Flip a coin. When it comes to twins, the odds of how they’ll be positioned at delivery time (head down, feet first, or buttocks locked) are anyone’s guess — which means you may be left guessing as to whether you’re going to be delivering vaginally or via C-section.[1]
Here’s a look at the possible fetal positions for twins and the likely twin delivery scenarios for each situation.
Twin delivery depends on positioning. If both babies are head-down (vertex/vertex), a vaginal birth is usually possible, though C-sections can still be needed if complications arise. Mixed or breech positions increase C-section likelihood. When one or both twins are breech, doctors may attempt to reposition Baby B after Baby A is born, but many cases still require a C-section for safety. Oblique or transverse twins almost always mean surgery. Babies lying sideways or at an angle typically can’t be delivered vaginally, so doctors will recommend a C-section to ensure a safe delivery for both.
Vertex/vertex position
Good news! If both babies are head-down (called the vertex position), you’ll likely be able to go into labor naturally and attempt a vaginal birth. But do keep an open mind — even perfectly positioned singletons sometimes need to be delivered by C-section if they show signs of stress during labor or if labor stalls for some reason. This goes double for twins.[2]
Vertex/breech position
The second best-case scenario for a vaginal birth is the vertex/breech set-up. This means that if Baby A is head-down and in a good position for delivery, your doctor may be able to manipulate Baby B from the breech position to vertex after Baby A is born.[3]
Called internal version, your physician will reach inside your uterus to move Baby B into a better position for delivery — or, if he's still breech, to pull him right out the door. (Don’t worry — it may feel odd, even uncomfortable, but since Baby A essentially warmed up and stretched out the birth canal, the process is over pretty quickly.)
Sometimes, another practitioner will be simultaneously performing external cephalic version (manipulating the baby from the outside) by pushing down on the top of your abdomen. (Yes, it sounds crazy and it feels bizarre, but the goal is to get Baby B out in the quickest and safest way possible.) External cephalic version is sometimes deemed too risky to attempt during twin pregnancies, however, so it may not be an option.
Breech/vertex or breech/breech position
If Baby A is breech or if both your babies are sitting on their tushies, your physician will almost certainly recommend a C-section. While external cephalic version is commonplace for breech singletons and can work in the vertex/breech multiple pregnancy, it’s often not possible because of the potential risks when the babies are in other positions during labor and delivery.
Baby A oblique
When Baby A is oblique, it means his head is pointed down, but toward either of your hips, rather than squarely at your cervix. If you were carrying only one baby, a practitioner would probably try an external cephalic version to bring the baby’s head where it needs to be (facing the exit), but that may not be an option in a twin pregnancy when the baby closest to the birth canal is oblique.
In this case, two things can happen: An oblique presentation can correct itself as contractions progress (which can result in a vaginal birth), or your doctor will recommend a C-section to avoid a long, drawn-out labor that may or may not lead to a vaginal birth.
Have more questions about your baby's development? You can get answers about what happens each week of your twin pregnancy in the What to Expect app.
Transverse/transverse position
In this case, both babies are lying horizontally across your uterus rather than vertically. Like the Baby A breech presentation, this almost always results in a C-section.
"With my first set of twins both were head down for delivery and were born vaginally five minutes apart, but B flipped after A was born," recalled What to Expect Community user Mammamoose88. "They had to reach up and turn her the right way. With this set of twins they have been all over the place. Head down, transverse, breech."
No matter how your twin babies are positioned in utero, rest assured that your practitioner will do everything possible to ensure the healthiest and safest delivery and birth possible, based on the fetal positions of your twins.
And before you know it, you'll be holding both of your beautiful babies in your arms.
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