Delivery for intrauterine growth restriction of one fetus in a twin pregnancy at Genesis Dnepr, Dnipro.

Labor when one twin has growth restriction — this refers to the management of labor in a multiple pregnancy when one fetus is lagging in development and requires closer monitoring. This may be relevant for women with twins in whom ultrasound and Doppler studies have shown signs of growth restriction in one baby. It is important to discuss in advance with your physician and obstetrician the monitoring plan, the frequency of examinations, the possible mode of delivery, and preparations for emergency measures for the newborns. The question of pain relief should also be agreed on beforehand if necessary. Decisions are made individually and may change during labor in the interest of the safety of the mother and the babies.

What this delivery approach means

Delivery in the setting of growth restriction of one fetus in a twin pregnancy involves management of a multiple pregnancy with intensified monitoring of both fetuses and the mother. This means the delivery plan is formed based on growth dynamics, Doppler studies, and the overall condition of the mother and fetuses. Important issues — timing of delivery, possible mode of delivery, and preparation of neonatal care — are discussed in advance. The plan remains flexible and may change in the interest of safety.

Intensive monitoring: frequent ultrasounds and Doppler assessments to evaluate the condition of the growth‑restricted fetus
Decisions about the timing and mode of delivery are made based on clinical data
There may be a need for preterm delivery and preparation for neonatal care
Discuss analgesia and the birth plan with your doctor/obstetrician in advance
Limitations of this approach: choices are based on clinical indications, not personal preference

Before meeting with the team, gather the results of recent examinations and a list of questions — this will help you make a more informed decision.

Who this delivery format may be suitable for

This delivery approach is discussed when growth restriction is detected in one fetus of a twin pregnancy and involves more careful planning. It may be appropriate when it is necessary to decide in advance on the frequency of monitoring, timing, and possible mode of delivery. It is important to discuss the examination results, your expectations, and pain-relief options with your doctor and midwife/obstetrician.

A woman who wants to discuss the labor scenario and monitoring plan in advance
A partner who plans to be present and provide support during labor
A need to discuss pain-relief options with an anesthesiologist beforehand
A twin pregnancy in which one fetus shows slowed growth
A desire to remain active during labor if medically permitted
Previous birth experience that the parents want to take into account when planning
A need for a calm and clear delivery plan with the possibility of adjustment

The final decision is made by the doctor and midwife/obstetrician based on examinations and the condition of the mother and fetuses. The plan may be adjusted at any time in the interest of safety.

When this approach may be limited or changed

It is not always possible to stick to the original birth plan, especially if the situation changes during labor. If one twin shows growth restriction, the decision about the mode of delivery may be adjusted in favor of a safer option. The doctor and midwife will explain the reasons for any changes and offer appropriate alternatives.

Obstetric complications requiring immediate action, such as heavy bleeding
Signs of fetal distress on cardiotocography or Doppler studies
The need for urgent intervention, including operative delivery (cesarean section)
Contraindications to the chosen method of pain relief for a particular patient
Infectious or organizational restrictions on the partner’s presence during labor
Severe or unstable maternal condition when the priority is her safety
Ambiguous or conflicting test results requiring reconsideration of the plan

Such changes are a normal part of clinical decision‑making in the interests of the mother and baby. It is best to discuss questions and possible options in advance with the labor and delivery team.

Who and how decides on the mode of delivery

The decision on the mode of delivery is made jointly by the pregnant woman and the medical team. The pregnant woman can state her preferences and previous experience, and the doctors assess the examination data and the condition of the fetuses.

If one twin shows growth restriction, additional tests and specialists are more often involved in the discussion.

The plan is agreed on in advance but may change during labor for safety reasons.

The pregnant woman states her preferences, previous experience, and expectations for delivery
The obstetrician and midwife assess the pregnancy, test results, ultrasound, and condition of the fetuses
Additional data: Doppler studies, cardiotocography (CTG), and fetal growth dynamics
The anesthesiologist discusses pain relief options and possible contraindications
The neonatologist is involved if there is a risk of preterm birth or if the newborn may need assistance
The joint decision is based on examination findings and the safety of the mother and babies

Ask questions and bring the latest test results to the discussion of the birth plan. The final decision will be explained and adjusted as necessary during delivery.

