A vaginal birth is just as safe as a caesarean section when delivering twins, according to new Canadian research that seems to have found an answer to a dilemma long faced by obstetricians.
The study, led by Canadian doctors and which included data from 25 countries, found that the risks of delivering twins via C-section were equal to those of a vaginal birth.
Researchers followed 2,800 women with low-risk twin pregnancies, and tracked outcomes such as death during delivery or complications for the infants, such as evidence of brain damage. They found that at least one of the outcomes affected 57 of the babies born by C-section and 52 of the babies born vaginally.
The number of C-sections for twin births has risen in recent years under the assumption that it is the safer option.
“There is a perception that twins need to be born by C-section, that the second twin may do better,” lead study author Dr. John Barrett, a specialist in high-risk pregnancy at Sunnybrook Health Sciences Centre in Toronto, told CTV News.
But the findings show, Barrett said, that that is not the case.
“What this study shows is that there is really no advantage to plan a C-section because the outcome for the babies is essentially the same,” Barrett said.
The study was funded by the Canadian Institutes of Health Research and was presented late last week at the annual meeting of the Society for Maternal Fetal Medicine in San Francisco.
Kitchener, Ont. mother Kelly Fron declined her doctor’s suggestion to deliver her twin boys, Colton and Kaylen, via C-section when they were born five months ago. Fron made her decision on the grounds that, “having two babies was hard enough never mind recovering from surgery.”
Surgery carries its own risk factors, including infections and other complications for the mother. And emerging research suggests babies born by C-section are at greater risk of diabetes and asthma.
Barrett said a vaginal birth is also a better option when considering subsequent pregnancies.
“In the next pregnancy we don’t have to deal with the consequences of a scarred uterus,” he said.
The study does have some limitations, including the fact that it looked at births only from low-risk, healthy pregnancies. All of the mothers were very close to their due dates and had babies already in the head-down position.
Therefore, the findings do not answer the question of C-section versus vaginal birth safety in pregnancies where the first twin is in the breach position.
Dr. Kenneth Lim, an obstetrician specializing in high-risk pregnancies at B.C. Children’s and Women’s Hospital in Vancouver, said the study goes a long way to answering that hotly debated question of whether C-sections are safer.
"There is some thinking among caregivers that caesarean might be safer," Lim told The Canadian Press. "That's why the study was done and designed to try to answer this question."
Dr. Leke Badmos of Toronto East General Hospital said the findings should encourage more doctors and patients to reconsider C-sections.
“Now with this we clearly know what to do,” Badmos told CTV. “And we can comfortably assert there is no difference in the outcome.”
With a report from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip and files from The Canadian Press
