - there are instances where a vaginal birth could be devastating to both twins, and because of that most practitioners insist that all twins be delivered by cesarean section. However, that is not always necessary. Let’s learn about twins!
There are two major categories of twins - fraternal and identical. Fraternal twins happen when two eggs are released instead of one, and both are fertliized and attach to the uterine wall. Identical twins happen when one single egg is fertilized and then it splits into two zygotes.
Depending on when the split happens for Monozygotic (Identical) twins from one zygote to two, the fetuses will share different amounts of placenta.
Can you see that when the split happens early on, the twins have separate placentas and amniotic sacs? The later the split happens, the more the two fetuses share. First it’s the same sac with different placentas, then it’s the same sac and the same placenta, and last it’s even the same body.
So how can we decide which twins can be born vaginally?
When twins are born vaginally they come out one at a time, so if there’s anything that make it difficult to deliver one at a time (conjoined twins, twins sharing a placenta, etc), we can rule those out right away. Then we have to thing about the babies positions.
When one or both babies are sideways, they cannot be delivered vaginally. When one is up and one is down, it is possible to consider delivering babies vaginally. The best possible position is to have both head down. Many midwives feel comfortable delivering twins at home when they carefully pick the healthiest parents and babies so that they know they will not end up with an emergency. In very midwifery-friendly hospitals the midwives can continue to provide care and deliver vaginal twins so long as the Ob-Gyn is near by, and even sometimes in the actual operating room itself. This is less beautiful than a regular labor room, but it is safer in case of emergency and it doesn’t change the way the midwives provide care.