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I help twin and multiples parents go from surviving to thriving: from pregnancy - postpartum - relationships - raising multiples - with global experts and inspiring parent, celebrity and influencer stories.
Are you a new Gen Y or Gen Z parent or parent of twins and multiples? Do you want to thrive, rather than just survive?
Welcome to our show - a modern, step, by step guide to get you best set up for thrivival!
No outdated, frumpy or stuffy content - we're for NEW parents, we are new parents and we have found the best of the best experts, research and stories. If you're time poor - look no further - community and support building, efficiency hacks and tools, pregnancy, symptom management, partner support, body, bust, skin, hair, postpartum recovery, PND, logistics and travel, parenting twin psychology, childcare need-to-knows, returning to work and more!
I'm Emily, a twin and twin mum. I have researched extensively the best tips, efficiency hacks, expert advice. Books, white papers, medical papers, online groups, articles - sifted through it all, for you. I hope this podcast helps you best navigate this exciting time.
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Podcast: Hey There Thivival
Hi everyone.
Welcome to the Hey
There, Thrivival podcast.
My name is Emily Haigh today
we have a very exciting guest
Obstetrician Gynecologist, Dr.
Sarah Lyons
Sarah's actually also a twin herself.
to add to that, she delivered
my twins here in Australia.
Today, Sarah is going to offer you
a wonderful overview of each of the
phases, what an obstetrician does.
Also who they work with.
So if you are in the pregnancy
stage, you can really understand
what that runway looks like what
to expect in terms of timing.
then also talking about different
elements if you're having twins, a
couple of top tips talking through
delivery, and then postpartum.
I hope you love this episode.
Please rate and subscribe
so we can get this.
Podcast in front of more parents like
yourself, and hopefully help them
to thrive rather than just survive.
Okay, let's get in.
Emily: Sarah, welcome to the podcast.
It is so great to have you here today.
I'm really excited to talk to you
Could you please give the audience
a little bit of an introduction
on who you are and what you do?
Sarah: Thanks for having me, Emily.
I'm an obstetrician
gynecologist working in Sydney.
I have been public and private care
at a local hospital, but I've got a
1-year-old, so currently just working
in the public sector and getting a whole
new experience about what happens after
I finish my job as an obstetrician.
I'm also a twin, so I have a twin brother,
which gives me a good insight into.
What it's like growing up as a twin and,
hearing my mum's stories about how tough
it is to raise twins and how much you
really need that village around you.
and just really nice touch that I
actually met you when I delivered
your twins a few years ago now.
So, a special full circle moment
to be here chatting with you today.
Emily: It is, you know, it's so,
crazy that a twin delivered my twins.
and also that I'm a twin.
there's a lot of twins going on.
Did you, did
Sarah: is.
Emily: Did, did you know when they
booked the doctors, did you get
matched to that delivery based on
your expertise in, in high risk?
Is that how it works?
Sarah: Uh, so all obstetricians can, uh,
manage twin pregnancies particularly.
and with birth being cesarean
section, it's quite similar for
a birth, for two babies as one.
so I do do a high risk cesarean
list at the public hospital.
Emily: Mm-hmm.
Sarah: are put onto any list.
I did do some extra study.
I did a year in a team called
Maternal Fetal Medicine who manage
Emily: Mm-hmm.
Sarah: and twins.
Are all considered a more high risk,
but there are twins that are lower risk.
So having, what we call DCDA
twins and then, monochorionic or
MCDA twins can be higher risk.
And so sometimes having more intensive
scanning through that model of care.
But in terms of the birth itself,
most obstetricians in Australia would
be able to manage a twin pregnancy.
Emily: All right.
There you go.
so for today we've got a, an audience that
have clicked into this podcast episode.
They've seen it's with an obstetrician,
they're excited, potentially
they're expecting twins or.
They've just had them.
Who knows?
I'd love you to go through the key
areas that we're going to cover.
so the audience gets an idea of what
sort of insights we'll go through.
Sarah: Yeah, absolutely.
So I guess, we'll start with
running through the, the
overview of the three trimesters.
So what to expect in each trimester and
how it differs a little bit with twin
pregnancy compared to having one baby.
Emily: Mm-hmm.
Sarah: a little bit about.
Birth and the postnatal period and how an
obstetrician supports women through and
families through each of those trimesters.
Emily: Mm-hmm.
Sarah: other things that are really,
I think, are really important are
things like how a partner or support
person can help, uh, both antenatally
and in the, um, birth setting and
then some top tips to thriving in
pregnancy and delivery and postpartum.
Emily: Lovely.
So let's kick off with pregnancy.
do you want to explain what an
obstetrician gynecologist or
OB GY in, specifically does?
Sarah: So in Australia it's you train
in both obstetrics and gynecology.
obstetrics is all about pregnancy care,
looking after women from preconception
all the way through to birth.
