Planned C-section no safer than vaginal delivery of twins

The media has recently reported on a Canadian study of twin births that determined a planned cesarean delivery is not necessarily any safer for either mother or child than a planned vaginal delivery.

Reasearchers involved in the Twin Birth Study, published in the New England Journal of Medicine, commented on the controversy regarding the safest method for the delivery of twins at or near term. A policy of planned cesarean section for the delivery of twins gained support after the publication of the Term Breech Trial, which showed that planned cesarean delivery was safer for mother and child when the fetus was in the breech presentation. The results of the Twin Birth Study however, found no benefits of planned cesarean section, as compared with planned vaginal delivery, for the delivery of twins between 32 and 38 weeks of gestation, if the first twin was in the head first position.

“In this large, randomized trial comparing delivery strategies for twins between 32 and 38 weeks of gestation, planned cesarean section did not reduce the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery (with cesarean section if medically indicated). We found a higher risk of an adverse perinatal outcome for the second twin than for the first twin, as others have found; however, planned cesarean section did not reduce this risk.”

A review of the last 300 twin deliveries from our own centre (not a randomized trial like the Twin Birth Study) would certainly support the findings of this landmark study. We have recommended, when the first twin is head first and the pregnancy has otherwise been uncomplicated, that the woman should plan on a trial of labour and vaginal delivery; a caesarean section should be left for obstetrical reasons only.

However, we recognize that some women who plan for a vaginal delivery will end up having a caesarean section because of either fetal or maternal reasons. Just like what happened in the Twin Birth Study, many of the women planning a vaginal delivery ended up with a caesarean section. A very small number of women will also end up delivering the first baby vaginally and the second one by caesarean section (less than 5% chance in our own data). The most important point of the study is that a planned trial of labour - and hopefully a vaginal delivery - is certainly an appropriate option for many women with an otherwise uncomplicated twin pregnancy. Speak to your health care provider about what you would like and what they think is best in your circumstance.