Will I Have to Have a C-Section With Twins?

Are Twins Always Delivered by Cesarean Section?

Pregnant Woman Talking to Doctor
Discussing Delivery Options in a Twin Birth. Tetra Images / Getty Images

During a pregnancy with twins or multiples, families anxiously await the arrival of their babies. But as much as they look forward to their arrival, they may wonder about how their babies will be delivered. Many assume that twins are always delivered by cesarean section (also known as c-section). Or, they may have heard horror stories about mothers who delivered one baby vaginally but had to have a c-section for the second baby.

This is known as a combined delivery in medical terms or “the worst of both worlds” by the moms of twins who endure both the discomfort of labor before birth and recovery from surgery after birth. Although distressing, a combined delivery is actually relatively rare. It happens in less than 5% of twin births.

Ultimately, the right choice for delivery method is the one that provides the best outcome for the babies, and for mom. Your medical caregivers will weigh the risks and benefits of each method based on your specific circumstances at the time of delivery. Both cesarean and vaginal delivery can be safe options for a twin birth.

Should Twins Be Delivered by C-Section?

It’s true that twins are more likely to be delivered by cesarean section. In the United States, about a third of all babies are delivered by c-section. However, the majority of twins result in a surgical delivery. One estimate indicates that up to three quarters -- 75 percent -- of mothers of twins have a c-section.

Other estimates put the number at closer to sixty percent. Either way, it’s clear that more than half of all twins, and nearly all higher order multiples, are delivered by cesarean section. However, a 2013 study suggested that a c-section isn’t necessarily any safer than a vaginal delivery when it comes to twins.

The study, which reviewed 2,804 women and their babies, showed the same rate of favorable outcomes for moms and babies with both a planned cesarean section or vaginal delivery. In both groups, about 2% of babies and 7% of mothers experienced serious complications. 

Although the study covered a wide variety of hospitals around the world, it only focused on situations where a vaginal delivery could be safely attempted and where mothers delivered between 32 weeks and 38 weeks gestation. It excluded mothers whose babies were not in optimal position to be delivered vaginally and required a c-section. 

While the study showed that vaginal delivery can be just as safe as a c-section for twins, it still confirmed that a c-section is the most common type of delivery for multiples.   Of the women who planned a vaginal delivery, 44% ultimately ended up having a c-section. However, the results can encourage mothers of twins who meet the right conditions to plan a vaginal delivery, rather than automatically planning a c-section.


Conditions that Warrant a C-Section with Twins

In some circumstances, the condition of the mother or the condition of the babies mandate a planned c-section. Some examples of these might include:

  • Previous cesarean section
  • When the presenting baby (the baby closest to the birth canal) is breech
  • One or both twins are transverse (lying across the uterus) 
  • Conditions like placenta previa

Other situations may present complications that necessitate consideration of a planned c-section but don’t always result in surgery. For example:

  • If the twins are monochorionic and share a placenta
  • If the babies will be delivered preterm
  • If the second baby is breech
  • If there is a size discordance, with the second twin much larger

No matter how the babies are delivered, the most important issue is a safe and healthy birth, ensuring  optimal outcome for the babies and for their mom. 

More answers to Frequently Asked Questions About Twin Pregnancy.


Barrett, J. "A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy." New England Journal of Medicine., October 3, 2013, pg. 1295.

Christopher D, Robinson BK, Peaceman AM. "An Evidence-Based Approach to Determining Route of Delivery for Twin Gestations." Reviews in Obstetrics and Gynecology., 2011, pg. 109.

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