Twin home birth: Outcomes of 100 sets of twins in the care of a single practitioner

Abstract

Abstract Background:Research on outcomes of community (home or birth center) twin birth is scarce. This study evaluates the outcomes of twin pregnancies entering care with a single practitioner in a community setting. Methods: This is a retrospective observational cohort study of 100 consecutive twin pregnancies planning community births during 12 years with a single obstetrician. Outcomes measured included mode of delivery; birth weights; Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; delivery interval; blood loss; chorionicity; weight concordance; and other maternal or neonatal morbidity. Results: Of the 100 twin pregnancies who entered into care, 31 (31%) transferred to a hospital-based clinician prior to labor. The remaining 69 sets of twins were still in the obstetrician’s care at the onset of labor. Of those 69 pregnancies, 79.7% (n=55) were di-amniotic-di-chorionic and 21.3% (n=14) were mono-di. The vaginal delivery rate was 91.3% (n=63) including 16/21 primips/TOLACs (76.2%) and 47/48 multips (97.9%); 6 mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal delivery did not vary significantly by chorionicity; 91.4% (53/58) of di-di and 90.9% (10/11) of mono-di twins gave birth vaginally. There were 8 transports in labor (11.6%) with 2 birthing vaginally and 6 via cesarean. Average gestational age was 39.0 weeks (range 35-42). Compared to primiparas, multiparas had less perineal trauma and higher rates of community, vaginal, and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment. Conclusions: A community birth leads to high rates of vaginal birth and good outcomes for both mothers and babies in properly selected twin pregnancies. Community twin birth with midwifery style care under specific protocol guidelines and with a skilled practitioner may be a reasonable choice for women wishing to avoid a cesarean section—especially when there is no option of a hospital vaginal birth. However, this study is underpowered to calculate uncommon adverse neonatal outcomes. Training of future practitioners in vaginal twin and breech birth skills remains an imperative.