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The Multiple Births Foundation

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early.

Vaginal delivery of more than one baby

People often assume that if you are expecting more than one baby they must be born by caesarean section. In fact, almost half of all twins are born vaginally and the process is similar to having a single baby.

If the first baby is in a head down position, it's usual to consider having a vaginal delivery. However, there may be other medical reasons why this would not be possible. For example, if you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

If planning a vaginal delivery, it is usually recommended that the mother has an epidural for pain relief. This is because if assistance with delivery is needed, it's easier and quicker when the mother already has an epidural in place.

If you have a vaginal birth, you may need an assisted birth, when a suction cup (ventouse) or forceps are used to help deliver the baby.

Caesarean section for multiple births

If you are expecting more than one baby, you may choose to have an elective caesarean section from the outset of your pregnancy. Alternatively, your doctor may recommend a planned caesarean section later in the pregnancy as a result of potential complications.

Your babies' positions may determine whether they should be delivered by caesarean section. If the presenting (first) baby is in a breech position (feet, knees or buttocks first) or if one twin is lying in a transverse position (with its body lying sideways), you will have to have a caesarean section.

Some other conditions might also mean you will need a caesarean section, for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.

If you have previously had a very difficult delivery with a single baby, you may also be advised to have a caesarean section with twins.

Even if you plan a vaginal delivery, you may end up having an emergency caesarean section. This could be because

the babies become distressed,

the cord prolapses (when the cord falls into the birth canal ahead of the baby),

you have high blood pressure,

the labour is progressing slowly,

an assisted delivery doesn't work.

In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if the baby becomes distressed. This occurs in less than 5% of situations when twins are born.

Special care

As multiple pregnancies are generally less likely to carry to full term, parents expecting more than one baby should be prepared for the possibility that their babies may come early and spend some time in a neonatal intensive care unit. These can sometimes be quite upsetting places to begin with, and parents can think their babies look small and vulnerable amongst all the technology. It may be a good idea to try to visit the neonatal intensive care unit on a hospital tour during your pregnancy to prepare yourself for the possibility that your babies may spend some time here.

Although the thought of having premature babies may be worrying, studies have shown that premature multiples mature more quickly than single babies born at a similar time and multiples are often better equipped for early starts. Some premature babies may only need a short stay with little medical treatment.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about pregnancy, labour and life with a new baby.

The Twins & Multiple Births Association (Tamba) provides support and information to parents expecting twins, triplets or more babies. They publish a Healthy Multiple Pregnancy Guide, which is available free on Tamba's website if you register.

NHS choices also provide information on delivering twins.

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It is unusual for multiple pregnancies to go beyond 38 weeks, so if you are expecting a twin birth or more than two babies you will need to consider your options early. People often assume that if you are expecting more than one baby they must be born by caesarean section.

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Different babies, different needs - best beginning

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Different babies, different needs - best beginning

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Giving birth to twins - Pregnancy and baby guide - NHS Choices

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Giving birth to twins - Pregnancy and baby guide - NHS Choices

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It's important to understand your birth options if you're expecting more than 1 baby.
Twins and triplets are more likely to be born early and need special care after birth than single babies.

Your birth choices with twins

It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

You'll normally be advised to give birth in a hospital, as there's a higher chance of complications with twins.

There are usually more health professionals at a multiple birth - for example, there may be 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).

You'll already have met your obstetrician and midwives to discuss your baby's birth beforehand, so they will not all be strangers.

For more information on who's who, read about the antenatal team.

The process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.

This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.

Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.

You'll be offered a drip in case it's needed later - for example, to restart contractions after your first baby is born.

Triplets or more babies are almost always delivered by a planned caesarean section.

Can you have a natural birth with twins?

Lots of women think they have to have a caesarean section with twins. In fact, more than 40% of twin births are vaginal.

If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.

If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.
Find out more about the signs and stages of labour
You're more likely to have a vaginal birth if the first twin is in a head-down position.

But there may be medical reasons why a vaginal birth is not recommended.

If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.

As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.

Once the first baby is born, your midwife or doctor can 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, it should be born soon after the first, as your cervix is already fully dilated.

If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.

Caesarean section and twins

In the UK, more than half of twins and almost all triplets are delivered by caesarean.

You may choose to have a planned caesarean, or your doctor may recommend a caesarean, if:

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

1 twin is lying sideways (transverse)

you have a low-lying placenta

your twins share a placenta

you have had a difficult delivery with a single baby before

As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.

In very rare cases, some women deliver 1 twin vaginally and then need a caesarean section to deliver the second twin. This happens in less than 5% of twin births.

