"YOU'RE HAVING TWINS!" DOESN'T ALWAYS MEAN YOU'RE HAVING A CESAREAN: Multiple Birth Moms Aren't Restricted to Cesarean Surgeries

WASHINGTON—When it comes to twin births, two times the fun doesn't always mean twice as many complications. Cesarean surgeries are not requirements for women pregnant with multiple babies. Not only is it possible for mothers of multiples to give birth vaginally, but research shows that it often is the safer option.

From the beginning of their pregnancy, women carrying multiple babies may be labeled high-risk and inundated with precautionary information. The assumption, which often is supported by hospitals, is that unplanned cesarean surgery in labor is likely and therefore planned cesarean surgery is the safer option. Lamaze International, an advocate for normal birth and a leader in childbirth education, warns women not to make this assumption and points to research showing the dangers of unnecessary cesarean surgery.

A study published in the Cochrane Library, an international repository research on the effects of health care practices, reports that there is not enough evidence to suggest that elective cesarean surgery with twins results in better outcomes. A second study on multiple births reveals that cesarean surgery for delivery of the second twin (when the baby is not in the head-down position) increases the risk of infection and produces no obvious benefit for mother or baby.

At a rate of 29.1 percent in 2004, birth by cesarean surgery is on a drastic rise. The increase is attributed to several factors, including fear of malpractice claims, the incorrect perception that cesarean surgeries are safer and will prevent future urinary and uterine problems, hospitals' policies against vaginal birth after cesarean (VBAC) and the increase in multiple births. The Public Citizen Health Research Group in Washington, D.C., estimates that half of the nearly one million cesareans performed every year are medically unnecessary.

In today's "culture of cesareans," mothers of multiples face an uphill battle for choices in childbirth. While women carrying multiple babies are more likely to encounter complications than mothers of single babies, cesarean surgery is not mandatory and increases risks. Research indicates that women who undergo cesarean surgery increase the risk of infection, hemorrhage, surgical and anesthetic complications, and maternal death, as well as newborn respiratory problems. Future reproductive problems associated with previous cesarean surgery include infertility, uterine rupture, preterm birth, low birth weight, and stillbirth. According to the American College of Obstetricians and Gynecologists, a vaginal birth is possible for mothers of twins when the first twin is positioned head-down, which is nearly 80 percent of the time. Additionally, a mother of ! triplets is a candidate for a vaginal birth if she has an uncomplicated pregnancy, has not has previous uterine surgery and is at least 32 weeks pregnant at the time of birth.

"I would advise any woman expecting twins to find a caregiver who does not routinely perform cesareans for twin births," Judith A. Lothian, RN, PhD, LCCE, FACCE, author of The Official Lamaze Guide: Giving Birth with Confidence. Choosing a caregiver skilled in multiple births is important for mothers who want to increase their chances of having a vaginal birth. The Official Lamaze Guide is a guide for expectant mothers, and covers pregnancy, birth and early parenthood.

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Lamaze International, based in Washington, DC, envisions a world of confident women choosing normal birth. For more information about Lamaze and the Institute for Normal Birth, visit www.lamaze.org.

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