Can I Homebirth with Multiples or If a Baby Isn't in Position?

Carrying multiples does not automatically disqualify you from homebirthing. Whether or not you can have a birth at home will depend on your situation, from number of babies to your overall health. While finding a midwife skilled enough and willing to deliver twins or triplets may be tricky, it is not impossible! Concerns mainly lie in the likelihood that twins will not be positioned correctly, that one may be breech or both transverse. This can make for a sticky situation, but shouldn't necessarily interfere with birth plans.

More than half of all twin pregnancies result in an elective C-section. When both twins are head down, as occurs 40% of the time, a vaginal delivery should be nearly the same as with a singleton baby. The concern is that one of the twins will be breech, though this does not make vaginal delivery impossible. ECV can be attempted, as well as maternal positioning to try to turn the babies. Twins are much smaller than singleton babies, which usually means that they have an easy passage down the birth canal even if one is breech.

Twins do pose a higher risk of prolapsed cord if the water breaks, placental abruption and thus maternal hemorrhage, so do not allow your membranes to be artificially ruptured. A skilled midwife can handle a twin delivery, even if certain complications arise. The low weight of the babies generally decreases the severity of the problem if cord prolapse is an issue, as their size means they are less likely to cause the cord to compress. If the twins appear healthy throughout the pregnancy and are at least 35 weeks when labor begins, a homebirth is still an option.

Triplets are more likely to be transverse and often come even earlier than twins, weighing even less. They are likely to need medical attention at birth, which can sometimes be handled by a skilled midwife. Many of these babies just need oxygen for a bit but are otherwise okay. Triplets are more likely to be positioned in a way that can hinder birth, being that there are a variety of positions they can be in. If your babies look healthy, and the hospital is within 30 miles, triplets do not have to be a reason to birth at home unless you have gone into labor too early.

The choice to birth at home with triplets is up to you; however, finding a midwife that will assist a vaginal home delivery of triplets may be difficult, as not many are skilled enough or insured enough to handle it. The risks are even higher for quadruplets are more. These babies are often very small, very premature, and at a high risk for a number of problems. If you are expecting quadruplets, the best place for you to birth is in the hospital. Birthing at home could endanger the infants and the mother.

If the baby is not head down and facing the right direction in early pregnancy it is not cause for alarm. The midwife can attempt to turn the baby by external cephalic version (ECV), and many attempts can be made. Other techniques may be successful in coaxing the baby into the best birth position. Scheduling an induction or early C-section is unnecessary, as most babies will turn head down by the time labor begins. Allowing the mother to begin labor naturally is best.

Only 7% of babies are breech at 38 weeks and only 4% at 40 week. In a frank breech, where the butt is engaged in the pelvis, vaginal delivery is very possible. The baby's butt is nearly the same size as its head and is very maleable, so it can pass down the birth canal without difficulty. The complete, footling, and kneeling positions when the feet are down carry a higher risk of cord prolapse & compression, and the baby's head becoming stuck along with a higher death rate. Some midwives are trained to handle these deliveries, but many are not skilled enough. Vaginal birth can still be successful with these babies but carries risks, so a C-section may be the better option despite the increased risks to the mother.

Transverse lie occurs in 1 out of 2500 births. A transverse baby is lying with his shoulder or back facing the cervix, making his descent down the birth canal impossible. If the baby is not in a position favorable to vaginal birth (vertex or frank breech) by the second stage of labor, the mother will need to transfer to the hospital for a C-section.

An occiput posterior position is when the back of the head is facing the mother's back. This makes it harder for the child to descend into the birth canal. Homebirth is still an option for this situation, although transfer to the hospital due to maternal fatigue and desire for pain relief as a result of the long, hard labor that results is common.

Twins are the best candidates for homebirth, though it is possible with triplets. If your babies are measuring unusually small or seem unhealthy, you should deliver in the hospital. If you are carrying quadruplets or more or go into labor before 35 weeks, homebirth is not a healthy option. Unusual positions are more common with multiple pregnancies but shouldn't prevent a successful vaginal delivery. Frank breeches are usually delivered free of complication, but a child that is feet first may need to be delivered by C-section. A transverse baby cannot be born vaginally. Whether you should birth at home depends on your specific situation and is a choice you should discuss with your healthcare provider(s). Many twins, triplets, and breech babies are born safely at home everyday.

Angela Horn, "You can't have a homebirth, because..." Home Birth Reference. URL: http://www.homebirth.org.uk/
Jennifer VanderLaan, "Labor Challenges." Birthing Naturally. URL: http://www.birthingnaturally.net/birth/challenges/emergencies.html