Pregnant with Twins

Twins and Spinning Babies
"I am expecting twins, can I use the same Spinning Babies techniques for my pregnancy and labor?"
2 hour old twin girls. Can you tell which one was breech? Yes! The First Principle of Spinning Babies works well with multiples.
If you can, start early. Otherwise, start today! If you begin late in pregnancy, you may need to add professional help to balance uterine ligaments.

 


Ask your doctor or midwife if there is any medical reason not to do any activity that you would like to try out on this site or any other.

When to start? Linda writes:

I have a mom 22 weeks pregnant with twins. Right now, it appears they have their own sac and placentas. Should we be worried about getting them head down this early on?

Linda (I attended your workshop in Florida.)
 
 
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to This email address is being protected from spambots. You need JavaScript enabled to view it." name="Lydia" style="vertical-align: top; ">Lydia
 
Its not about getting them head down now, Linda. Its about getting more Balance for the mom now so that 
  • She is more comfortable as her body grows
  • The placentas get optimal blood circulation
  • The babies have the most room on the day they decide to go head down - so that they can when that moment happens.
 
Balance first; fetal position (at 28 weeks and beyond) is one of the signs of balance or imbalance. Optimal fetal position isn't so much the goal of the activity as it is the result of optimal balance. 
 

The 1st Principle of Spinning Babies is Balance 

Balancing the womb means to help the womb be more symmetrical by releasing tension, twists or torsion in the uterine ligaments. These are supporting “ropes” that can get tight and spasm. Most women do not feel discomfort, others feel the jabbing spasms, especially about 15 to 20 weeks of pregnancy. 

  • More important than how babies are born is how babies are grown. You may have to find good advice yourself about diet and rest during a twin pregnancy. Here's a good start: Midwife Mary Cronk of the UK gives Guidelines for Twin Pregnancy.  And in the US, the late Dr. Tom Brewer’s diet on http://www.blueribbonbaby.org/ helps twin moms go full term. If you are well nourished and healthy, and stay healthy through good nutrition for your needs, you are likely to go full term.  

Balance is achieved with pregnancy activities that add flexibility in the joints and the fascia. Professional bodywork helps and I suggest myofascial release and chiropractic adjustments to correct any misalignments of the pelvis. 

Misaligned pelvic joints pull the uterus off center and can, at times, effect fetal position.  Women with loose ligaments may need to wear a pregnancy belt, beginning in midpregnancy (or as soon as you learn about pregnancy belts).
 

Relaxation of the abdomen and pelvis will help baby A to flip head down.  Relaxation for this purpose means relaxing the involuntary muscles, including the muscle fibers within the uterine ligaments, such as the broad ligament.
We don’t know how the twins are going to effect each other with movement. I don’t have much collective wisdom gained on this issue, so I'm going to tell you what seems to be likely. Think of say, multiple sized marbles filling a jar. You want to get one more in, so you jiggle the jar a little bit. The marbles shift some. You add water and jiggle, now the marbles accommodate each other more easily. Let's think now about the babies.

Two babies may be lined up like two little compact ovals or they may be curled near each other, likely with one or two layers of amniotic sac membrane between them. Sometimes the inside of the womb is pear shaped, sometimes heart shaped. A heart shaped uterus may have a variable amount of septum separating the right and left sides of the womb, more or less. Either way, relaxation methods listed here at Spinning Babies relax the involuntary muscles and ligaments. This is your first task. 

The first thing to do when you have a friend to help is have your abdomen jiggled while you relax completely.  This jiggling or sifting is called manteada in the Yucatan from where it is as important to prenatal care as taking a blood pressure is in our country.  See the Techniques section and then click on Rebozo for sifting techniques. 

 

After sifting with the rebozo, do a forward leaning inversion.

 

The 2nd Principle of Spinning Babies is Gravity.

Working with Gravity in a twin pregnancy.