What to discuss with your doctor in advance

Before the consultation, make a list of key questions so you can get a clear plan of action. When preparing for delivery with growth restriction of one twin, it is especially important to clarify monitoring and possible scenarios. Below are questions that will help you prepare for the discussion with the maternity team.

What type of delivery do you recommend and what are the reasons for that choice?
Can my partner be present, and under what conditions is this possible?
Which pain-relief options have been considered, and do I have any contraindications?
Are there any special considerations related to previous births or a prior cesarean section?
Which chronic conditions or medications in my medical history are important to take into account?
Can I bring and review the results of recent ultrasounds and tests?
What is the plan of action if the condition of the fetus or the mother worsens?
What should I bring to the maternity hospital and which documents should I prepare?
When is it best to come to the clinic at the first signs of labor?
What are the postnatal stay conditions and the availability of neonatal care?

Write down the answers and bring your medical records to the appointment — this will make the discussion easier. If anything remains unclear, ask additional questions during the consultation.

How preparation for delivery is carried out in the case of one twin's growth restriction

When preparing for delivery with growth restriction of one fetus in a twin pregnancy, the team develops a plan based on the latest examinations and the clinical picture. Preparation is a series of practical steps: verifying data, agreeing on monitoring, discussing possible scenarios and organizational details.

The main point is to be ready for different options while keeping the safety of the mother and babies the priority.

Consultation with an obstetrician‑gynecologist to assess the condition and agree on the plan
Review of the maternity record and current ultrasound and Doppler results
Scheduled follow‑up examinations to monitor the fetuses' growth dynamics
Discussion of possible modes of delivery and the criteria for changing them
Consultation with an anesthesiologist if a choice of analgesia/anesthesia method is needed
Partner preparation: rules for presence and practical recommendations for support
Gathering documents and a minimal set of items for the stay in the maternity hospital
Discussion of the emergency action plan and contact details for the labor ward

The plan will be updated as new information becomes available and during labor if necessary. Feel free to bring your test results and ask questions at the appointment.

How labor proceeds in this situation

Labor when one twin has growth restriction is managed with increased attention to the condition of both fetuses and the mother. Usually it follows a sequence of clear steps: admission, assessment, continuous monitoring and readiness to change the plan if necessary. Below is a typical course of events, which may vary depending on findings.

Admission to the maternity unit with contractions or at a previously agreed scheduled time
Initial examination by the obstetrician and midwife to assess the mother and fetuses
Connection to fetal heart monitoring (CTG) and periodic assessment of uterine contractions
Ongoing observation of contractions and cervical dilation by the medical team
Monitoring the condition of the growth‑restricted fetus with ultrasound and Doppler as needed
Discussion of and initiation of pain relief in consultation with the anesthesiologist, if required
Support in the delivery room: presence of the team and, if permitted, a partner for support
The pushing stage under monitoring and coordinated action by the doctors and midwife
Birth of the first, then the second baby, initial neonatal assessment and care
The first hours after delivery — observation of the mother and newborns, and planning for further follow‑up

The birth plan will be refined as new information becomes available and during labor. The team will explain any changes and offer safe options.

Pain relief in labor with growth restriction of one twin

Options for pain relief are discussed in advance with the anesthesiologist and the obstetric team, based on the current condition of the mother and fetuses. Decisions take into account investigation results, possible contraindications, and the likelihood of changes to the birth plan. The decision is made jointly and may be adjusted during labor in the interest of safety. Complete absence of pain cannot be guaranteed, but the team will select the most appropriate method.

Discuss pain-relief options in advance at a scheduled consultation with the anesthesiologist
Epidural analgesia may be considered if there are no clinical contraindications
Joint selection of the method by the patient, the anesthesiologist, and the obstetric/maternity team
The decision can be changed during labor depending on the situation
Limitations apply in cases of infection, coagulation disorders, or other contraindications
The condition of the growth-restricted fetus is taken into account when choosing and monitoring analgesia
A plan is in place for emergencies, including rapid conversion to another type of anesthesia

Discuss your expectations and fears at the appointment — the anesthesiologist will explain available options and risks. During labor the team will inform you of any changes and the reasons for choosing a particular method.

