Expecting Twins? It's Your Call

Pregnant mothers of twins experience similar outcomes in C section and vaginal birth

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Women who are pregnant with twins may often choose to have a planned cesarean section instead of giving birth vaginally. But is one method safer than the other?

A recent study presented at a conference tested this question. The researchers found that both methods of giving birth led to similar rates of complications for the babies.

Neither vaginal birth nor C-section appeared to be better than the other.

The study has not yet been published in a peer-reviewed journal, so the results are preliminary.

"Attend all prenatal visits."

The study, led by Jon Barrett, MD, of the Sunnybrook Health Science Centre at the University of Toronto, looked at whether twin babies had better outcomes if they were born by C-section or vaginally.

Vaginal birth is the typical form of delivery. C-section is a surgical procedure used to deliver a baby.

The researchers randomly assigned 2,804 pregnant women across 26 different countries to give birth to their twins by either a planned C-section or by a vaginal birth. A total of 1,398 women were scheduled to have a planned C-section, and 1,406 were assigned to have a planned vaginal birth.

The women all gave birth between 37 weeks, 5 days and 38 weeks, 6 days. Women were only included if one of their twins was facing head down (the appropriate position for vaginal birth) and the babies were estimated to weigh between 3.3 and 8.8 pounds.

Women who had a condition or complication that prevented them from going through a natural labor were excluded from the study.

Then the researchers tracked the rate of death or serious illness or birth defects among the babies across both groups of women.

Among the 2,781 babies born by C-section, 57 of them (2.05 percent) either died or had a serious illness or complication at birth. Among the 2,782 babies born vaginally, 52 (1.87 percent) died or had a serious complication at birth.

Characteristics among the women in both groups were similar in terms of the average number of children women had already had and the weeks of pregnancy the women were at when they were assigned one birth method or another.

The groups were also similar according to the range of the mothers' ages, the direction their second twin was facing and how many had twins sharing a placenta versus twins with separate placentas.

The groups were also similar in terms of the countries they came from and the death rate of babies that currently occurred in those countries.

The researchers found that there was no difference in the risk of death or serious complications among twins whose mothers planned to give birth vaginally versus those who planned to give birth by C-section.

The second of the twins to be born were almost twice as likely to be the ones that suffered a serious complication or death, but this did not vary between the two groups.

Overall, 90 percent of the women who planned a C-section had both babies by C-section. Meanwhile, 60 percent of the women who planned a vaginal birth gave birth to at least one of the twins vaginally. Four percent of the women who planned a vaginal birth delivered their second twin by a C-section after vaginally delivering their first twin.

"The results of the study show that vaginal birth is safe and should continue to be offered to women who are pregnant with twins," Dr. Barrett said in a prepared statement. "There's no evidence that a cesarean section is better for the babies or you."

The study was presented February 11 at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, in Dallas, TX. No information was available regarding the study's funding or financial disclosures of the authors.

Reviewed by: 
Review Date: 
March 7, 2013
Last Updated:
March 11, 2013