Verified and reviewed by: Midwife Maria Midstam

The destination is close, although it may feel like a long journey ahead. If you are pregnant with twins, the birth is carefully planned with a doctor. Half of all twin births are by caesarean section, and the other half are vaginal births.

It may seem like an eternity away, but the end is approaching! The last trimester is here and at the end of this period you will finally meet your little babies. One consolation for those expecting twins is that you often don't go beyond week 38+0. But it's good to be aware that twins often choose to come out earlier than that, 50 % are born before week 37+0.

Planning for the birth of twins

During the last trimester, you will see a doctor who will plan your birth.
The decision on vaginal delivery or planned caesarean section depends on several factors:

• The twins position in the uterus
• If you are had a child earlier
• Results from ultrasound controls
• Children's how you feel before giving birth

About half of twin deliveries are vaginal and half by caesarean section.

Vaginal twin birth

If a vaginal birth is planned, the the opening phase similar to a normal childbirth.
At the birth center, a midwife and assistant nurse care for you in the beginning, and the babies monitored by CTG to check the heart rate.

When it is time for the first baby to be born, the delivery team is expanded. They are often present:

• Two midwives
• One to two obstetricians
• A pediatrician
• Two assistant nurses

After the first twin is born, the doctor or midwife will help guide the second baby into the correct position. The baby's position is often checked with ultrasound, and the uterus can rest for a while before labor starts again. If the second baby is not feeling well or if the labor is prolonged, the delivery can be terminated with suction bell, forceps or caesarean section.

Caesarean section for twin births

A caesarean section can be planned, acute or immediately depending on the situation.

Planned caesarean section

In the case of a planned caesarean section, you will be given a predetermined date and will be admitted the same morning. You will be given spinal anesthesia and is awake during the operation. A curtain is set up between you and the staff, and a urinary catheter is admitted because the bladder is temporarily stunned.

The team is larger than in a normal birth:

• Two midwives per baby
• Two assistant nurses
• Obstetrician
• Pediatrician

When the babies are born, they are welcomed by a midwife and shown to the parents.

If they need help, pediatricians are on hand. Afterwards, the surgical incision is sewn up and you are moved to the awakening until the feeling in your legs returns.

Acute caesarean section

An emergency caesarean section is performed if the birth needs to be completed more quickly, but there is usually time for brief information and preparation.

Immediate caesarean section

This option is used if the babies or the mother need help quickly.

• The parent sleepy and receive information only afterwards.
• This only happens when the situation requires the children to come out immediately.

Important to consider

Although the plan is a vaginal twin birth, you should always be prepared that it can be a caesarean section. The mode of delivery can be changed depending on the well-being of the babies and the progress of the process.

Rapid responses

How is a twin birth planned?

The planning is done in the third trimester together with the doctor, based on the position of the twins in the womb and the previous mode of delivery.

What are the chances of giving birth to twins by caesarean section?

Approximately 50 % of all twin deliveries are by caesarean section.

What determines the mode of delivery?

Position of the twins, parents' preferences, previous mode of delivery and the babies' well-being according to ultrasound.

How is a vaginal twin birth different from a normal birth?

The opening phase is the same, but more people are involved in the birth, and both babies are continuously monitored by CTG.

Can a twin birth end in a caesarean section even if it starts vaginally?

Yes, it may be necessary if there are complications or if one of the babies is unwell.

FAQ - Frequently asked questions about twin birth

1. How long do you stay pregnant with twins?
Often not beyond week 38+0, and half are born before week 37+0.

2. Who decides whether to have a caesarean section or a vaginal birth?
The decision will be made together with your doctor based on the position of the twins and your previous birth history.

3. Can the second twin be born long after the first?
The uterus may rest for a while, but the baby is constantly monitored and is usually born shortly afterwards.

4. Are you always awake during a caesarean section?
For planned caesarean sections, yes - you will have a spinal anesthetic. For immediate cuts, you are put to sleep.

5. How many people are involved in a twin birth?
Several people are involved: midwives, doctors and nurses, sometimes also pediatricians.

6. Can you influence how you want to give birth to twins?
Yes, you are involved in the planning together with the care staff.

Source: 1177.se

Here you can read about the first, second and third trimesters of a twin pregnancy.