Safety and monitoring during labor in this situation

During labor, when one twin is lagging in growth, the team pays increased attention to monitoring and timely response. Surveillance includes assessment of the mother and both fetuses, regular evaluation of progression, and readiness to change the plan if needed. This is common clinical practice — the goal is to protect the safety of the mother and babies.

Observation by the obstetrician and the midwife
Assessment of the fetuses' heart rates; cardiotocography (CTG) if needed
Monitoring labor progress: contraction frequency and cervical dilation
Regular assessment of the growth-restricted twin with Doppler and ultrasound as indicated
Rapid access to a neonatologist and equipment for neonatal support/resuscitation
Readiness to change the delivery plan if the condition of the mother or fetuses worsens
Monitoring maternal symptoms and adjusting analgesia as necessary

Monitoring is a routine part of labor management and does not necessarily mean there is a problem. If you have further questions, discuss the details of monitoring and possible scenarios with your care team in advance.

What happens if labor doesn't go as planned

A birth plan is a guideline that may change as the clinical situation evolves. If one twin shows growth restriction, the team is prepared to promptly adjust management for the safety of the mother and babies. Any change will be explained and agreed upon where possible; if necessary, it will be carried out quickly and in a coordinated way.

Ask the partner to temporarily leave the delivery room in case of infectious or organizational restrictions
Switch from spontaneous labor to augmentation of contractions if labor is slowing down
Decide on emergency cesarean section if there is a threat to the fetuses or the mother
Forego epidural anesthesia if there are contraindications or technical obstacles
Change from an upright position to the traditional (supine) position if more controlled maneuvers are required
Abandon a minimal-intervention approach if there are signs of risk to the baby or the mother
Call in a neonatologist and the operating team for rapid newborn assistance
Keep the patient informed about the reasons for changes and offer alternative safe options

Changing the plan is not a failure but a normal part of clinical decision-making for safety.

Ask questions at any time — the team will explain the reasons and next steps.

Possible risks and limitations

Any chosen mode of delivery has its limitations — this is a normal part of clinical decision-making. In deliveries when one fetus in a twin pregnancy has growth restriction, it is important to understand in advance which factors may affect the plan. The doctor and midwife will discuss possible scenarios and the criteria for changing management.

Limitations of the delivery mode depending on the condition of the mother and the fetuses
The need for urgent operative intervention if the condition of the mother or the fetuses deteriorates
Switching from spontaneous labor to induction/augmentation of labor or cesarean section if indicated
Limitations in the use of certain pain-relief or anesthesia methods when contraindicated
Risk of needing additional neonatal support and monitoring of the newborns
Limited ability to predict outcomes based on others’ birth experiences
Influence of pregnancy complications and chronic diseases on the choice of delivery mode

These limitations are taken into account when planning delivery individually. The doctor and midwife will explain possible changes in management and their rationale.

What happens immediately after birth

Immediately after birth, the team assesses the condition of the mother and the newborn and arranges initial contact and monitoring. In deliveries where one twin had growth restriction, attention to examinations and neonatal care is especially important.

In the first hours it is possible to determine the baby’s primary needs and adjust the care plan if necessary.

Initial skin-to-skin contact between mother and baby, if their conditions allow
CTG (cardiotocography) monitoring and a mandatory newborn examination by a neonatologist
Monitoring for bleeding and the mother’s overall condition by the physician and obstetrician
Assistance with the first latch and support for breastfeeding if the mother wishes
Arranging additional care for the newborn if needed (involving a neonatologist)
Transfer of the mother and baby to the postpartum ward or observation unit
Observation during the first hours with regular checks and answers to questions

The team will explain in detail all steps and the reasons for necessary actions in the first hours after birth. If anything causes concern, don’t hesitate to ask — you will be given clear answers.

Role of the physician and the team in managing labor

Labor is managed by a coordinated team in which each specialist has specific tasks and areas of responsibility. The physician assesses risks and makes clinical decisions, while the other team members provide monitoring, support and prompt execution of orders.

When one twin has growth restriction, coordinated work is especially important for rapid response to changes. The patient is informed about what is happening and questions are answered as needed.

