So I was recently asked about twins and vaginal delivery vs c/section so here goes. Twins can deliver vaginally if they are both head down. Twins are a complicated situation all around though because risk of preterm delivery (approx 50%) and other risks with twins such as monoamniotic and cord transfusion issues, but I won't get into those in this post. As far as delivery goes, if the twins are delivered preterm such as less than 32 weeks, and it is not a first vaginal delivery, it may be reasonable to deliver them breech or allow the head first one to deliver and the second one deliver breech if fetal heart tones on that twin are appropriate and the baby is descending the birth canal well on its own. Generally twins are taken by c/section if they are beyond 34 weeks and not head down though. The reason is because if the head becomes entrapped in the cervix after the rest of the body has delivered, they can become strangulated or end up with broken necks trying to maneuver them out that way. It is safer to just do the c/section. Even if one is head down and delivers vaginally, the other one may stay breech and is still a risk for head entrappment or other cord prolapse and problems in that transition period of waiting for the second twin to drop. Therefore, instead of having to hurry and prep mom for an emergency c/section after delivery through the vagina on the first, a c/section is performed from the beginning to ensure safety of both babies. However, if both babies present at term head down, they will likely stay that way and vaginal birth is reasonable as long as both babies are tolerating labor well. Sometimes twins don't tolerate things as well because of placental or cord issues and may warrant a c/section regardless.
