Do Multiples Equal Cesarean?

A Guide to Vaginal Twin Births

By Neilia Sherman

Once a woman gets over the shock of being told that she is pregnant with twins, her first question will likely be, "Will I still be able to have a normal vaginal delivery?"

Although there is a good possibility of having a vaginal birth with twins, the risk that a twin pregnancy will end in a Cesarean section is higher than with a singleton gestation, according to Dr. Washington Hill, who is the director of maternal-fetal medicine at Sarasota Memorial Hospital in Florida.

"The odds of having a C-section are going to depend on the presentation [of the baby]," says Dr. Hill. "It can also depend on whether or not any complications occur during the pregnancy, such as a significant discrepancy in the growth of the twins. The odds that a twin pregnancy will end up in a C-section would be about one-third."

The issue of presentation has to do with how the babies are positioned in the uterus. The majority of singleton pregnancies end with the baby in the head down or vertex position. Twins can be positioned in many combinations, such as both head down, one head down and one breech (feet or bottom first) or even both breech. In the both breech case, a C-section is usually necessary, whereas when one or both twins are vertex, a vaginal birth is possible. In either case, the method of delivery will largely depend on the policy of the hospital, the expertise of the doctors and the wishes of the mother.

Cynthia Mathews of Roanoke Rapids, N.C., made the decision that she wanted to try for a vaginal birth soon after finding out that she was pregnant with twins. She discussed her wishes with her doctor. "My doctor gave me all the possibilities, as well as reassurance, within my first trimester..." she says. "My doctor wanted what made me happy. My doctor also knew that I didn't want stitches in two different places, if I could help it."

It's Complicated

Want to see more?

• Pregnancy & Birth Statistics: Cesarean Section Delivery
• Just in Case: Making a Plan for Cesarean Birth
• Keep Those Babies in There: Avoiding Premature Delivery With Twins
• I Wish Someone Had Told Me What I Needed to Know About Bed Rest
• Talk about it!