Obstetrician-gynecologist — assesses risks and decides on the mode of delivery
Obstetrician — manages the labor process, monitors contractions and the mother’s condition in the delivery room
Anesthesiologist — discusses pain relief options, assesses contraindications and performs procedures
Neonatologist — examines the newborn and organizes neonatal care if necessary
Operating room/surgical team — prepares the room and performs emergency cesarean section when indicated
Nurses — monitor vital signs and assist with care coordination
Communication with the patient — explaining what is happening and agreeing on any changes to the plan
Coordination of team actions — rapid change of approach in response to changes in the mother’s or fetuses’ condition

The team works together to prioritize the safety of the mother and children and to make the process understandable. If anything remains unclear, ask — you will be given a detailed explanation of the next steps.

How this format benefits the patient

This delivery format provides a more predictable structure and clear monitoring criteria, which reduces uncertainty during the waiting period.

If growth restriction is detected in one fetus of a twin pregnancy, the plan is usually discussed in advance to agree on priorities and team roles.

This helps the woman understand what to expect and what decisions may be needed during labor. Discussing details beforehand makes the process calmer and more manageable.

A clear, pre-discussed plan for labor management
The opportunity to discuss personal preferences with the team
Fewer surprises due to regular fetal monitoring
The option to choose and arrange for a specific doctor to be present at delivery
Availability of pain relief options, subject to medical clearance
Comfortable accommodations and standard staff support
Continuous monitoring of the mother and both newborns
The team's readiness to quickly implement alternative plans if necessary

Discuss all points in advance with your doctor and midwife to feel more confident. The plan can still be adjusted in the interest of the safety of the mother and the babies.

How a pre-delivery consultation works

A pre-delivery consultation is a structured review of the situation and possible scenarios. At the appointment, the doctor and midwife examine your history, maternity record (exchange card) and current investigations. If one twin shows growth restriction, they discuss monitoring frequency and the criteria for changing the plan. One visit may not resolve all questions; sometimes additional assessment is needed.

Medical history taking: previous deliveries, chronic conditions, current medications and complications
Review of the maternity record (exchange card) and previous test and investigation results
Review of recent ultrasounds, Doppler studies and tests to assess fetal growth dynamics
Discussion of your preferences regarding the mode of delivery and partner presence
Explanation of possible limitations and the criteria for changing the delivery plan
Referral to an anesthesiologist or neonatologist when necessary or indicated
Agreement on an action plan, hospitalization criteria and signs that warrant immediate hospital arrival

Please bring your maternity record and the latest test results — this will streamline the consultation.

Decisions may be refined as new information becomes available and during labor.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparing for admission for delivery

Preparing for admission helps start monitoring more quickly and make informed decisions.

It is especially important to have recent test results on hand in cases of childbirth where one fetus in a twin pregnancy is lagging in growth.

Bring documents and information that the team can quickly check on arrival. Discuss any long-term medications with your doctor in advance.

Documents: passport, health insurance and other required papers
Maternity/antenatal record with notes from pregnancy care and previous findings
Latest ultrasound, Doppler and laboratory results to assess trends
A list of regularly taken medications and confirmation of their use with the doctor
A minimal set of items for the mother as agreed with the clinic
Basic newborn supplies according to the maternity ward’s recommendations
Necessary items and documents for the partner if planned to be present
Contact phone numbers of relatives and copies of important documents for convenience at admission

If you have doubts about medications or test results, discuss them during the pre-admission consultation.

This will simplify admission and speed up the start of monitoring.

Maternity ward conditions

The maternity ward is organized to provide safe and transparent support during labor and the postpartum period. The team includes a physician and a midwife, as well as on‑call anesthesiologist and neonatologist for prompt assistance if needed. If growth restriction is detected in one twin, the ward provides intensified monitoring and access to additional investigations. The facilities are designed for various labor management scenarios with safety as the priority.

Delivery rooms equipped for monitoring and assisting during labor
Postpartum rooms with the option of rooming‑in for mother and baby
An on‑call neonatologist and equipment for initial newborn care
Availability of an anesthesiologist for consultation and for providing analgesia/anesthesia as indicated
Possibility of partner‑supported births subject to medical and organizational conditions
Provision for individualized labor support according to an agreed plan
Rapid access to the operating room and surgical team if operative intervention is required

If you have specific questions about the facilities or support, discuss them at a preliminary consultation. Conditions may be adjusted depending on the clinical situation and the team's recommendations.

