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 last beyond 37 weeks, and only 1.5% of triplet pregnancies go beyond this stage. The average length of the pregnancy for triplets is 34 weeks.
Be prepared for your babies to spend some time in special care. Just under half of all mothers of twins saw at least one of their babies spend time in neonatal care, while over 90% of triplets require neonatal care.
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 because there's a higher chance of complications with a twin birth.
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 the babies will be closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once your waters have broken. You will be given a drip in case it is needed later.
Triplets or more babies are almost always delivered by elective caesarean section.
Almost half 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 when the mother already has good pain relief.
You can find out more about the signs and stages of labour. The Twins & Multiple Births Association (Tamba) publishes a Healthy Multiple Pregnancy Guide. The guide is available free on 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 would not be possible, which are listed below. 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 is born, the midwife or doctor will check the position of the second by feeling your tummy and doing a vaginal examination. If the second baby is in a good position, the waters will be broken and this baby should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.
Triplets or more babies are almost always delivered by elective caesarean section. If you’re expecting twins or multiple babies, you might like to contact the Twins & Multiple Births Association (Tamba) for advice and support.
Many mothers think that you have to have a caesarean section with twins. It's true that, in the UK, more than half of twins and almost all triplets are delivered in this way. 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.
The 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 if you have placenta praevia (a low-lying placenta) or if your twins share a placenta (monochorionic). You can find out more about what problems can occur with the placenta.
If you have 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, the cord prolapses (when the cord falls into the birth canal ahead of the baby), you have high blood pressure, the labour is progressing slowly or assisted delivery doesn’t work. 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 if the baby becomes distressed. This occurs in less than 5% of twin births.
Examining the placenta
After the birth, your midwife will examine the placenta to check that it has been delivered complete and to examine the membranes around the placenta. If the 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. If the babies are both, the only way to determine if they're identical is through DNA testing.
If your babies are premature
Jane Hawdon, a consultant neonatologist at University College Hospital London, outlines some of the things you should consider in case your babies are born early:
- You may need to move your care to another hospital with appropriate facilities if complications in your pregnancy indicate an early delivery: this may not be near to home if you want to ensure there are enough beds for both your babies in the neonatal unit.
- Ask if your chosen hospital has a transitional care unit: these units allow mothers to care for their babies if they do not need intensive care. Hospitals with transitional units are more likely to be able to keep you and your babies in the same place.
- Check if your hospital has cots that allow co-bedding (where your babies sleep in a single cot), if this is appropriate and how you want your babies to sleep.
- If you have one baby in the hospital and one at home, you will need to think about splitting your time between the two: when you visit your baby in hospital, ask if you can bring their twin and if co-bedding is allowed during visits.
- If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is having trouble feeding. You may then need to put the twin who can feed on the breast to encourage milk production in order to get enough milk to feed both babies (you can find out more about feeding multiple babies).
- Check if your hospital offers support from a community neonatal nurse, which would enable early discharge, for example if your baby is still tube fed.
- When you go to clinics for follow-up appointments, ask not to be booked into early morning appointments: getting out of the house with two babies, particularly if one is unwell, can be very difficult.
You can find out more about getting out and about with twins.