Editing Multiple birth (section)

===Cesarean section or vaginal delivery===
A study in 2013 involving 106 participating centers in 25 countries came to the conclusion that, in a twin pregnancy of a [[Gestational age (obstetrics)|gestational age]] between 32 weeks 0 days and 38 weeks 6 days, and the first twin is in [[cephalic presentation]], planned [[Cesarean section]] does not significantly decrease or increase the risk of [[Perinatal mortality|fetal or neonatal death]] or serious neonatal [[disability]], as compared with planned vaginal delivery.<ref>{{Cite journal |last14=Twin Birth Study Collaborative Group |vauthors=Barrett JF, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA, Gafni A, Joseph KS, Mason D, Ohlsson A, Ross S, Sanchez JJ, Asztalos EV |year=2013 |title=A Randomized Trial of Planned Cesarean or Vaginal Delivery for Twin Pregnancy |journal=New England Journal of Medicine |volume=369 |issue=14 |pages=1295–1305 |doi=10.1056/NEJMoa1214939 |pmc=3954096 |pmid=24088091}}</ref> In this study, 44% of the women planned for vaginal delivery still ended up having Cesarean section for unplanned reasons such as [[pregnancy complication]]s. In comparison, it has been estimated that 75% of twin pregnancies in the United States were delivered by Cesarean section in 2008.<ref>{{Cite journal |vauthors=Lee HC, Gould JB, Boscardin WJ, El-Sayed YY, Blumenfeld YJ |year=2011 |title=Trends in Cesarean Delivery for Twin Births in the United States |journal=Obstetrics & Gynecology |volume=118 |issue=5 |pages=1095–101 |doi=10.1097/AOG.0b013e3182318651 |pmc=3202294 |pmid=22015878}}</ref> Also in comparison, the rate of Cesarean section for all pregnancies in the general population varies between 40% and 14%.<ref>{{Cite web |last=Gallagher |first=James |date=23 November 2011 |title=Women can choose Caesarean birth |url=https://www.bbc.co.uk/news/health-15840743 |url-status=live |archive-url=https://web.archive.org/web/20120819201245/http://www.bbc.co.uk/news/health-15840743 |archive-date=2012-08-19 |website=BBC}}</ref>

Fetal position (the way the babies are lying in the womb) usually determines if they are delivered by caesarean section or vaginally. A review of good quality research on this subject found that if the twin that will be born first (i.e. is lowest in the womb) is head down there is no good evidence that caesarean section will be safer than a vaginal birth for the mother or babies.<ref>{{Cite journal |last1=Hofmeyr |first1=GJ |last2=Barrett |first2=JF |last3=Crowther |first3=CA |date=19 December 2015 |title=Planned caesarean section for women with a twin pregnancy. |journal=The Cochrane Database of Systematic Reviews |volume=12 |issue=12 |pages=CD006553 |doi=10.1002/14651858.CD006553.pub3 |pmc=4110647 |pmid=26684389}}</ref>

[[Monoamniotic twins]] (twins that form after the splitting of a fertilised egg and share the same amniotic fluid sac) are at more risk of complications than twins that have their own sacs. There is also insufficient evidence around whether to deliver the babies early by caesarean section or to wait for labour to start naturally while running checks on the babies' wellbeing.<ref name="Shub-2015">{{Cite journal |last1=Shub |first1=A |last2=Walker |first2=SP |date=23 April 2015 |title=Planned early delivery versus expectant management for monoamniotic twins. |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD008820 |doi=10.1002/14651858.CD008820.pub2 |pmc=8947902 |pmid=25906204}}</ref> The birth of this type of twins should therefore be decided with the mother and her family and should take into account the need for good neonatal care services.<ref name="Shub-2015" />

Cesarean delivery is needed when first twin is in non cephalic presentation or when it is a monoamniotic twin pregnancy.