When to seek urgent medical attention

If dangerous symptoms appear, do not wait for a scheduled appointment — contact the clinic or go to the maternity hospital.

This is especially important in multiple pregnancy and when one fetus has growth restriction, as the condition of the mother and fetuses requires closer monitoring.

Below are signs that require immediate medical evaluation.

Bloody or heavy vaginal bleeding
Your water has broken, especially if there are unusual particles or an abnormal odor
Regular contractions that increase in intensity or frequency
Severe, unusual abdominal or pelvic pain
Reduced or absent fetal movements compared with usual activity
A significant rise in blood pressure or a feeling of pressure in the head
Severe headache, especially if accompanied by visual disturbances
Visual problems: blurring, double vision, or loss of part of the visual field
Marked weakness, fainting, or difficulty breathing
Fever and/or shaking chills
Any sudden change in how you feel that seriously worries you

If you notice one or more of these signs, do not delay seeking help. It is better to check with your doctor or go to the labor and delivery unit for a prompt assessment.

Frequently Asked Questions

Question: Can the mode of delivery be chosen in advance if one fetus in a twin pregnancy has growth restriction?
Answer: The delivery format is discussed in advance based on examinations and the condition of the fetuses; the final decision depends on the physician’s assessment.
Question: Is this type of delivery suitable for everyone, or are there contraindications?
Answer: Not for everyone — suitability is determined by the condition of the mother and fetuses and by examination results during consultation.
Question: Can the birth plan be changed during labor?
Answer: Yes, the plan can be changed for medical reasons if necessary for the safety of the mother and babies.
Question: Can the delivery format be discussed and prepared for before labor begins?
Answer: Yes, discuss options and the monitoring plan at a pre-delivery consultation with the obstetrician and midwife.
Question: Can a partner be present during this type of delivery?
Answer: A partner can be present if there are no medical or organizational restrictions; presence conditions should be clarified in advance.
Question: Is epidural anesthesia available in this situation?
Answer: Epidural anesthesia can be considered if there are no contraindications; the anesthesiologist makes the final decision after assessment.
Question: Who decides on pain relief?
Answer: The decision is made jointly by the patient, the anesthesiologist, and the obstetrician, taking into account examinations and the condition during labor.
Question: What if the chosen method of pain relief proves unsuitable?
Answer: Alternative pain-relief options will be considered or the plan will be adjusted in the interest of safety.
Question: When should I go to the hospital when labor starts?
Answer: Come according to previously agreed criteria — for regular contractions, rupture of membranes, bloody discharge, or other worrying symptoms.
Question: What should I bring to the maternity hospital?
Answer: Bring identification, your maternity record, recent examinations, a list of regular medications, and the minimum personal items needed for your stay; confirm details at your appointment.
Question: Are documents and the maternity record required on admission?
Answer: Yes, the maternity record and ID speed up admission and help the team quickly assess the situation.
Question: Can I come with already completed examination results?
Answer: Yes, bring your latest ultrasound, Doppler studies, and lab results — this will facilitate planning and decision-making.
Question: What happens if a cesarean section is needed during labor?
Answer: The team will explain the indications and perform the cesarean promptly, while providing neonatal support to the newborn.
Question: How long is the usual hospital stay after delivery?
Answer: Length of stay depends on the course of labor and the condition of the mother and babies and is determined by the physicians based on observation.
Question: What happens immediately after the baby is born?
Answer: A neonatologist performs an initial examination, CTG (cardiotocography) is used if indicated, assistance with the first latch/breastfeeding is provided, and the mother is monitored during the first hours.
Question: Can I meet the doctor in advance or discuss the plan in person?
Answer: Yes, consultations are available to discuss the plan, pain relief, and monitoring before admission.
Question: How can I prepare my partner for their role during labor?
Answer: Discuss the type of support, presence rules, and practical recommendations at the consultation so your partner knows how to act in the delivery room.
Question: What if it becomes clear during labor that the chosen format is impossible?
Answer: The team will offer a safe alternative and explain the reasons for the change; if you are worried, notify the staff immediately.