So thinking about how medical
problems affect a pregnancy, how
pregnancy affects those medical
problems, and then providing care.
For all aspects of pregnancy.
whereas a gynecologist, focuses
more on women's health issues, so
things like endometriosis periods,
contraception, there's definitely a
lot of crossover, between the two.
And some people end up specializing
in more in one than the other
Emily: Mm-hmm.
Sarah: how an obstetrician
supports pregnancy.
we work alongside midwives,
Emily: Mm-hmm.
Sarah: both in pregnancy and
during birth to support women.
Through that time,
Emily: Mm-hmm.
Sarah: Blood tests, ultrasounds, and
then doing checkups throughout pregnancy.
So they start off less frequent.
And then as pregnancy progresses,
start to see women more often.
So, uh, anywhere from, uh, from, six
or eight weeks gestation, we might
see you, look at your dating scan,
go through all your bloods, and
Emily: Mm-hmm.
Sarah: women frequently through pregnancy,
arranging scans, talking about birth,
responding to any blood tests, et cetera.
the first is the first part of pregnancy.
Up until 12 weeks of pregnancy, an
obstetrician might see you at around
six or eight weeks of pregnancy for
a first visit, sometimes a bit later.
But getting a dating scan is
really important 'cause that's
when I'm gonna find out if there
is or more babies in there.
So it's
Emily: Mm-hmm.
Sarah: to get that early dating
scan, then an obstetrician
will go through all of your.
and make, start to make a bit of a
plan for pregnancy based on things
like your medical history, your age,
and how many babies you're having.
So in twins, thinking about
whether it's, what we call a die
chronic or mono, chronic pregnancy.
So that means whether the two
sacs, two placentas or the babies
are sharing a placenta and at that
stage would normally see, women
about every once every four weeks.
And that.
Increases in, frequency
throughout the pregnancy.
Emily: That's, a nice clear overview.
Let's go into the second trimester.
what sort of activities
do you work on there?
Sarah: Yeah, sure.
So in the second trimester, often we see,
women approximately every four weeks.
If you have a, monochorionic
pregnancy, we'll see you a bit
more often from 16 weeks onwards.
'cause we wanna get fortnightly
ultrasounds looking for some of
the complications that can occur
specifically from monochorionic twins.
that includes things like twin-twin
transfusion syndrome where, the
Emily: Mm-hmm.
Mm-hmm.
Sarah: risk for having what we call
aneuploidy or chromosomal problems.
So that might be through something called
an NIPT blood test, which can be done
from 10 weeks of pregnancy, in conjunction
with an early structural scan, looking at
things like the thickness of the back of
the baby's neck and making sure there's
any no, abnormalities such as abdominal
wall defects or those sorts of things.
And we know that they're slightly
more common in twin pregnancies
than in singleton pregnancies.
Emily: And so just to clarify M-C-D-C-D-A,
that that is identical and then DCDA.
Is fraternal.
That's the correct delineation, isn't it?
Sarah: DCDA twins can
actually be identical as well.
It all depends on when the embryo splits.
Most of DCDA twins, 80 to 90% of them are.
Two eggs, two sperm, two embryo,
Emily: Mm-hmm.
Sarah: number of them are
actually identical as well,
which is really interesting and
most people don't realize that.
and then, monochorionic twins,
have share a placenta, so, but
Emily: Mm.
Sarah: either have two sacks, so
they also share a sack as well,
Emily: Mm-hmm.
Sarah: mono amniotic amnio.
Amniotic mono, amniotic.
Sorry, I
Emily: Yeah.
You nailed it.
Sarah: it.
Not, um, twins.
and they have additional risks.
So
Emily: Mm-hmm.
Sarah: type of twins that we, we see
in terms of risk profile are twins
that have two placentas and two sacks.
So the DCDA twins.
Emily: Right.
So that was my type of twins, right?
Sarah: But your boys
aren't identical, are they?
Emily: No, no, no.
They're, definitely not, no.
they were both, I mean, bald
and fair when they were born.
But definitely, don't.
Look identical at the moment.
okay, Well that'll be really interesting.
And I've also heard of all
the different types of twins.
So mirror twins, where children, exactly.
Mirror each other when they're identical.
I don't know if you've heard of
that, but there's a whole host of,
categories as they understand it.
I don't know if you're
across all of that but
Sarah: mirror twins, but um,
Emily: Haven't you, it's on the, it's
deep in the twin chats and on some
of the articles and things like that.
So
Sarah: I'll
Emily: there's a few, um.
Sarah: dive.
Emily: You have to let me know as
I understand it, it's a thing, but
yeah, you probably, you might have to.
Check the, sources.
And is it common to
find issues with twins?
Is it a normal level of, you
might see some issues but then
some of them work themselves out?
