Giving birth to multiple babies

Where will I give birth?

Where you give birth is up to you and you should be supported in your choice. However, you will be advised to give birth in hospital so you have access to medical facilities and doctors if you need them. It’s sometimes called a delivery suite or an obstetric unit.

When will I give birth?

The National Institute for Health and Care Excellence (NICE) recommends that all women carrying multiple babies should plan to give birth earlier than women carrying single babies. This helps to reduce the risk of complications, such as stillbirth.

If you don’t go into premature labour naturally, you will be advised to have an induction or caesarean before your due date. The timing of this will depend on how many babies you’re carrying, whether they share a placenta or amniotic sac and whether there are any complications.

If your pregnancy has been uncomplicated, you may have a planned birth at:

• 37 weeks if you are carrying twins with their own placentas (dichorionic)  
• 36 weeks if you are carrying twin babies that share a placenta (monochorionic)  
• between 32 and 33+6 weeks if you are carrying twin babies that share a placenta and amniotic sac (monochorionic monoamniotic)  

You may have a planned birth at 35 weeks if you are carrying triplets and:

• all 3 babies have their own placentas and amniotic sacs (trichorionic triamniotic), or  
• all 3 babies have their own amniotic sacs and 2 of the babies share a placenta (dichorionic triamniotic).

You’ll have an individual assessment to decide when to give birth if you:

• have had a complicated twin or triplet pregnancy
• are expecting triplets where all 3 babies share 1 placenta but each has its own amniotic sac (monochorionic triamniotic)  
• a triplet pregnancy where any babies share an amniotic sac (dichorionic diamniotic monochorionic diamniotic or monochorionic monoamniotic).

Unless labour starts on its own, the timing of the birth is your choice. Your doctors will talk to you about the risks of delaying the birth past the times listed above. If you choose to wait, you’ll be offered weekly appointments with your specialist doctor so they can keep a close eye on your babies.

How can I give birth?

From about 24 weeks, your midwife and doctor will talk to you about your options for giving birth. This will depend on:  

• how many babies you’re carrying
• the position of the first (presenting) baby in your womb  
• how well the babies are growing
• your wishes.

Both vaginal birth and caesarean section have benefits and risks. Your doctor or midwife should explain what these are for you so you can make an informed decision about how you want to give birth.

Be aware that sometimes things don’t go to plan during labour and you may need to do things differently. For example, if you want to deliver the baby naturally, you may still end up needing a caesarean section.

Natural labour

If you are having twins and the baby nearest to the neck of the womb (often called the presenting twin) is head-down and you have no other complications, you should be able to have a vaginal birth if you want one. The position of your second twin can change after the first baby is born, so this does not influence how you give birth.

When you give birth, there will be several health professionals in the delivery room. There may be:

• 2 midwives
• a doctor in the delivery room or nearby
• other doctors and nurses who specialise in caring for newborn babies
• an anaesthetist, to make sure that your pain is controlled.

Monitoring your baby during labour

Your healthcare team will monitor your babies’ heartbeats during labour so they can check how they are coping. This is done using electronic fetal monitoring.

Pain relief

Your healthcare team will explain your pain relief options while you are pregnant and again when you’re in labour. They may advise you to have an epidural. As well as relieving pain, this can help if you need to have a caesarean section or assisted birth. Find out more about pain relief in labour.  

Delivering your second baby

If you give birth to your first baby vaginally, your midwife or doctor will check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.

If the second baby is in a good position, they should be born soon after the first, as your cervix is already fully dilated. The average time between the birth of the first and second baby varies, but the second baby is usually delivered within about 30 minutes to an hour after the first.

In a small number of cases, the first twin is delivered vaginally and the second twin is delivered by caesarean section.

If you are carrying 3 or more babies, you will probably give birth by caesarean section.

Caesarean section

In the UK, more than half of twins and almost all triplets are delivered by caesarean. You may choose to have a planned caesarean. Your doctor may recommend a caesarean section if:

the first baby is lying feet, knees or buttocks first (breech) or lying sideways (transverse)

• 2 babies share a placenta and amniotic sac
• you have a low-lying placenta
• you have had a difficult delivery with a single baby before
• there are any complications in the pregnancy that mean you need to give birth early  
• if you are having triplets or more. In this case, you’ll be offered a caesarean section at 35 weeks. If you’ve had any complications or if you are in established (active) premature labour, this may happen earlier.

If you have decided to have a caesarean section but go into labour naturally, you should go straight to hospital. The doctors will talk to you about whether a vaginal delivery or caesarean section is safer for you and your babies.

What happens after I give birth?

If your babies are born early, they may need to spend some time in the neonatal intensive care unit.  

Going home from the hospital

If your babies need care, your doctors will do everything they can to try and discharge them at the same time. But unfortunately, this isn’t always possible. 

This can be very difficult because you may need to spend time settling 1 baby at home while visiting the other in hospital. It may help to ask for support from other family members, such as grandparents or siblings. You’ll also have support from a midwife and health visitor, among other health professionals. Read more about support for you and your premature baby at home.

Feeding your babies

You will be offered support with feeding your babies in hospital and once you’re at home. You may choose to feed 2 babies together or you may prefer to feed 1 at a time.  

If you would like to breastfeed, your body should be able to produce enough milk for all your babies.

Some mothers combine breast and formula feeding, while others choose only to formula feed their babies. The important thing is to do what works for you.

Whatever you are doing, it will help to write the details down every time you feed, including which baby you’ve fed, on which breast and for how long. You will probably be very tired and this will make it easier for you to remember what you’re doing. It will also help when you’re talking to your health visitor or getting advice from a breastfeeding support group.

Twins Trust has more information about breastfeeding multiple babies.

Your relationship with your babies

Some parents bond with their babies straight away, while others find it takes more time. You may find that you develop a closer bond with 1 baby over another in the early days. This can be upsetting but natural, so try not to worry. Your relationship with your babies will develop over time. Find out more about bonding with your baby.

Postnatal depression

You may experience postnatal depression. You may have feelings of sadness or lose interest in things you used to enjoy. Symptoms can start any time in the first year after the birth. Postnatal depression can be treated with the right care and support.

Postnatal depression can also affect dads and partners, so it’s important that you keep an eye on each other and ask for help if you need it. Find out more about postnatal depression for dads and partners.

More information and support

Twins Trust offer help, information and advice for families with multiple babies. You can contact their helpline by phone or online. They also offer parenting courses and virtual clubs.  

If you’re looking for advice from the Tommy's midwives, call our pregnancy line on 0800 014 7800 (Monday to Friday, 9am to 5pm), or email us at [email protected].