You may have heard that being pregnant with twins means an automatic C-section, but that isn't always the case. When it comes to twins these days, about half come into the world vaginally.
Not surprisingly, labor and delivery can get a little more complicated when you've got multiple babies looking forward to their debuts. So remember that no matter what route they take from your snug womb to your even snugger embrace, the best way is the one that's healthiest and safest for them — and for you.
Is a vaginal birth possible with twins?
After you get the good news that you've got more than one baby inside that growing bump, you'll find that your pregnancy is supervised by a whole team of experts — led by your prenatal practitioner. They'll want to check in frequently with you to reduce your risk of any potential complications of carrying twins. They'll also begin going over options for your birth plan.
As you approach your due date — and on the day you go into labor — here are the things they'll be looking for to proceed with a vaginal delivery:
- You don't have any health issues. You'll more likely be able to try for a vaginal delivery if you don't have any health conditions that might put you or your babies at risk. These include conditions such as preeclampsia and gestational diabetes.
- Both babies are head down. Consider yourself lucky if both babies end up in the head-down position when it's time to deliver. This is called vertex/vertex. It's the most cooperative possible fetal position that twins can wind up in on delivery day, and it happens about 40 percent of the time. You'll likely be able to go into labor naturally and attempt a vaginal birth. Keep in mind, however, that even perfectly positioned singletons sometimes need to be delivered by C-section, and this goes double for twins.
- The first baby is vertex. If your first baby (the one nearest the exit) is head down but your second baby is breech (baby's buttocks or feet are positioned to be delivered first), you may still be able to give birth vaginally. In this case, you'd deliver your first little one, and then your practitioner would try to turn your second baby into the head-down vertex position. Your practitioner will do this either by applying manual pressure to your abdomen (external version) or by reaching inside your uterus to turn the second (internal version). If your second baby still won't flip, your practitioner may pull the baby out feet first. This is called a breech extraction.
When is a vaginal birth unlikely with twins?
If you want to give birth vaginally, your practitioner will do what they can to help you. But there are cases where they'll likely recommend a C-section:
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- The first baby is breech. If your first baby (the one nearest the exit) or both of your babies are in the bottom-down position, your practitioner will almost certainly recommend a C-section. An external version is considered too risky in this situation.
- The first baby is oblique. This means your little one's head is pointing down, but toward either of your hips instead of squarely at your cervix. If your first baby takes this position, one of two things could happen: He or she may get in the proper position for vaginal birth as contractions progress or, more likely, your practitioner will recommend a C-section so that you're able to avoid a long, drawn-out labor that may or may not lead to a vaginal birth.
- Both babies are in the transverse position. This means both babies are lying horizontally across your uterus. This positioning almost always results in a C-section.
- Your baby (or babies) are experiencing fetal distress. If either of your babies shows signs of fetal distress during labor, you may need a C-section immediately. Signs of fetal distress include changes in fetal heart rate, meconium (baby's first stool) in the amniotic fluid or diminished oxygen supply.
- You're having triplets (or more). High-order multiples always fall into the category of a high-risk pregnancy. Therefore, if you're pregnant with three or more babies, a C-section will likely be scheduled. Why? Even with medical advances, it's still usually safest. However, some doctors say that vaginal delivery can be an option if your first baby is in the vertex position and there are no other complicating factors.
What is a combined C-section and vaginal twin birth?
A mixed birth (also referred to as a combined birth) occurs when the first baby is delivered vaginally but the second baby requires a C-section. This is rare and is usually done only if there's an emergency with the second baby. A cord prolapse — where the umbilical cord comes out before the second baby, cutting off his or her blood supply — is one example.
What happens during a vaginal birth with twins?
Every labor and delivery experience is unique — even for moms of singletons. So it's helpful to go in prepared for what you might expect — and be willing to be flexible. Your labor and delivery team will do what's best for you and your babies as things progress. Here are some ways your multiple-birth experience may differ:
- You'll probably deliver in a hospital operating room. Because labor and delivery for multiples tends to have a higher possibility of complications, your practitioner will likely recommend that you give birth in a hospital. It's better for you to be in a hospital where the staff and medical equipment are readily available and prepared to handle an emergency, such as a necessary C-section, should one arise. While you may be able to labor in a comfy birthing room, you'll likely be transferred into an operating room when it's time to push.
- You'll be watched more closely. A soon-to-be singleton mom usually has one fetal monitor strapped to her abdomen or inserted internally. But if you're having multiples, you should expect to have two (or more) fetal monitors. These will help your practitioner keep a close eye on how each baby is responding to your contractions. Early on, the babies' heartbeats may be monitored with external monitoring, which means you'll have a little more freedom to move around. In the later stages of labor, the first baby may be monitored internally while the second baby is still monitored externally. This will make it harder for you to move about, because you will be connected to a machine, but it's worth it to make sure everything is moving along safely.
- Labor could be shorter. Will you have to wait double the time to end up with double the cuddles? Not necessarily. Labor is often shorter with multiples. If you're delivering vaginally, that means you'll get to work on the pushing part faster.
- It could also be longer. With a baby duo growing within, sometimes the uterus can become stretched to a point where it might weaken mom's contractions. If that happens, it might take longer to become fully dilated, which could prolong labor.
- You'll probably have an epidural. Some hospitals or practitioners strongly encourage — or even require — an epidural when delivering multiples. The epidural is for a good reason: It makes things easier (and safer) should you need to have an emergency C-section to deliver one or all of your babies. If you'd like to avoid an epidural, talk to your practitioner ahead of time.
- The room will be crowded. This is good news. In addition to your obstetrician or midwife, and the delivery team, each baby will have their own team of pediatricians and pediatric nurses to care for them after their arrival.
- Once the first baby arrives, the second one is often not far behind. Provided everything is going smoothly, the second twin in a vaginal delivery usually comes within 10 to 30 minutes of the first. In fact, most moms of multiples report that delivering number two is a snap once they've welcomed number one.
However it ends up playing out — whether your new arrivals come vaginally or by C-section — you'll soon arrive at the best part: peering into those adorable little faces.
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