Delivery of Twins and Multiple Babies

Twin babies in diapersTwin babies in diapers

Twins and multiple babies are associated with a higher risk of childbirth complications, as well as premature birth. About half of all twins deliver at 36 weeks or less. Half of triplets deliver before 32 weeks.

Many mothers of twins and multiple babies go into premature labour spontaneously. Others may need to have premature labour induced because of fetal growth restriction, hypertension in the mother, or placental abruption, where the placenta pulls away from the walls of the uterus.

When a woman carrying a multiple pregnancy goes into labour, a number of precautions should be taken:

  • The labour should be carried out at a hospital under the care of an obstetrician.
  • A trained obstetric attendant should remain with the mother throughout labour.
  • The babies should be monitored throughout labour.
  • An anaesthetist should be immediately available in case a caesarean section is needed.
  • Each baby requires its own specialist who is skilled in the resuscitation and care of newborns.

The first twin bears the brunt of dilating the cervix and birth canal. If the twin is in the normal head-down position, there is usually no problem with its delivery. If, on the other hand, the first twin is breech, there may be major problems with vaginal delivery, and a caesarean section may be required.

The second twin usually comes out within 15 minutes after the first. If the first twin was born vaginally and the second twin is positioned head down, it can usually be born vaginally. Sometimes the doctor may need to turn the baby within the womb, to make its position more favourable for birth. A caesarean section may be required in some cases.

In very rare cases where the first twin was born prematurely, contractions can stop altogether and the second twin may be born days or weeks later.

In the case of triplets, the first baby to be born usually comes out vaginally, without complications. The next two babies, however, may need complex obstetrical maneuvers or caesarean section to be delivered safely and many obstetricians recommend caesarean section for all triplets. When the mother is carrying four or more babies, a caesarean section is recommended.

Nicolette Caccia, MEd, MD, FRCSC
Rory Windrim, MB, MSc, FRCSC