Our Twins’ Birth Story: Vaginal Or Caesarean?

Are you pregnant with twins and trying to decide which birth plan sounds right to you? Is your OB comfortable delivering vaginally or caesarean (c-section) and letting you decide? Are one of the twin babies head down and the other breech and you aren’t sure if you want to risk a vaginal delivery? That was me. I had the choice of how to deliver and I wasn’t sure what to do! This was my thought process leading to our twin birth story. Hopefully our experience will help you decide.

Our singleton birth was born via vaginal delivery. I loved the whole experience. When we found out we were expecting twins, my OB at the time said he would only deliver twins via cesarean. This really bummed me out, because I wanted to at least have an option. I ended up moving OBs because we moved cities when the twins were 32 weeks gestation. To read about how we found out we were pregnant with twins, click here.

Vaginal or caesarean?

I am a big fan of our new OB. He is a well seasoned veteran who was confident in giving me options. I have fraternal di/di twins. He said, depending on how the babies were presenting, it was possible for me to give birth vaginally. I really wanted to try delivering vaginally again. Having newborn twins and a toddler at home, I didn’t think that a caesarean recovery would fit into our life. I felt if I had the option to help ease the transition to becoming a family of 5, then I should try. 

We were hoping that both babies would present head down to make it an easy decision to do a vaginal birth. However, our babies had other plans. During the first 37 weeks, my daughter (baby A) was always head down and my son (baby B) was transverse (sideways). We were hoping that our son would move more into a head down position. This way we would feel more comfortable committing to a vaginal birth. My OB said that he was willing to try a vaginal birth if I was up to it.

The OB went over the pros and cons for both vaginal and caesarean births. There is research that supports that giving birth vaginally to twins can be the safest form of delivery. At least if baby A was presenting head down. Research articles even support trying vaginal births for twins even if the second baby is breech. They claim that they could attempt to flip baby B during delivery. However, I couldn’t find very many success stories in the USA with our current situation. Also, the research did state that you should only attempt this delivery with a provider that is experienced with this. I don’t remember my OB or anyone really, who had any successful delivery stories of delivering twins like this. I’m sure he had but at the time I didn’t remember feeling reassured.

Here are some articles you might find helpful:

Birth Plans by: Twins Trust

Giving Birth to Twins by: Pregnancy Birth & Baby

How both deliveries would play out

Vaginal

For a vaginal birth I would need an epidural, IV, and give birth in the operating room. This was all in case I needed an emergency caesarean (c-section). I would hopefully give birth quickly to my daughter since she was in the head down position. The providers would then attempt to do a Webster Maneuver to spin baby B head down. I would then hopefully give birth to him vaginally. During vaginal birth, providers are usually able to do delayed cord clamping, immediate skin to skin, and breastfeeding. These are important interventions, especially for high risk deliveries like twins.

However, there is a lot of risk to vaginal delivery of twins. My OB said that there is a chance that baby B would naturally move head down after baby A was born. However, there is an equal chance of him doing the opposite and going breech. There is also risk of the umbilical cord getting wrapped around the baby’s head or body or getting compressed. If the baby started showing distress or the cord was compressed, then we would need to do emergency surgery (c-section). In an emergency c-section my husband would not be allowed to be in the room during the birth.

Caesarean

For a scheduled caesarean, my husband would be allowed to be in the room the whole delivery and could even take pictures. I would be awake for everything and it would hopefully be a more controlled and relaxed situation. I possibly would not be awake in an emergency c-section. My provider tries to do delayed cord clamping and skin to skin during a scheduled caesarean when appropriate. Breastfeeding within the hour after birth is also encouraged. They don’t get to do these things during an emergency c-section.

Of course, caesareans do not go without risks as well. C-sections are considered major surgery and can cause some complications to mother and babies. There is no clear, set answer for multiples deliveries because there are many things to consider. Make sure you ask your provider to go through all the risks and benefits to each option.

Ask the nurses

Due to my high risk pregnancy, I had multiple stress tests done every week at the hospital. These were done on the birthing unit. To read about this experience click here.

Vaginal birth

I got to ask many nurses what they experienced and what they would do in my situation. Honestly, it was 50/50. About half of the nurses thought that I should try to avoid a c- section. Especially, since the OB was willing to try a vaginal birth. The nurses thought that since I pushed out my first born in 3 pushes, it would possibly be easier the second time. They also thought that the recovery for a c-section with three kids wouldn’t be ideal.

Caesarean

The other half of the nurses said, why risk it? The nurses liked the idea of how much more controlled and predictable the caesarean delivery sounded. Potentially a safer option for the babies by reducing the risk of fetal distress and cord compression. Another reason is if I picked the c-section it would guarantee just one birth recovery. Also, my husband could be included in the delivery. The nurses that were for the caesarean also reassure me that it wasn’t as scary as everyone makes it sound. They made it sound like the recovery was very doable with twins and a toddler. Very funny how they had very similar apposing opinions.

I loved hearing all their insights, even if it was 50/50. However, I don’t remember them talking about many situations similar to mine. I only remember one similar situation. Baby A was head down and baby B was breech. The mother gave birth to baby A vaginally but ended up having to do an emergency c-section. I really didn’t want to put my babies at an added risk and recover from two different deliveries.

So, I didn’t decide. I just kept thinking about it and said that the babies will just decide for us. If I go into labor early, then the doctor will make the decision for us. I personally just felt too much pressure and too much weighing on this decision. I wanted to do what was right for our family and situation (because this is different for everyone!). 

The final decision

37 weeks came along and we had our very last ultrasound on a Friday at 5pm, at the OB office. It turns out the babies did decide for us. My daughter was head down like usual. My son decided he was going to turn up more towards the breech position. Also, it turns out I wasn’t dilated and barely effaced, meaning my body wasn’t physically ready to delivery these babies.

That was it for me. The fact that I wasn’t dilated or effaced much, I would have to be induced from nothing and on an epidural. This could be a whole other conversation, but pretty much I felt like the chances of me ending in a c-section were higher because I was starting at zero.

Unfortunately, my decision was definitely fear based. Even after talking with many people, there wasn’t a clear or certain enough answer for me to be comfortable with the unpredictability of a vaginal birth. I didn’t want to risk the health of my children just because of slight inconvenience for myself. I wish I could have read about or heard someone who went through what I was going through. After many discussions with multiple people, my husband, and medical professionals, we decided to do the scheduled caesarean. My OB was okay with this decision based on our reasons and we were going to have our babies in 3 days! Wow! All of a sudden it felt really real!

The last weekend

The weekend before the birth we lived it up. We soaked up as much time as we could with our daughter as an only child. We went out to dinner with family, we went to the beach together, went mini golfing, got ice cream, and played and laughed endlessly. This especially seems unattainable now with the COVID-19 pandemic. The night before the birth, our daughter spent the night at her grandparent’s house where she stayed for the rest of the week. My husband enjoyed our last night without any children at home.  We packed and prepped for the birthday, relaxed, ate well, and just enjoyed the peace.

Read the second blog post to read about the twins’ birth story and our hospital stay!

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Photo by Autumn Goodwin