Giving birth to twins

Do I have to go to the hospital for my twin birth?

Almost all women who expect twins or multiple births give birth in a hospital (Tamba 2009). It is not impossible to have twins in a birthing center or at home, but most doctors recommend having a birth in the hospital.

The reason is that there are some risks in the birth of twins or multiples (NCCWCH 2008: 11, 254, NHS 2010, RCOG 2006). After four out of ten twin births, one baby or even both must be treated in the intensive care unit (Tamba, 2012).

If labor does not start spontaneously by the 38th week, it is better to start the birth of their twins at this time. After that, the placenta often does not work as well and the risk of stillbirth increases.

Childbirth can either be initiated or followed by a planned caesarean section (NCCWCH 2011b: 173, NICE 2011, RCOG 2006, Tamba 2009). These measures can not be performed at home or by midwives in a birthing center, so you need to have your children born in a hospital.

Of course, the ultimate decision is yours. If you are considering a home birth or birthing center, you should talk to your midwife. Or make an appointment with the head of the obstetric department in your hospital.

Even if you decide to have a birth in the hospital, there are ways to make your room comfortable.

Do I have to have a cesarean section?

Not necessarily, but the odds of having a caesarean section are higher than if you were pregnant with just one baby. More than half of all twins are born by caesarean section, which means that four out of ten twins are not born by caesarean section (NCCWCH 2011a: 73).

In some hospitals, physicians make it a rule to give birth to identical twins who divide a placenta (monochorionic twins) by caesarean section because the risk of complications is higher (NHS 2010, RCOG 2008: 7). But if both twins thrive well and there are no other concerns, a vaginal birth is possible.

If your twins share a placenta, you should talk to your doctor about your individual circumstances during pregnancy. Then you can decide together how best your babies should be born (MBF 2010, RCOG 2008: 7).

It usually depends on the location of your first twin, whether you need a caesarean section or not (NCCWCH 2011a: 73).If the first twin is in a head position, a vaginal birth is possible. (NCCWCH 2011a: 3).

Many doctors and midwives attempt to deliver the second baby vaginally, even if it is in breech. In about five percent of all cases it is necessary to get the second twin by caesarean section (NHS 2010, Tamba 2009).

You will also be advised to have a planned caesarean section if:

  • One or both of your babies are much smaller than usual at the time of pregnancy.
  • The placenta covers the entrance to your cervix (placenta praevia) (NCCWCH 2011a: 74).

You may already be in labor and may end up with an unplanned caesarean section if:

  • There are complications during labor.
  • One or both babies suffer from fetal distress.
  • You have hypertension that does not respond to treatment.
  • you have preeclampsia (pregnancy poisoning) (NHS 2010).
  • The umbilical cord has settled in the birth canal in front of your baby (prolapse) (NHS 2010).

What else can influence what kind of birth I will have?

On the one hand your place of residence and on the other hand the treatment policy of your hospital. Both can play a role when it comes to deciding for or against a caesarean section. And your doctor may also be a factor in the decision-making process.

Talk to your doctor and midwife about your situation in the medical sense and what your own ideas are. Ask if the doctors at your birth hospital have any experience giving birth to twins with a vaginal delivery and what the hospital's twin birth guidelines are.

Will I have contractions twice?

No. Here the birth of twins is very similar to that of a single child. Even if you give birth to two babies, you will only have to go through the first phase of labor when the cervix slowly opens.

Since giving birth to twins is riskier, it will often involve medical intervention. And since you give birth to two babies, there should also be two midwives with you. To do so, a GP should always be available if his / her intervention is needed (NHS 2011).

What happens during a twin birth?

Most twins are born before the 38th week. If you have not had a labor contract by then, it may be that you are advised to have your contractions started (Tamba 2009).

During labor, it's common practice to electronically monitor your twins (CTG) (NHS 2011). This will measure your baby's heartbeat and the strength and frequency of your labor (Tamba 2009). Mostly, the doctor will give you an intravenous access if needed later (NHS 2011).

The doctors will offer you painkillers, eg. B. pethidine or meptide (trade name). You may also be given epidural anesthesia because it can be intensified if you need obstetrics or a cesarean section. (NHS 2010).

You can discuss your painkiller priorities with your midwife during pregnancy and include them in your birth plan (Tamba 2009). Nevertheless, contractions and birth naturally remain unpredictable. Your midwife may need to recommend something at a certain time that is not what you originally wanted. It will always be in the interest of your and your baby's health.

When your first baby is born, your midwife or doctor will check the location of your second baby. This is done by palpating your abdomen, a vaginal exam, or an ultrasound (NHS 2011).

When your second baby is in the right position, his amniotic sac is bursting. If the labor pains stop after the first baby, you will be given hormones in the drip to restart (NHS 2011).

Usually you will be recommended an afterbirth. This means that the placenta is released by hormone injection instead of waiting for a natural birth. The reason for this is that there is an increased risk of bleeding if the placenta is larger and the uterus has been stretched by two babies (NCCWCH 2008: 31, Tamba 2009).

How can I avoid a Caesarean section?

Try to stay healthy during pregnancy, eat healthy and try to stay active during labor. Staying mobile increases your chances of avoiding a caesarean section.

Of course, this can be difficult with a twin birth if your babies are constantly monitored at the same time. Some hospitals have mobile monitoring equipment that you can carry while you walk around.

Towards the end of your pregnancy, you can try to encourage your babies to a head position (optimal fetal positioning). This gives your babies the maximum space to turn, if necessary (Sutton and Scott 1995). It's not 100% proven to work, but worth a try.

A birth partner can help you, in addition to anything the midwives do, during labor. You will need good, solid support when your contractions start. Ask your partner, friend, relative, or doula to take on this role for you (NCCWCH 2011a: 5, 14, 106).


HFEA. 2011. Improving outcomes for fertility patients: multiple births. A statistical report . Human Fertilization and Embyrology Authority.

MBF. 2010. Monochorionic twins. Information for parents when twins share one placenta .London: The Multiple Birth Foundation.

NCCWCH. 2008. Intrapartum care . NICE clinical guideline. National collaborating center for women's and children's health.

NCCWCH. 2011a. Caesarean section . NICE clinical guideline. National collaborating center for women's and children's health.

NCCWCH. 2011b. Multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period . NICE clinical guideline.

NICE. 2011. Antenatal care for women who are pregnant with twins or triplets: understanding NICE guidance.

NHS Choices. 2010. Birth options: twins and triplets . NHS Choices, Live well.

NHS Choices. 2011. Multiple births: the pregnancy care planner .

RCOG. 2008. Management of monochorionic twin pregnancy . Green top guideline no 51. Royal College of Obstetricians and Gynecologists.

Sutton J and Scott P. 1995. Understanding and Teaching Optimal Fetal Positioning . Tauranga, New Zealand: Birth Concepts

Tamba. 2009. The healthy multiple pregnancy guide. Guildford: Tamba

Tamba. 2012. Tamba twins and multiple healthcare survey . Guildford: Twins and multiple births association

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