Or is it uncommon?
Is there any more context you can provide
Sarah: sure.
Uh, so I think there's two
different risk profiles to consider.
So there's risks to mom with a
twin pregnancy that are increased
compared to having a single baby.
And then there's also risks
to the babies themselves.
So for moms, we know that.
Having more placenta, which obvious
obviously is the case with twin
pregnancies mean you're at increased
risk of things like preeclampsia,
which is a blood pressure problem in
pregnancy, which can be quite serious.
We know that twin moms are at increased
risk of gestational diabetes, so
would usually recommend an early
diabetes test, and as well as.
Higher risk of iron deficiency anemia.
So usually would start women on oral iron
earlier in pregnancy because two babies to
grow is double the amount of iron that's
going across the placenta and causing
increased risks of deficiency for mum.
Emily: Mm-hmm.
Sarah: And then we think
about the risks to the baby.
we know that half of all twins
are delivered early, 50% chance
of preterm birth, and that's.
Whether that's, going into labor
by yourself or having birth brought
on either by an induction or
cesarean section because of concerns
about the babies, we know there's
increased chance of ab abnormal,
anatomy or structures of the baby.
so that's why those scans
are really important.
And then the risks that we
briefly spoke about before.
One or both babies being
small, sharing the placenta and
having abnormal blood vessels.
So having twin, twin transfusion
syndrome or various forms of that.
as well as thinking about the increased
risk of stillbirth, for twin pregnancies
compared to singleton's, which is
why I, we'd recommend if all is
going well, that twins are delivered
a little bit before their due date.
so for.
mono twins usually around 36 to 37 weeks.
And for DCDA twins usually fall
is well around 37 to 38 weeks.
Emily: And is that, do you know if
that's a global standard as well?
That those timelines or delivery.
Sarah: Uh, good question.
I think, guidelines vary a little
bit from country to country.
The
Emily: Mm-hmm.
Sarah: Australian, medicine is
practiced is pretty similar to the uk.
in the uk, the Royal College of Obstetrics
and Gynecology, or the NICE guidelines,
which we often reference would be
similar, but I can't speak to other
countries around the world, unfortunately.
Emily: Okay.
So let's, jump into trimester
three and what your role is then.
And again, timing or any specific call
outs for, people having multiples.
Sarah: so the, we test again for
diabetes around 28 weeks of pregnancy,
Emily: Mm-hmm.
Sarah: to see women more frequently.
if you're having, Dichorionic twins,
we would see you fortnightly, from
28 weeks compared to four weekly.
Before that the Monochorionic twins,
we continue to see fortnightly as
long as all is well until 34 weeks.
And then from 34 weeks till
delivery, we see, women.
weekly, to check on how they're going.
And the really important thing about
trimester three is preparing for birth.
So talking about risks and benefits of
vaginal birth versus cesarean section.
some reasons why we might recommend
a cesarean section for women, for
their birth, depending on what's
happening with the growth of the
babies, the position of the babies.
And so for.
A vaginal delivery.
We really want twin one to be head down
and ideally the bigger twin if possible.
so we worry about things like if the
baby's, the twin one is breach, that
they can actually get stuck, to, coming,
coming down through, the vaginal canal
or of twin ones smaller, then we often
would recommend a cesarean section.
But both, Options are on the
cards for lots of women, and
it's about their choice as well.
So I would say more twins are born
by cesarean section, by a vaginal
Emily: Mm-hmm.
Sarah: lots of vaginal
births of twins still happen.
Emily: Okay.
Wonderful.
And with that, that conversation, are
there any different, ways of handling that
or how that would go for someone that's
perhaps at the public versus private?
Is there, do you know if there's
a distinguishable difference?
Sarah: similar, discussion for most
people publicly, verse privately,
in terms of what their options are.
The first thing I always start with is I.
Do you have a preference?
because
Emily: Yeah.
Sarah: some people with twin pregnancies
knowing the risks of vaginal birth
versus cesarean section, would
opt to have a cesarean section.
We know that, with.
Trying for a vaginal birth, that we
have about a 5% chance of needing
it to do a cesarean for twin two.
we know things like, postpartum
hemorrhage are more likely in twins.
so it's just about planning for whatever,
suits the whole, the patient and the
patient's story, uh, much better.
But as I said, sometimes we would
recommend a cesarean section.
Emily: Okay.
And I do think we're very lucky in
Australia as well in terms of the quality
of care, and especially, I mean, here in
Sydney at, at the hospital that you or
the hospitals you work between, they're
just so specialized and there's so much
wonderful information, around, what,
what the risks are and, and checking
the babies and checking the mum.
I think we're actually very lucky.
any particular, pieces of advice around
when you're looking for an obstetrician,
in terms of finding someone that's
a really good match for you, or do
you think that it's just a matter of
finding someone and partnering together?