Finding out if your twins are identical

After the birth, your midwife will examine the placenta to check that it's all there and look at the membranes.

If your babies have a single placenta with 1 outer membrane (chorion) and 2 inner membranes (amnion), they must be identical (monozygotic).

Otherwise, the only way to tell if they're identical is through DNA testing. This is not available on the NHS.

For advice on how to find out if your twins are identical, you can phone the Multiple Births Foundation on 020 3313 3519 or email them at imperial.mbf@nhs.uk.

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It's important to understand your birth options if you're expecting more than 1 baby. Twins and triplets are more likely to be born early and need special care after birth than single babies. It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.

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Breastfeeding Twins - Association of Breastfeeding Mothers

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Breastfeeding Twins - Association of Breastfeeding Mothers

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Mums expecting twins aren't always encouraged to consider breastfeeding; but twins, and even triplets, can be breastfed exclusively. Only a few women won't have enough milk for their babies. Milk supply works on the principle of supply and demand. Breastfeeding tells a mother's body to produce more milk in response to her baby's (or babies') needs. With two babies, more milk is removed from the breasts, so more milk is made. The best way to make sure you establish a good supply is to feed your babies often in the early weeks and to ask someone knowledgeable to help you check that they are attached and breastfeeding correctly.

During the first few days and weeks, babies send signals to your milk supply and may sometimes feed more frequently. This frequent feeding is sometimes perceived as a sign of a lack of milk but, if feeds happen responsively, milk supply will swiftly increase, and feeding will settle into a pattern again. Your babies' weight gain and their nappies will reassure you that they are getting the milk they need.

"I found out at an antenatal scan that I was expecting twins. I asked if I could breastfeed them and was told that I would have to give bottles as well. This upset me as I'd really enjoyed breastfeeding my other two children. The twins were born at 36 weeks (though I nearly had them earlier than that). They never had bottles. I'm glad I found out in advance that it's possible to breastfeed twins."
How can I breastfeed two babies?
Confidence and the belief that it can be done are important. Attend a breastfeeding support group or workshop while you're pregnant to increase your confidence and find out where to get support locally. If you have any questions after your babies are born, you'll know who to ask. Perhaps you can be put in touch with someone who has breastfed twins (or see the Facebook group mentioned below).

"The twins were our first children and I thought I'd like to try to breastfeed. I read a little and a friend invited me to watch her breastfeed her baby. Most of the mums I met at a twins' club hadn't tried, but I decided to give it a go. Our babies were born at 37 weeks after a straightforward labour and the hospital staff were generally encouraging. I wish I'd known a bit more about growth spurts though and how to let the babies increase my milk supply at these times. I also wish I had known about antenatal hand expressing."

Twins can be fed separately or together. Many mums find that they do both in different situations and when their twins are at different stages of development. Feeding babies together can be a good way to establish a plentiful milk supply quickly and can save time. While mum and each baby are still learning about breastfeeding, it may be easier to spend some time feeding separately. As the babies grow and their head control develops, it will be easier to breastfeed them together. Later still, the babies will be able to position themselves. Decisions like when to swap breasts and which positions work best, will vary from family to family.

"Don't be afraid to ask for help positioning the second twin in the early days, so you can have a go at feeding two babies together."

Rugby hold, Parallel and Crossover holds
Breastfeeding cushions designed with twins in mind are more likely to enable a mum to tandem feed and even feed hands-free. However, some mums find they prefer to use V-shaped or normal pillows or cushions or use positions where no cushions are needed. If you have someone to assist you in the early days, they can help you position a second baby after the first one has started feeding.

"After a couple of weeks, I got the hang of feeding lying down and that made things a lot easier at night. When they were a little older, I managed to find a way of feeding both lying down. You get inventive about using different positions and doing things like answering the phone while breastfeeding."

"Our girls are now 17 months old and I'm still enjoying breastfeeding them. Now they are toddlers, I tend to feed them separately, but I used to do a mixture of breastfeeding separately and together."

What if my babies are born early?
Twins are more likely to be born early than single babies. If babies are born early, their mother's milk will be different to full-term milk and have specific advantages for pre-term babies. Breastmilk reduces a baby's chances of becoming ill and some conditions can be particularly serious in a pre-term baby. If twins are born very early, they may need to be fed by tube or special cup until they are able to breastfeed. Expressing breastmilk for premature babies will mean a mother is making a valuable contribution to her children's welfare, especially as hospital staff are responsible for other aspects of their care. Donor milk can also be an option.
Won't I be too tired to breastfeed?
Tiredness is sometimes given as a reason not to breastfeed twins, but there's no evidence that breastfeeding in itself is tiring. In fact, breastfeeding mums can make the most of opportunities to sit or lie down. It's important to eat a balanced diet and to rest when your babies sleep.

