It's important to understand your birth options if you're expecting more than 1 baby.
Your birth choices with twins
It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.
You'll normally 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 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).
You'll already have met your obstetrician and midwives to discuss your baby's birth beforehand, so they will not all be strangers.
For more information on who's who, read about the antenatal team.
The process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.
This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.
Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.
You'll be offered a drip in case it's needed later – for example, to restart contractions after your first baby is born.
Triplets or more babies are almost always delivered by a planned caesarean 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 twin births are vaginal.
If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.
If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.
You're more likely to have a vaginal birth if the first twin is in a head-down position.
But there may be medical reasons why a vaginal birth is not recommended.
If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.
As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.
Once the first baby is born, your midwife or doctor can 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 your cervix is already fully dilated.
If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.
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 a planned caesarean, or your doctor may recommend a caesarean, if:
- the first baby is lying feet, knees or buttocks first (breech)
- 1 twin is lying sideways (transverse)
- you have a low-lying placenta
- your twins share a placenta
- you have had a difficult delivery with a single baby before
As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.
In very rare cases, some women deliver 1 twin vaginally and then need 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 your babies have a single placenta with 1 outer membrane (chorion) and 2 inner membranes (amnion), they must be identical (monozygotic).
Otherwise, the only way to tell if they're identical is through DNA testing. This is not available on the NHS.
For advice on how to find out if your twins are identical, you can phone the Multiple Births Foundation on 020 3313 3519 or email them at email@example.com.
Video: how can my twin or multiple births be managed?
In this video, a midwife explains what can happen when giving birth to more than 1 baby.
Media review due: 2 November 2022