OB Guidelines Appendix G: The Delivery of Twins

If you are having twins, the following explains possible events and risks related to your labor and delivery.

Timing of Delivery

• About 40 percent of twin pregnancies begin labor early.
• Sometimes, medical problems require an early delivery.
• Almost all patients with twins give birth before or by their due dates.

Route of Delivery

The recommended route of delivery depends in large part on how the babies are presenting.

• Both heads are down: vaginal delivery for both babies.

• The first baby is not head down: cesarean is most often recommended.

• The first baby is head down, the second baby is buttocks down or sideways, the options are:

  • cesarean delivery of both twins;
  • vaginal delivery of the first baby, attempt to turn the second baby for vaginal delivery;
  • vaginal delivery of the first baby, breech vaginal delivery of the second baby; or
  • vaginal delivery of the first baby, cesarean delivery of the second baby (uncommon).

Each option has risks.

• Vaginal delivery poses risks for the second baby, including birth trauma (rare).
• A cesarean includes the risk of bleeding, infection, and surgical injury to the bowel or bladder.

Vaginal breech delivery of the second twin is not recommended when:

• the second baby is estimated to be much larger than the first,
• the birthing person’s pelvis is judged to be too small to allow the baby to deliver safely, or
• the baby is very small (less than 4 pounds) or very early (less than 32 weeks).

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