Sarah: Yeah, good question.
I think there are so many
wonderful private obstetricians
out there that are all really
Emily: experienced.
Sarah: But I think if, when you're
having a twin pregnancy, it's
really important to ask are they
experienced with delivering twins?
and another important consideration to
think about is the hospitals that they,
can deliver babies in.
so at the public.
Hospital that I work at, we can deliver
babies from 23 weeks of pregnancy.
And obviously nobody wants or plans
to have a baby at 23 weeks, but
knowing that
some twins can come early is a
really important consideration.
Some private hospitals won't
have a nursery that has the
capacity to look after babies
younger than 36 weeks or 32 weeks.
So, a really important question that I
would be asking an obstetrician if I was
pregnant with twins is, where do you work?
What's the earliest gestation we
can have the twins at the private
hospital, and do you work at another
hospital that can facilitate that?
So when I've looked after twin
pregnancies privately, I like to book
them into the public hospital for
private care as well, just in case
those babies come before 32 weeks.
I'm lucky at the private
hospital I have worked at that.
Twins can be looked after if
they're well and well grown from
32 weeks of pregnancy onwards.
but unfortunately
not all private hospitals will
have their facilities to do so.
Emily: when we are talking about
people having twins early, do you want
to go into that a little bit more?
Because, my experience of that is I
was on a, a twin parent group and it
was off the richter , everyone was
kind of going at different times.
We had someone, I think 28 weeks was
the earliest and they went to NICU.
And when I think about the
audience listening to this, that
potentially hearing 28 weeks on,
they're maybe feeling some fear.
do you want to talk
about the process there
Sarah: so we know that the absolute
earliest that a baby can survive is
23 weeks of pregnancy, but obviously
they're super tiny, very fragile, and
have lots of potential complications,
including things like infections,
feeding issues, Every week that you
get further along, babies do better.
Once you get further along, the
lower chance of that can happen.
if you are risk of preterm
birth, or we're planning birth
before 34 weeks of pregnancy,
we would
give.
a dose or two doses of steroids
to a mum via an injection, to
help mature the baby's lungs.
And we know that steroids can
also help reduce the chance
of infections for babies.
Babies learn to suck at around 35
weeks of pregnancy for the most part.
So if they're born before that, they often
need a little feeding tube to help them
feed, so they're not able to breastfeed.
and so learning to suck is a skill,
just like learning to walk is a skill.
And we know that most babies walk,
somewhere between 12 and 15 months.
And so learning to suck happens for
most babies around that 35, 36 week
mark, babies might need help with
breathing, so they're sometimes on
special machines if they're born.
Before that.
it can be a really stressful road
for parents with babies in the NICU.
And most babies, if they do go
to the NICU, tend to stay there
untill around their due date.
but as you get further and
further along, babies don't
necessarily need to go to the NICU.
So at 37 weeks, a smaller number
need to go, to the nursery.
They can help if they're a good size.
So most nurseries are around 2.2
to 2.3
kilos.
Any baby less than that
needs to be admitted.
'because they can't manage
things like their temperature.
And so it's about, feeding
temperature regulation, breathing by
themselves, those sorts of things.
Emily: I have no idea if you remember,
but we were, we had one baby in NICU.
'because he was born not breathing.
So he was on a CPAP,
Sarah: Yeah,
Emily: for anyone listening, I believe
is blowing, fluid out of the lungs.
Is that correct?
It's like a mouth or nose attachment.
Sarah: a nose attachment to help, blow
air into the lungs to keep them open.
Emily: I'm realizing that I
didn't really know what it was.
and look, it was quite confronting.
'because I had had the babies and was
under medication for recovery and just was
a bit confused about what was happening.
But I will say that the
NICU is all wonderful.
they were just so great.
and we had some other twin
parents in there as well with us.
So we were kind of
Sarah: a special,
Emily: through.
Sarah: full of angels that work there.
The NICU nurses and
doctors are just amazing.
I actually, I saw a twin mom last
week and she said her babies were in
the NICU for about three weeks and
it's really tough leaving hospital
without your babies and then you're
back pumping, feeding the babies.
You spend lots of time there and
it's, really, really stressful.
then when she brought the babies home,
she said it was like being a new mom.
All over again.
'cause you're learning a whole new
set of skills and all of a sudden
there's not a monitor or a nurse that's
responding to their every whimper.
Emily: Yeah, definitely.
Well, we were lucky.
We had six days in hospital
and so I was still there, and
then I would be wheeled down.
Sarah: I am glad you weren't walking
that far after your cesarean.
Emily: Yeah.
No, no.
They were, those midwives
don't, they don't let you get
away with anything, do they?
They've seen it all before.
they even were asking what I
was doing in there, one of the
ladies said,, why are you here?
