New Medical Research Answers: C-Section or Vaginal Delivery for Twins?

Joe Rawlinson by Joe Rawlinson - April 25, 2017

Today, we have some interesting research that has come out recently about whether you should plan to have a cesarean section delivery of your twins or if you should plan for a vaginal birth of your twins. Now, this research was recently published in the New England Journal of Medicine. The background of this research was that many twin births are associated with a higher risk of problems just before and after birth than a singleton birth.

Delivery Room

Now, we’ve talked about this before. Twin pregnancies often have many more complications than a regular singleton birth, and so the research was asking and stating it is unclear whether a planned cesarean section results in a lower risk of problems than planned vaginal delivery in a twin pregnancy. So, the article was very interesting in that they randomly assigned groups of women who were pregnant with twins between 32 weeks and 38 weeks of gestation with their twin pregnancy. They told one group to plan for birth by cesarean section and told the other group to plan to have a vaginal delivery.

They tracked these moms through to delivery of their twins. What’s interesting to know is that almost 91 percent of those who had planned for cesarean delivery actually delivered their twins via cesarean section.

Almost 44 percent of those who had planned vaginal delivery ended up delivering their babies via cesarean. So, these numbers are very interesting. Pretty much, if you are scheduled for a cesarean section, odds are you’re going to have your twins via a cesarean section. Now, if you’re planning to have a vaginal delivery of your twins, it’s less likely that you’re going to have to deliver them via cesarean section.

Now, as we’ve talked about in the past, it could be for numerous different reasons or complications that your doctor decides it is necessary to deliver your twins via cesarean instead of vaginally. Now what they found in the research that between those deliveries via cesarean and those who are delivering vaginally, they found no significant difference as far as babies who died or babies who had complications at birth or even effects to mother. Their conclusion was that for a twin pregnancy between those weeks of 32 weeks and 38 weeks, if the first twin is head down in the pelvis and ready to be born, then a planned cesarean did not significantly decrease or increase the risk of death.

The bottom line is that if you’re considering how you want your twins to arrive in the world, often times your doctor or your hospital may even have a policy that twins need to be delivered via cesarean sections. Now this research throws into question that longstanding idea that your twins have to be born via cesarean and that there’s really no other option. So, if you want to have your twins via cesarean, that’s great. It’ll most likely work out for you. Or, if you want to have a vaginal delivery of your twins, that’s great.

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Our girls were born via cesarean section and that was a conscious choice that we made well in advance of their arrival. Both of our previous sons had been born via c-section and so we decided to go that route as well with our girls. Now, if you want to have a vaginal delivery of twins, as we’ve talked about before, there are more risks associated with that and you might not always get that outcome. As the research indicated, 44 percent of those pregnancies that were planned to be a vaginal ended up a cesarean delivery of the twins. So talk it over with your doctor. If your doctor is insistent that you have to have a cesarean, this research would indicate that hey, you can look somewhere else. You can go and talk to other doctors to see who would be more aligned with how you want to have your babies.

That being said, even if you find a doctor and a facility that says, “Okay, yeah. You can try for a vaginal delivery.” You have to keep your mind open to the possibility that the twins will not be able to be born that way. The research was very specific in saying that there’s no difference between the complications from cesarean and vaginal delivery if the first twin is head down and ready to be born.

Now, if your twins are sideways or your twins are breech then things can be more complicated and the risks are greatly increased, and I couldn’t find anything in the research to contradict the need to then have a cesarean section. It’s very interesting if your into the details of medical research. It’s a pretty thick read. It is in a medical journal. Nevertheless, it does give you some more options when you’re expecting your twins.

Picture by George Ruiz

This question was originally addressed on the Dad’s Guide to Twins Podcast Episode 48: Research on Cesarean Section vs. Vaginal Delivery + Getting Twins To Sleep By Themselves.

Further Reading

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2 thoughts on “New Medical Research Answers: C-Section or Vaginal Delivery for Twins?”

  1. I saw this study when it came out and it was great to see. We had been wrestling with this and are expecting our twins any day now (my money’s on today!).

    The element that truly stuck out for me in this study is a hint that doctors may not have the same level of experience delivering twins, or singletons, vaginally as doctors did, say, 30 years ago. That level of conversation isn’t often comfortable for doctors, but it was important for us in our decision-making.

    • @Dave – I hope that research like this that the public knows about will help facilitate good conversations between patients and doctors. By taking the emotion out of the decision and relying on some research, it helps make it easier to discuss the reality of things.


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