Updated July 29, 2024

It is not uncommon for a twin pregnancy to be automatically scheduled for a Cesarean birth. But, what do you do if you have already had a Cesarean and want a VBAC with twins?

You might be wondering if a vaginal twin birth is safe, what obstacles you might face, or if there are additional risks to manage giving birth with twins. 

In this article, we are digging into the evidence on twin VBAC safety and how to improve your chances of having a vaginal birth with twins. We’ll also go over the most common questions we hear from our doula clients and VBAC community about twin pregnancy and birth. 

Is VBAC with Twins Safe?

In general, there is good news for families planning a VBAC with twins. The American Academy of Family PHysicians published an article in 2011 that summarized ACOG’s 2010 update on VBAC. That article states that

“Women with twin gestations who attempt VBAC have similar outcomes to women with singleton gestations. Therefore, TOLAC can be considered in women who have had one previous cesarean delivery with a low transverse incision and who have no contraindications for twin vaginal delivery.”

Concurrently, a small retrospective study was conducted by the International Journal of Gynecology and Obstetrics, published in 2022, looking at the TOLAC success rates of twin mothers with no prior vaginal births. The study indicates that 31% of those who attempted a TOLAC with twins (and no previous vaginal birth at all) achieved their VBAC. They noted that those who chose an epidural had a greater chance of success. 

Additionally, according to a 2021 study, the risk of uterine rupture with twins is higher in the VBAC group compared to a planned repeat c-section, but both groups are still relatively low risk (.87% and .09% respectively).

What does this all mean? Well, VBAC with twins should be an option for those planning a twin delivery. However, we think it is incredibly important to discuss your specific situation and options with your provider. We believe that the choice is always yours to make.

Risk Factors for C-Section with a Twin Delivery

A study of 821 twin pregnancies was performed in 2020 and showed high rates of vaginal delivery (82.8% when the first twin presented head down). It’s important to note, however, that mothers delivering for the first time, IVF pregnancies, inductions and non-cephalic presentation (not in a head down position) of the second twin were risk factors for c-section delivery.

Improving your Chances of a Successful VBAC with Twins

In the study referenced above, 75.7% of parents who attempted a VBAC with twins were successful vs. 75.4% of those with just one (singleton) baby. The difference in outcomes is statistically insignificant. So, preparing for a twin VBAC should be approached similarly to preparing for VBAC in general, with one exception. 

1. Find a provider who supports VBAC & vaginal birth for twins

The biggest challenge you may face with a twin pregnancy preparing for VBAC is finding a provider to support you. Learning how to recognize a VBAC supportive provider will be critical. 

Although the research shows vaginal birth for twins is generally safer than Cesarean, some providers still discourage it. Make sure your provider supports vaginal twin birth, as well as VBAC.

2. Hire an experienced VBAC doula

Having someone in your corner whose only job is to educate you, advocate for you, and believe in you is a huge deal. Finding a doula who knows how to support VBAC and is familiar with twin deliveries is especially important in your delivery preparation. If you don’t already know, I encourage you to find out the game-changing benefits a doula can bring to your birth.

Check out our VBAC doula directory for VBAC doulas in your area. 

3. Take a VBAC course

Being educated about VBAC is essential. There are a lot of myths and fear-based information out there surrounding VBAC and its safety. Taking a VBAC specific course will help you sort out the evidence-based information, help you prepare your mind and body, and enter your birth with confidence. The knowledge you gain will give you the ability to make the best decisions during your journey.

4. Learn to question the norm and be insistent

Twin VBAC can have a lot of stigmas, and people have many differing opinions about it. Your knowledge and thoughts about your birth might vary drastically from that of your support team and provider. 

Dig into the facts about VBAC and twin birth and be insistent when you have made your choices. This will reassure your birth team that you are making educated decisions. They will see that you are prepared to stand up for your right to make informed decisions regarding your care. 

5. Know the differences between twin and singleton pregnancies

While VBAC outcomes are similar between those birthing just one or two babies, there are some differences in twin pregnancies that are important to know. Knowing these differences ahead of time will help you prepare and meet these differences with confidence rather than fear. 

Frequently Asked Questions about VBAC with Twins

Here are some answers to questions you may have if you are pregnant with twins and wondering about your birth options.

Can you have a VBAC with twins?

Yes, parents expecting twins can safely attempt a VBAC. When comparing twin births to singleton births choosing VBAC, studies have shown no differences in adverse outcomes for mothers or babies. 

Is VBAC safer than repeat Cesarean?

According to the APA, VBAC is generally considered safer than an elective repeat Cesarean for most parents. Babies born vaginally have fewer complications and adverse outcomes than those born via Cesarean. 

Is a C-section better for twins?

French researchers studied 6,000 twin deliveries and showed that those born vaginally had less neonatal morbidity and mortality than those born via Cesarean when the first twin is head down (cephalic presentation).

Is labor worse with twins?

Labor generally takes an average of three hours longer with twin births. It is recommended to wait a few more hours for cervical change during labor before calling a twin pregnancy failure to progress.