Why do twins usually come early?

The birth of twins / multiples

Twin and multiple births are always something special. In any case, they should take place in a maternity hospital where appropriate neonatal first aid is guaranteed.

Twins and multiples are considered mature at an earlier stage. A twin pregnancy lasts an average of 37 weeks, and in many cases the children are born even earlier. Triplets are usually born around the 34th week of pregnancy (SSW) and quadruplets often as early as the 31st week of pregnancy. In general, multiple pregnancies are associated with a higher risk of premature birth.

Twin and multiple births require particularly intensive monitoring by gynecologists, midwives, pediatricians and anesthetists. The birth should therefore always take place in a specialized maternity clinic with an attached children's clinic and neonatal intensive care unit in order to ensure appropriate initial care for the newborn.

What must the pregnant woman consider if she is expecting multiple babies?

In the event of an impending premature birth or pregnancy symptoms (e.g. placental insufficiency), pregnant women with multiple pregnancies are often admitted to a perinatal center at an early stage (from about the 34th week of gestation). If a premature birth occurs in the clinic, this is far gentler on the children than transport to such a center after the birth.

In general, in the case of a multiple pregnancy, the pregnant woman should take it easy early on and “shift down a few gears” in order to avoid premature labor as much as possible. Early maternity leave is also often beneficial for pregnancy.

Preventive and gynecological examinations and ultrasound examinations take place more frequently in twin and multiple pregnancies; in addition, weekly CTG examinations (cardiotocography) are carried out from the 28th week of pregnancy.

How does the birth of twins and multiples go?

In the case of triplets or higher multiple pregnancies, delivery should always be made by caesarean section.

Twins can be delivered vaginally if certain requirements are met:

  • The situation of the children: Before giving birth, it is important to perform an ultrasound to make sure that both children are "childbearing possible". Ideally, both are in the skull position, which is the case in around 45% of all twin pregnancies. If one (35% of the cases) or both children (10% of the cases) are in breech position, the pregnant woman is often advised to have a caesarean section - especially if the first twin is in breech position. If one or both children are lying sideways, vaginal birth is impossible.
  • The birth should take place after the completed 32nd week of pregnancy or the children should have an estimated birth weight of more than 1,800 grams.
  • The estimated weight difference between the twins should not be more than 20% or 500 grams.
  • There must be no evidence of a mechanical obstacle to the birth (e.g. narrow pelvis); Maternal diseases in which vaginal birth is not possible (e.g. preeclampsia) should also be excluded.
  • Identical twins should not be delivered vaginally if they are in a common amniotic cavity and share a placenta (monochorionic-monoamnial twins); in this case there is a greater risk of umbilical cord complications.

About 30 - 50% of all twins are delivered by caesarean section. The 38th week of pregnancy at the latest is usually set as the time of birth. This is to prevent the endangerment of children from increasing placental insufficiency.

More medical personnel are available for a twin birth than for a single birth. Usually two midwives and two specialists or interns for gynecology and obstetrics are present and two paediatricians are on call, especially if the baby is premature. An anesthetist is also usually available in the event of a caesarean section or epidural anesthesia (PDA).

After the onset of regular contractions, both children are continuously monitored using CTG. Many clinics recommend a PDA for twin births. This means that the pelvic floor is optimally relaxed during the expulsion period and childbirth is made easier. In addition, an emergency operation can be performed at any time, if necessary.

The course of labor can generally be longer in the case of twin births, since the strength of the uterus is often reduced by the strong stretching.

After the birth of the first child, contractions may weaken until the second twin is ready for birth. Nevertheless, the second child should follow as soon as possible, the optimal interval between the babies is 15 to 25 minutes. The second child is at risk of a lack of oxygen: As soon as the first child is born, the uterus contracts and the adhesive surface for the placenta is reduced. As a result, there is also a reduction in the oxygen exchange area. The longer the second child stays in the uterus, the higher the risk. Therefore, the second child must be monitored continuously. If there is a risk, action is taken actively: For example, oxytocin is administered so that labor does not stop for too long after the birth of the first child.

The twins are carefully examined and monitored by pediatricians after they are born. In addition, after the delivery, it is important to ensure that the placenta is complete and that no residues remain in the mother's body. Contractions should be given generously because the uterus often does not contract well enough after twin pregnancies, which can lead to high blood loss. Atonic bleeding is also more common.

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Dr. med. Kerstin Lehermayr, Dr. Britta Bürger (2000)
Medical review:
Petra Welskop, President of the Austrian Midwives Committee
Editorial editing:
Philip Pfleger

Updated on:

Weyerstahl T., Stauber M .: Gynecology and Obstetrics. Dual series; Georg Thieme Verlag Stuttgart, 4th edition 2013

Geist C., Harder U., Stiefel A .: Midwifery - textbook for pregnancy, childbirth, postpartum and work. Hippokrates Verlag in MVS Medizinverlage Stuttgart, 5th edition 2012

Jahn-Zöhrens U .: Experience relaxed - pregnancy and childbirth. Ed .: German Midwives Association e.V .; TRIAS Verlag in MVS Medizinverlage, Stuttgart 2011

Huch R., Largo R .: Pregnancy, birth and first baby months. TRIAS Verlag in MVS Medizinverlage, Stuttgart 2009

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