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Twins

My dear Friend, Jeanne Bazille with one of her many sets of twins she welcomed into the world.

My dear Friend, Jeanne Bazille with one of her many sets of twins she welcomed into the world.

I am expecting twins, can I use the same Spinning Babies techniques for my pregnancy and labor?

TwinsBMap32wk

Yes! Spinning Babies approach works well for multiples. If you can, start early. Otherwise, start today. You may need to add professional bodywork help to balance uterine ligaments.

Ask your doctor or midwife if there is any medical reason not to do any of these activities (inversion, particularly).

When to start Spinning Babies approach in a Twin Pregnancy?

I typically suggest 20 weeks for a singleton. With multiples the start of daily balancing activities might begin earlier, for instance, 16 weeks… Start gently, pace yourself, and be steady rather than athletic, please!

Start now

 

Is it too early?

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.)

Gail responds:

It’s not about getting them head down this early, Linda. Its about getting more Balance for the mom now for:

  • Comfort as her body grows
  • Optimal blood circulation
  • So the uterus has the most room on the day the babies decide to go head down – so that they can move head down when gravity and the weight of babies’ heads unite for that moment to happen.

Balance first; a head down fetal position (at 28 weeks and beyond) is the first signs of balance – but not a sure sign. Optimal fetal position isn’t so much the goal of the activity as it is the result of optimal balance.

 

 

 

 

 

 

 

 

 

 

 

 

 

Is it too late?

Faruks Twins in Mumbai.1st flipped at 40 weeks

These sleepy twins were breech at 40 weeks and then, with one Forward-leaning Inversion flipped head down in time for a stress-free vaginal birth.

Spinning Babies gentle techniques work for twins, too!

Balancing the womb means to help the womb be more symmetrical by releasing tension, twists or torsion in the uterine ligaments. These are the supporting “ropes” that can get tight and spasm. Most women do not feel discomfort from the spasm. While others feel jabbing pain or just discomfort.

 

Balance Means Make Room For Babies!

Balance is achieved with pregnancy activities, such as the activities on this website. Professional bodywork also helps overcome torsion or tensions from accidents or  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).

Alignment of the uterus with the aligned pelvis will help baby A to flip head down.

 

What is specific to twins in fetal positioning?

We don’t know how the twins are going to effect each other with movement. Think of 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 multiple babies in the womb.

Two babies may be lined up like two little compact ovals next to one another or they may be curled facing each other, a bit like a puzzle. More amniotic fluid than less gives more room for a big position change. Drinking 3 quarts or liters is about right for the average pregnant person. Add more if you are doing athletics or live in a hot, dry climate.

Rebozo.thumbsup

After using Rebozo Sifting is a gentle jiggling of the abdomen to relax the broad ligament (in the style shown in the photo). Please don’t be over vigorous. You aren’t trying to force a baby to move. This is a physiological change you are seeking and a deep relaxation of involuntary muscles. We can’t do that with over excited sifting!

 

I notice that twins moms who do several Forward-leaning Inversions in one day (not day after day!) may have babies go head down afterwards. It really surprised me that it worked for these two twins held in their advocate’s arms. Their mother did only one Forward-leaning Inversion and that was at 40 weeks! The both immediately went head down. Its more usual that a twins mom would do 7 or more in one day and then two days later the twins might be head down.

Lina Duncan and Faruk's Twins

 

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.

Twin Belly Map cropped

 

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 [Forward-leaning 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 if twins are lying sideways?

Hi, Gail-

I took your workshop in [Massachusetts] earlier this year; loved it and have been making great use of the pelvic release [Sidelying Release] & the [Standing] 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 [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.

Many thanks for your teaching….do you ever stop & just smile thinking of how many uncountable c/s you’ve prevented with your teaching???!

Michelle L’Esperance

Certified Professional Midwife, N. American Registry of Midwives

WarmWelcomeBirthServices.com

 

Should I have a cesarean?

If you are facing a cesarean because one or both twins are breech (bottom first) or one or both are sideways, you may like to try the activities listed above and below. 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 very well.

Here and 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 vaginal breech birth- the gate is wide open!

Choose a doctor with skills to support this common twin birth scenario. If you have to travel for your birth, remember how you birth sets how you will live. While not all intended natural labors continue with a vaginal birth (some have cesareans because the baby or babies aren’t lined up to come into the pelvis or because of mother or baby health reasons). So many women could have empowering twin births.

Personally, I find twin births to nutritionally well fed and healthy women go quite amazing!

 

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.

