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 positioned.

• If both heads are down, vaginal delivery is recommended.

• If the first baby is not head down, cesarean is most often recommended.

• If the first baby is head down and 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
  • Vaginal delivery of the first baby, cesarean delivery of the second baby (this is not generally recommended as a planned route of delivery)

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 second baby is very small (ultrasound estimated weight of less than 1500g) or very premature (less than 32 weeks).

When counseling patients regarding options of breech delivery or internal or external version, the obstetrician should include information about their experience with this procedures.

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