“Delivery of Twins – Double the Fun!” – with Dr. Stephanie Melka

In this episode, Dr. Melka and Dr. Fox talk about delivering twins. It has become somewhat unusual in the U.S. for twins to be delivered vaginally. Dr. Melka and Dr. Fox talk about training obstetricians for this scenario, whether planned C-Sections are always best, and more.

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While delivering twins vaginally has become somewhat unusual in the United States, Dr. Melka and Dr. Fox talk about situations in which it is possible. Some doctors are uncomfortable with vaginal deliveries for twins because there is a tendency for the second baby to be breech, even if the first twin was born head first, complicating the delivery. However, Dr. Fox notes that it is important that physicians are trained in delivering twins vaginally, because it is often possible. Dr. Melka notes that when she was an intern, she learned from Drs. Fox and Silverstein that “anytime someone is delivering twins, you come in because you can learn something.” Dr. Fox explains that every vaginal delivery of twins should have two doctors present: one who is experienced and one who is learning.  

In the U.S., the average rate of twins being delivered by cesarean is about 80%. However, Maternal Fetal Medicine Associates in New York City has noticed that some patients choose them because they wish to deliver their twins vaginally. While this is not always possible, there are some indications that can help an obstetrician decide whether a vaginal delivery is likely to be safe. One example is that if the twins are of similar weights, a doctor may be more comfortable with a vaginal delivery because there’s a smaller possibility of complications delivering a breech twin B. Dr. Melka also points out that it is often safer to deliver twins with an epidural. Dr. Fox also points out that during pregnancy, sharing research can help a patient feel more confident and informed about their decision.  

Dr. Fox predicts that in the future, it may become more likely for some hospitals or healthcare providers to see an increase in C Sections for twins while this rate drops for others, as sometimes the decisions come down to preference and training. He discusses that a study found that there wasn’t a real advantage or disadvantage to either planning a C-Section or planning to deliver twins vaginally. Dr. Melka notes that she’s “more than happy” to schedule a C-Section if that’s what the mother wants and that so long as the mother and baby are healthy, “it’s a good outcome.”  

Dr. Stephanie Melka is an OBGYN with Maternal Fetal Medicine Associates in New York City and a previous guest on Healthful Woman. To learn more about Dr. Melka, listen to this episode of the podcast.