Eat about 6 protein servings a day, including an egg unless sensitive; with 3 quarts of water; salt-to-taste; dark greens daily and other fresh veggies;  one Vitamin C source such as fruit or hibiscus tea; and a couple of servings of whole grains, not so much bread as whole cooked grains such as slow cooked oatmeal, brown rice, quinoa, bulgar, buckwheat groats (high in iron). Tom Brewer recommended a baked potato with its skin (wash it well before baking and avoid the green ones!). I’d add to make one quart of the water a pregnancy tea of bulk sourced Red Raspberry Leaf Tea (1 part) and Alfalfa (1/4 part). Other additions in the tea can attend to other needs, such as 1 part Nettles for iron. Steep 5-15 minutes and drink hot or warm.

Other Techniques for Twin Pregnancy Fetal Positioning

Body Balancing (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.

Sidelying Release is the Queen of Balance. More than sidelying, you are addressing 30 or more muscles that effect pelvic alignment and comfort. See the instructions, it’s tricky!

The Standing Release is a gentle Myofascial bodywork. 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. See Spinning Babies; Parent Class Video Download for how to do it.

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, also called Abdominal 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, by Danita Thomas Heagy, D.C  Read the full article 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.

Techniques to use in a twin pregnancy

In order:

  1. Jiggling (Manteada, Chunging, sifting…) This can be done by your partner or friend.
  2. Forward-leaning 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. How many and how long? Once a day for 30-seconds each with head down twins. Breech? Keep scrolling down!
  3. Maternal positioning is more effective following the balancing techniques. Gravity follows balance. Arrange pillows to Rest Smart.  Hips higher than knees, belly lower or equal to spine 24/7  Mind your posture always.
  4. Movement – gentle swimming belly down may be a good way to use the counter pressure of water to help the babies into position.
  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:

  1. Uterine contractions help head down babies rotate from posterior to anterior (if necessary), so use Balance, Gravity and Movement in early labor, especially.

Ask your nurse or doctor, “Is there anything about my situation that I should avoid getting upside down?”

Balance the mother and the baby will turn.

  • Another arrangement of Spinning Babies techniques could be:
  • Forward-leaning Inversion; and
  • Standing Sacral Release,
  • Abdominal/Diaphragmatic 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 professionals 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 for 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 Sidelying 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 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:

 

Breech Twins

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.

Forward-leaning Inversions several times in one day and then at least once daily may help give you a pelvic adjustment and release spasms/tension/twists in the cervical ligaments. This allows the lower uterine segment to become symmetrical and “make room for the babies” to get head down.

How often for breech twins?  Once a day before 26-30 weeks. Then on one day only if after 30 weeks, you might try the Forward-leaning Inversion 7-14 times in one day for 30-seconds each, followed by the breech slant board (breech tilt board). Then, when babies are head down, do one FLI a d day.

Doing head stands in deep water (for those who feel safe doing so) may be quite helpful, especially after doing balancing techniques.

Avoid a manual version

In what’s called a External Cephalic Version (ECV) a doctor or midwife manipulates the baby around through the abdomen to a head down position. It’s not safe to do with twins.

 

Can I have a vaginal breech twin birth?

Breech twin birth can be nearly as safe as head down twins if you have a couple of skilled attendants. Whether twins or singletons, every breech baby deserves a provider who knows 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.  So if only the second twin is breech, then many doctors and some midwives who do twins will have the skills to support a vaginal birth (if not their peer support). Read about breech vaginal birth elsewhere on this website.

There are still skilled doctors and midwives accepting parents late in pregnancy to help avoid a cesarean if vaginal birth is a healthy possibility for those parents.

Most doctors today lack skills for natural breech births and that includes twin breech births. It is considered medically safe for the regularly skilled doctor to pull out the second twin if breech vaginally. Fewer let the second twin be born spontaneously, and the safety in spontaneous 2nd twin depends on how the second twin is doing. Monitoring is called for, and most 2nd twins do quite well but some don’t like to be left behind and Mama’s loving push and some need a gentle hand to guide them out along with that push.

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. The second trimester is 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.

An 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:

I can answer with my opinion.

Non-invasive techniques such as the two you mention seem compatible with multiples as well as singletons.

More importantly, let’s acknowledge the woman with a breechling who desires 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 doctor, even if the cesarean plan is causing distress. 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. Changing providers may lead to an empowering vaginal breech birth.

Meanwhile, I’d suggest self care or professional myofascial body balancing and pelvic alignment. a craniosacral therapist and a Chiropractor certified in Websters make a good team approach. Moxibustion and Acupuncture have some success as well.

I think more is better than one modality. We don’t know which a particular 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

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.

Watch a slide show on a twin HBAC (home birth after cesarean), click here.

Ernst Twins and parents

“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 health-related 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 and protein intake 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.