Birthing Twins: Natural vs. C-section

You may already know that twins are more likely to be born through C-section than single births for a variety of reasons. If you’re lucky enough to have two buns in the oven, you might have given your method of delivery a bit more thought than the average mom-to-be!

To help you out, we’ve compiled a few reasons why you might want to have a natural birth versus a C-section when you’re expecting twins!

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15 Natural: Head-down

If both of your babies are head-down, you’re in luck! This is a position that is usually favorable for a normal vaginal delivery, unless there are other concerns. The head-down position is easiest regardless of the type of pregnancy, as the head has the largest area in relation to the birth canal in babies. Getting the head out first makes the rest of the process faster, with less risk for other complications.

If, however, one or more of your babies are not head-down, don’t worry. Sometimes your babies may still change position late in pregnancy. You might want to consult your doctor of midwife to see if external cephalic version, or manually rotating one or more babies, is possible.

14 Depends: One is Breech

If, however, at least one of your babies is in a breech position, it may depend on how confident your doctor is that she can deliver both of them safely. If the twin that is closer to your birth canal, probably the one that will be born first, is head-first, your doctor will usually say go to a vaginal delivery.

However, if the twin that is in breech is the one closer to your birth canal, you will have a slightly higher chance of giving birth by C-section. This is because there is a risk that in the process of giving birth, the babies’ chins will interlock, a situation which will require an emergency C-section. Do note that it is still possible to deliver both babies normally in this case, but you may have to talk to your doctor about it.

13 C-Section: Both Breech or Transverse

Don’t get us wrong: it’s still possible to give birth vaginally to two babies that are in breech position. However, in this situation the risk for complications such as umbilical cord prolapse and head entrapment rises. Some doctors will opt not to take that risk. This is especially if you’re giving birth earlier than usual, as can be the case with multiple pregnancies.

If, however, one or both of your babies are in a transverse lie at the time of childbirth, you are far more likely to need a C-section.

12 Natural: Uncomplicated Pregnancy

If you’re having an uncomplicated pregnancy, other than the fact that you’re having twins, you have a far greater chance of having a natural delivery. Studies find that, if you’re perfectly healthy and your babies are of normal weight, giving birth vaginally can be just as safe as a C-section birth. This is especially if the babies’ positions are favorable to a vaginal birth.

11 C-Section: High-Risk

If, however, you have other conditions such as preeclampsia or gestational diabetes, you may have a greater chance of needing a C-section. This is because having a health condition increases your risk for childbirth complications such as hemorrhage. Giving birth to twins has its own risks as well. When all those risks add up, it just might not be safe to give birth vaginally. Again, this will depend on your specific condition and situation, so do check with your doctor or midwife on this.

10 Natural: Doc is Confident

While doctors in general have a reputation for getting scalpel-happy, there are plenty who advocate for vaginal births unless it’s absolutely medically necessary to get a C-section.

If your own doctor is 100% confident that you can give birth vaginally, then consider yourself lucky and go for it. Note that despite this, she will still want you to give birth within the vicinity of an operating room, just in case unexpected complications arise.

9 Depends: Doc Says No

If your doctor says no to a normal birth, ask why. If there is a clear medical reason for this, then you might want to go with a C-section. Do note, however, that just because one doctor says no it doesn’t necessarily mean that you absolutely can’t get a natural delivery.

In some cases, this may just be because the doctor or hospital may not be well-equipped to perform vaginal deliveries for your specific case of multiple birth. This may, perhaps, be because there aren’t a lot of those cases in your area and so they might want to cut back on the risks. If you suspect this is so, check with another doctor or facility where your odds might be better.

8 Natural: Babies Have Separate Placenta

If your twins have separate placentas, you have a better chance of having a complication-free natural birth. All fraternal, or non-identical, twins will have separate placentas, while only up to a third of identical twins will. This is because giving birth to one twin is not likely to affect the blood supply of the other.

You and your doctor will be able to see whether the pair share a placenta or not in your prenatal checkups, so you will likely be prepared in advance for this situation.

7 Depends: Babies Share a Placenta

If your babies share a placenta, it is more likely that you will have to get a C-section. This is because there is a higher risk that the placenta will abrupt before the second twin is born. Your doctor may have to assess the likelihood of this situation from a scan.

One other problem with sharing a placenta is that the distribution of nutrients between the two of them may be unequal. In some cases, this may result in one baby being undernourished, which could pose many problems that we’ll discuss later.

6 C-Section: Cord Problems

If there are any problems with your one or both of your babies’ umbilical cords, your doctor may want to schedule a C-section as early as possible. This may include tears or an underdeveloped umbilical cord, or there may be an increased risk for cord compression.

This is because, as you may already know, the umbilical cord is the channel in which nutrients and oxygen get to your baby. When there are problems with the umbilical cord, the risk for one or both babies suffocating in the womb rises as the babies grow in size. In this case, your doctor may want to schedule surgery at 36 or 37 weeks.

5 C-Section: Placental Problems

Problems with one or both placentas are also a reason to get a C-section. The placenta, after all, supplies the umbilical cord with oxygen and the nutrients that your baby needs.

One major risk if that one or both placentas are implanted too low in your uterus. This increases the risk that when you give birth, the placenta presents in your birth canal first, blocking the babies’ exit. This can also cut off your babies’ blood supply, making it riskier to deliver vaginally.

4 Natural: Babies Same Size

In some cases, one twin may be bigger than the other. However, if you’re fortunate enough to have babies of the same size, which you will be able to see in your ultrasound, you have a better chance of having a natural childbirth. This is because this means that both your young ones have an equal share of nutrients and are therefore both perfectly healthy.

3 C-Section: One Baby Smaller

If one baby is smaller, however, your babies may have an unequal share of nutrients and oxygen. Giving birth to the bigger, healthier baby will usually be no problem in this case. However, a vaginal birth may be riskier for the smaller baby, who might not have the opportunity to develop his vital functions yet. This is especially if the baby is underweight relative to his gestational age. In this case, a C-section may be necessary to ensure that both babies have a good chance of survival.

2 Weigh Your Options

When you’re a mom-to-be faced with the decision of giving birth to your twins vaginally or through C-section, we encourage you to think it through! Delivering twins may involve a higher risk for certain complications, depending on your specific situation. However, in some cases, it can be just as safe as delivering through C-section.

It's important for you to hear out both the pros and cons of each type of delivery and make the decision you feel is best for you and your babies. No one situation is the same, so don’t feel bad if you don’t make the one that you’re “expected” to.

1 Prepare for the Unplanned

Finally, no matter which option you choose, make sure that you’re prepared for the unplanned. If you opt for a natural delivery, for instance, something may turn up on the big day that may require you to have a C-section to ensure your babies’ survival. Your doctor will have likely prepared for this possibility in advance, so the transfer should be quick. In fact, in some cases one twin will be born vaginally and, if conditions are unconducive for the other twin to be born this way, the other will be born through C-section!

On the other hand, even if you’ve had your mind set on a C-section, something may also come up later that may get you to reconsider and give birth naturally. Again, everything really depends on your specific situation so it’s best to be prepared for either case!

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