Maternal Positioning

Understanding and Teaching Optimal Foetal Positioning author, midwife Jean Sutton, recommends keeping your belly lower than your spine (or equal) when standing, knees lower than your hips.
Let your belly be a hammock. Wash your kitchen floor, etc., on your hands and knees with kneepads on. Crawl around to pick up after your child, etc. or just to crawl. Leave off squatting and duck walking, but do dip your knees a bit to strengthen your thighs. Gravity works 24/7.

Gravity works best when the womb is in an ideal position and tone it self, and the pelvis bones, too, especially the sacrum.
When time is of the essence, for example, you are 32-34 weeks or more, you need to attend to your pelvis and ligaments with professional help.

 

The 3rd Principle of Spinning Babies is movement

Walk, stretch, dance, and crawl. If you are healthy and not experiencing early labor symptoms, you may be able to walk and swim, do yoga and dance like any woman carrying a single baby. Be sure to eat well and listen to your body! 

 

Hi Gail,

I am a Doula in the UK, I use your techniques all the time, most recently at a lovely natural twin birth in a midwife-led unit.  I use rebozo sifting and inversion at every visit and use many other techniques in labour!

 

Thanks for all your good work!

-Selina

PS: More info on the twins here

 

http://deverra.blogspot.com/

 

http://www.magicalbirth.co.uk/ 6.html

 

 

What you might do in a Twin Pregnancy when one or both babies are not head down

Please know that having the upper twin in the breech or sideways position is normal and that these activities may or may not change that twin's position. We are hoping to get the first twin head down. 
 
Hi, Gail-
I took your workshop in [Massachusetts] earlier this year; loved it and have been making great use of the pelvic release & the sacral release techniques, esp.
Last week spent some time with a doula client of mine who's G2P1, and was 35+3 with transverse twins. We did the [Pelvic Floor Release (Side-lying Release)  and the Standing Sacral Release, some good heart-to-heart talking, moxa, and the next morning Baby A was confirmed vertex by U/S! Exciting.
I remember you recommend only doing the Pelvic Floor, side-lying release 2x during pg; right? Mama is wondering why & whether she can do it again (we also did it a month ago). I'm curious too! [Learned it that way, but more important than how many is that it is done on both sides each time it is done.]

Also, while I'm picking your brain, at what point do you start having clients do the forward-leaning inversions (kneeling on couch, forearms on floor)? [The sooner the better! Before pregnancy is best!]

Many thanks for your teaching....do you ever stop & just smile thinking of how many uncounteable c/s you've prevented with your teaching???!
Michelle
Michelle L'Esperance
Certified Professional Midwife, N. American Registry of Midwives
WarmWelcomeBirthServices.com
BirthDoulaWorkshop.com

 

If you are facing a cesarean because your first twin is breech, or bottom first, try these activities anyway. They may help. It depends on why the baby is breech. If it is because there is a twist in your lower uterine segment, then these "balancing activities" may work well. Here are there, there are still Obstetricians and trained midwives (homebirth in the US) who are specially trained in breech birth complications. If you find one that is comfortable with breech, you may still be supported in a plan for a vaginal birth even if the first twin is breech. Second twins often do well with a breech birth- the gate is wide open! 

 

More on some of the Techniques for Twin Pregnancy Fetal Positioning

Myofascial Releases

Myofascial work on your sacrum can return a folded or twisted sacrum to its ideal angle and release the twist it would cause in the lower uterine segment. A symmetrical, or balanced, womb will allow the baby to turn and face the mothers right hip or back more easily. Myofascial body work is a gentle body work. Your partner can learn to “release your sacrum” after car rides, etc.  In a car, your sacrum is tilted back and liable to wrinkle a bit, like a rug irritating baby’s nose (so to speak). The main problem is that the twist in the sacrum distorts the womb and the baby has a more difficult time lining up with the pelvis and cervix during the birth. This makes the birth longer.

Diaphragmatic Release is a technique of myofascial workers, craniosacral therapists and Chiropractors (some) which amazingly helps the tissues relax around the womb. It effectively releases the round ligaments which can be so tight they hold a baby’s forehead in front.
The diaphragmatic release will accomplish emotional release as well. The whole person approach resolves deep tension quickly.

