C-Section Safe for Twins

Planned cesarean section for twins no better or worse than planned vaginal delivery

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Carrying twins may mean a higher risk of pregnancy complications for some women. Often, a mom carrying twins plans for a cesarean section instead of a vaginal delivery.

A recent study found that either option for delivery appeared to be fine for the babies.

The children of mothers who had a planned cesarean section (C-section) did no better and no worse than the children of mothers who planned a vaginal birth. The rate of serious problems or deaths was about the same in both groups.

"Discuss twin birthing options with your OB/GYN."

This study, led by Jon F. R. Barrett, MD, of the Department of Obstetrics and Gynecology at the Sunnybrook Research Institute in Toronto, compared twin births in planned C-sections versus vaginal births.

The researchers randomly assigned pregnant women carrying twins to have either a C-section or a vaginal delivery when they were between 32 and 39 weeks pregnant.

All the women's pregnancies involved the first twin with his or her head down, the safest position for a baby just before delivery.

Of the 1,398 women who were assigned to a C-section, 91 percent gave birth by C-section.

Of the 1,406 women assigned to a vaginal birth — to have a C-section only if medically necessary — 44 percent ended up giving birth by C-section.

Women who were assigned to have a C-section had their babies about a day earlier, on average, than the women assigned to a planned vaginal birth.

The researchers compared the outcomes of the babies in both groups of mothers.

They compared what proportion of children died or had a serious birth complication in the C-section group to that percentage in the group assigned to vaginal delivery.

The researchers did not find any major differences between the two groups in terms of those serious possible outcomes.

In the C-section group, 2.2 percent of the children either died or had a major, life-threatening complication at birth.

In the group of children whose mothers were assigned to attempt vaginal delivery first, 1.9 percent of the babies died or had a serious outcome.  

The researchers concluded that planning to have a C-section did not increase or decrease a newborn's likelihood of being born alive without serious problems.

"The route by which twins are delivered is most often determined by the positions of the baby at delivery or specifics related to their medical condition," said Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC.

"The outcomes for the babies are identical regardless of route of delivery," he said. "Vaginal deliveries, however, are generally safer for the mother. Hence, with all things being equal, the vaginal route would be preferred."

This study was published October 3 in the The New England Journal of Medicine. The research was funded by the Canadian Institutes of Health Research. The authors declared no conflicts of interest.

Review Date: 
October 8, 2013
Last Updated:
October 10, 2013