If you’re expecting twins, you likely feel a mix of excitement and worry as you approach delivery. Does your multiple pregnancy mean you can’t have the natural birth you’d hoped for? Absolutely not! Actually, natural childbirth of twins is possible in most cases.
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Natural Childbirth of Twins: Twin Birth Statistics
Twins account for about 3% of all births (1). This makes you stand out from the majority of pregnancies but is not so rare as to leave your doctors baffled. An experienced caregiver will be fully prepared to confidently and safely help you deliver your babies.
Statistically, a woman is more likely to have a cesarean delivery with twins than with a singleton pregnancy (1). However, studies continue to confirm that in most cases, if women are allowed a trial of labor rather than a planned cesarean section, there is a high chance of delivering vaginally (2).
Twins are at a higher risk of preterm birth, and this is what causes most complications for multiples. This may also affect your choices for how your baby is delivered. In most cases, though, twins make it safely to term or near enough to term to be healthy and have no lingering complications. We’ll be focusing on natural childbirth of twins who are full-term (at least 37 weeks gestation) or near-term (between 35 and 37 weeks) babies.
Natural Childbirth of Twins: Define a Natural Delivery
What is natural childbirth? Some people use the phrase natural delivery to mean vaginal delivery, as opposed to a cesarean section. Some use the phrase natural delivery to mean unmedicated delivery — one without an epidural or other pain medication. Both are possible even with a multiple birth. All the tools and education that apply to deliveries of single babies can be used in the natural childbirth of twins. You can use the same breathing, relaxation, and positioning techniques to cope with labor contractions.
Therefore, we’ll be focusing mostly on the circumstances that go into whether you’ll be able to deliver your babies vaginally. Your care team will look at several key factors, namely:
- The position of each baby
- Each baby’s weight
- Mom’s health, and
- The health of the babies
Babies’ Positions
The biggest factor in whether or not you’ll be able to deliver vaginally is the position or presentation of your babies — which part of baby’s body is closest to the cervix (1, 3). Let’s review presentation before we talk about how it affects natural childbirth of twins.
Vertex or Head Down – Head-down is the “proper” position for delivery and the easiest and safest position for a vaginal birth. In most cases, both babies are vertex at the time of birth(1).
Breech – Buttocks, legs, or feet are over the cervix in a breech presentation.
Transverse or Sideways – At an angle that is neither vertex nor breech.
Read More: Presentation and position is discussed further in our Week 18 Pregnancy article.
How Position Affects Natural Childbirth of Twins
With two babies, all possible combinations of fetal presentation can occur. Your chances of being able to safely deliver vaginally vary depending on how your babies present.
Vertex/Vertex
Your best chance of having a successful natural childbirth of twins is if both babies are head-down. If both of your babies are vertex and there are no other complications, you have a good chance of being able to deliver them vaginally.
Vertex/Breech
Many of the studies you’ll find on vaginal delivery of twins relate to the lower twin being vertex and the other having a breech presentation. Doctors are learning that a cesarean section is not always necessary just because one twin is breech (4). A mother may deliver the first baby vaginally and then the caregiver may attempt to turn the second baby to deliver head-down. Sometimes a vaginal delivery in a breech position is an option, or it may be necessary to deliver the second baby by cesarean delivery.
Breech/Breech
If both babies are breech, or a mix of breech and other nontraditional presentation, most caregivers will recommend a scheduled cesarean section. We always encourage moms to do their own research and to talk with a trusted provider about what their best options are and why. Breech positions may not absolutely rule out vaginal delivery, but you should understand that there’s a good chance that in this particular case, a cesarean section may be the safest way to deliver your babies.
Extra Precautions in Natural Childbirth of Twins
Because of the higher risks associated with the delivery of twins, some additional safeguards are taken during labor and delivery. These may include:
- Ultrasound scan during labor to help identify your babies’ presentations and positions.
- I.V. so that your healthcare team can move quickly if medication or surgery becomes necessary.
- An anesthesiologist present in case you need an emergency cesarean delivery.
- Pediatricians or other medical personnel present or available to take care of the babies.
- If vaginal birth is attempted, it is usually in an operating room in case a cesarean section becomes necessary.
- Caregivers may recommend epidural anesthesia in case painful interventions, such as forceps delivery, are needed (1). Knowing this ahead of time will give you the ability to talk to your doctor about your wishes.
- After delivery, your provider will pay close attention to your bleeding. In a twin pregnancy, your uterus is over-distended and the rapid change in the size of your uterus can cause extra bleeding. If this becomes an issue, medications can be given to contract the uterus and help stop the bleeding (5).
Natural Childbirth of Twins: Research and Communicate
Open communication with a care provider you trust is a game changer in helping you understand your options for twin delivery. Educate yourself on the various extra precautions that may be suggested with a multiple pregnancy, whether they’re essential, and you feel about them. Talk to your doctor about what to expect during labor and delivery, and communicate your feelings and preferences. Natural childbirth of twins is possible, and you can still plan a natural birth that meets your hopes and goals!
Kopa Birth’s online childbirth classes allow you to prepare for a natural childbirth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class to learn more about preparing for a natural hospital birth.
References:
- Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2016). Pregnancy, Childbirth, and the Newborn: The Complete Guide. Minnetonka: Meadowbrook Press.
- Castro, H. D., Haas, J., Schiff, E., Sivan, E., Yinon, Y., & Barzilaya, E. (2017). Trial of Labor in Twin Pregnancies. Obstetric Anesthesia Digest, 37(1), 30-31. doi:10.1097/01.aoa.0000512024.58989.b4
- The American College of Obstetricians and Gynecologists. (2010). Your Pregnancy and Childbirth Month to Month, 5th edition
- Castro, H. D., Haas, J., Schiff, E., Sivan, E., Yinon, Y., & Barzilaya, E. (2017). Trial of Labor in Twin Pregnancies. Obstetric Anesthesia Digest, 37(1), 30-31. doi:0.1097/01.aoa.0000512024.58989.b4
- Glade, B.C., Schuler, J. (2011). Your Pregnancy Week by Week, 7th edition. First Da Capo Press
Average Baby Weights in the First Year