Multiple births

If you are expecting more than one baby, this article will help you understand your birth options, including planning for vaginal or caesarean birth.

This article covers the following topics:

Vaginal delivery of more than one baby

Caesarean section for multiple births

Special care

Further information

It is  is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting more than one baby you will need to consider your options early.

Vaginal delivery of more than one baby

People often assume that if you are expecting more than one baby they must be born by caesarean section. In fact, almost half of all twins are born vaginally and the process is similar to that of giving birth to a single baby. 

If the first baby is in a head down position, it's usual to consider having a vaginal birth. However, there may be other medical reasons why this would not be possible. For example, if you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

If planning a vaginal delivery, it is usually recommended that the mother has an epidural for pain relief. This is because if assistance with delivery is needed, it's easier and quicker when the mother already has an epidural in place.

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.

Caesarean section for multiple births

If you are expecting more than one baby, you may choose to have an elective caesarean section from the outset of your pregnancy. Alternatively, your doctor may recommend a planned caesarean section later in the pregnancy as a result of potential complications. 

Your babies’ positions may determine whether they should be delivered by caesarean section. If the presenting (first) 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 other conditions might 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.

If you have previously had a very difficult delivery with a single baby, you may also 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,
  • an assisted delivery doesn’t work.

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.

Special care

As multiple pregnancies are generally less likely to carry to full term, parents expecting more than one baby should be prepared for the possibility that their babies may come early and spend some time in a neonatal intensive care unit. These can sometimes be quite upsetting places to begin with, and parents can think their babies look small and vulnerable amongst all the technology. It may be a good idea to try to visit the neonatal intensive care unit on a hospital tour during your pregnancy to prepare yourself for the possibility that your babies may spend some time here.

Although the thought of having premature babies may be worrying, studies have shown that premature multiples mature more quickly than single babies born at a similar time and multiples are often better equipped for early starts. Some premature babies may only need a short stay with little medical treatment.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses  which are a great way to find out more about birth, labour and life with a new baby.

The Twins & Multiple Births Association (Tamba) provides support and information to parents expecting twins, triplets or more babies. They publish a Healthy Multiple Pregnancy Guide, which is available free on Tamba’s website if you register.

NHS choices also provide information on delivering twins.