You’re pregnant with twins – congrats! For those who are wondering about the safety of a vaginal twin delivery, know that the circumstances make all the difference. If mom is healthy, babies are near term, big enough (but not too big), positioned well, and there are no other complications, then a vaginal birth is probably quite safe. If mom has health problems, the babies are premature, too small or large, in breech or transverse positions, or there are other problems, then a vaginal birth might not be a safe risk and C-section might be the better choice.
The safety of a vaginal birth of twins depends on the position of the babies. If both twins are in a vertex position (head down), then the risks are about the same as for single babies. There's a small amount of increased risk for prolapsed cord (where the umbilical cord slips through the cervix in front of the baby, potentially cutting off circulation), after delivery of Twin A (the one closest to the cervix), but it doesn't happen very often. When it does, doctors begin performing a C-section.
If Twin A is vertex, but Twin B is not, a vaginal birth might still be a safe option. After Twin A is born, the doctor will either turn Twin B to a vertex position, deliver her breech or, if necessary, deliver her by C-section (that vaginal-plus-C-section scenario only happens in about 4% of twin births).
If Twin A is breech, however, there's very little chance she’ll be delivered vaginally. Some doctors and midwives will deliver single breech babies vaginally, but not twins. There are too many variables and things that might go wrong, and most won't take the chance.
Why do twin births happen in the operating room? If Mom's in the OR and something goes wrong, they won't waste time getting her from her labor room to the operating room. They can start an emergency C-section immediately. Ideally, there is one pediatrician and one nurse for each baby in the operating room.
Why do pregnant moms of twins need an epidural? So Mom can be quickly anesthetized for an emergency C-section. An epidural would prevent the need for general anesthesia. If you’re committed to having an unmedicated, natural birth, one option might be to have the epidural tube placed, but no anesthesia injected into it during labor.
Are twin pregnancies high risk? Twins tend to come a few weeks early (around 36 weeks) but usually do well. That said, twin pregnancy and twin delivery are considered high risk. If the twins share the same amniotic sac, they should be followed by a perinatologist (maternal-fetal medicine specialist) because of the risk of getting tangled in each other's umbilical cord. Sometimes problems with diabetes or high blood pressure during pregnancy complicate the picture further. Remember the goal is to deliver two safe babies to one safe mom. While a vaginal birth is safe in many twin pregnancies, it isn't the best option for all.