Does A Twin Pregnancy Always Have To End In A C-Section Birth?

Does a twin pregnancy always have to end in a cesarean birth? Obstetrical Nurse Wanda Steele discusses the various factors to be considered when preparing for a multiple birth.
Wanda Steele, RNC

The question
I just found out I'm pregnant with twins! All my friends are saying I will probably have to have a c-section delivery. Is this always the case with twin births?

The expert answers
Congratulations, Christina -- what exciting news! There are several factors which will determine whether or not you will have a cesarean delivery. A twin pregnancy, just being a multiple pregnancy, puts you at an increased risk for many complications. The rate of delivery by cesarean section is increased markedly for a number of reasons. The method of delivery, even in a singleton pregnancy, is determined in part by the position of the baby. A baby that is in the vertex or head first position is in the optimal position for a vaginal delivery. The head of the baby is the largest part of the baby. The head being the first thing through the narrowest part of the pelvis reassures us that the rest of the baby will be deliverable through the pelvis. The head of the baby, even though it is the presenting part in the pelvis can be angled in many directions and this can directly affect the method of delivery.

When a baby is presenting in the occiput posterior position (facing up) this takes more room in the pelvis than a baby that is facing occiput anterior (facing down). The baby can be born in this position if there is enough room in the pelvis or it can turn to an anterior position as the head is descending into and through the pelvis. If the pelvis is not large enough and the baby will not turn, a cesarean delivery may be performed. Although they are also "head first" presentations, there are many other positions that could require a cesarean delivery. Face, hand, arm and shoulder presentations are a few examples.

Because of the possibility of complications, a breech (buttocks or feet first) presentation necessitates a cesarean delivery in most cases. A baby that is lying in the transverse (crosswise of the mother's abdomen) position is at risk for many complications, the least of which is prolapse of the cord and is another reason for cesarean section. All of these presentations and risks for cesarean delivery are equal for the first baby but in the instance of twins, the second baby is at higher risk for one of the complicating positions. Yes, there is always the possibility of delivering one infant vaginally and one by cesarean delivery.

Another factor that impacts the method of delivery is the gestation of the babies. Premature infants can be more prone to intracranial bleeding due to a long labor and delivery process. To reduce the risk of this complication for the babies, a cesarean may be the best delivery method. Twins are at higher risk for premature delivery than singletons.

An additional factor that can determine the method of delivery is a complication that is affecting the mother and putting the babies at risk. If the mother is experiencing preeclampsia (high blood pressure, protein in the urine, visual disturbances and/or headache) the stress of a labor and delivery situation may put the mother and ultimately, the babies, at risk. A cesarean may be performed to prevent any additional complications. Gestational diabetes, intrauterine growth retardation of one or both infants and placental insufficiency are a few of the complications that could lead to birth by cesarean delivery. Babies who are stressed by complications the mother is experiencing are less prone to tolerate a routine labor and delivery and more likely to exhibit signs of this distress and would be delivered by cesarean section.

Now for the good news: Caregivers have become increasingly proficient in handling the many complications involved in multiple births. This is by virtue of the fact that there are many more multiple births in this day and age. Caregivers have many more "tools" at their disposal these days than they used to, and can watch you and your babies throughout your pregnancy with a higher chance of a good outcome for you and the babies. A cesarean section, if necessary, is far from the worst thing in the world, especially if it allows you and your babies to avoid some of the other possible complications.

Take care of yourself and follow the advice of your caregivers. I wish the best for you and yours.

Wanda :)

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