Giving birth to twins
8-minute read
Key facts
- Twins are more likely than singleton babies to be born early, often before 38 weeks.
- Your doctor will most likely advise you to give birth in a hospital because there's a higher chance of complications with a twin birth.
- About 1 in 3 of all sets of twin births are vaginal births.
- You may choose to have an elective caesarean, or your doctor may recommend a caesarean section because of potential complications.
- Even if you plan a vaginal birth, you may end up having an emergency caesarean section due to complications during labour.
Twin births
Twins are more likely to be born early, often before 38 weeks, so it's important to understand your birth options. Less than 1 in every 2 twin pregnancies continues beyond 37 weeks.
Because of the likelihood that your babies will be born early, there is a good chance one or both of them will spend some time in the special care ward in hospital.
As twins are often born early, it's a good idea to discuss with your midwife or doctor where you should give birth. You should also talk about whether you would prefer a vaginal or caesarean birth. Your doctor or midwife will most likely advise you to give birth in a hospital because there's a higher chance of complications with a twin birth.
It's common for more medical staff to be involved in the birth of twins, such as a midwife, an obstetrician and 2 paediatricians — one for each baby.
While the process of labour is the same as when single babies are born, twin babies are more closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once your waters have broken. You will be set up with a drip, in case it is needed later.
Vaginal birth
About 1 in 3 of all twin births are vaginal births. The birth process is similar to giving birth to a single baby. If you're planning a vaginal birth, your health team may recommend that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when the mother already has good pain relief.
If the first twin is in a head down position (cephalic), it's usual to consider having a vaginal birth. However, there may be other medical reasons why this would not be possible. If you have had a previous caesarean section, discuss with your doctor whether you should have a vaginal birth with twins.
If you have a vaginal birth, you may need an assisted birth, which is when a suction cup (ventouse) or forceps are used to help you birth your babies.
Once your first baby is born, the midwife or doctor will check the position of your second baby. They do this by feeling your abdomen (tummy) and doing a vaginal examination. If your second baby is in a good position, your waters will be broken and your baby should be born soon after the first, as the cervix is already fully dilated. If contractions stop after your first birth, hormones will be added to your drip to restart them.
Caesarean section
You may choose to have an elective caesarean from the beginning of your pregnancy. Your doctor may also recommend a caesarean section later in the pregnancy because of potential complications. You’re nearly twice as likely to have a caesarean if you’re giving birth to twins, than if you’re giving birth to a single baby.
Your babies' position may determine whether they need to be born by caesarean section or vaginally. You will need to have a caesarean section if the baby that will be born first is in a breech position (their feet, knees or buttocks are presenting first). You will also need to have a caesarean section if one twin is lying in a transverse position (with their body lying sideways).
Some other conditions also mean you will need a caesarean section — for example, if you have placenta praevia (a low-lying placenta).
If you have previously had a very difficult delivery with a single baby, you may be advised to have a caesarean section with twins. Even if you plan a vaginal birth, you may end up having an emergency caesarean section.
This could be because:
- one or both babies become distressed
- the umbilical cord prolapses (falls into the birth canal ahead of the baby)
- your blood pressure is going up
- your labour is progressing too slowly
- assisted delivery doesn't work
In very rare cases, you may give birth to one twin vaginally, and then need a caesarean section to birth the second twin if it becomes distressed.
After the birth
Giving birth to twins is usually joyous and exciting. However, it can also be an overwhelming and stressful time. It will take time for your body to heal after giving birth. After the birth it is important for you to eat well, sleep as much as possible and stay active, so your body can recover.
Don’t forget to book in for your 6-week postnatal check with your maternity care provider or doctor. You can also ask for this check earlier than 6 weeks if you feel you need it.
Trying to learn how to feed and look after 2 babies can also be very challenging. Families with twins are more likely to experience higher levels of financial stress, relationship breakdown, exhaustion, depression, and social isolation.
If you are experiencing any of these challenges, it is important to seek our support from family, friends and health professionals. Organisations like the Australian Multiple Birth Association provide practical and emotional support to families with twins and can be very useful in helping you and your family deal with the challenges of looking after your babies.
If your babies need special care
Twins are more likely than single babies to be born early. When deciding where to give birth, it is important to choose a hospital that has the facilities and staff to look after premature babies, who may need special care.
Ask if your chosen hospital has a special care nursery or a neonatal intensive care unit. These units provide care to premature or sick babies while also allowing parents to look after their babies as much as possible. Hospitals will also try to keep you and your babies in the same place if possible.
You might also want to ask if your hospital has cots that allow co-bedding (where your babies sleep in a single cot).
If you have one baby in the hospital and one at home, you will need to think about splitting your time between the two. When you visit your baby in hospital, ask if you can bring their twin and if co-bedding is allowed during visits.
If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is having trouble feeding.
Check if your hospital offers support from a community neonatal nurse, which may allow for you and your babies to leave hospital earlier.
When you go to clinics for follow-up appointments, it's a good idea to ask not to be booked into early morning appointments. Getting out of the house with two babies, particularly if one is unwell, can be difficult.
Resources and support
For more information about twins, as well as information about practical and emotional support for families with twins, visit:
The Australian Breastfeeding Association offers information on breastfeeding multiples.
If you’re expecting triplets or more read this Pregnancy Birth & Baby page on Multiple birth - triplets or more.
Speak to a maternal child health nurse
Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.
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Last reviewed: February 2023
