Giving birth to multiples

Giving birth to multiples

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Will I have to deliver by c-section if I'm carrying more than one baby?

Not necessarily. Whether you're able to try for a vaginal birth depends a lot on how the babies "present"– that is, how they're positioned in the uterus.

Most practitioners recommend trying for a vaginal birth as long as:

  • Both babies are head down (which they are in about 40 percent of twin pregnancies).
  • Neither you nor your babies have problems that would make a c-section necessary.

On the other hand, you can count on having a scheduled c-section if your first twin (meaning the one that's lower in your uterus, who will be born first) isn't head down, if your twins share one amniotic sac, or if you're carrying more than two babies.

There's less agreement on what to do if the first twin is head down but the other one isn't. Some experts argue that attempting a vaginal delivery is a reasonable choice, while others feel that a planned c-section is the best way to go.

Finally, you should be aware that even if you successfully give birth vaginally to the first twin, you may still end up needing a c-section for the second. This happens about 10 percent of the time, and it's even more common when only the first twin is head down. In fact, in one study, nearly 1 in 4 women with one twin positioned head down and one not ended up having a c-section for the second twin.


Follow one woman through her pregnancy with twins and watch her give birth.

Assuming I can try for a vaginal birth, how will labor and delivery be different?

You have a higher chance of complications during labor and birth than a woman delivering a single baby, so you should plan to deliver in a hospital.

Potential complications include a higher risk of a prolapsed cord when your water breaks, a placental abruption (particularly after the delivery of the first twin), and postpartum hemorrhage for both vaginal and c-section deliveries. For this reason, certain precautions are necessary.

First, you'll need to choose an obstetrician skilled in delivering twins, both vaginally and by c-section. The doctor should be affiliated with a hospital that has adequate medical staff immediately available throughout your labor. The hospital should have a nursery equipped to care for premature babies, since many twins are born a little bit early.

When you arrive at the hospital, an ultrasound will be done to confirm the position of your babies. You'll also receive an IV, as well as continuous electronic fetal monitoring of each baby for the duration of your labor.


Watch one mom's emergency c-section and learn how the surgery is done.

If you want pain medication for labor, an epidural is the best choice. An epidural can later be used to provide additional pain relief in case the doctor has to reach inside your uterus to manipulate the second twin after delivery of the first or you need an immediate c-section for any reason.

When it comes time to deliver, you'll give birth in a delivery room that doubles as an operating room instead of a regular birthing room. Your team of medical personnel may include one or two obstetricians, a midwife (if you're using one), an anesthesiologist (in case you need to deliver by c-section), at least two nurses (with additional help on stand-by), and two pediatricians (one for each baby).

After you give birth to the first baby, you practitioner will assess the position and size of your second baby abdominally and vaginally, and possibly by ultrasound as well.

What happens next will depend on the position of the second baby. If the baby's head is near your cervix and low enough in the birth canal, your practitioner will rupture the amniotic sac and continue to monitor the baby's heart rate.

The contractions usually start again shortly after the birth of the first twin (if they don't, you may be given Pitocin), and you'll push the second twin out much as you did the first, though it's likely to take a lot less work on your part.

The second baby may arrive within minutes of his sibling – or as much as half an hour or more later. If the baby's heart rate doesn't remain normal or other complications develop during this time, he'll be delivered promptly by c-section.

If the second twin's head isn't down but his buttocks descend into your pelvis, this is called a breech. Your practitioner may deliver this baby vaginally as well or do a c-section.

When neither the baby's head nor his buttocks are in place near your cervix (which can happen even if he was head down before the first twin delivered), the doctor may perform an "internal podalic version." This involves reaching inside the uterus, grabbing the baby's feet, and extracting him feet first. In some cases, a c-section will be necessary to deliver the second twin.

What will a c-section be like?

If you're having a cesarean for twins or more, it will proceed more or less like any c-section, with a few differences. For one thing, more medical personnel will be in the room. As usual, there will be two obstetricians, an anesthesiologist, and two nurses to tend to you during the surgery, but there will also be a pediatrician and a nurse for each baby. (If you were having triplets, for example, that would add up to 11 medical professionals.)

There will also be a baby warmer for each baby, and resuscitation equipment at the ready. And, depending on the size and position of your babies, you may end up needing a somewhat larger incision than usual.

What will my recovery be like?


See what the first days of c-section recovery are like for one mom.

That will depend on whether you've had a vaginal birth or a c-section and whether you've had other complications, like a postpartum hemorrhage. If everything goes well, you can expect to be discharged from the hospital within two days after a vaginal birth and within four days after a c-section.

All new mothers can use lots of help taking care of a new baby and recovering from birth, but you'll be even more exhausted if you're taking care of multiples. Arrange to get as much help at home as you can.

Some babies aren't able to go home right away. Because multiples tend to have more complications, particularly those related to being born earlier and smaller, it's not uncommon for them to be admitted to the neonatal intensive care unit (NICU). This is necessary for about one quarter of all twins, three quarters of triplets, and almost all higher-order multiples.

If you want to breastfeed your babies, be sure to get an early start and ask for guidance from the hospital staff while you're there. Get in touch with a certified lactation consultant or a La Leche League chapter in your community, so you'll have support in place after you get home.

If your babies are in the NICU and not yet ready for oral feedings, you'll need to pump your breast milk in the meantime. The hospital should have an electric breast pump available for you to use while you're there, and you can rent one to use once you go home.

Learn more:

Watch the video: Twins Born 13 Days Apart (May 2022).