If you're expecting twins, you're probably getting used to the idea that your pregnancy is higher-risk than a single-birth pregnancy.
There's an incredible amount of decisions you'll be making while you wait to meet your babies, and one of those decisions, which you'll hopefully have a say in, is whether or not you'll be delivering your twins vaginally or via Caesarean section (whether that C-section is planned or happens in an emergency situation may be a whole different circumstance).
You might have a personal preference for one delivery method over the other, but there may be pre-existing medical reasons why one option isn't recommended for you.
For example, if you've had a C-section previously, it's not recommended you have a vaginal birth if you're pregnant with twins.
Your doctor may also suggest a Caesarean delivery if:
- Baby A is lying feet- or knees-first or is breech.
- One twin is lying transverse.
- You have a low-lying placenta.
- Your twins share a placenta, or, more often, if they share an amniotic sac.
- You experienced a difficult delivery with a single baby previously.
According to Maternal Fetal Medicine Associates, which specializes in high-risk obstetrics, nearly 75 percent of twins in the U.S. are delivered by C-section. This number comes from "malpresentation of the first or second twin, prematurity, maternal comorbidities, and patient preference. However, recent literature suggests that, for many women with twin pregnancies, vaginal delivery can be achieved without increasing maternal or neonatal morbidity."
A twin birth study that was conducted over eight years across 106 health centers in 25 countries looked at planned vaginal vs. planned C-section deliveries in twin pregnancies.
It included 2,804 women with twin pregnancies that reached a gestation of 32 weeks (and 0 days) up to 38 weeks (and 6 days). The study explains that "among the 1,393 women in the planned vaginal delivery group, the C-section rate was 39.6 percent and the combined vaginal-Caesarean rate was 4.2 percent. After removing the 196 women who had their C-section before labor, for the women who attempted labor, the Caesarean delivery rate was 34.4 percent, and the combined vaginal-Caesarean rate was 4.9 percent."
Meanwhile, the study found that for those with twin pregnancies that surpassed 32 weeks, the chance of a vaginal delivery was around 65 to 75 percent, and the chance of a combined vaginal-Caesarean delivery was about three to 10 percent. In cases where the delivering obstetrician was comfortable with active management during the second stage of labor, the chance of vaginal delivery could be as high as 85 percent and a combined vaginal-Caesarean delivery rate could be lower than one percent.
Pick a method, any method
When you're carrying and preparing to deliver twins, there are three possible ways they can come into this world:
- Via vaginal delivery.
- Via C-section.
- Via a combination of the two.
If you find yourself in an emergency situation, you likely won't have a choice and will need to undergo a C-section to deliver your babies as quickly and safely as possible.
If things go smoothly throughout your pregnancy, and you, as the mother, don't have any comorbidities AND if your babies are doing well and aren't both in a breech position when it's go-time AND if your OB-GYN and / or medical team is on board, then you may end up being able to decide whether you want to opt for a vaginal delivery.
The third delivery method, as mentioned earlier, ends up with you having to face a combination of both delivery scenarios; opting for a vaginal delivery, successfully giving birth to Baby A, and then running into an unforeseen issue and needing to have Baby B delivered via an unplanned C-section.
It will vary from pregnancy to pregnancy, but, usually, delivery is recommended at 38 weeks for dichorionic-diamniotic twins and at 37 weeks for monochorionic-diamniotic twins, unless there are other factors at play (such as gestational age, fetal position and / or weight, and overall maternal and fetal health) that indicate to your fetal assessment team that your babies should be born sooner.
Benefits and complications on both sides
No matter how your babies are delivered, there are benefits and complications that come with each delivery method, and the decision will be made based on many different factors to ensure, as much as possible, that complications are mitigated for the safe delivery of both babies.
When it's time to welcome your twins into this world, you'll head to the labor and delivery department of your hospital.
At this point, because you have a higher risk of running into complications with a multiple birth pregnancy (problems can include peemature breakdown of the placenta, postpartum hemorrhage; uterine atony, which is the leading cause of postpartum hemorrhage; difficult extraction, cord prolapse, or head entrapment, to name a few), your babies will be electronically monitored. Two belts with sensors (one for each baby) will be attached to your belly, allowing the team to continuously monitor each twin's fetal heart rate.
