When a woman discovers she is expecting twins one of the first questions is often ‘can I deliver naturally?’
But while it’s true you’re more likely to have a caesarean than with just one baby, it is by no means a foregone conclusion.
Figures vary but it is estimated around half of women expecting twins in the UK will have a natural birth.
Reasons for caesarean
The main reasons for a caesarean in twin pregnancies are:
- placenta previa (low lying placenta close or covering the cervix)
- malpresentation (where the first baby is not positioned normally, i.e. head down, in the pelvis)
- cervical dystocia (where the cervix fails to dilate)
- a previous c-section
Vaginal delivery
Where there are no complications and the first twin is positioned head down (cephalic presentation) vaginal birth will proceed as normal, although there will be extra medical professionals in attendance for the delivery stage.
The time between the babies being born is typically 10 minutes to half an hour. If it lasts longer than an hour then medical staff may wish to intervene.
However if twin one is positioned bottom down most hospitals would advise a caesarean.
You will be monitored throughout the pregnancy to determine the position of the twins. Also investigate and discuss the twin birthing policy of your local hospital as the level of intervention used varies across maternity units.
The expert view
Philippa Bennett, National Childbirth Trust antenatal teacher and mother of five children including twins Max and Jemima says: “I always recommend parents of twins have two birth plans: a vaginal one and a caesarean one. If they’re planning a vaginal birth I advise they put the caesarean plan deep into their hospital bag and forget about it. But if something happens during the birth you can produce it and say this is what we’d like.
“The most important thing for a vaginal birth is that twin one, the lowest twin, is head down. If twin one is head down then the mother shouldn’t be offered a caesarean, that’s what the NICE guidelines say, and it doesn’t really matter what the position of twin two is. If twin two is head down then great but if not, the doctor can manipulate it once the first is born to be head down, or it’ll be born breech. The second being breech is less of a problem because the first twin has come down and made a route through.
“The birth of the second twin is quicker, there’s not such a long ‘pushing’ stage of labour because the muscles have already been stretched. If the baby is higher up the mum’s tummy the doctor may try and rotate the baby by pressing on the mum’s tummy to persuade the baby to do a forward roll, it’s called ECV — External Cephalic Version — to manipulate the baby to be head first. After twin one has come out twin two has a lot of space so quite often they rotate but if twin two is in a good position a midwife may use her hands on the mum’s tummy to keep the twin stationary while twin one is being born — then twin two can come out head first.”
A mum’s view
Anni McTavish mother to Angel and Aoife says: “I hadn’t had chance to write out my birth plan because they were early — my waters broke at 32 weeks. I had wanted to have them at home but when my waters broke early I had to go into the hospital. When I arrived at hospital they monitored me and I felt fine but I could tell they were coming.
“I was upright on the bed with Aoife on all fours and she came out head first and it was great. But Angel twisted round and became breech. When she was born she got her head caught so they did have to use forceps to help her out.”
Bounty
Bounty
