Occasionally the placenta and membranes of the first twin are delivered before the second baby is born. Excessive bleeding may occur from the placental site and the placenta of the second twin may also begin to separate. The second sac of membranes should be ruptured immediately and the baby and placenta delivered as quickly as possible. The uterus should then contract and bleeding be controlled.
-Mayes' Midwifery, Betty Sweet Ed., Balliere Tindall, 1997
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Research has shown that women who are expecting twins can have a VBAC as easily as women expecting one child without added risks, including uterine rupture.
-Diana Korte, The VBAC Companion, Harvard Common Press, 1997
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The obstetrical tendency toward weight and salt restriction has made many multiple pregnancies a nightmare of complications, and most doctors view them as high risk. The fact that typical bio-technical medical management results in a toxemia rate of 50% in twin pregnancies and 75% in triplet pregnancies is ample proof of the nutritional neglect=hypovolemia=toxemia etiology.... Cervical cerclage and labor suppressing drugs may be recommended along with bed rest, weight restriction, and cesarean section. Predictably, this results in low birth weight, premature babies as well as a higher incidence of abruption and hemorrhage in mothers.
-Anne Frye, Understanding Diagnostic Tests in the Childbearing Year, Labrys Press, 1997
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Immediate postpartum: Watch for signs of shock! Treat prophylactically: keep mother supine and elevate lower extremities. Keep mother and babies warm. Offer sweetened fruit juice or other high fructose beverages, as tolerated. Be prepared to stay with mother and baby for at least 12 hours postpartum. It may take babies somewhat longer than normal to stabilize. Mother needs to be watched for any signs of postpartum eclampsia, which is more common after twins due to rapid changes in circulation, excessive fluid retention, etc. There is more necessity for immediate diuresis, yet kidney function is slower.
-Valerie El Halta, Study Outline for Twins, Midwifery Today Issue 39
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Reprinted from Midwifery Today E-News (Vol 1 Issue 42, Oct 15, 1999)
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