Twin pregnancies: planning the mode of delivery

Women who are pregnant with twins can opt for a vaginal delivery or a caesarean section if the first baby presents in a head-down position. In our research, we saw clear indications that a planned vaginal delivery before 37 weeks leads to better outcomes for the twins compared to a planned caesarean section. The percentage of caesarean sections for twins is particularly high outside the Netherlands, sometimes more than 90%. This means that a large percentage of women who deliver before 37 weeks (roughly half) undergo a caesarean section, resulting in unnecessarily high surgical risks and less favourable outcomes for the babies.
Babies born after 37 weeks have better outcomes with a planned caesarean section than a planned vaginal birth. As these differences are extremely small and the risk of complications is higher following a caesarean later in the pregnancy, a planned vaginal birth is also recommended after 37 weeks.