Key takeaways
Many parents can have a vaginal birth with twins, depending on your babies' position, size and health
You’ll still need to give birth in hospital so any complications can be treated quickly
Some planned vaginal births end with a caesarean for the second baby if concerns arise
You can choose pain relief such as gas and air or an epidural during labour
When a vaginal birth with twins may be possible
If you’re expecting twins, triplets or more and hoping for a vaginal birth, talk with your midwife and doctor early.
These conversations often start in the second trimester, then continue as your pregnancy progresses and more information is available.
A vaginal birth is usually considered when your pregnancy has been straightforward, you’re over 32 weeks and your health is stable.
Your babies ideally need to be head down, similar in size and not lying breech or sideways.
Your team will also explain a small chance of needing surgery. Sometimes, after a vaginal birth for twin one, twin two still needs a caesarean.
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What happens during a vaginal twin birth
Because twin births carry higher risks, vaginal deliveries usually happen in a hospital delivery room or operating theatre. This keeps doctors, midwives and equipment close by if you or your babies need extra support.
Both babies’ heart rates are monitored using belts and sensors on your bump so staff can track heartbeats and contractions. If it’s difficult to pick up twin one’s heartbeat clearly, your team may suggest a scalp electrode for closer monitoring.
If labour slows or your babies show distress, an assisted birth with forceps or a ventouse may be recommended.
After twin one is born, staff check twin two’s position, sometimes with an ultrasound scan. Twin two is usually born within about thirty minutes, although this can vary.
Once both babies are here, you’ll deliver the placenta or placentas. You’ll usually be offered an injection, such as Syntocinon or Syntometrine, to help your uterus contract and reduce blood loss.
You’ll see more staff than at a singleton birth, each with a clear role in looking after you and your babies. This may include one or two midwives, an anaesthetist, an obstetrician and neonatal doctors and nurses for each baby. Student doctors or midwives may also be present, but you can ask for them to leave if you feel uncomfortable.
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Pain relief and birth choices with twins
If you’re planning a vaginal birth, you can usually choose from the same pain relief options offered in singleton labours. These might include gas and air, pethidine, an epidural or a spinal block.
Your team may recommend an epidural when you’re having twins, because there’s a higher chance of needing an assisted birth or caesarean. An epidural can also make it easier to manage discomfort if twin two needs turning before birth.
It can help to talk through pain relief early, so your preferences are recorded in your notes and birth plan. Remember that plans sometimes change during labour, and you’re always allowed to ask questions and revisit your choices.
Getting support as you plan your twins’ birth
Thinking through your options for a vaginal birth can feel overwhelming, but you don’t have to do it alone.
Our flagship Twins Trust pregnancy course - Preparing for Twins / Triplets (LINK) - brings together trusted information to help you prepare for life with twins from pregnancy onwards.
You might also find it helpful to use our Pregnancy Countdown Tool (LINK) for Premium Members to see which appointments and checks to expect each week.
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