I Am Carrying Twins. Is C-section Inevitable?

What Are The 3 Favorable Conditions That Promote Vaginal Twin Delivery?

Three conditions that promote vaginal delivery are:

1. Head–Down Position of The Twins

If the first twin is in a head-down position or both the twins are in a head-down position, then the situation can be said, to be favorable to vaginal birth.

2. The Position of the Second Twin

After the first twin is born, the doctor will do a vaginal examination and if needed an ultrasound scan too. This will reveal the position of the second child. If the child is in a good position, an easy vaginal delivery through an already fully dilated cervix is possible. Even if the contraction stops, doctors restart it by introducing hormones through the drip.

Even if the second twin is not in a favorable position the doctor can turn the baby to a vertex position which can be a success in some cases

3. Pregnancy Without Any Complications

If the mother and her babies are free from the issues that make a C-section necessary and if the babies are older than 34 weeks, your doctor suggests trying a vaginal birth.

3 Unfavorable Conditions That Prevent Vaginal Twin Delivery?

Some of the conditions that prevent vaginal delivery are:

1. The Unpromising Position of the First Twin

When the first twin is in a breech or transverse position, the situation becomes unfavorable for a vaginal delivery. The doctor may be able to deliver a single breech baby vaginally, but definitely not the twins.

2. Monochorionic Twins

Monochorionic twins are identical twins sharing the same placenta.  It is impossible to deliver monochorionic twins vaginally.

3. Monoamniotic Twins

Identical twins that share the same amniotic sac inside the mother’s womb make the vaginal delivery risky.

When Is C-section Administrated In A Twin Pregnancy?

When the umbilical cord falls into the birth canal ahead of the baby, the situation favors a C-section as a vaginal birth is impossible. Other situations during which C-section is the only option in a twin pregnancy are:

• Non-progressing labor: If the labor is not progressing as your cervix is not opening and the babies show signs of distress, C-section is the only option.
• Placenta Previa: Low lying placenta, which partially or completely covers the cervix – Placenta Previa – is a condition that is often associated with a twin pregnancy. This hinders vaginal birth and favors C-sections.
• Previous complicated vaginal delivery: If the previous vaginal delivery (single) was very laborious, the doctors will advise for C-section with the twins.
• Fetal distress: Fetal distress occurs when the baby’s oxygen supply hampers due to umbilical cord compression, placental abruption, etc.
• Placental abruption: When the placenta detaches from the wall of the uterus (the chances are more in twin pregnancy) C-section is administrated.
• Previous C-section: If the mother had a C-section previously, the doctor will not go for a vaginal birth when she is pregnant with twins.
• Pre-eclampsia: If the mother is suffering from severe preeclampsia, decreasing blood flow and oxygen level can lead to C-section.
• Hemorrhaging: If you have a history of severe blood loss or have issues that can cause hemorrhage, C-section happens.

What Is Combined Vaginal And Cesarean Section?

This is another procedure of delivery that happens in a twin pregnancy. Here, after giving birth to the first twin vaginally, the second twin is coming through a C-section. This is, in fact, quite a rare occurrence (around 2-3%). The causes can be:

• The first twin is delivered vaginally without any issues. But, it is possible that the second twin’s position doesn’t favor a vaginal birth and the doctors are unable to turn the baby to a deliverable position.
• Another chance is that after delivering the first twin some complications arise (to mother or child) which put the baby’s life at stake. Like cord prolapse, which can lead to cutting the oxygen supply of the second twin.
• Placental abruption in which the placenta tears away from the womb during the first delivery, which reduces the oxygen supply to the second twin.

As we always say, in the course of delivery, we can’t expect a 100% guarantee. The complication can appear at any point in the procedure. We can’t predict anything earlier. Now the only way that remains is to go for an immediate C-section to deliver the second baby. That is why choosing the hospital and obstetrician is very significant when carrying twins.

Always choose an obstetrician who is a master in delivering twins, both vaginally and through a C-section. Make sure the hospital you choose has facilities to take care of premature babies (neonatal intensive care unit). Also, no need to get too anxious if anyone or both of your babies has to get admit the neonatal intensive care unit (NICU). It is fairly common among twin babies born with low birth weight.

Stay well-nourished, and well hydrated. Think positively. God blessed you with double joy. Think about it. Happy delivery!