Dear Henci

I am working as a childbirth educator in Canada.  In my region, families expecting twins are recommended to have an epidural during labour, regardless of the health and positions of the babies.  From what I can gather, the physicians are recommending an epidural in labour "just in case" , because of the increased risk of caesarian birth with twins.

The moms have expressed some concern with having an epidural, because of the known risks associated with epidurals for single births. 

I would like to know what the benefits and risks are for an epidural during twin labour and delivery.

Thanks

Jen Cody

I am not aware of any studies of epidural effects specifically in labor with twins, but there is no reason to believe that laboring with twins would somehow reduce its potential adverse effects. In fact, I would think some adverse effects might have worse consequences for twins, who might be more vulnerable in labor and present a more complicated delivery. Epidurals greatly increase the risk of an episode of maternal hypotension, which would reduce placental perfusion and therefore fetal oxygen supply, and epidurals interfere with the ability to push effectively, which might be required at a twin birth.  If the concern is the unexpected need for instrumental or surgical delivery of the second twin, I have been told by clinicians that spinal anesthesia can be administered quickly and will take effect rapidly. I would flip the obs' recommendation and say I think it might be a good idea to avoid an epidural "just in case."

-- Henci

Thank you for the information regarding twins and natural birth!

I am 35 weeks pregnant with identical twin girls. Throughout my pregnancy it seems that my providers have predicted one disaster after another such as suspected twin- to- twin transfer syndrome, uterine growth restriction, and calling the outcome of my pregnancy "bleak." All of this served only to make my husband and I stressed out and fearful. However, I guess we beat the odds with no medical interventions beside rest. Both girls are gaining weight and growing strong.

Tragically, throughout this experience, I have begun to loss the confidence in myself to be able to labor and deliver these girls. My doctor also gave the, "just -in- case" epidural recommendation. I delivered my first child, a son, three and a half years ago without medications in a record 5 hours from the onset of contractions to his delivery. It was the most beautiful, natural, and rewarding experience of my life. Your comment helped me to realize that I can only be robbed of that experience with this pregnancy if I allow it to happen.

Thank you! You couldn't have said anything nicer to me.

Ironically, when Elizabeth Noble revised her book on multiple birth, she found that the preterm birth rate with twins had increased over the intervening years, despite the fact that at the time of the earlier book, ultrasound scans were not routine, and twins were often not discovered until late in the pregnancy. We know that chronic high stress is strongly associated with preterm birth. Makes one wonder if all that high-tech surveillance and fear mongering from early on is actually counterproductive of healthy births. 

-- Henci

An anecdotal story from my practice as a Home Birth Midwife in an area of Amish & Mennonite women.  There have been about 20 sets of twins in this area in the 10 years I've practiced here and only one set of twins had a bad outcome...the one where the woman declined further care with me and transferred to a doctor at a local community hospital at 20 weeks gestation.   Now, the moral of the story is not that hospitals/doctors are bad.  No.  This woman felt secure with the added testing that I would not have recommended.  The biweekly NST's the frequent ultrasounds and all the visits to the doctor made her feel safe & secure that the twins would be healthy.  The unfortunate truth is that with all this testing she still arrived in labor at 37 weeks with one of the babies already dead with no apparent cause.  This woman and the women of this community saw this as God's will.  They do not blame the doctor.  I do believe that no amount of testing can guarantee a healthy baby.  No epidural, "just in case" is going to guarantee a good outcome, and I suspect that it does actually do the opposite in some cases. P.S.  I'm kind of glad she did transfer out of my care, because this experience would have changed my mind about recommending  "the million dollar work-up" with twins.