Delivering twins or triplets by caesarean section - how can I prepare?

Caesarean birth with twins or triplets: what to expect

Caesarean section, or caesarean birth, is the most common way for twins, triplets or more to be born in the UK. Over half of twin pregnancies and almost all triplet and quadruplet pregnancies are delivered this way.

Even if you hope for a vaginal birth, it helps to understand caesarean birth too. That way, if plans change, you already know your options and can still share your preferences.

In a caesarean birth, your babies are born through a cut in your abdomen and womb. This may be planned in advance or decided during labour if it becomes the safest option for you and your babies.

Key decisions and what happens during a caesarean

Your team will look at several medical factors when recommending how your babies are born. These may include the position of each baby. If a baby is breech (bottom or feet down) or lying across your womb (transverse), vaginal birth may not be safe.

Sometimes a big size difference between your babies makes a caesarean safer. This can be especially important if one or more babies may need treatment in the neonatal unit after birth. You may also be advised to have a caesarean if you have placenta previa, where the placenta covers the cervix.

Your own health matters too. Conditions such as gestational diabetes, pre-eclampsia or other complications can make surgery the safest choice. Complications for your babies, such as Twin-to-Twin Transfusion Syndrome (TTTS), growth restriction or signs of distress, can also lead your team to recommend a caesarean.

If labour is progressing very slowly and your babies start to show distress, doctors may first try an assisted vaginal birth. If that is not possible or safe, this can become an emergency caesarean. In a small number of twin births, the first baby is born vaginally and the second needs to be born by emergency caesarean. This happens in fewer than 5% of twin births.

You will usually have a spinal or epidural anaesthetic so you are awake but numb from the waist down. In theatre you are likely to have one or two midwives caring for you, an anaesthetist, a doctor or surgeon performing the operation and a neonatal team for each baby. Student doctors or nurses may be present, but you can say if you would rather they were not in the room.

As long as your babies are stable, you should be able to have early skin-to-skin contact in theatre or soon after in recovery. If they need extra help, they may be taken quickly to the Neonatal Intensive Care Unit (NICU) and your partner or birth companion may be able to go with them. LINK to how to prepare for nicu article

Planning your caesarean and early days at home

Planning ahead gives you more control over a situation that can feel very medical and busy. You can talk with your team about your caesarean birth preferences, including how you meet your babies and what helps you feel calm.

You may find it helpful to:

• Line up support for driving, lifting and cleaning so you can focus on recovery
• Pack your hospital bag (LINK - INF-14) early and include peppermint capsules to ease trapped wind after surgery
• Choose a supportive feeding pillow to reduce pressure on your abdomen while feeding your babies
• Set up a safe space so you can change and dress your babies at waist height rather than on the floor
• Plan any music or specific requests for surgery and discuss them with your doctor before the day
• Arrange a check-up with your midwife or GP to review your scar around four to six weeks after birth
• Pack plenty of maternity pads to manage bleeding in the weeks after your caesarean

After surgery you will usually stay in hospital for a few days. Staff will monitor your recovery and support you with feeding and bonding, whether your babies are with you on the ward or being cared for in the neonatal unit.

It is normal to feel pain and tenderness in your abdomen, alongside tiredness. Regular pain relief such as paracetamol, taken as advised, and gentle movement can reduce the risk of blood clots and help your recovery. Some people are given blood-thinning injections for a few weeks; you will be shown how to use these before you go home if they are needed.

You will have bleeding, which can last up to six weeks. If the bleeding stays very heavy after the first few days, contact your midwife so they can check there is no other cause.

At home, you will usually be advised not to lift anything heavier than your babies for the first four to six weeks. Try to avoid driving or going up and down stairs repeatedly in the first month. Feeding can feel uncomfortable at first, so use pillows and positions that keep your babies’ weight off your scar.

Ongoing recovery checks

Scar care is an important part of looking after yourself. You will usually go home with a dressing over your wound and be advised when to remove it and how to keep the area clean and dry. Check your scar daily for signs of infection, such as redness, swelling, heat or discharge, and speak to your midwife or GP if you are worried.

Before you leave hospital, a midwife or physiotherapist may talk you through gentle exercises that support your pelvic floor and abdominal muscles, and what movements to avoid. Around six to eight weeks after birth you should be offered a check with your midwife or GP to review your scar, bleeding and general recovery. Some people are offered a postnatal physiotherapy appointment, especially after a more complicated birth. If this is not mentioned but you would find it helpful, you can ask for a referral.

You do not have to navigate this alone. If you are a first-time parent, or your twins are joining an existing family, our Preparing for Twins / Preparing for Triplets courses (LINK) are a one-stop shop for information about multiple pregnancy, birth and the early days. It is designed to help you feel confident, informed and supported as you prepare for life with multiples.