I'm like, my baby's here.
anyway, it is a wonderful place.
I think it's, it's good
to call that out as well.
In this day and age we're really lucky
that there has been, so many forward
movements because historically, it
was a lot harder if you're having
twins back in the 1900s, for example.
so that that's something else
to just note that, you know,
we're best set up as we can be.
So, with, pregnancy, any top tips?
You are a new mum as well.
Any tips around how to thrive?
I.
Sarah: So I think education
is really, really important.
going to birthing classes I found even
as an obstetrician, really beneficial.
So thinking about it from a different
point of view, thinking about it as
the woman who's pregnant compared to
looking after someone being pregnant.
And also my partner who's nonmedical,
he found it really helpful to have a
bit more of an insight into what happens
I think seeing a lactation consultant
when you're having twins before having
your babies is really important.
So you have a bit of an idea
about how to breastfeed.
You can express some colostrum beforehand.
As I said at the beginning, having
a village, single mum, single baby
two babies, first baby, fifth baby.
It can be a really isolating time
and having people around to help
you in that postnatal period is just
worth I found it so, so helpful.
for dads, I think it's all partners
that, Really, really important to
think about, you can do everything
but birth and breastfeed that baby.
I think mums take so much pressure
on themselves, and I certainly did.
I wanted to do everything and felt
relinquishing control was actually more
difficult than I thought it would be.
But that
baby is
50% theirs as well, so relinquishing
bathing, feeding as they get a bit bigger.
Having some time to yourself so they
can look after the baby for half an
hour and go for a walk or your hair blow
dried, or whatever it is you need to do
to make yourself feel a bit more human.
'cause it's, it's hard, it matter
how you have your babies, whether
it's vaginal birth or a cesarean
section, recovery and looking after
yourself is really important, and
I found looking after myself has
definitely made me a better mum.
Because I've got more
patience my own cup is full.
I also thought that,
educating myself would help.
So I tried to read,
every baby book out there
And there's so much conflicting advice
There's lots of right ways to do things.
It's not one way only, whether
you're breastfeeding on demand
or you're feeding via a strict
routine, whether breastfeeding,
bottle feeding, a combination of
the two, whatever works for you.
And I think it's just a bit of trial
and error accepting that, you know,
getting through the day is sometimes
the biggest achievement you'll do.
Emily: those are really good tips.
I would second all of those.
if you can't fill your cup,
it's very difficult to be able
to look after others as well.
And definitely with
partners, jump in there.
and if you can help with the feeding
part of the partners happy to express
or formula with twins as well.
especially because once you make
the call, the baby's probably
not going to, go to a bottle.
later if they're used to just mum and
then, you're really tired at that point,
so it's, you can't really tap out.
Sarah: Yeah our paediatrician said to us,
you know, get that bottle in with some
expressed milk or formula pretty early on.
And we went, oh yeah, yeah.
You know, and then we hadn't for a
month and then she, you know, I just
breastfeed 'cause that was the easiest.
then we tried to give her
the bottle and she refused.
And it was this whole ride of
trying to get the bottle back
in, which was really hard.
Emily: They're very picky babies.
Sarah: sure are.
Emily: they're very sassy for
that small, small little bodies.
Sarah: Yes.
Personalities come through
nice and early, don't they?
Emily: Oh mine had
personalities in the stomach.
Honestly.
One of them was, I'll tell
you a quick, because this, I
think this is quite comical.
One of them was kicking, and I
thought it was the one on one side,
not the other one, but it turned out
Charlemagne was, his feet was over his
brother, and that his brother was like
this with his legs in like a crab.
And so he was kicking and he literally
came out kicking, and when he used
to stand, he'd kick his feet and his
brother would still lie like this.
So it's.
Sarah: A couple of years on, is he
still the more, boisterous brother,
or have they, has his twin brother
Or has his twin brother
caught up to him a bit?
Emily: he's, he's still got the same
active, outgoing personality, but he is,
and his brother's definitely more sleepy.
I think that was like the kind of
predominant thing, but yeah, it's, it is
very strong, so it's quite interesting.
Sarah: find that so interesting,
the whole idea of genetics As
I said, I've got a twin brother
Emily: Mm-hmm.
Sarah: and we're not identical.
but we grew up in the same household
and we are just so different.
It's just funny.
I look at him sometimes
and it's just amazing.
he's kind of just cruises through life.
Really happy-go- lucky and definitely
doesn't have the same OCD tendencies,
and, drive that I have to get
life sorted in a different way.
really
Emily: Yeah, it is funny, isn't it?
I, I feel like, you get your
mix with, your family's genes.
You don't know what kind of mix between
your parents and then the throwbacks.
but it, there's definitely a
personality like I can see in my
twins who's more one and who's more
the other, or like a throwback or.
in the middle of the spectrum.
And then myself, my twin sister as well.
