Don't Rule Out Vaginal Delivery for Twins: Study
No significant differences seen in results for mother, babies compared to C-section
The rate of cesarean delivery was 91 percent in the planned cesarean group. (Some women didn't complete the study.) For women assigned to the planned vaginal delivery group, 56.2 percent delivered both twins vaginally, and 4.2 percent had a combined vaginal-cesarean delivery. Forty percent of those planning a vaginal birth ended up having a cesarean-section, according to the report.
No difference was noted in the rate of serious adverse outcomes for babies or mothers between the two groups, the study authors noted.
The author of an accompanying journal editorial said mothers-to-be should be reassured by the findings. "This study found that a plan to deliver by cesarean or vaginally will yield a roughly equivalent result. It's a good study that should reassure women who want a vaginal delivery and their obstetricians that it's a reasonable and safe option," said Dr. Michael Greene, director of obstetrics at Massachusetts General Hospital in Boston.
However, Greene doesn't feel that this study will lead to a change in clinical practice, at least not in the United States.
"Obstetricians in the U.S. have resorted to more and more cesarean deliveries for circumstances that they see as a risk to the fetus," Greene explained. He added that breech births, where the baby is positioned for delivery with either buttocks or feet first, instead of head first, have all but disappeared in births of single babies.
"Almost half of the pregnancies in this study ended up being delivered by cesarean anyway. Presumably, there was an undue risk associated with carrying out vaginal delivery of the twins. Doctors have to use their best judgment," noted Greene.
Barrett and Greene said that women carrying twins who want to try to deliver vaginally need to make sure their obstetrician is experienced in delivering twins vaginally.
"Realize that you have a choice, and find a center or an obstetrician who is willing to [honor] your choice. If they can't offer vaginal delivery in their hospital, they should refer you to a center that can, rather than just diverting you to a cesarean delivery," said Barrett.