Cesarean section in multiple pregnancy

A cesarean section (C-section) makes it possible to deliver a fetus through an incision in a woman's abdomen and uterus. In a multiple pregnancy, the direction and size of the incision depends on the position of the fetuses. When possible, the incision is made across the bottom of the abdomen above the pubic area. This is called a transverse incision. Instead, it may be in a line from the navel to the pubic area, which is called a vertical incision.

Multiple pregnancies require cesarean delivery more often than pregnancies with one fetus. However, a planned cesarean is not necessary for most twin births; vaginal delivery under normal conditions does not endanger the mother or the twins.1

Reasons to have cesarean delivery for a multiple pregnancy

You may need a cesarean delivery if:

  • You have three or more fetuses.
  • A fetus is breech or crosswise (transverse). (A first-born breech is delivered by cesarean; a second-born breech after a vaginally delivered first-born can sometimes be delivered vaginally.)
  • A fetus weighs less than 2000 g.
  • You have locking twins.
  • You have conjoined (Siamese) twins.
  • You have twins that share one amniotic sac (monoamniotic twins), because of the risk that the cords will get tangled.
  • There are signs of fetal distress, such as a very rapid or very slow heart rate.
  • Your cervix has not dilated over time despite adequate uterine contractions.
  • The uterus is overstretched and cannot contract enough during labor (uterine inertia), making labor long and difficult.

A twin vaginal birth after one previous cesarean (VBAC) is sometimes considered a safe choice. For more information, see the topic Vaginal Birth After Cesarean (VBAC).

A cesarean section is a surgical operation, and recovery is longer than after a routine vaginal delivery. You will need extra help while recovering.

For more information on cesarean section, see the topic Cesarean Section.


  1. Hogle KL, et al. (2003). Cesarean delivery for twins: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 188(1): 220–227.

Last Updated: July 16, 2009

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