Like who, who's got the personality.
Yeah, it's, it's a thing.
which is like a science
experiment when you've got twins.
okay, let's jump into delivery.
we've covered off a bit of this, but if we
were to talk about private versus public
delivery, any additional call outs, who's
in the delivery room, and then again,
just about the, the OB and, and the role.
Sarah: Yeah, so just quickly going back to
public versus private, important thing to
consider free, public is obviously free.
if you've got Medicare in Australia,
usually have a big team of people
looking after you, but you might
not see the same face, regularly.
Where I work, we have a specialized twins
clinic, which is overseen by a consultant
obstetrician, but every clinic there's
new junior doctors coming through.
We usually have a midwife that's
fairly consistent, but it might
not be that team on the day.
the consultant that runs the Twins Clinic,
is on birthing unit once a fortnight.
if you are planning an induction of
labor or you're going into spontaneous
labor, the chances of it being someone
that you know aren't as high certainly
does happen compared to private,
where it can be quite expensive.
private health insurance will cover some
of it, but usually have out of pocket
costs of several thousand dollars.
but you do have continuity of care,
so you usually have one obstetrician
or a small group of obstetricians
who are looking after you.
You usually meet them all
through the pregnancy.
And so, you have a fairly good
understanding by having had that same
person for your whole pregnancy looking
after you and I already mentioned the
difference about the, different NICU
units in private hospitals as well.
in terms of the birth, whether it's
public or private, there's definitely
a cast of thousands in the birth
for, twins, and that's whether it's a
vaginal birth or cesarean section, we
might touch on vaginal birth first.
So,
you would normally have one
midwife looking after you.
When it comes time, you're fully
dilated, gonna start pushing.
the obstetrician would be in the room and
usually that's a consultant obstetrician
with one or two junior doctors.
Then you have two full pediatric
teams so if it's very early,
that pediatric team is.
Very large and, to term you might
have doctors or one doctor and
a nurse, just depending on the
sit, the clinical situation.
In terms of things we like for
vaginal births, we recommend that
women have an epidural because of the
risks to second twin particularly.
So even if they're both head down at
the start of labor, the second twin can
turn, and be sideways or bottom down.
And we need to try and sometimes
manipulate the baby into.
favorable position for birth, sometimes
the second twin is delivered breach.
and as I mentioned earlier about the risk
of needing a cesarean section because
of fetal distress for the second twin.
Sometimes you birth one baby and
the uterus kind of thinks it's all
done and has a little bit of a rest.
So we usually start the hormone drip,
to re encourage that uterus to keep
contracting to birth the second baby.
and we know that there are increased
risks such as postpartum hemorrhage, so
We'd recommend a drip in the arm, and
would usually give them an infusion of
a hormone called syntocinon, which is
synthetic or manmade oxytocin, which
is what your body, produces to labor.
to reduce the risk of
postpartum hemorrhage.
along the birthing process, you are
likely to meet an anesthetic doctor
as well, who would be the doctor
that puts in the epidural, And we'd
recommend continuous monitoring,
so heart rate trace monitoring.
Both babies during labor because of
the risks of, babies becoming stressed,
developing something called fetal
distress, which is an abnormal heart
rate pattern in labor then thinking
about a cesarean section, there's even
more people at a cesarean section.
we have one or two anesthetic
doctors, an anesthetic nurse,
obstetrician, a second doctor who's
the assistant for the cesarean section.
at least two nurses who are helping
the surgical side of things.
And then the paediatric
teams, plus or minus, uh.
Theater assistant or an orderly who's
helping with positioning on the bed or,
running to get extra equipment, et cetera.
that can be really overwhelming,
But the, the main thing is you are
focusing on the birth and just kind
of don't worry about everyone else.
They're there.
Just do a job to make sure you
are safe and your babies are safe.
Emily: Yeah, and I think
that's really good.
I, I must admit, they'd talked about there
being a bunch of people for the pregnancy,
and I was confused as to what that meant.
But the great thing is they're all there.
I.
Because they are helping you.
And then the reason why there's so
many is because if you're having
twins, they've got focused people,
which is exactly what you want.
Sarah: Yeah, I guess through, The third
trimester, if you've privately booked with
an obstetrician, you'd be touching base
with them regularly at your appointments,
and then we might get called out if you're
worried about things like bleeding or
fluid leaking, you think you're in labor,
worried about baby's movements, et cetera.
And then at the time of birth, so an
obstetrician performs the cesarean section
if that's how your babies are born or
is there for birth Sometimes we need
to do instrumental births to help if.
been a prolonged process or if the babies
are stressed in that pushing process.
so an instrumental means a vacuum or a
forceps birth choosing which instrument
really depends on lots of factors.
so we're gonna pick the one that
we think is gonna help, facilitate.
Birth most effectively.
