If giving birth to one baby isn’t worrying enough, carrying twins, triplets or more can be a truly terrifying prospect!  We spoke to independent midwife, Amber Thatcher, to get her advice on labour and delivery of to two, three or more babies at the same time….

There can be more complications with multiple births so it’s important to understand your birth options and to think about where you would like to give birth.  If your pregnancy progresses well and there are no complications, you still have a choice as to where to have your babies, although because of potential complications you’ll be advised to give birth in a hospital.

Twins and triplets are more likely to be born early.  It’s not usual for twins and multiples to be delivered before 38 weeks.  Fewer than half of all twin pregnancies go beyond 37 weeks, and about 75% of triplets are born before 35 weeks.

Be prepared for your babies to spend some time in special care.  Just under half of all parents of multiples see at least one of their babies spend time in neonatal special care.

Vaginal Birth – Twins

Triplets or more babies are almost always delivered by elective caesarean section and lots of women think they have to have a caesarean section with twins, but in fact, more than 40% of all twins are born vaginally.

If the first twin is in a head-down position (cephalic), it’s usual to consider having a vaginal birth. If you’re planning a vaginal delivery, your babies will most likely be closely monitored during labour. To do this, an electronic monitor will be strapped to your bump and a scalp clip may be fitted on the first baby once your waters have broken. You may also be given a drip.

An epidural may be offered for pain relief. This is because if there are problems, it’s easier and quicker to assist the delivery if you already have good pain relief in place.

Once the first baby is born, your midwife or doctor will check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.

If the second baby is in a good position, it will probably be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones may be added to the drip to restart them.

More health professionals will usually be present at the birth – for example, there may be a midwife or two, an obstetrician and two paediatricians: one for each baby.

Caesarean Section – Twins

It may be that it isn’t possible to have a vaginal birth.  In the UK, more than half of twins and almost all triplets are delivered by caesarean. You may know you’re going to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a caesarean section later in the pregnancy as a result of potential complications.

If you have had a previous caesarean section, it’s not usually recommended that you have a vaginal birth with twins.

Your babies’ position may determine whether they should be delivered by caesarean section. If the presenting baby is in a breech position (feet, knees or buttocks first), or is lying in a transverse position (with its body lying sideways), you will most likely have to have a caesarean section.

Some conditions also mean you will need a caesarean section. For example, this may be necessary if you have placenta praevia (a low-lying placenta) or if or the cord prolapses (when the cord falls into the birth canal ahead of the baby).

Even if you plan a vaginal birth, you may end up having an emergency caesarean section. This could be because the babies become distressed, or labour doesn’t progress, for example.

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin, but this happens in less than 5% of twin births.