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Pregnancy and baby

Giving birth to twins or more

How will my twin or multiple births be managed?

Media last reviewed: 20/03/2014

Next review due: 20/03/2017

Twins and triplets are more likely to be born early, so it's important to understand your birth options.

It's usual for twins and multiples to be delivered before 38 weeks. Fewer than half of all twin pregnancies go beyond 37 weeks, and hardly any triplet pregnancies go beyond this stage. About 75% of triplets are born before 35 weeks.

Be prepared for your babies to spend some time in special care. Just under half of all parents of multiples see at least one of their babies spend time in neonatal care. 

Birth choices with twins

As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or consultant early in your pregnancy. Also discuss where you would like to have the birth, although you'll be advised to give birth in a hospital as there's a higher chance of complications with twins.

More health professionals will usually be present at the 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 your babies will be closely monitored. To do this, an electronic monitor will be strapped to your bump and a scalp clip may be fitted on the first baby once your waters have broken. You will be given a drip in case it is needed later – for example, to restart contractions after your first baby is born.

Triplets or more babies are almost always delivered by elective caesarean section.

Vaginal birth and 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 and quicker to assist the delivery if you already have good pain relief.

Find out more about the signs and stages of labourTamba (the Twins & Multiple Births Association) also publishes a healthy multiple pregnancy guide. This is free from Tamba's website if you register first. 

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 isn't possible, which are listed below. If you have had a previous caesarean section, it's not usually recommended that you have a vaginal birth with twins.

If you have a vaginal birth, you may need an assisted birth. This is where a suction cup (ventouse) or forceps are used to help deliver your babies.

Once the first baby is born, your midwife or doctor will check the position of the second baby 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, hormones may be added to the drip to restart them.

If you're expecting twins or more, you might like to contact Tamba's free helpline on 0800 138 0509 for advice and support.

Caesarean section and twins

In the UK, more than half of twins and almost all triplets are delivered by caesarean. You may choose to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a caesarean section later in the pregnancy as a result of potential complications. 

Your babies' position may determine whether they should be delivered by caesarean section. If the presenting baby is in a breech position (feet, knees or buttocks first), or if one twin is lying in a transverse position (with its body lying sideways), you will have to have a caesarean section.

Some conditions also mean you will need a caesarean section. For example, this may be necessary if you have placenta praevia (a low-lying placenta) or if your twins share a placenta (monochorionic).

Find out more about what complications can affect the placenta.

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

The Royal College of Obstetricians and Gynaecologists (RCOG) 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 if the baby becomes distressed. This happens in less than 5% of twin births.

Checking the placenta after twin births

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

About one-third of all identical twins have two chorions and two amnions (DCDA) and either one fused placenta or two separate placentas, making them indistinguishable from non-identical (dizygotic) twins. In this case, the only way to tell if they're identical is through DNA testing. This isn't usually offered on the NHS, but is available through the Multiple Births Foundation for a fee.

Find out more about preparing for twins.

Page last reviewed: 09/06/2014

Next review due: 09/06/2016


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