Ask The Labor Nurse: The Truth About Twins

Why I love Call the Midwife.


I'm always the last in line when it comes to television, but I've finally gotten caught up on Call the Midwife, the PBS series about midwifes and nuns in a gritty neighborhood in London in the 1950s. Usually, when it comes to TV or movies with birth scenes in them, my family won't watch with me because apparently (I don't think I really do this, but they say I do) I criticize the inaccuracies of the scenes. Apparently (again...I don't think this is true), I pick apart every contraction, nurse and push and rant about how, "that's not how it goes in real life." I'm just saying...I don't think I'm that annoying, but my family disagrees. Whatever...

There are no inaccuracies to rant about in this show though (which is why my clan sat through all of the back episodes on Netflix with me). I'd say PBS got it spot on. The situation in the first season's episode six would have made me crap my scrubs if I'd been the nurse.

It's the one where the character named Chummy delivers the surprise triplets to a single woman in a dark room with no lights, water or delivery supplies. In a nice turn of events, my husband turned to me and said, "Really? Would that happen in real life?" Yes! Back in the '50s that could have totally happen. There were plenty of surprise twins and triplets because they didn't have ultrasounds. It still happens in some parts of the world where women don't get prenatal care. What is remarkable about that birth is not just that Chummy delivered them all vaginally, but that it went so incredibly smoothly and all the babies survived. Supposedly they were premature, but no matter—they cried and breathed and didn't show the least bit of concern that they were born in a slum with not so much as a diaper or a blanket.

Nowadays, hardly anyone has surprise twins, much less triplets. Women today have ultrasounds early and often. Plus, as soon as that extra heartbeat shows up, that pregnancy is ramped up to a high-risk category. I'm not sure I agree that every twin pregnancy is high risk (in fact, most are completely normal) and, up until recent years, twin pregnancies weren't considered such a big medical deal. Most twins were born vaginally, and mother and babies were all quite healthy.

Read more: Facts about twin pregnancies you might not know.

The official word now from the American College on Obstetrics and Gynecologists is that vaginal deliveries are fine if the twins are in the right position. In many hospitals though, most twins are born by C-section. Some of that is because younger doctors are not trained in medical school on how to deliver twins vaginally. Many are trained that C-sections are the better option and they don't feel confident in their skills. Older doctors trained before the big C-section era know what to do and aren't as freaked out.

That all-C-section trend might be waning just a bit though as more doctors and hospitals are willing to give vaginal birth a go. Studies show (and so does history) that vaginal birth for twins can be a very safe option as long as the twin closest to the cervix is head down (vertex position). These studies also show that a pre-planned C-section birth isn't necessarily a safer option, and in fact they don't support policies of planned C-sections for twins at or after 34 weeks. It all depends on babies' positions and mom's health.

What else is different about twin pregnancies? Women pregnant with twins are at somewhat higher risk for such complications as hypertension, gestational diabetes, preeclampsia, placental issues and premature labor and delivery. If mom gets prenatal care and sees a midwife or doctor regularly, those complications will most likely be caught early. It's when women don't get prenatal care that they tend to get into trouble.

Read more: How safe is a vaginal birth for twins?

If you're ready to compare and contrast twin birth scenes, check out this blog on the Every Mother Counts website last week about an American midwife in Tanzania. It's graphic and a bit gruesome, but a really great read. Once you've finished, you'll be more grateful than ever for your midwife or doctor, your hospital and nurses and the supportive team who will surround you at the moment of birth.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.