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Delivering Twins

Reviewed by James Brann, M.D.

Expect Delivering Earlier than Your Due Date

Delivering Twins, Learn What Every Mother Should Know.

Expecting two babies can be stressful—and expensive! In addition to differences in how much you need to eat and how many strollers you need to buy, you should also know what to expect for labor and delivery.

Many twin pregnancies are delivered earlier than pregnancies with only one baby. This is because twin pregnancies are more likely to have problems that require an early delivery or C-section. If you and the twins do not have any health problems, you may be able to carry the twins up to 40 weeks (full-term). No matter how long your pregnancy lasts, when you go into labor, your babies will be monitored closely to make sure you have the safest delivery possible.

More than 50% of twins are born preterm, and twin births have a higher risk of problems with the baby’s heartbeat and position. In most cases, if your babies are born preterm, they are more likely to have problems no matter what type of delivery you have. If you go into labor before the twins are 36 weeks along, the doctor will probably check to see how developed their lungs are. If they are not quite ready, you may be given a steroid shot. Your doctor will then try to delay the birth until the steroids have time to help your babies’ lungs develop. The type and timing of delivery will depend on the type of twins you have and how they are positioned when it’s time for you to give birth.

What Type of Twin Pregnancy Do You Have?

Depending on the “type” of twin pregnancy you have, your delivery options may differ. Many doctors will try to find out whether your twins are in their own sac or not. If the twins are in the same sac, your doctor may encourage you to consider elective delivery at 36 or 37 weeks. If they are in different sacs, you may be able to carry the twins the full 40 weeks.

Twins in the same sac (monochorionic) often have higher risks than twins in different sacs. Because the risk of problems increases as the pregnancy continues, you may need to be induced. A doctor may give you drugs to start contractions at 36 or 37 weeks. If you want a C-section instead of a vaginal delivery, your doctor will probably schedule it around this time.

Position of the Twins

The position of your twins will be a big part of what you can expect for the delivery of your twins. Depending on how they are positioned inside your uterus, you may not be able to choose how you want to give birth. Sometimes, the position of the babies makes a C-section delivery the only option. Your twins may be in any of the following arrangements when you go into labor or are induced:

  • Vertex/Vertex: Both babies are head-down. This is the best position, especially if you want to have a vaginal birth.

  • Vertex/Breech: The first baby is head-down; the second is bum- or feet-first. This is the second best possibility if you want to have a vaginal birth. Many times, the first baby is born normally and the second is moved or turned inside of you to be born vaginally as well.

  • Breech/Vertex or Breech/Breech: The first baby is bum- or feet-first; the second is either head-down or in the same position as the first baby. This combination can make vaginal delivery risky. Your doctor will probably recommend a C-section if this is how your babies are lying.

  • Transverse/Any position: The first baby is sideways (horizontally across your uterus). No matter what position the second baby is in, your doctor will probably recommend a C-section delivery.

In general, if the first baby is head-down, there is a good possibility that he or she can be born vaginally. The second baby may or may not be able to be delivered vaginally. If the first baby is not head-down, it is safer in most cases to have a C-section delivery, regardless of the position of the second baby.

Vaginal Delivery of Twins

If the babies are both head-down, most doctors will recommend a vaginal delivery for twins. Unless there is a health risk for you or the babies, vaginal delivery has fewer complications than C-sections do. Vaginal childbirth for twins is even possible for women who have had a C-section in the past. Your healthcare provider will check you and the babies before and during labor to make sure a vaginal delivery is a safe option.

During labor, the doctors will monitor the heartbeat of both twins. If they notice warning signs of a problem, they may try to speed up delivery. Doctors may help labor along by giving drugs to increase your frequency of contractions. This often happens when the labor is going too slowly.

Many doctors try to deliver the second twin less than half an hour after the first twin is born. If the second twin’s heartbeat appears normal, though, no particular time limit is needed. Up to 25% of second twins are born via C-section after the first twin was delivered vaginally. This can be due to problems the second baby is having or a risky position of the second twin.

C-Section Delivery of Twins

More than 60% of twin births are C-section deliveries. Sometimes the C-sections are “elective,” or chosen and planned ahead of time. Other times, they are emergencies: no one planned the surgery in advance, or something happened during vaginal labor that made a C-section necessary and urgent. Overall, C-sections are common and safe for the delivery of twins, but they are not needed in every case.

Elective C-Section with Twin Pregnancy
Depending on your health and the health (and type) of your twins, your doctor may recommend a planned C-section before natural labor starts. This may be done if the twins are in the same sac and labor hasn’t begun by 37 weeks. Sometimes, vaginal delivery can be risky, and an elective C-section is planned to avoid danger for the twins or the mother. The mother can also choose, in many cases, to have a C-section at her request once the twins have reached a minimum of 36 weeks.

Emergency C-Section with Twin Pregnancy When a C-section is not planned ahead of time, it is called an emergency C-section. This can happen when the twins show slow heartbeats or other problems occur. Emergency C-sections also happen when the first twin is born vaginally but the second twin is not doing well. Sometimes, when a woman is pregnant with twins, labor naturally begins very early or another problem happens that makes an emergency C-section necessary. In general, C-sections are safer when they are planned ahead of time.

The Birth of Twins

Remember that it’s OK to ask your doctor all of your questions about having twins. He or she can help explain what you can expect based on your twins’ type, growth, and position. Finally, don’t be afraid about giving birth to twins! Even if you end up with a surprise delivery or an unexpected C-section, your twins have a good chance of being safe and healthy.

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