This is a rare complication (historical incidence 0.1 per cent) which may occur if Twin 1 is breech and Twin 2 is leading with a head. It is probably only of historical importance as, nowadays, virtually all twins presenting as such are delivered by caesarean section.
Caesarean section. There are some countries in continental Europe and Africa where vaginal delivery in some selected cases of triplet pregnancy is advocated and practised. In the UK and many other parts of the world, the only accepted method of delivery for triplets - and indeed other higher order multiples - is caesarean section. This is because they have a higher incidence of prematurity and growth restriction. This makes them more prone to such problems as fetal distress.
It is not possible to continuously electronically monitor all three during labour and therefore distress in one or more of them may go unrecognised.
One hour. Most will be delivered within thirty minutes of each other. Beyond this it may be necessary to stimulate the uterus to expedite delivery of the second twin.
However, the operative word here is "acceptable" and it applies to the obstetrician. Most obstetricians feel that after one hour, vaginal delivery of Twin 2 is unlikely and probably waiting longer poses some risk to this baby. It is also true, however, that in the presence of satisfactory monitoring of the baby's condition and if the mother so wishes, a much longer interval can be allowed. Twins have been known to be born several hours apart with no undue consequences to Twin 2. Probably the most famous is the pair born on two different days of two different years, Twin I on 31 December and Twin 2 on January 1.
There is no cast-iron rule in this, as long as safety measures are not flouted.
Mothers who have delivered twins are at an increased risk of heavy blood loss (postpartum haemorrhage or PPH) after delivery. Measures are therefore routinely taken to minimize this risk.
Twins sound like a catalogue of bad news
It tends to come across as such but it is not. Try to see the bigger picture. Over 85 per cent of mothers with twin pregnancies go home with not one, but two perfectly normal bundles of joy.
Last update: February 21, 2013