Evidence On Delivering Twins

At this moment, I am supporting and serving women in Okinawa, Japan. And, in the past couple months, I have encounter and met a great number of women who are currently pregnant with multiples. In fact, it is an honor and a joy to serve a sweet friend and very strong woman who is one of those mommies expecting twins. Likewise, I strongly consider that education, knowledge and research it is one of the greatest ways to advocate for ourselves and speak aloud about our rights. So, I wanted and dedicated time to research and to find evidence about pregnancy with multiples.

In the article, "An Evidence-Based Approach to Determining Route of Delivery for Twin Gestations," the Department of Obstetrics and Gynecology from Northwestern University and Feinberg School of Medicine, and the Department of Obstetrics and Gynecology from Indiana University School of Medicine, considered that "although delivery may take place due to iatrogenic or spontaneous etiologies -no matter what the indication- optimizing the route of delivery for twins is an important component of care that must be thoughtfully considered." Moreover, they acknowledged that "there is considerable controversy about the intrapartum management of twin pregnancies, which is due primarily to an absence of well-designed clinical trials and to conflicting recommendations in the literature."


Consequently, they questioned "which route of delivery is preferred?" and in their review they found, "if the presenting twin is cephalic, the option of vaginal delivery must be contemplated." Likewise, they said, "if the second twin presents cephalic, one may allow the fetal head to descend into the pelvis." Moreover, they also emphasized that: "when choosing the vaginal route, one must be prepared for the second twin to change position after delivery of the first. [And,] the second twin experiences positional change in approximately 20% of twin planned vaginal deliveries."

Nevertheless, they considered that the evidence also suggests, "if the second twin’s presentation be breech or oblique -or should the obstetrician opt to deliver the fetus in a non-cephalic presentation in an attempt to expedite the remainder of the second stage- two additional options exist for vaginal delivery: external cephalic version (ECV) followed by vaginal delivery or internal podalic version followed by breech extraction." But, "if neither ECV followed by vaginal delivery nor internal podalic version followed by breech extraction is successful, then a cesarean delivery should be performed. [And,] when the first twin is delivered vaginally and the second by cesarean, it is called a combined delivery."

Note: According to the Farlex Partner Medical Dictionary, Internal Podalic Version is the"maneuver to deliver the fetus by inserting a hand

into the uterine cavity, grasping one or both feet, and drawing the through the cervix; rarely indicated today except for the delivery of a

second twin."