Giving birth to multiple babies

Where will I give birth?

Where you give birth is up to you and you should be supported in your choice. However, you will be advised to give birth in hospital so you have access to medical facilities and doctors if you need them. It’s sometimes called a delivery suite or an obstetric unit.

When will I give birth?

The National Institute for Health and Care Excellence (NICE) recommends that all women carrying multiple babies should plan to give birth earlier than women carrying single babies. This helps to reduce the risk of complications, such as stillbirth.

This means that even if you don’t go into spontaneous premature labour, you will be advised to give birth before your due date.

You may be offered an induction (starting labour artificially) or a caesarean section. Exactly when this will be will depend on your circumstances. But if your pregnancy has been uncomplicated, this may be at:

• 37-38 weeks if you are carrying twins with their own placentas (dichorionic)
• 36-37 weeks if you are carrying twin babies that share a placenta (monochorionic)
• between 32 and 33+6 weeks if you are carrying twin babies that share a placenta and amniotic sac (monochorionic monoamniotic)
• 35 weeks if you are carrying triplets with their own placentas and amniotic sacs (trichorionic triamniotic), or 1 baby that has a separate placenta and 2 babies that share a placenta and all 3 babies have separate amniotic sacs (dichorionic triamniotic).

You’ll have an individual assessment to decide when to give birth if you:

• have had a complicated twin or triplet pregnancy
• are expecting triplets where all 3 babies share 1 placenta but each has its own amniotic sac (monochorionic triamniotic)
• a triplet pregnancy where any babies share an amniotic sac (dichorionic diamniotic monochorionic diamniotic or monochorionic monoamniotic).

Unless labour starts on its own, when you give birth is ultimately up to you. Your doctors will discuss the risks of continuing with the pregnancy beyond the recommended time. If you still do not want to have a planned birth at the recommended time, you’ll be offered weekly appointments with your specialist doctor. They will monitor your babies closely during this time.

How can I give birth?

You will be able to talk to your midwife and doctor about your options for giving birth. In a twin pregnancy, this will depend on several things, including the position of the first (presenting) baby, the position of the placenta, their growth and how your pregnancy is progressing.

Both vaginal birth and caesarean section have benefits and risks. Your doctor or midwife should explain what these are for you so you can make an informed decision about how you want to give birth.

Be aware that sometimes things don’t go according to plan during labour and you may need to be prepared to do things differently. For example, you may want to deliver naturally, but you may still end up needing a caesarean section.

Natural labour

If you are having twins and the baby nearest to the neck of the womb (often called the presenting twin) is head-down and you have no other complications, you should be able to have a vaginal birth if you want one. The position of your second twin can change after the first baby is born, so this does not influence how you give birth.

The delivery room may seem crowded when your babies are being born. There will be at least 1 midwife but there may be 2. A doctor will be in the delivery room or nearby. Doctors and nurses specialising in the care of newborn babies may also be in the room and an anaesthetist might be there to make sure that your pain is controlled.

Monitoring your baby during labour

Your healthcare team will monitor your babies’ heartbeats during labour so they can check how they are coping. This is done using electronic fetal monitoring.

Pain relief

You may be recommended to have an epidural. This can help if you end up needing to have a caesarean section or assisted birth – which is more likely if you are pregnant with multiple babies. Find out more about pain relief in labour.

Delivering your second baby

Once the first baby is born, your midwife or doctor can check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.

If the second baby is in a good position, they should be born soon after the first, as your cervix is already fully dilated. The time between giving birth to your first and second baby varies from woman to woman, but the second baby is usually delivered within about 30 minutes to an hour after the first.

In very rare cases, some women deliver 1 twin vaginally and then need a caesarean section to deliver the second twin. This happens in less than 5% of twin births.

Caesarean section

In the UK, more than half of twins and almost all triplets are delivered by caesarean. You may choose to have a planned caesarean. Your doctor may recommend a caesarean if:

• the first baby is lying feet, knees or buttocks first (breech) or lying sideways (transverse)
• you have a low-lying placenta
• you have had a difficult delivery with a single baby before
• you’ve had a c-section before
• there have been any complications in the pregnancy such as concerns around growth, or if treatment was needed for complications like TTTS
• if you are having triplets or more. In this case, you’ll be offered a caesarean section at 35 weeks. If you’ve had any complications or if you are in established (active) premature labour, this may happen earlier.

If you have decided to have a caesarean section but go into labour naturally, you should go straight to hospital. The doctors will offer an emergency caesarean section, but if things have moved too far along or you have gone into very early labour it may be safer to have a vaginal birth, if the presenting (first) twin is head down.

What happens after I give birth?

If your babies are born premature, they may need to spend some time in the neonatal intensive care unit. Find out more about your premature babies’ time in hospital.

Going home from the hospital

If your babies need care, your doctors will do everything they can to try and discharge them at the same time. But unfortunately, this isn’t always possible.

This can be very difficult because you may need to spend time settling 1 baby at home and also visiting the other in hospital. It may help to ask for support from other family members, such as grandparents or siblings. You’ll also have support from a midwife and health visitor, among other health professionals. Find more about support for you and your premature baby at home.

Breastfeeding your babies

Having multiple babies does not necessarily mean you will have problems breastfeeding, if that’s what you want to do. Your body should be able to produce enough milk for all your babies.

You’ll probably be advised to feed your babies separately for a while until you get used to it. Once you feel comfortable, you may want to try tandem feeding. This means feeding 2 babies at the same time. Breastfeeding can take time and patience, so the advantage of tandem feeding is that you won’t have to keep switching from baby to baby and spend all your time nursing.

Just be aware that you have different babies with different personalities, which means they’ll probably have different appetites and nursing patterns. If so, you could try letting your hungrier baby dictate the feeding schedule of both (or more) and carry on tandem feeding. Or you may need to feed your hungrier baby more often. Some mums feed their babies on demand during the day and then tandem feed at night.

If you are struggling with tandem feeding, you could alternate bottle feeding 1 baby while nursing the other. Or you could nurse one after the other. The important thing is to do what works for you.

Whatever you are doing, it will help to write the details down every time you feed, including which baby you’ve fed, on which breast and for how long. You will probably be very tired and this will make it easier for you to remember what you’re doing. It will also help when you’re talking to your health visitor or getting advice from a breastfeeding support group.

The Twins Trust has more information about breastfeeding multiple babies.

Your relationship with your babies

Some parents bond with their baby immediately, while others find it takes more time. If you’ve had twins or triplets, you may find that you develop a closer bond with 1 baby over another in the early days. This can be upsetting but natural, so try not to worry. Your relationship with your babies will develop over time. Find out more about bonding with your baby.

Postnatal depression

If you’ve had a multiple pregnancy, you are more likely to experience postnatal depression. This is when you have feelings of sadness, hopelessness, guilt or self-blame all the time for weeks or months after you’ve had a baby. The symptoms can vary from mild to severe and it can affect women in different ways. Postnatal depression can be treated with the right care and support and most women will make a full recovery.

Postnatal depression can also affect fathers and partners, so it’s important that you keep an eye on each other and ask for help if you need it. Find out more about postnatal depression and what support is available.

More information and support

Twins Trust offer help, information and advice online, over the phone, or via Twinline (0800 138 0509 or [email protected]) for families with multiple babies. They also run antenatal and parenting classes throughout the country and manage an active social networking community with closed Facebook groups for single parents, families with children who have special educational needs, grandparents and those who have sadly been bereaved. 

The Tommy's midwives

If you’re looking for advice from the team, call our pregnancy line on 0800 014 7800 (Monday to Friday, 9am to 5pm), or email us at [email protected].