Cesarean Births Not A Foregone Conclusion

May 2009

So much has been said about the increased risk of complications with twin and multiple births. It's true that there is an increased risk, but by no means are complications a foregone conclusion. There's no reason to believe, for instance, that your twin pregnancy necessitates a cesarean surgery. Mothers of multiples can have vaginal births and in most cases, this is the safest option.

Early Signs

In an effort to educate mothers on the early signs that a pregnancy is in trouble, women carrying multiples are flooded with information and cautionary advice. They're also labeled high risk. Hospitals often support the idea that a planned cesarean section is preferable to an emergency cesarean. Common sense, however, dictates aiming for a vaginal birth even with a multiple pregnancy. Cesarean surgery is major surgery, and an unnecessary cesarean is an unnecessary risk.

Cochrane Library published a study proving that there is a lack of evidence to support better outcomes for twins delivered by elective cesarean surgery. Another study showed that delivering a second twin by cesarean because he's not in the head-down position poses a risk of infection and provides no clear benefit for the infant or its mother.

The rise in the number of surgical births is due in part to the physician's fear of malpractice suits. Some doctors still think that cesarean births are safer since they are performed in a controlled environment. Others believe that cesarean sections can help prevent damage to the urinary tract and uterus. Some hospitals have a policy of not performing vaginal birth after cesarean (VBAC), and this too, increases the rate of surgical births. With so many couples using fertility treatments, multiple births are on the rise, and this also affects how many births will be performed by cesarean. An important piece of data to keep in mind is that the half of all the cesareans performed each year may be unnecessary.

More Usual

While triplets and higher order multiples are most often delivered by cesarean, a vaginal birth is more usual for twins. Sometimes the presentation of the babies does indicate the necessity for a cesarean delivery. Here are signs that twins can be delivered vaginally:

The pregnancy has lasted longer than 32 weeks
The baby closest to the cervix (Twin A) is the largest of the two
Twin A is in head down position
Twin B is either head down, breech, or in the sideways (transverse) position
Twin B is smaller than Twin A
Neither baby is in fetal distress
There's no evidence of cephalopelvic disproportion (CPD)