Once breastfeeding is established, it gets easier to go out or travel with twins, because breastmilk is available immediately and at the right temperature. Imagine the sheer number of bottles to be washed, sterilised, made up with hot water then cooled down for bottle-fed twins, and the cost of formula.

Breastfeeding involves the release of specific hormones that help a mother to feel relaxed. This is particularly beneficial for mums of twins who are likely to have an even busier time than other mothers. Also breastfeeding will help your uterus (particularly enlarged after having twins) to contract back to its pre-pregnancy shape and size and will help you lose weight more quickly.

If families feed their babies at the same time, they may choose to wake the other twin at night to minimise the number of night feeds. Breastfeeding at night can be done lying down and can help to establish a good supply of milk.
But my family and friends want to help
Grandparents or others might ask if they can help by giving a baby a bottle, but if bottles are introduced early on, this may make breastfeeding more difficult to establish and reduce a mother's milk supply. Dummies may also mean the demand on your milk is reduced so the supply reduces. However, some mothers of twins do find that expressing breastmilk can be useful and allows someone else to feed the babies occasionally.

There are lots of other things that family and friends can offer to do to help parents of newborn twins e.g. cuddling a baby, changing a nappy, offering mum a drink or sandwich, helping at bath time if needed, or hanging out washing. The support and encouragement of friends and family is an important aspect to breastfeeding twins successfully.
More information:

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Many new mums worry about whether they will have enough milk, but in fact there are very few women who don't have enough.

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AIMS -  Twins and Multiples: More Babies, More Decisions, Same Rights

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AIMS -  Twins and Multiples: More Babies, More Decisions, Same Rights

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Journal Vol. 29, No. 4 - Twins and Multiples: More Babies, More Decisions, Same Rights

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Journal Vol. 29, No. 4 - Twins and Multiples: More Babies, More Decisions, Same Rights

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NHS information

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Problems getting twins to sleep

There are several reasons why 2 or more babies may be more difficult to get into a good sleeping routine.

Twins and triplets are more likely to be born prematurely and spend time in neonatal care, where they're used to being touched and nursed frequently.

They may miss this contact and find it hard to settle when they come home.

If you're still visiting 1 baby in hospital, it can be hard to establish a good routine with the other baby at home.

Other things to note:

Newborn babies, in particular premature babies, have tiny stomachs and need to feed frequently.

It may take longer to get into a routine with 2 babies to care for.

More than 1 person may be caring for your babies, and they'll take a while to get used to being handled in different ways by different people.

You may want to comfort a restless twin faster than you would a single baby, as you're worried they may wake up their twin.

But there are plenty of ways to encourage a good sleeping routine so everyone gets enough rest.

Can my twins sleep in 1 cot?

You can put your twins to sleep in a single cot while they're small enough. This is called co-bedding and is perfectly safe.

In fact, putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe them and their twin.

If you put your twins in the same cot, follow the same safe sleeping advice as for a single baby.

They should be placed on their backs with the tops of their heads facing one another and their feet at opposite ends of the cot, or side by side on their backs, with their feet at the foot of the cot.

Use a single cot for co-bedding, but not a Moses basket, as it'll be too small for 2 babies.

Co-bedding means you can keep your babies with you in your room for longer.

With triplets, you can place them next to each other across a cot while they're still small enough to fit.

They should be laid on their backs with their feet touching the side of the cot.

When your twins are older, you may choose to put them in separate cots placed close together so they can continue to comfort each other.

If older twins are disturbing one another, you may think about giving them separate rooms if you have enough space.

It's recommended that babies sleep in the same room as their parents for the first 6 months, as this is known to reduce the risk of cot death.

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There are several reasons why 2 or more babies may be more difficult to get into a good sleeping routine. Twins and triplets are more likely to be born prematurely and spend time in neonatal care, where they're used to being touched and nursed frequently.

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EXPECTING TWINS, TRIPLETS OR MORE?THE HEALTHY MULTIPLEPREGNANCY GUIDE

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EXPECTING TWINS, TRIPLETS OR MORE?THE HEALTHY MULTIPLEPREGNANCY GUIDE

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TAMBA

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Twins Trust - We support twins, triplets and more...

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We're still here for you...We're changing how we work so we can keep supporting you and your families during the COVID-19 pandemic.

