Giving Birth to Twins – Vaginal or Cesarean?

Around 3 percent of all births are twins. In the United States, the number of twin births in 2020 was 112,437 (Source: CDC). If you’re part of the 3 percent, you probably want to know what carrying twins means for your birth. You may have even heard that people pregnant with multiples always have a c-section. The truth is, about 50 percent or more of twins are born vaginally. When pregnant with twins, there are multiple variables that determine the safest way to give birth. 

Factors that Influence Your Birth with Twins

Health complications – If you do not have any complicating factors affecting your pregnancy, like preeclampsia, placenta previa, or active genital herpes, your chance of having a vaginal birth is more likely. 

Positioning of each baby – The positioning of your babies is one of the most significant factors affecting the ability to safely have vaginal birth. Ideally, both babies are head down (vertex) at the end of your pregnancy, which happens about 40 percent of the time.

In about 30 percent of twins, Twin A (the baby closest to your cervix) is head down and Twin B is breech (head up). This position is also acceptable for vaginal birth — after Twin A is birthed, your doctor can attempt to turn Twin B into the head down position. Sometimes, Twin B will turn on their own. If your care provider is experienced in handling a breech birth, you may be able to birth Twin B in the breech position if turning head down is not successful. If Twin B remains breech, your doctor may request a c-section. Around 4 percent of twin births are vaginal followed by c-section.

If the position of Twin A is breech or in any position other than head down, you may be required to have a cesarean.

Prematurity – If you go into labor prematurely, your care provider will help you weigh your options for the safest way to give birth. Depending on the level of prematurity and/or your babies’ positions, you may need a c-section.

Complication during labor – If you or one or both of your babies experience a life-threatening complication during labor, including cord prolapse and fetal distress, you will need a cesarean. 

As with all pregnancies and births, your choice of care provider and hospital can influence the kind of care you receive in birth. Ask about your doctor’s statistics when it comes to twins — how often they care for people pregnant with twins, and how many have resulted in a vaginal birth. Find out how they determine if a cesarean twin birth is needed. If you aren’t satisfied with the kind of care you’re receiving, interview other providers in your area and make a switch, if possible. 


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