When it's go-time
If you're trying for a vaginal delivery, you'll labor in a regular room until you're fully dilated, and then you'll head to the operating room to give birth to your babies, so that you're already where you need to be, in the unfortunate event you run into an emergency during the delivery and need to switch to a C-section.
Operating rooms are also larger, so have more space to accommodate the medical and pediatric teams that will be assigned to each of your twins, regardless of how they're delivered. As a rule with all twin pregnancies, pediatric teams are present in the delivery room in case your babies require neonatal support or resuscitation.
With all of that said, double the amount of professionals for double the amount of babies requires a lot more room than someone who is giving birth to a single baby.
While giving birth to my twins, in between contractions, I remember opening my eyes and counting at least 12 people in the operating room with my husband and me. A team like that calls for a larger room that's equipped for any scenario.
Benefits of vaginal delivery
- When you give birth vaginally, the recovey period is shorter, in general, than when you undergo a C-section.
- You experience less pain afterward, which is very helpful as you try to care for your newborn twins, and you can typically get back to your regular activities sooner.
- Giving birth vaginally signals to your body that it's time to begin producing milk for the babies you just delivered.
Complications of vaginal delivery
- The position your twins are in can cause complications. If both twins are head-down, it's generally considered safe to go ahead with a vaginal delivery, but if one or both babies are in a breech or transverse position, you run the risk of potentially having to undergo a C-section. Having said this, in my personal experience, when it was time to push, Baby A was head down and Baby B was breech. After Baby A was delivered, Baby B was still doing great and no issues with his vital signs, so he was able to be flipped head-down and extracted safely without me having to undergo a C-section.
- With a vaginal delivery, you might be unable to deliver your baby's head during a breech extraction because it can't fit through your contracted cervix. This is called head entrapment, and it can happen if Baby B is quite a bit bigger than their twin, if they're premature and have a larger ratio of head to abdominal circumference, or if a breech extraction isn't done fast enough (within five minutes or less).
- While some people may not wish to have an epidural for delivery, regional anesthesia (an epidural) is highly recommended for a vaginal delivery of twins because if you have to undergo an unplanned C-section, attempting to place an epidural in an emergency situation wastes precious time that's better spent on helping get your babies out. An epidural also makes fetal monitoring of both twins easier and makes it possible to extract the second baby if it's breech.
Benefits of C-section delivery
- In the event of an emergency (like a sudden drop in fetal heart rate or oxygen levels), the surgeon can deliver your babies almost immediately.
- Caesarean deliveries can reduce the risk of labor complications.
- A pre-planned operation allows you to know your delivery date ahead of time (unless you go into labor naturally the day before, which is exactly what happened to another twin mom I know).
Complications of C-section delivery
- As is the case with any surgical procedure, you run the risk of getting an infection at the incision site, or having to deal with bleeding, or watch for blood clots...all while trying to navigate twin motherhood and care for your newborn babies.
- The recovery time is typically longer than with a vaginal delivery, and your recovery may differ, depending on whether the surgeon has to use a midtransverse incision or a low-transverse incision (this decision depends on the mother's anatomy.
- There are limitations to how much you can lift (nothing more than your newborn), and you can't drive for several weeks after the procedure, which is not ideal when you have two babies' worth of pediatrician appointments to get them to in those early days.
Each method calls for postpartum healing
However you deliver your babies, they'll be welcomed with open arms by a team of medical professionals who are ready for any scenario and will do whatever they can to ensure the safe arrival of your twins.
While you may not be able to guess how or when you'll meet your babies (unless you're me and you call their exact birthday five months in advance...what can I say, it must have been my own twin brain offering special insight on that one?), you can plan ahead and prepare for your postpartum recovery.
This will ensure you're not frantically trying to track down items that are essential to your postpartum healing and recovery when you should be focusing on getting in as many newborn snuggles as you can.
Did you want to deliver your twins vaginally or via C-section? Did you run into any complications and have to change your delivery method on-the-fly? Let us know in the Comments section below or connect with us on Instagram to share your thoughts!
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