Twin vaginal birth - cephalic presenting & breech

[Nigatsudo]

Hello! I'm 31 weeks pregnant with twins and weighing whether to have a caesarean or vaginal delivery. The presenting twin is cephalic and the other is breech. Hospital says the choice is mine. Has anyone delivered vaginally with the same presentation? I'd love to hear your experiences. Thanks!

It's my first pregnancy and they're DCDA

Not what you asked for, but I went for a section after seeing the stats on delivering both vaginally, regardless of position. It was pretty low, and I decided going through a vaginal birth for one and then having to have an emergency section for the other would be the absolute worst of both worlds.

Also, I don't know what your hospital is like, but because of the high section risk, I'd have had to do the vaginal birth in a theatre room anyway, so wouldn't have had the nice water/chilled experience I dreamt about before I knew it was twins!

Ask the hospital about the risk for the twins in a natural birth in comparation with cesaeian with that presentation. If there are any risk of natural birth complications that could affect the twins future health or cause hypoxia, brain injuries etc or possible disabilities, then the risk maybe too much. If not risk is up to you or whatever is best for you.

I'm pro natural birth wherever possible and plenty of women have given birth to twins naturally but that sounds too risky to me. Personally, I'd go with a planned section and hope that if there is a second pregnancy I can try for a vbac.

We discussed birth options with the obstetrician today and they didn't consider a vaginal birth more high risk than a caesarian - which has made the decision harder! My understand from Twins Trust data is that 4-5% of vaginal twin births end up with the second needing an emergency section which seems fairly low odds - 1 in 50 essentially. It would probably be pretty medicalised and on the labour ward with epidural & constant monitoring etc (and induced if I go past 37wks) so not the idyllic birthing centre experience! But I hadn't expected that.

When I had my twins 20 years ago I was told if twin 1 was cephalic vaginal birth was an option regardless of whether twin 2 was cephalic or breech. Twin 2 gets a lot of room to move around after twin 1 is born.

I had a vaginal delivery.

I've got twins and ended up with an emcs but my plan was elective. Can't think of anything worse than labouring, delivering one and then a section just for fun.

I had same presentation but dt2 flipped at 36 weeks (that was a painful moment, thought I was going into labour). I was induced and then scanned after dt1 as once there's lots of room dt2 can move position but everything was OK and delivered dt2 20 minutes later.

My twins presented as Twin 1 head down, Twin 2 head up so same as yours I think.

My care team said that vaginal birth could be attempted and this is what I went for. The suggestion was that Twin 2 tends to rotate once they have more space and as the uterus continues to contract. As Twin 1 was born, a midwife kept a steady hand on my stomach to help prevent Twin 2 turning too rapidly. T2 did a gentle turn and was born a few minutes later.

Good luck with your babies!

I had my twins more than 40 years ago, vaginal delivery, both breech, at 38 weeks. I was advised to have an epidural, but otherwise everything was perfectly straightforward.

something to consider if you do end up being induced. Induction in general raises your odds of needing a c section to 22%. 15% chance of needing ventouse, forceps etc. A 37 week induction has about a 30% rate of ending in emergency section (as advised by my hospital). I would ask for the odds of you needing an emergency c section based on your personal circumstances, an induction at 37 weeks with twins. My personal odds - single baby, first time to full term, over 35, bmi above 35 and 37 week induction gave me odds of ending in EMCS 40%. I went for an elective.

I had a rather chaotic quick twin delivery at 36w, 30 years ago.

DT1 was born in the side room, then I had to move to a delivery room on the other side of the ward (where they had another delivery trolley because we had used the stuff from the nearby delivery room).

The registrar had arrived from her bed, gave me an injection, felt the position of the baby (although this was rather rough, I don't think she turned the baby) told me to push and DT2 started crowning. Then registrar left me with the two midwives, and the junior doctor at the other end of the room who was holding my first baby with someone who I think was the house paediatrician, but who knows 🤷‍♀️

This is all I know because no one told me about anything that was happening (and looking back it was scary that they were so out of control and little prepared).

But I have been told second twin often turns after the first is born. (Still feel bloody lucky though).

That's good to hear! But since then, midwives are much less used to delivering breech babies so their expertise in this area has probably reduced.

Twin 1 was cephalic and twin 2 transverse. They both stayed in that presentation from 18wks to 40 when I was induced.
Twin 1 was born with arm over face and then twin two moved into place and was born 12 minutes later.

If your team are telling you that a vaginal delivery is no more of a risk, and that’s what you want to do, then go ahead.

Random, but Jamie Otis from MAFS USA is on Insta, and she literally just have birth to twins vaginally; one was breech.

Often when the NHS quotes the risk of c sections, they aren't separating out emergency c sections where there is a medical problem already from electives. So it overstates the risks of a planned section and makes them sound no safer than a vagunal birth. However, as I understand, it planned c sections are generally safer than vaginal birth. it would he worth asking for clarification.

Interesting, I can't remember the exact figure I found but it was much more in line with the poster who quotes 40% risk of emergency section for a singleton. I think it was something like 60% chance of one or both needing a section which definitely made up my mind.

The risks are different between vaginal and sections but as PP has mentioned I believe that it's lower overall if you look at just planned sections.

That is awesome 🤩