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 special care.

As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or doctor early in your pregnancy.

You should also discuss where you would like to give birth. You will most likely be advised 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 two 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 given a drip in case it is needed later.

Vaginal birth

About one third of all twins are born vaginally and the process is similar to that of giving birth to a single baby. If you're planning a vaginal delivery, it's usually recommended 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, it's usually not recommended you 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 deliver the babies.

Once the first baby is born, the midwife or doctor will check the position of the second baby by feeling your abdomen and doing a vaginal examination. If the second baby is in a good position, the waters will be broken and this baby should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.

Caesarean section

You may choose to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a caesarean section later in the pregnancy as a result 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.

The babies' position may determine whether they need to be delivered by caesarean section or not. If the presenting baby - the one that will be born first - is in a breech position (feet, knees or buttocks first), or if one twin is lying in a transverse position (with its body lying sideways), you will need to have a caesarean section.

Some conditions also mean you will need a caesarean section; for example if you have placenta praevia (a low-lying placenta) or if your twins share a 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
• the labour is progressing too slowly
• assisted delivery doesn't work

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if it becomes distressed.

After the birth

After the birth, your midwife will examine the placenta to determine what type of twins you have. Twins can either be fraternal or identical.

If your babies need special care

Depending on where you plan to give birth, you may need to go to another hospital with appropriate facilities if complications in your pregnancy indicate you're likely to have an early delivery. This may not be near to home, so make sure to check there are enough beds for both your babies in the neonatal unit.

Ask if your chosen hospital has a transitional care unit or a special care nursery. These are places that allow mothers to care for their babies if they need special care but not intensive care. These hospitals are more likely to be able to keep you and your babies in the same place.

You might also want to ask if your hospital has cots that allow co-bedding (where your babies sleep in a single cot), if this is appropriate and if you want your babies to sleep together.

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. You may then need to put the twin who can feed on the breast to encourage milk production in order to get enough milk to feed both babies.

Check if your hospital offers support from a community neonatal nurse, which would allow for you and your babies to leave hospital earlier, for example if your baby is still tube-fed.

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.

For more information and support, visit Twins Research Australia.