Emily: Amazing.
I mean, OBs are magicians in, in
my mind, just being able to do all
these things and knowing what to do.
I mean, obviously there's
a lot of training, but,
Sarah: and I always say medicine,
but particular obstetrics
is a mix of art and science.
So experience accounts for so much.
it's a really special time.
That's a real privilege to be part of it.
Emily: Yeah, I imagine it's, I mean, would
be, is it exciting when you're a doctor
to be having twins instead of a one baby?
Is that, is that a thing or am I
Sarah: look, some, I would say that some
non obstetricians are just terrified
of the prospect of birth, at all.
Emily: mm-hmm.
Sarah: obstetricians, I guess
we're worrying about the risks
and how best to manage them.
So it's not like, oh, yay, there
are two babies instead of one.
It's like, okay, let's think of making
sure we've got, you know, all the boxes
ticked for preparation for, to try
and reduce the risk of complications.
But it is nice.
It's super special to deliver a ba to
be, be there for a birth of one baby.
but two, I've delivered triplets
a few times as well, but, yeah,
so it's a really special thing.
Emily: okay.
any additional callouts on,
thriving anything else to add.
Sarah: I think it's really important
to think about what's important
to you for birth generally.
try not to be so concrete about an
absolute plan for things, because
unfortunately, birth doesn't
always go according to plan.
having an open mind asking the
right questions, but going with
the flow and, we're all there
to keep mums healthy and keep.
Baby's healthy, and that's the overall
most important thing to consider.
if you are aiming for a vaginal birth,
having a support person who's there
to support and isn't going to sit on
their laptop in the corner, and they're
totally on your side, whether that's.
holding the shower head over you
back massages, cold compresses
for your forehead, lots of snacks,
keeping you hydrated, whatever it is.
Making sure you are really clear
with them about what their role is.
And that's why I think getting your
support person along to birthing
classes, together and prepping for
birth together is really important.
I think just being excited about,
the baby and becoming parents.
It's really, is a really big part of the
process, pregnancy is nine months, birth
is one day, and parenting is a lifetime.
really trying to.
open-minded and not feel too disappointed
if you don't have the birth that
you envisaged is really important.
I think it's really important, having
healthy babies is what we are here
for, and whether that's via cesarean
section or vaginal birth doesn't
ultimately matter in the long run.
Emily: say you're really,
you want vaginal only?
I know that no, medication, et cetera.
would you say it might be beneficial
for first time parents especially,
or maybe even anyone having a second
birth, if they've had a very seamless
one the first time to perhaps get
educated on all potential outcomes as
well as their support personal partner?
So when they land there,
there's less shock,
Sarah: Yeah, I think, educating and
being aware of what the possible outcomes
will be, knowing that lot more than half
of twins are born by cesarean section.
think if you want to have birth,
for example, aiming to not
have an epidural, have those
discussions early, have them often.
Continuity can be really important in that
setting so that everyone's on the same
page for you on the day of your birth.
and, finding people that are
going to help support you, as
much as possible around safety.
in, in pregnancy and birth.
Emily: Okay, great.
And one, thing to add as well.
So with the partners,
in the delivery room.
is there anything partners should know
or support people if they're in the
room with you for example, say they
want to go and if there's a C-section,
they want to go and have a look or this
delivery, they want to have a look.
Any, any tips that you
want to share for D-Day?
Sarah: Yeah.
Uh, I always say partners, don't be brave.
If you are feeling queasy, the look of,
an epidural or you don't like the sight
of blood, be open and honest about that.
I have caught a six foot four man
who's just about to hit the floor.
We've had to send dads to emergency
department with cracked heads.
just sit on the floor if you're
not feeling up to it, it is.
is blood.
It's, it's a pretty intense
period, of time, and I think
just focusing on supporting mom
to have, have a, a beautiful
birth is what's really important.
So yeah,
Don't be brave.
Emily: Great advice.
My partner was told that
no one would catch him.
He was six four.
He was told distinctly.
He is like, if you get up
and have a look and you fall.
We are busy, we won't catch you.
So, don't do it and he said he had,
he did have a look of course, and
then he literally did feel his head
spinning, so luckily he didn't.
Sarah: usually can't see too much.
everyone's really worried they're
gonna see everything at the time of a
Emily: Yeah.
Sarah: but there's a belly and a, a, drape
and you can really only see the baby.
So, yeah.
Emily: Okay.
Sarah: it's, it does happen.
Emily: Yeah, I, I bet it does.
'cause I think people don't
quite know what they're in for.
Sarah: Yeah,
Emily: okay, let's, go to postpartum.
what does OB do for postpartum?
Any tips for thriving
Sarah: depending on how many weeks you
were, when your babies were born and what
type of birth you have, you might stay in
a hospital from six hours to five days.
