How Safe Is A Vaginal Birth For Twins?

Beth’s sister is pregnant with twins and wants a vaginal birth.  Beth says, “It seems like an uphill battle” because she has to labor in an operating room and have an epidural right from the start of labor.  Beth wants to know if delivering twins is riskier than delivering a single baby, if twins are more fragile and if all this OR the epidural business is really necessary. 

Kudos to your sister, Beth.  I’m always glad to hear when a woman takes control of her own birth experience or at least as much control as she can, given the circumstances.  The circumstances make all the difference.  If mom is healthy, babies are near term, big enough (but not too big), positioned well and there are no other complications, then a vaginal birth is probably quite safe.  If mom has health problems, the babies are premature, too small or large, in breech or transverse positions or there are other problems, then a vaginal birth might not be a safe risk and c-section might be the better choice. 

Let’s break the questions down:

Is a vaginal birth for twins riskier than a vaginal birth for a single baby?  Not necessarily.  It depends on the position of the babies.  If both twins are in a vertex position (head down), then the risks are about the same as for single babies.  There’s a small amount of increased risk for prolapsed cord (where the umbilical cord slips through the cervix in front of the baby, potentially cutting off circulation), after delivery of Twin A (the one closest to the cervix), but it doesn’t happen very often.  When it does, it’s c-section time.

If Twin A is vertex, but Twin B is not; a vaginal birth might still be a safe option. After Twin A is born, the doctor will either turn Twin B to a vertex position, deliver her breech or, if necessary, deliver her by C-section (that vaginal-plus-c-section scenario only happens in about 4% of twin births).    

If Twin A is breech, however, there’s very little chance she’ll get her vaginal delivery.  Some doctors and midwives will deliver single breech babies vaginally, but not twins.  There are too many variables and things that might go wrong (they also might not and probably won’t go wrong) and most won’t take the chance. 

Is a vaginal birth for twins riskier than a c-section?  Not usually.  In fact, studies in Ireland and France (both have better infant mortality statistics than the US) indicates vaginal birth can be safe and successful and a planned c-section is not necessary if babies are older than 34 weeks, in good positions and there are no other complications. A vaginal birth is usually less risky than a c-section (as long as everybody’s healthy).