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Feeding twins, triplets and moreA booklet for parents with advice and information

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Feeding twins, triplets and moreA booklet for parents with advice and information

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Multiple Births Foundation

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A vital resource to professionals and families alike, it aims to improve the care and support of multiple birth and twins families through the education of all relevant professionals.

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Baby Sleep Information Source

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While a vast amount of research has been done concerning the sleep of single babies, much less has focussed on multiples. Here we summarise the research which has been done.

Whilst Sudden Infant Death Syndrome (SIDS) is extremely rare, the rate is two- to four-times higher in twins, compared to singleton babies. This is likely to be because many more twins are born premature and/or at a low birth weight; factors which are associated with increased SIDS risk in all babies.

It is important that parents are aware of how the sleep environment of twins can affect SIDS risk, as well as its effect on babies' sleep, and ease of night-time care.

Twins Trust, a charity focused on twins and multiple births, provide information for sleeping twins and multiples.

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MULTIPLE BIRTHS -A PARENT’S GUIDETO NEONATAL CARE

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MULTIPLE BIRTHS -A PARENT’S GUIDETO NEONATAL CARE

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TAMBA

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Twins Trust - We support twins, triplets and more...

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Supporting you through every milestone of your journey with twins, triplets or more. From being pregnant with twins, triplets or quads through to parenting twins, triplets or quads, we are here for you.

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Sprogcast is a podcast about pregnancy, birth and parenting by midwife Mark Harris and Childbirth Educator Karen Hall, this one features independent midwife Virginia Howes talking about risks and possibilities for normality when giving birth to twins and doula Mars Lord discussing her experiences as a mother of twins and specialist twin doula

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Sprogcast - Episode 11 - Twins (March 2016) by Pinter & Martin

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Hosted by Karen Hall and Mark Harris, with midwife Virginia Howes and doula Mars Lord

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Postnatal Depression - a guide for mothers of multiples

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Postnatal Depression - a guide for mothers of multiples

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Lullaby Trust

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You may like to sleep your twins in their own Moses baskets or cots from birth, or you may decide to co-bed them in the early weeks and months.

Co-bedding means siblings share the same sleep surface during any sleep period, for example by being in the same cot together.

Whichever you decide, all The Lullaby Trust advice for safer sleep should be followed for each baby, for each day and night time sleep.

This includes, for example:

Please have a read of our other safer sleep guidance for information on sleeping babies as safely as possible.

Safer sleep for twins: FAQs

Can I bed-share/co-sleep with my twins?

The safest place for a baby to sleep is in their own clear, flat, separate sleep space, such as a cot or Moses basket. Sharing a bed with an adult is a significant risk for babies born prematurely or at a low birth-weight, which is common in multiples.

Co-sleeping is particularly dangerous if either you or your partner smokes (even if you do not smoke in the bedroom), has drunk alcohol or taken drugs (including medications that may make you drowsy), or are very tired.

If you choose to bedshare with twins or multiples we would advise not to bedshare with more than one baby at a time due to risk of accidents associated with bedsharing with more than one baby or child.

You can find further information on our co-sleeping page.

If my twins were slept close together on the NICU, shouldn't I be continuing this at home?

Premature or low birth-weight twins are often slept in close proximity on the Neonatal Intensive Care Unit to model the intrauterine environment and improve the development of vital functions like heart rate and breathing.

Once your babies are discharged, they should be ready to be slept according to the safer sleep advice for all babies. You can also phone our information line with any queries on 0808 802 6869.

My health visitor told me it's better for twins to sleep in the same cot together than to sleep separately. Why is this?

At The Lullaby Trust, we often will promote co-bedding your twins so that you can share a room with them, if you have restricted space. Sharing a room with your babies is a really important measure you can take to reduce the chance of SIDS.

However, there are other reasons you might want to co-bed your twins that you might want to look into. Various areas of research have suggested that putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe them and their twin.

I've read that babies need separate sleep spaces once they can roll and move about the cot. What is the best thing to do if I don't have space for two cots in my room?

Sometimes it can be tough in a practical sense to adhere to all of the safer sleep messages, particularly if you are short on space.

If you can't fit two cots in your bedroom for your twins, make the advice work for you - you may like to leave doors open between your rooms, or perhaps take in turns with a partner to sleep with the twins in a nursery room.

If possible, you may even be able to borrow something smaller than a second cot for a couple of months, such as a crib. Give our information line a call to have a chat about any further options.

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You may like to sleep your twins in their own Moses baskets or cots from birth, or you may decide to co-bed them in the early weeks and months. Co-bedding means siblings share the same sleep surface during any sleep period, for example by being in the same cot together.