Pregnancy Guide
NHS Choices

Giving Birth to Twins

It's important to understand your birth options if you are expecting more than one baby.

Twins and triplets are more likely to be born early and need special care after birth than single babies.

Birth choices with twins

It's a good idea to discuss your birth options with your midwife or consultant early in your pregnancy. You'll probably be advised to give birth in a hospital as there's a higher chance of complications with twins.

There are usually more health professionals at a multiple birth, for example there may be a midwife, an obstetrician and two paediatricians – one for each baby. For more information on who's who, read about the antenatal team.

The process of labour is the same, but the babies will be closely monitored. To do this, an electronic monitor will usually be strapped to your bump. A scalp clip may be fitted to the first baby once your waters have broken. This won't harm them or hurt them in any way.

You will be given a drip in case it is needed later - for example, to restart contractions after the first baby is born.

Triplets or more babies are almost always delivered by a planned caesaraen section.

Can you have a natural birth with twins

Lots of women think they have to have a caesarean section with twins.  In fact, more than 40% of all twins are born vaginally and the process is similar to that of a single baby.

If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief. This is because, if there are problems, it's easier for your antenatal team to deliver your babies quickly if you've already had an epidural.

You can find out more about the signs and symptoms of labour.

If the first twin is in a head down position (cephalic), it's usual to consider having a vaginal birth.

However, there may be other medical reasons why this would not be possible. If you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

If you have a vaginal birth, you may need an assisted birth, when a suction cup (ventouse) or forceps are used to help deliver the baby.

Once the first baby has been born, the midwife or doctor will check the position of the second by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.

If the second baby is in a good position. it should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, you may be given via a drip to restart them.

Caesarean section

In the UK, more than half of twins and almost all triplets are delived by caesarean. You may choose to have a planned caesarean, or your doctor may recommend a caesarean for medical reasons.

If the first baby is in a breech position (feet, knees or buttocks first) or if one twin is lying in a transverse position (with it's body lying sideways), you will have to have a caesarean section.

There are other conditions that make it more likely that you will need a caesarean section. For example, you may need one if you have placenta praevia (a low-lying placenta) or if your twins share a placenta (monochorionic).

If you have previously had a difficult delivery with a single baby, you may be advised to have a caesarean section with twins. As with any pregnancy, if you plan a vaginal birth, you may still end up having an emergency caesarean. This could be because the babies become distressed or the cord prolapses (when the cord falls into the birth canal ahead of the baby).

The RCOG (Royal College of Obstetricians and Gynaecologists) has more information on umbilical cord prolapse in late pregnancy.

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin. This happens in less than 5% of twin births.

Finding out if your twins are identical

After the birth, your midwife will examine the placenta to check that it's all there and look at the membranes. If the babies have a single placenta with one outer membrane (chorion) and two inner membranes (amnion), they must be identical (monozygotic).

Otherwise, the only way to tell if they're identical is through DNA testing. This isn't available on the NHS.

For advice on how to find out if your twins are identical, you can phone the Multiple Births Foudnation on 020 3313 3519 or email them at mbf@imperial.nhs.uk.


Last Updated: 08/11/2017 13:21:39