Delivery of twins is associated with greater risks for both mothers and babies. Previous studies have looked at deliveries that have already happened (retrospective studies), and these studies have suggested that cesarean section may be a safer method of delivery for twins. This has led to an increase in planned C-section deliveries for twin pregnancies. In a new, large, international study of planned cesarean section vs. planned vaginal deliveries, the outcome was the same for both babies and mothers. There was not a greater risk of harm by planning on a vaginal delivery at first, and performing a caesarean section if necessary. Many of the planned vaginal deliveries did up having a cesarean section, but most did not. In the planned vaginal group, 40% had cesarean section delivery of both twins and 4% had combined vaginal-cesarean, while 56% delivered both twins vaginally. Based on this study, vaginal delivery is safe for both mothers and babies, and in uncomplicated pregnancies it is not necessary to plan for a cesarean section just because there are twins. In light of the rising evidence that cesarean sections are performed more often than necessary in the United States, this study lends further support of vaginal delivery in more cases.
J.F. Barrett et al. A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy. N Engl J Med 2013; 369:1295-1305 http://dx.doi.org/10.1056/NEJMoa1214939