Homeopathy

Homeopathic Pulsatilla, 30 C, is an over the counter dose available at natural food stores and online. Don’t touch the remedy and only place in a clean, taste-free mouth. Avoid mint, menthol, tea-tree oil and coffee during the days you are taking homeopathics.

Generally, the directions are to take Pulsatilla 30 C once a day for three days, then take a day off and try a does of Pulsatilla 200 C one time.
 If that doesn’t work, or you don’t want to risk it not working, seek a professional homeopath.

Chiropractic

Chiropractic adjustments can help the various soft and bony structures of the body relating to the womb. (Seen here, at right) One well known release is called the Webster maneuver. It is the same as for helping to flip a breech baby. It works well for a posterior. And can be used safely for twin pregnancies.
 

Here is a lovely case study on helping breech twins flip head down spontaneously after Webster's Manuever on the Chiropractic 

Journal of Pediatric, Maternal & Family Health

 

Resolution of a Twin Breech Presentation with the Application of Webster and Diversified Chiropractic Technique
 
Danita Thomas Heagy, D.C  Read the full article here. 

 

What are we finding here?

 

Overview of Maternal Positioning for Twin Pregnancy

Once you balance the womb and supporting ligaments, more room will be available within the womb, the sides will be softer and more flexible. A single baby will be able to sort herself out with gravity and movement. If the twin babies themselves aren’t blocking each other, then they, too, will move into place. 
 

 

Debbie's Abdomen with Twins

Techniques to use in a twin pregnancy

In order:
   
1.    Jiggling (Manteada, Chunging, sifting...) This can be done by your partner or friend.
2.    Inversion—Reasonable for every twin-carrying mother in the first two trimesters. But inversion may not be for every twin mother in the third trimester. Each woman is different and has different tolerance for being upside down. See the video in Techniques/Inversion. How many and how long? One a day for 30-seconds each, or several in a day for 3-4 days and then occasionally once babies are head down.

3.    Maternal positioning follows each relaxation technique. Arrange pillows to Rest Smart.  Hips higher than knees, belly lower or equal to spine 24/7  Mind your posture always.
4.   Movement - swimming belly down and doing head stands in deep water (for those who feel safe doing so) are good ways to use the counter pressure of water to help the babies into position.

 
   See warnings in the article on Inversion in the Techniques section of this website.

Deep Relaxation of involuntary muscles is assisted by professional techniques/bodywork:
5.    After 36 weeks, avoid squatting and other things to engage baby until baby turns to face your right hip or is definitely LOA. Once labor is underway, especially as baby gets to "0" or +1 station," then

see if squatting is helpful for any fetal position.

Labor helps the posterior baby into position:
6.    Uterine contractions help rotation, so use posture and movements in early labor.
   

 

Ask your nurse or doctor, “Is there anything about my situation that I should avoid getting upside down?” If your bag of waters is not overly full there probably won't be a problem, but it is best to ask.

 

Balance the mother and the baby will turn.

Another arrangement of Spinning Babies techniques could be:

    * Inversion (leaning forward as shown on the videos on SpinningBabies.com) ; and
    * Sacral release,
    * Abdominal release (both Myofascial) and
    * Chiropractic adjustments of the pelvis, and neck, regularly.
    * Moxibustion at 33 weeks or later, particularly 2x a day for 20 minutes each on the outer (and upper) little toe nail (bladder 67) for the weeks 34-35 of gestation
    * Acupuncture with only the very well experienced with pregnant women. I’d feel comfortable with student or new acupuncturists myself, but I want to save you time and money. Be efficient and see the best. Find a community acupuncturist to reduce costs and get several appointments in for the cost of one visit to a “regular” acupuncturist.



