Guide to giving birth to twins

If you’re expecting twins, you’ve probably wondered how a twin delivery goes and whether you should have a vaginal or c-section birth. The recommendation for vaginal twin delivery or c-section depends on the position of your infants in the uterus and that neither you nor your babies have difficulties that would necessitate a c-section. It also relies on your country’s culture and the practitioner you see.

How will my baby’s position effect delivery?

If you want a vaginal twin birth, it’s best when both twins are head down.

Both babies are head-down

Many countries encourage natural birth if both babies are head down. However, if you have health issues or one or both of your babies are in distress, a c-section may be indicated. Also, in some cultures, c-sections are a status symbol, which may impact the advice you receive.

Head down baby A, breech or transverse baby B

Baby A is the closest to the birth canal and the first born. Most doctors will advocate a twin vaginal birth if he or she is head down. If twin B is breech or transverse (sideways), some doctors advise vaginal birth while others advise c-section. It depends on the doctor and the country’s culture.

Baby A is breech

Most doctors will advise a c-section if baby A is breech or transverse.

How to deliver twins safely

The safest approach for delivering twins at or near term has been debated. The Term Breech Trial, a research on singletons, bolstered support for scheduled cesarean delivery of twins. It demonstrated that a scheduled c-section is better for a full-term pregnancy with a breech baby. Large twin cohort studies suggest that twins born by elective c-section had a better prognosis than twins born vaginally or by emergency c-section. Nonetheless, a big study published in 2013* indicated no benefits of scheduled cesarean section over planned vaginal delivery for twins between 32 and 38 weeks gestation, assuming twin A was head first. A 30-minute emergency c-section is one of the protocol’s requirements.

Will I have an early baby?

Twins carry a larger risk of premature birth than a singleton. About half of twin-carriers deliver at term. This suggests they give delivery at 37+0 weeks. The other half has an early birth. The appropriate gestational age for twins is debated in the medical profession. Your doctor may propose an induction or c-section before you go into labor spontaneously.

How do twin vaginal births go?

Ditte Toft Heskjr has delivered twins before. She works in a Danish hospital with twin pregnant mothers and women with delivery anxiety. She explains the process of a vaginal twin birth and how to have a pleasant birth experience.

1. Latent phase

The technique is the same until the uterus is 10 cm dilated. The latent phase lasts until 3 cm uterine dilation. We urge ladies to stay at home if their contractions are weak or irregular. To avoid a singleton delivery, women should go to the hospital when their contractions are five minutes apart and last 60 seconds. 5-7 minutes for twin births. The latent phase lasts 8-12 hours.

2. Active Phase

When your uterus is 3-4 cm dilated, the active phase begins. During this time, most women go to the hospital. During birth, move around and take different positions to facilitate your child’s rotation. You can walk about, take a shower, or use a bathtub when I’m not running a CTG*. Keep a positive attitude in the delivery room and bring whatever makes you feel safe and secure. Like your own pillow or favorite music. I also advise the partners of the pregnant ladies to remove their shoes. The mother frequently checks in with her partner and the midwife to ensure all is alright. This phase lasts 4-6 hours. The first birth usually takes longer.

3. Transition phase

Your uterus is now 8-10 cm dilated. The contractions are the most painful. Use the techniques you’ve learned, like different breathing techniques. Even though it feels impossible, your midwife advises you to listen, cooperate, and utilize the tactics.


This phase normally lasts an hour. At full dilation, you’ll need to lay or sit on the bed so the midwife can conduct a CTG and track the curves. This is a time of severe contractions and the children are under a lot of strain. Be mindful that a little stress is healthy for them. The heartbeat can slow down as long as it is normal. Stress causes their bodies to awaken and prepares them for having to breathe once they are born.

4. Pushing phase

You are 10 cm dilated and the babies are starting to descend. You may feel tempted to push. First twin: 60-90 minutes, second twin: 15-20 minutes. Many women receive a drip to help them contract during twin births. So they can have the second twin faster. I normally stay with the woman and her partner until 5-10 contractions remain before the first twin is born. Then I call in a backup team of doctors and midwives to help deliver the infants. When the first twin is born, I check the position of the second twin, which may have shifted. The baby must lie with their head or buttock down. If the baby is transverse, I’ll try to guide it during contractions. If I fail, a c-section is required. About twins and c sections The placenta(s) will be born shortly after the children. This is rarely painful.
Having twins increases the chance of excessive bleeding during labor. This is because the uterus was huge. An IV drip causes the uterus to contract.

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