When considering birth options for twins, women should consider the position and size of the babies, as well as 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).

When the first twin’s (the lower one) head is down but the second twin isn’t, your doctor may attempt a vaginal delivery by changing the baby’s position or doing breech extraction, which isn’t possible if the second twin weighs much more than the first twin.

Emergency C-section deliveries for the second twin following a va.ginal delivery for the first twin are more common in second twins with very low birth weight. Small babies may not tol.erate labor as well.

If one twin is lying sideways or dia.gonally (ob.lique), there’s a chance the baby may shift position as your labor progresses, or your doctor may try to turn the baby head-down via ex.ternal cep.halic version or i.nternal p.odalic version (changing position in the ut.erus), which means you may be able to deliver both vag.inally.

When both twins are breech, a planned C-section is recommended because your doctor isn’t able to turn the fetu.ses. According to studies, planned C-sections have fewer negative ne.onatal outcomes than planned vag.inal births in breech babies.