It's important to understand your birth options if you're expecting more than 1 baby.

Twins and triplets are more likely to be born early and need special care after birth than single babies.

Your birth choices with twins

Giving Birth to Twins - What You Need to Know 

It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

You'll normally be advised to give birth in a hospital, as there's a higher chance of complications when giving birth to twins.

There are usually more health professionals at a multiple birth – for example, there may be 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).

You'll already have met your obstetrician and midwives to discuss your baby's birth beforehand, so it is likely that you will already be familiar with them. 

For more information on who's who, read about the antenatal team.

When giving birth to twins, the process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.

This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.

Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.

You'll be offered a drip in case it's needed later – for example, to restart contractions after your first baby is born.

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Natural births with twins

Lots of women think they have to have a caesarean section with twins. In fact, more than 40% of twin births are vaginal.

If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.

If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.

Find out more about the signs and stages of labour here.


Can I have a natural birth with twins? 

You're more likely to have a vaginal birth if the first twin is in a head-down position.

But there may be medical reasons why a vaginal birth is not recommended.

If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.

As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.

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, it should be born soon after the first, as your cervix is already fully dilated.

If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.

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Caesarean section and twins

In the UK, more than half of twins and almost all triplets are delivered by caesarean.

You may choose to have a planned caesarean, or your doctor may recommend a caesarean, if:

  • the first baby is lying feet, knees or buttocks first (breech)
  • 1 twin is lying sideways (transverse)
  • you have a low-lying placenta
  • your twins share a placenta
  • you have had a difficult delivery with a single baby before

As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.

In very rare cases, some women deliver one twin vaginally and then need a caesarean section to deliver the second twin. However, this occurs in less than 5% of twin births.

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Finding out if your twins are identical

When will I know if my twins are identical? 

After the birth, your midwife will examine the placenta to ensure it has been delivered intact, and to examine the fetal membranes (amniotic sac) for any abnormalities. 

If your babies have a single placenta with one outer membrane (chorion) and two inner membranes (amnion), they must be identical (monozygotic).

Otherwise, the only way to tell if they're identical is through DNA testing. This is not available on the NHS.

For advice on how to find out if your twins are identical, you can phone the Multiple Births Foundation on 020 3313 3519 or email them at [email protected].

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Additional Information

In this video, a midwife explains what can happen when giving birth to more than 1 baby.

If you're expecting twins or triplets then your pregnancy, your birth and the following days after  

More in What happens in labour and birth

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