Relax involuntary muscles and relax the broad ligament with
Rebozo sifting (manteado) as well as the

Abdominal (diaphragmatic) release.
Maya Massage. Once the flow is returned full force to the womb the babies may even grow more symmetrically.
Use a pelvic floor release in late pregnancy or any time in labor  when Baby A is entering the pelvis in a difficult position, labor is not progressing in spite of strong contractions or serious back labor.

Doing only maternal positioning isn't likely, by itself, to help a breech twin turn at 32 weeks or later, especially after 35 weeks gestation. This is a subjective claim, however, success depends on many factors!

 Here are the links for more information to make sense of these instructions:


http://spinningbabies.com/techniques/in-pregnancy/what-to-do-first


http://spinningbabies.com/techniques/in-pregnancy/3-principles-in-pregnancy


http://spinningbabies.com/techniques/bodywork-and-professional-help


http://spinningbabies.com/techniques/in-pregnancy/will-my-labor-be-hard

 

Frequently, I get emails from mothers or their doulas asking if one or more of the techniques is safe for them to use to try to get their breech twins into a head down position. Most doctors today accept no natural breech births and that includes no first twin breech births (some docs will pull out the second twin vaginally and fewer will let the second twin be born spontaneously). Many parents don't know of this challenge to their birth plan until the babies are within a month or weeks of birth. The time to bring better balance into the body to encourage head down babies in early in pregnancy, with the second trimester being a key time for body balancing. Still, some women can help their babies be head down later in a twin pregnancy. Continue the balance techniques (without the breech tilt, which is not in this category of techniques) until birth.

Here's a sample email:

"...She really wants a vaginal birth. She is with a very good OB now, but he is not comfortable doing Baby A as a vaginal breech. There are other options she is pursuing. I just wondered if doing techniques such as the ones you describe or for example, the Webster's Technique or moxibustion would be safe seeing as how it's twins...." 

 

My answer was something like this:

"This is a tricky question. If there are no randomized control studies then I can answer with my opinion. 

 

 
There is a cycle that happens in pregnancy when a woman has a breech and dsires a natural birth or VBAC and has a doctor who doesn't/or can't support her desires. She desires her original birth plan strongly. She realizes her doctor isn't on board with that but he/she is so good in other ways, and the relationship is already established. 
Change seems more alarming than continuing with the original plan. Trying to get twins to flip, which does happen,
becomes the only way to keep the established relationship with the doctor and continue the hope for a natural birth. 
 
The chances of natural birth are diminished with this approach.
 
I'd suggest finding an excellent myofascial release and craniosacral therapist along with Websters and Moxibustion. We don't know which her body might respond to, but time is of the essence and flipping is  less likely without increased balance of the soft tissues and pelvic joints. "

 

All pregnant mothers benefit from increased balance, even pregnant mothers of twins:

Sifting with the Rebozo can help with good fetal position. You don't have to have a malpositioned twin to enjoy Rebozo sifting. This can be every two weeks in early to mid pregnancy, weekly if you can get it, or even daily in late pregnancy if you are working with a malposition. 

Have a standing sacral release and an abdominal (diaphragmatic) release if you have a friend to help you.

Do one or two side-lying releases in pregnancy. Do both sides as are in the instructions.


First time mothers or women who've had long or difficult OP births before:
       If baby engages in OP or ROT position, you may try to disengage baby by Inversion (Trendleberg) for 2-10 minutes in pregnancy or 30-40 minutes in a non-prgressing labor and let baby try entering the pelvis again. 

Do not use inverted positioning if first baby is NOT engaged, unless jammed at the brim. Read about chin tucking in Baby Positions. 

Repeating the inversions daily for a couple weeks eventually gives you a pelvic adjustment and releases spasms in the cervical ligaments, allowing the lower uterine segment to become symmetrial!


      Always talk to your babies. Have your partner talk to the first baby directly by putting a tube (paper towel roll or clean vacuum hose) to the lower right side of your belly and talking heart to heart to get baby’s attention. This will encourage your baby to look to the sound and get his/her head in an LOT position, the ideal start position.
The most important thing is love.

