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Delivering Multiple Newborns

Planning and anticipating the birth of twins, triplets or higher-order multiples is exciting. For some families, however, it can also be overwhelming and stressful.

At the Brigham Comprehensive Care Center for Multiples, we take a patient-centered approach. In the last trimester, you will have the opportunity to review our approach to delivery and options for pain management. Although we encourage vaginal delivery when possible, we recognize a cesarean delivery sometimes is necessary or the patient's preferred choice. At the Brigham, we strive for a gentle cesarean delivery experience.

Twins

Multiple pregnancies are at higher risk of complications toward the very end, so the optimal timing of delivery needs to be well-planned.

The following are general recommendations on the ideal timing of delivery for uncomplicated twin pregnancies. Please note: If you have complications during your pregnancy, your timing may be different.

  • Dichorionic diamniotic (Di-Di) twins: 38 weeks
  • Monochorionic diamniotic (Mo-Di) twins: 34 to 37 weeks
  • Monochorionic monoamniotic (Mo-Mo) twins: 32 to 34 weeks (with hospital admission between weeks 24 and 28 for daily fetal surveillance)

Twin pregnancies do not always involve a cesarean delivery. Mo-Mo twins, however, should always be delivered by cesarean section to avoid umbilical cord complications for the non-presenting twin at the time of the first twin's delivery.

For uncomplicated Di-Di and Mo-Di twin pregnancies, the best mode of delivery depends on factors such as:

  • Positions of the twins
  • Gestational age
  • Estimated fetal size
  • Your obstetric care provider's experience

For uncomplicated Di-Di and Mo-Di twin pregnancies, we generally encourage vaginal delivery if the presenting twin is head-down. However, there may be medical reasons that make a cesarean delivery a better choice.

During your third trimester, your obstetric care provider should discuss with you the best mode of delivery for your pregnancy. Determining the best plan for you will depend on many different clinical factors that are specific to your pregnancy.

If you have had a prior cesarean section, you may still be a candidate for delivering twins vaginally. Learn about vaginal birth after cesarean (VBAC) deliveries.

Videos on Twin Pregnancy

Triplets and Higher-Order Multiples

The timing of delivery for triplets and higher-order multiples is hard to predict due to the complications that can arise toward the end of pregnancy. Cesarean is the preferred mode of delivery in these cases.

If labor has not occurred on its own, most uncomplicated trichorionioc-triamniotic (Tri-Tri) triplets are scheduled for delivery around 35–36 weeks. In planning delivery timing for other types of triplets or higher-order multiples, many clinical factors pertaining to your case are taken into consideration.

Newborn Intensive Care Unit

The Brigham's state-of-the-art Newborn Intensive Care Unit (NICU), the largest in Massachusetts, provides expert newborn care for nearly 3,000 premature and seriously ill babies and their families each year. Several patient rooms have been designed to accommodate twins, allowing us to keep your babies together throughout your stay here.

Prior to your delivery, you will have the option to consult with the NICU team in the event that one or more of your newborns may require care in this facility.

For More Information

Please use our online form to submit any general questions you have about multiple pregnancies. One of our MFM specialists will follow up with you. Please note that your question will be emailed and responded to through a private and secure system.

Learn how to pack and prepare when you’re delivering your twins, triplets or more by downloading our What to Bring Guide. Visit our Pregnancy Planner for more information on how to stay organized and informed when delivering singletons and multiples.

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