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Twin Pregnancies: Implications for Labor and Delivery

by Elisa Ross, MD

Carrying two babies at once involves some special considerations, as does the delivery of twins. Your doctor will want to ensure the well-being of both babies, so there is an increased chance that she might recommend a cesarean delivery. That delivery may come earlier than expected, as many women pregnant with twins or other multiples don't carry to full term.

Preterm labor
On average, twins tend to arrive about a month before the due date. Their lungs often are sufficiently developed, so the babies can breathe on their own and go home from the hospital within a few days. Some twins come so early, however, that a stay in the hospital is required. While two weeks before the 40-week due date is considered full term for twins, occasionally twins do go all the way to the due date.

Cesarean section
Although vaginal delivery of twins is very possible, and actually preferred in most situations, there is an increased chance that they might require a cesarean birth. Ultrasound is used to confirm the positions of the babies. Cesarean delivery is usually recommended for twins in all the same situations that apply to a single baby, including a non-reassuring heart rate and positions other than head down.

Vaginal birth of twins
If both babies are coming headfirst, most practitioners will encourage vaginal birth. Even if just the first baby is headfirst, a vaginal birth may be possible. Vaginal delivery of twins often takes place in the operating room with an anesthesiologist standing by in case the second baby cannot be easily delivered. If the second baby turns sideways, or if her heart rate is not optimal, a caesarean delivery may be required. By anticipating the potential need for surgery, precious time is saved since the team is already in the operating room. On the other hand, sometimes a few hours can go by between the birth of the first baby and the second. As long as the second baby is showing reassuring signs, labor and pushing may continue in the usual way.

The birth of twins is an especially wondrous event. Many mothers of twins comment on how special they felt during their pregnancy and the birth of their twins, and how truly amazing it is to watch the uniqueness of the development of their twin children.


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*  Cesarean Birth
*  Preterm Labor
*  Multiple Pregnancy


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