It really depends on what's,
what's happened around birth.
any complications that
might have occurred.
women that have had a cesarean section
might stay in a little bit longer.
taking regular pain relief,
it's really important.
It's safe in breastfeeding, trying to keep
your pain after having major abdominal
surgery at bay is really important.
so that you can best look after yourself
and subsequently look after your babies.
Think breastfeeding support,
particularly for twins.
no such thing as a stupid question.
Just ask, ask and ask again,
Knowing there's lots
of right ways to do it.
you might get.
Conflicting advice sometimes, or you
might, get told slightly different
variations which can be really hard
when you are in pain with twins.
Newborn period.
Kind of the
Emily: Mm.
Sarah: it all settling or the realities
of two babies all settling in.
but, take it all with a grain of
salt and you'll figure out what's
gonna work for you and your babies.
I always say that, it's great to
breastfeed, but a fed baby or fed
babies are happy babies and happy moms.
So, however that happens, is probably
the most important thing in terms
of recovery afterwards, just general
advice I say to families, whether
they're having one baby or two.
Just take it slow when you get home.
Don't let the cast of thousands
that are excited to see you and meet
your babies, come over immediately.
Allow yourself that time to recover.
And like I was saying earlier
about having a full cup, take
the time to look after yourself.
in terms of what an obstetrician does
postpartum, checking in, checking
the, stitches, the wound, your blood
loss, making sure it's reducing
daily, talking about contraception.
Important for everyone, but
even more important in twins.
we never know when you ovulate until
you get your first period, and that
can happen pretty soon after birth if
you're not exclusively breastfeeding.
so good contraception's
really, really important.
we'd see women at a six week checkup,
but often patients might touch base if
they're having any concerns, any earlier.
and then thinking about
other things generally.
So if you are needing any other
vaccinations that you couldn't have
in pregnancy, like rubella, getting
that organized, an anti-D injection
It's still a really, really busy time,
I think that whole idea of bouncing
back quickly, it takes time, you know?
Emily: Yeah.
Sarah: and I think having
allied health like your pelvic
floor and seeing physios really
Emily: Mm-hmm.
Sarah: and getting a sort of graded
return to exercise, is super important.
so around six weeks.
but that doesn't mean you go straight
back into whatever you might've
been doing pre-pregnancy, not
going off to intense HIIT classes.
really retraining that
pelvic floor is so important.
So, you know, postnatal pull,
specialized postnatal Pilates programs
or, there are lots of really good
online programs as well for busy mums.
But getting back exercise
in a, in a graded way rather
than straight back into it.
Emily: Yeah, I would agree with that.
Be gentle and just enjoy the time.
Right.
It's so beautiful
Sarah: It's
Emily: first time.
Like it's a lot, but it's so nice and they
smell, the baby smell is so beautiful.
And I guess that's nature.
Trying to make us really love them extra.
Sarah: Yeah,
Emily: Any other pointers for partners?
Sarah: I think ask the question
like, what do you need?
everyone's going to want
something different.
know, I actually quite like cooking, so
I actually enjoyed my partner looking
after our daughter, so I could just
potter her in the kitchen for 20 minutes.
But if you hate cooking, be like.
Cook me dinner every night, get,
dinners delivered, whatever it is
allowing you that chance to rest and
recover, is really, really important.
I think I.
Dads can be a bit forgotten in the
whole pregnancy postnatal period.
You know, some dads come to every single
antenatal visit and others you might
meet once or twice through a pregnancy.
So that time off work for them, for
example, to come to appointments, is
not seen in the same light, as you
turning up to your own appointment.
So having that conversation about what.
you want from each other in
that time is really important.
Emily: Perfect and partners
can potentially dial in
as well to those calls.
I don't know if there's any rules against
that, but if they need to, and then that
way they're hearing it from the source.
Sarah: Yeah.
Yeah, definitely always happy
to have a partner call in.
Emily: Well look, we are just
about wrapped up, any final
pointers, we haven't covered off
Sarah: everyone should see a
pelvic floor physio in pregnancy.
I think like they're just
worth their weight in gold.
I think there's no such
thing as a stupid question.
So if you're worried about
something, have the conversation.
there's so many support
services out there.
multiple pregnancy associations, hospitals
with midwife support, Facebook, whatever
it is that you need, reach out and
access that help and those services.
like I said, everyone needs that village,
Emily: Great advice and you're so
learned now being on both sides.
Well, Sarah, thank you so
much for joining today.
We've gone through obviously
what an obstetrician does.
your top tips, the,
pregnancy phase by trimester.
We've also talked about delivery and
postpartum, and then partner support.
So I think there should be
plenty of gems for new parents.
And I've got some friends
expecting ID twins, so I'm
sure they'll love this episode.
But, loved having you on.
Thanks for making the time
Sarah: No problem.
Bye