To watch a slide show on a twin HBAC (home birth after cesarean) click here: http://www.carolinabirthandbaby.com/unlikelyjoy/2008/06/my-twin-hbac-homebirth-vbac-journey/

 

"My Doctor wants to induce me at 37 (38) weeks."

Using the late Dr. Tom Brewer’s diet on http://www.blueribbonbaby.org/ twin moms are going full term with healthy 7-8 pound babies. It never hurts to eat green leafy veggies, plenty of lean protein and a gallon of water a day, with salt to satisfy your taste in your food.


35-38 week-old twins will nurse almost hourly each, with a 2-3 hour break while sleeping; while 40 week twins may go 2 hours more often, and 3 and sometimes 4 hours when sleeping.
Babies born early are at higher risk for health problems and death in the first year of life. If we can prevent premature birth we can reduce risk. Why work hard to keep the babies in the womb and then induce, or even surgically remove them, before 40 weeks? Where is the evidence of safety with that plan?

Some attitude

March of Dimes is giving obstetrics the dickens for causing an epidemic of premature babies when they are induced or sectioned before they are due.  Some twins may need to be born early for specific reasons, such as a significant twin-to-twin transfer, but that is the exception, not the routine.


Ask your doctor if the induction is “just in case,” or do you have a specific risk for continuing to go to term? An aggressive doctor or midwife might say, “You have a live baby today, I can’t guarantee that tomorrow!” (I’ve heard this a number of times!) Its one thing if one baby is slowing down and/or the heart rate is not variable or one baby isn’t growing, but the argument that your womb will get too big to work properly is bonkers. Eat well and get your iron up.

Full term is full term, twins or singletons. Placentas and wombs aren’t time bombs, but beautifully designed organs for safe gestation.


Feed your placenta so it is healthy enough to do the work for nine months. Don’t smoke or eat junk, and unless you have a preexisting liver ailment or other unusual situation your placenta should be happy to continue to nourish your babes. Discuss any decisions you make with your doctor and midwife. 


 

Pay attention to a good pregnancy diet for twins:


    * Eating 6 servings of quality protein (lean proteins, not a lot of peanut butter). Eat 100 to 150 grams of protein each day you are able to get it and keep it down;
    * 3-4 quarts of water a day, including up to a quart of Red Raspberry Leaf Tea (make sure you are drinking non-caffeinated tea and its not flavored black tea! Try and get the leaf bulk rather than bagged.);
    * Leafy green vegetables, like raw spinach, Spring Mix salads, broccoli and cooked kale with lemon, eat a green leafy every day;
    * A yellow fruit or veggie a couple times a week or more; and
    * Whole grains, not white breads. Brown rice or quinoa grain makes a lovely addition and are good for digestion, nutrition and energy levels.
    * Add Omega oils, such as Nordic Naturals cod liver oil in a capsule or oil. Eat happy fats such as avocados or a tablespoon of butter, not margarine, each day.
    * Salt to taste, which means, to me, a bit of salt on your food.

 

Transverse twins?

Read about helping transverse babies get head down. Its less likely the twins are blocking each other, though you'll hear that, then the womb needs some support for balance. When babies are vertical, you may prevent them slipping back by wearing the right pregnancy belt (which is the one that's most comfortable for you!).

 

Breech twins?

Breech twin birth can be nearly as safe as head down twins if you have a couple of skilled attendants who know not to pull on the breech and know how to rotate stuck arms out and how to bring the nape of the neck into view before helping the head out. The first twin opens the way for the second twin. Contrary to most talk, the danger of a twin birth is usually in the attendant, not the birth process itself. You need both, a breech baby that fits and an attendant that doesn't accidentally cause damage due to ignorance or wrong practice techniques. The main thing is the baby is in a “tube-shape” and your birth attendant really knows what they should not do. Read about breech and avoid a manual version (a doctor or midwife manipulates the baby around through the abdomen.

 

Happy Twin Parents after home birth

 

This is how we tell which twin came first!

Two day old twins