A cesarean section (C-section) makes it possible to deliver a fetus through an incision in a woman's abdomen and uterus.

Multiple pregnancies usually require a cesarean delivery. But for twin births, vaginal delivery may be an option.

Reasons to have cesarean delivery for a multiple pregnancy

You may need a cesarean delivery if:

• You have three or more fetuses.
• A fetus is breech or crosswise (transverse). (A first-born breech is delivered by cesarean; a second-born breech after a vaginally delivered first-born can sometimes be delivered vaginally.)
• A fetus weighs less than 2000 g.
• You have locking twins.
• You have conjoined (Siamese) twins.
• You have twins that share one amniotic sac (monoamniotic twins), because of the risk that the cords will get tangled.
• There are signs of fetal distress, such as a very rapid or very slow heart rate.
• Your cervix has not dilated over time despite adequate uterine contractions.
• The uterus is overstretched and cannot contract enough during labor (uterine inertia), making labor long and difficult.

A twin vaginal birth after one previous cesarean (VBAC) is sometimes considered a safe choice. For more information, see the topic Vaginal Birth After Cesarean (VBAC).

A cesarean section is a surgical operation, and recovery is longer than after a routine vaginal delivery. You will need extra help while recovering.

For more information on cesarean section, see the topic Cesarean Section.