Hesperian Health Guides

Delivering twins

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HealthWiki > A Book for Midwives > Chapter 12: Pushing: stage 2 of labor > Delivering twins

Dangers of twin births

Twin births may go well, but they can be more difficult or dangerous than a single birth. Twins are more than 3 times as likely to die than other babies, for these reasons:

  • Twins are more likely to be born early, and to be small and weak.
  • The cord (especially of the second twin) is more likely to prolapse.
  • The placenta of the second twin may start coming off the wall of the womb after the first twin is born. This can cause dangerous bleeding.
  • The mother is more likely to bleed heavily after the birth.
  • If the second twin is not born soon after the first, the womb may get an infection. The second twin may also get an infection.
  • One or both twins are more likely to be in a difficult or impossible birth position. Or the twins may get in each other’s way, making it impossible for them to be born.

For these reasons, we suggest that twins be born in a medical center. If the journey is very difficult, feel the mother’s belly to find out the position of the babies. This will help you know what problems to expect at the birth.

When both babies
are sideways, they
cannot be born
through the vagina.

It is very dangerous
to try to deliver them
at home.
MW Ch12 Page 219-1.png
When one head is
down, it is a little
less dangerous to
deliver at home.

If the head-down
baby is born first,
the other baby
may turn.
MW Ch12 Page 219-2.png
It is even better if
both babies are up
and down.

But a breech twin
will have the same
dangers as all
breech babies.
MW Ch12 Page 219-3.png
It is best if both
babies are
head down —
but it is still more
dangerous than a
single birth.
MW Ch12 Page 219-4.png

Delivering twins

MW Ch12 Page 220-1.png

If you deliver twins at home, make sure there are at least 2 skilled midwives at the birth.

  1. Deliver the first baby as you would any single baby.
  2. Cut the first baby’s cord, and tightly clamp or tie the end that is coming out of the mother. Twin babies sometimes share a placenta, and the second baby could bleed through the cord of the first.
  3. After the first baby is born, feel for the position of the second baby. If he is lying sideways, see below.
  4. The second baby should be born within 15 to 20 minutes, but might take longer. Deliver him as you would any other baby.

Possible problems when delivering twins

No contractions within 2 hours of the birth of the first twin
MW Ch12 Page 220-2.png
Encourage the labor to start again by letting the first baby breastfeed. If the baby will not breastfeed, massage the mother’s nipples as if you were removing milk by hand. If the second baby is head or bottom down, try breaking the waters. But do not break the waters if the second baby is sideways.
a syringe.
If these methods do not start labor, seek medical help as soon as you can.

Do not give medicines to get labor started again.

If the second baby is not born in 2 hours, the placenta may start coming off the womb, the cervix may start to close, or the second baby and the womb may get an infection.

turning a sideways baby, using two hands on the mother's belly.
The second baby is sideways

If medical help is close, go there now. If it is too far away, and you have experience turning babies, try the following:

  1. Try to turn the baby’s head down.

  2. MW Ch12 Page 221-1.png
    MW Ch12 Page 221-2.png
  3. If you cannot move the baby to a head-down position, try to move her to the breech position.

  4. If you cannot move the baby to either of these positions, go to a medical center. The baby will need to be born by cesarean surgery.
The mother bleeds before the second twin is born (or the first placenta is born before the second twin is born)

Bleeding after the birth of one twin and before the second twin may mean that there is an early separation of the placenta. Get the second baby out as fast as you can.

Stimulate the nipples, break the bag of waters, and ask the mother to push very hard.

This page was updated:11 Sep 2019