Cesarean no safer than vaginal delivery for twins

Delivering twins by planned vaginal birth is just as safe as delivering them by planned cesarean section, according to the newly released findings of a multi-site trial led by University of Toronto researcher, Professor Jon Barrett from the Department of Obstetrics and Gynecology.

“Our findings show that planned vaginal birth is the correct method for delivering twins in a pregnancy that is otherwise uncomplicated, and when the first baby is facing head down,” says Barrett. “We found that there is no reason for doctors or women to be planning to deliver twins by cesarean section, as the babies’ outcomes remain the same regardless of how they are delivered.”

The findings of the study, which involved 106 centres in 25 countries, were presented this week at the Society for Maternal-Fetal Medicine Annual Meeting in San Francisco. Nearly a decade in the making, it is the only large scale, randomized controlled trial that has been undertaken to determine the optimal method of delivering twins.

The study randomized 2,804 women with twin pregnancies, in which the first baby faced head down, for either a planned cesarean section or planned vaginal delivery. Women were enrolled between 2003 and 2011, and randomization was centrally controlled at the Centre for Mother, Infant and Child Research at Sunnybrook Health Sciences Centre, part of the University Health Network. Mothers and infants were followed to 28 days after birth.

As the number of multiple births in Canada and around the world has risen, so too has the trend of delivering twins by planned cesarean section. Barrett says he hopes the results of this study will help women and their physicians choose the method of delivery that is right for them.

“People are often not sure what the right delivery method is and sometimes default to cesarean section because they perceive it to be safer. However, we now know that is not the case,” says Barrett, who is also Chief of Maternal-Fetal Medicine at Sunnybrook Health Sciences Centre and Director of the Women & Babies Research Program at Sunnybrook Research Institute.

Additionally, the study found that those women who were randomized to planned cesarean sections delivered their babies earlier, something Barrett says should be avoided.

Dr. Barrett said he and his colleagues hope the findings of the Twin Birth Study will help decrease the rate of unnecessary cesarean sections. “I think these results will serve as a heads up to physicians to keep vaginal delivery skills in practice, so we don’t lose them,” he says.