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Twins and triplets are more likely to be born early, so it's important to understand your birth options.

With a multiple pregnancy, it's usual for your babies to be delivered between 37 and 38 weeks. Fewer than half of all twin pregnancies last beyond 36 weeks, and only 1.5% of triplet pregnancies go beyond this stage. The average length of the pregnancy for triplets is 34 weeks.

Be prepared for your babies to spend some time in special care. Just under half of all mothers of twins saw at least one of their babies spend time in neonatal care, while over 90% of triplets require neonatal care.  

Birth choices

As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or consultant early in your pregnancy.

Also discuss where you would like to have the birth, although you'll be advised to give birth in a hospital because there's a higher chance of complications with a twin birth.

Vaginal birth

Almost half of all twins are born vaginally and the process is similar to that of a single baby. If you're planning a vaginal delivery, it's recommended that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when the mother already has good pain relief.

See the Pregnancy care planner for the signs and stages of labour. The Twins & Multiple Births Association (Tamba) published a Healthy Multiple Pregnancy Guide. The guide is available free on Tamba's website if you register first. 

If the first twin is in a head down position (cephalic), it's usual to consider having a vaginal birth. However, there may be other medical reasons why this would not be possible, which are listed below. If you have had a previous caesarean section, you're usually not recommended to have a vaginal birth with twins.

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. You can find more information on forceps and vacuum delivery in the Pregnancy care planner.

Caesarean section

Many mothers think that you have to have a caesarean section with twins. It's true that, in the UK, more than half of twins and almost all triplets are delivered in this way. You may choose to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a planned caesarean section later in the pregnancy as a result of potential complications. 

Your baby's position may determine whether your babies should be delivered by caesarean section. If the presenting 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 conditions 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 (monochorionic).

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

Even if you plan a vaginal birth, 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 or 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 twin births.

Examining the placenta

After the birth, your midwife will examine the placenta to check that it has been delivered complete and to examine the membranes around the placenta. If the babies have a single placenta with one outer membrane (chorion) and two inner membranes (amnion), they must be identical (monozygotic). 

About one-third of all identical twins have two chorions and two amnions (DCDA) and either one fused placenta or two separate placentas, making them indistinguishable from non-identical (dizygotic) twins. If the babies are of the same sex, the only way to determine if they're identical is through DNA testing.