Twins and breech presentation

Women expecting twins have some additional things to consider when thinking about birth choices, including the position and size of the babies and whether to have a planned caesarean. In twin pregnancies it is common for one or both babies to be in breech position (bottom first rather than head first).

One mother had expected to have a caesarean because both babies were breech, but her latest scan showed one had turned. She had to reconsider whether to try a vaginal delivery. In her area special antenatal classes had been run for people expecting twins, and she would have liked to attend, but the person running them had left.

Another mother had two terminations because of a serious genetic abnormality and then conceived twins using pre-implantation genetic diagnosis and IVF. The safety of the babies was more important to her than whether or not she had a natural birth. She went into labour four weeks early, and had a caesarean when the first baby got stuck and the second baby's heart rate started to slow down. She was offered forceps for the first baby but the second would have needed a caesarean anyway.

When a single baby is breech, doctors may wait to see if turns spontaneously or may try to turn it, using external cephalic version (ECV). If the baby remains in breech position, women may be offered a choice between trying a vaginal birth or having a planned caesarean, but most women are advised to have a caesarean, as evidence suggests this is safer for the baby.

One mother was advised that ECV in late pregnancy could cause the placenta to separate from the uterus (placental abruption), so she had a caesarean. (The most recent evidence-based guidance is that in the hands of appropriately trained professionals ECV is a safe procedure). During the operation the baby's position caused some problems, but it was generally a good experience.

In some cases the baby's position becomes apparent only during labour. One mother had an emergency caesarean when this happened, because doctors thought her pelvis would be too small to allow a vaginal birth.

Guidelines on caring for women with a baby in breech position can be found on the Royal College of Obstetricians and Gynaecologists website (See also 'Looking back - caesarean birth').

For further links see our pregnancy resources.

Last reviewed May 2017.
Last updated August 2010.


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