Giving birth to twins

You have many choices and options for giving birth to your babies. Take the time to ask questions. Discuss your choices with your midwife or doctor. It’s important that decision making is shared between you and your healthcare providers.

You have the right to choose:

• the place where you give birth, such as a birthing centre or hospital
• your healthcare provider, such as a specialist obstetrician or midwife
• the way you deliver your babies — vaginally or a caesarean section

Your doctor or midwife may advise you to give birth in a hospital. This is because there's a higher chance of complications with a twin birth. Twins are also often born early.

Remember that there can be complications during labour and at the time of the birth. Things can happen quickly at the time your babies are being born. This is the same for any pregnancy, even single babies. Your birthing choice might not be possible if there is a risk to you or a baby. It’s important to know what might happen if your birth does not go according to plan.

It’s very important that you plan your choices early. It’s also important that you understand about tests or procedures that might happen during the birth process. You may be asked to sign a consent form. Get as much information as you need before deciding what you would like to happen.

Types of birth

It's common for several medical staff to be involved in the birth of twins. This could include:

• a midwife
• an obstetrician
• 2 paediatricians and 2 extra nurses or midwives — one for each baby

Vaginal birth

About 1 in 3 twin births are vaginal births. The process of labour is the same as when single babies are born.

Twin babies are closely checked during the labour. Your babies’ heart rates may be monitored. You may also be set up with a drip. This is done in case it is needed later.

Sometimes the first twin is in a head down position (cephalic). This is the usual position for a vaginal birth to go ahead.

If you're planning a vaginal birth, your health team may recommend that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when you already have good pain relief.

If you have a vaginal birth, you may need an assisted birth. This is when a suction cup (ventouse) or forceps are used. These can help you birth your babies.

Once your first baby is born, your midwife or doctor will check the position of your second baby. They do this by feeling your abdomen (tummy). They may also do a vaginal examination or use a bedside ultrasound machine.

If your second baby is in a good position, your waters may be broken. Your baby should be born soon after this happens. This is because your cervix is already fully dilated.

Sometimes contractions stop after the first baby is born. If this happens, you may be given medicine to strengthen and increase your contractions.

Caesarean section

You may decide early that you want a caesarean section for the birth. This is called planning an ‘elective caesarean’. Your doctor or midwife may also recommend a caesarean section as you get closer to the end of the pregnancy. This could be due to the chance of complications.

Your babies' position may determine whether they need to be born by caesarean section or vaginally. Sometimes, the baby that will be born first is in a breech position. This is when their feet, knees or buttocks are downwards. A caesarean section is usually recommended in this case.

Sometimes one twin is lying with their body sideways. This is called ‘transverse position’. A caesarean section is needed in this case too.

The chance of having a caesarean section is higher with twins. You’re about twice as likely to have a caesarean with twins compared to having a single baby.

Some other health issues also mean you will need a caesarean section. One example is if you have a low-lying placenta. This is called placenta praevia.

Even if you plan a vaginal birth, you may end up having an emergency caesarean section. This could be because:

• one or both babies become distressed
• the umbilical cord prolapses (falls into the birth canal ahead of the baby)
• your blood pressure is too high
• your labour is progressing too slowly
• assisted delivery doesn't work

In very rare cases, you may have both a vaginal and caesarean delivery. This is where you give birth to the first twin vaginally and then need an emergency caesarean section for the second twin.

If your babies need special care

Twin babies are sometimes premature (born early). One or both of your babies might need to spend some time in the special care nursery or a neonatal intensive care unit.

These units provide care for premature or sick babies. They also let parents look after their babies as much as possible. The hospital will try to keep you and your babies in the same place if possible.

In some cases, one baby may still be in the hospital while the other is at home. You will need to think about making time for both babies. Ask the hospital if you can bring the other twin when you visit your baby.

You can ask if co-bedding is allowed during visits. Co-bedding is where both babies sleep together in a single cot.

Check if your hospital offers support from a community neonatal nurse. This may help you and your babies leave hospital earlier.

You will need to make follow-up appointments at the clinic. It's a good idea not to book early morning appointments. It can be difficult getting out of the house with 2 babies.

After the birth

Giving birth to twins is usually joyous and exciting. However, it can also be an overwhelming and stressful time.

It can be a challenge trying to learn how to feed and look after 2 babies. Breastfeeding is important for all babies. Sometimes only one twin can feed properly. In this case, you may need to express milk. This will help feed the twin who is having trouble.

It will take time for your body to heal after giving birth. You may have stiches or bruising. Ask your midwife or doctor what to do to recover well. Exercises to strengthen your pelvic floor are important. A physiotherapist can give you different exercises depending on your needs.

After the birth, it’s important to eat well. You should try and sleep as much as possible and stay active.

Don’t forget to book in for your 6-week postnatal check with your midwife or doctor. You can also ask for this check earlier than 6 weeks if you feel you need it.

It’s important to seek out support from family, friends and health professionals. Organisations like the Australian Multiple Birth Association provide practical and emotional support to families with twins. They can be very useful in helping you and your family deal with the challenges of looking after your babies.

Families with twins are more likely to experience family issues and other stresses. These can include:

• financial stress
• relationship breakdown
• exhaustion
• depression
• social isolation

Emotional well-being

It’s common for women who have just given birth to feel very emotional. You may:

• have mood swings
• feel like crying a lot
• feel overwhelmed
• have anxiety

These feelings may be due to hormonal changes in your body. They happen about 3 to 5 days after birth. Most women have these feelings.

Sometimes the feelings don’t go away. Speak with your doctor or midwife if this happens. It could be a sign of postnatal depression or anxiety.

It’s important to get help early if you feel that you are not coping.

Resources and support

For more practical information and emotional support for families with twins, visit:

• Twins Research Australia
• Australian Multiple Birth Association
• The Royal Women’s Hospital

The Australian Breastfeeding Association offers information on breastfeeding multiple babies.

If you’re expecting triplets or more read this Pregnancy Birth & Baby page on giving birth to triplets or more.

Find out more about maternity services available in rural Australia.