Posted March 12, 2013 in BIRTHING

Twin Study: Planned Cesarean no safer than Vaginal Delivery


Have you noticed multiple births around the world are on the rise? So too is the trend of the planned cesarean deliveries that accompany them. According to the U.S Center for Disease Control the U.S. birth rate for twins is 33.1 out of every 1000 live births. Most of these parents are unsure what the best method of delivery is for twins and often succumb to a planned cesarean because they perceive it to be safer. Could a planned vaginal birth be the correct method of delivery when a twin pregnancy is uncomplicated, when the first baby is presenting head down? According to the American Journal of Obstetrics and Gynecology in January 2003, a planned cesarean may decrease the risk of a low 5-minute Apgar score if the first twin is presenting breech. Otherwise with twins there is no evidence to support a planned cesarean delivery.

At last, a meticulous study that gives hope to both women contemplating a vaginal birth for twins and the care providers who plan to support them included 2,804 women having twin pregnancies, in which the first baby presents head down, for either a planned cesarean or vaginal delivery. The findings involved 106 centers in 25 countries, and were presented at the Society for Maternal-Fetal Medicine Annual Meeting in San Francisco on February 14, 2013. After nearly a decade in the making, this is the only large randomized, controlled trial that has determined the most optimal method of twin delivery.

The Center for Mother, Infant and Child Research (CMICR) at Sunny Brook Hospital in Toronto, enrolled women in a central controlled study between 2003 and 2011, following each mother and infant for 28 days after childbirth.  “We found no reason for doctors or women to plan to deliver twins by cesarean section, as the babies’ outcomes remain the same regardless of how they are delivered.” says Dr. Barrett, Chief Maternal-Fetal Medicine at Sunnybrook Health Sciences Center. Also the study found that women, who planned a cesarean, delivered their babies early which is not good for babies and should be avoided, according to Dr. Barrett.

The findings of this twin birth study may help reduce the amount of unnecessary cesarean deliveries. In addition, results should serve as a reminder that it is important for care providers to keep vaginal delivery skills in practice, so they are not lost or forgotten. Cesarean deliveries are no longer preferable for all twins, and with this study women and their care providers can choose the method of birth that is right for them.

Charlotte Sanchez (CPM) is a Certified Professional Midwife and
Childbirth Educator of over 20 years.