Delivery with breech presentation of the first twin

What are deliveries with the first twin in breech presentation?

This is a situation in a twin pregnancy when the leading (first) fetus is in breech presentation, and it influences the choice of delivery management.

Who this applies to: women with twin pregnancies in which the first twin is breech — such cases require more careful evaluation.

You can discuss the birth plan in advance with your doctor and midwife, the criteria for attempting a vaginal birth, methods of monitoring, and possible analgesia options.

The final decision is made individually based on the condition of the mother and both fetuses and may change during labor in the interest of their safety.

What does this type of delivery mean

Breech delivery of the first twin is a situation in a twin pregnancy when the presenting (leading) fetus is in a breech position, and this affects the management of the birth. This presentation requires special organization and attention to the condition of both fetuses. Before labor, it is important to discuss the management plan, monitoring options, and contingency scenarios with your physician and obstetrician. The final decision is made individually and may change during labor.

Organizational preparation: availability of a neonatal team and necessary equipment.
Monitoring of both fetuses during labor with regular assessment of their condition.
Discuss the plan in advance with your doctor and obstetrician, including the criteria for decision-making.
Possibility of a trial of vaginal delivery under strict conditions.
The sequence of deliveries and tactics when the first twin is born differ from those in singleton pregnancies.
The decision may be adjusted during labor in the interest of the safety of the mother and babies.

Before labor, discuss expected scenarios and the action plan with the delivery team. Understanding the general approach will help you be prepared for different possible developments.

Who this delivery approach may suit

This approach is considered when the first twin (twin A) is in a breech presentation and a choice of delivery management strategy is required. It may be appropriate not simply “by preference,” but in situations where the clinical conditions allow and the woman wishes to discuss the plan in advance.

The final decision is always based on assessment of the condition of the mother and both fetuses and may change during labor.

A desire to discuss the birth scenario and the decision-making criteria in advance.
Presence of a partner or close person whose presence is important to the patient.
Questions about pain relief and a wish to discuss anesthetic options with the anesthesiologist beforehand.
A pregnancy without serious complications, allowing planning of management options.
A desire to remain active during labor and to participate in decision-making.
Previous birth experience that the patient wants to take into account when planning.
A need for a calm, clear delivery plan with contingency scenarios.

Discuss your preferences and clinical questions with your doctor and midwife at the prenatal consultation. The team will explain what can be planned in advance and what will be decided during labor.

When the format may not be appropriate or may require restrictions

Even if a vaginal birth with the first twin in a breech presentation has been discussed, the plan may be limited or changed for medical reasons. Such changes are a normal part of care and are made in the interest of the safety of the mother and both babies. It is important to understand that decisions are made based on the progress of labor and monitoring results.

Sudden obstetric complications requiring rapid correction or surgery.
Detected signs of distress in one of the fetuses on cardiomonitoring.
Slow cervical dilation or unfavorable labor progress.
The need for an emergency cesarean section to maintain safety.
Medical contraindications to the chosen type of analgesia, for example epidural anesthesia.
Infectious or organizational restrictions that prohibit partner attendance during delivery.
Serious maternal comorbidities when the mother’s safety is the priority.

You will be informed in advance about decisions and possible changes; during labor the team acts according to the situation. Discuss possible scenarios with your obstetrician and midwife at the antenatal/pre-delivery consultation.

Who decides on the mode of delivery

The decision on the mode of delivery is made jointly and is based on the clinical picture and your preferences. If the first fetus in a twin pregnancy is breech, this adds specifics to the assessment and planning. The patient states her wishes, and the medical team reviews tests, ultrasound, and the condition of both fetuses. The plan may change during labor in the interest of safety based on monitoring results.

- The patient’s wishes and preferences, expressed at the consultation and on admission to the maternity unit.
- Assessment by the obstetrician and midwife of the pregnancy, ultrasound, tests, and the fetuses’ dynamics.
- Medical criteria and risks that affect the possibility of a trial of vaginal delivery.
- Involvement of an anesthesiologist when discussing pain-relief methods and possible limitations.
- Involvement of a neonatologist in twin pregnancies and when neonatal support for the newborns is needed.
- Adjustment of the plan during labor based on monitoring and the changing clinical situation.

Decisions are made to ensure the safety of the mother and both babies.

Discuss your expectations and possible scenarios at the pre-delivery (antenatal) consultation.

What to discuss with your doctor beforehand

Before a pre‑delivery consultation, it’s helpful to prepare a list of questions to discuss with your doctor and obstetrician — especially if the first twin is breech. This will help you understand which scenarios are being considered and what information will determine the final choice of delivery mode. Discuss monitoring options, pain relief, and contingency plans in case the labour changes.

What mode of delivery do you consider appropriate for my specific situation?
What criteria determine whether a trial of vaginal delivery is possible?
Is partner presence allowed, and under what conditions?
What pain‑relief/anesthesia options are available, and are there any contraindications for me?
How will my previous childbirth experience or prior cesarean section be taken into account?
Which chronic illnesses or conditions could affect the choice of delivery mode?
What findings on ultrasound and test results are important for planning the delivery?
What is the plan if signs of fetal distress or other complications arise during labour?
What should I pack for the maternity hospital depending on the possible delivery scenarios?
Which documents and what arrangements for postpartum stay should I clarify in advance?

Bring these questions to your pre‑delivery consultation and write down the answers. This will help you understand the plan, which may need to change if required for safety.

How preparation for delivery with breech presentation of the first twin proceeds

Preparation for delivery when the first twin is in breech presentation includes medical assessment and organizational arrangements so that, if necessary, the team can quickly switch to backup options. The main goal is to predefine acceptable delivery scenarios and discuss the decision-making criteria. Preparation does not guarantee the chosen mode of delivery, but it makes planning more transparent.

Consultation with the obstetrician and midwife to assess the condition of the mother and both fetuses.
Review of the maternity record and current ultrasound and laboratory results.
Discussion of the birth plan: possible scenarios and criteria for attempting a trial of vaginal birth.
Consultation with the anesthesiologist to discuss pain-relief options and their limitations.
Preparation of the partner: rules for presence and their role during the delivery.
Organizational check of the maternity hospital: neonatal support and backup resources.
Collection of necessary documents and essential items for hospitalization and postpartum stay.

This preparation helps you and the delivery team better understand the expected steps and contingency plans. The final decision is made according to the situation during labor, with safety as the priority.

How labor proceeds in this scenario

When the first twin is in breech presentation, labor follows a well-organized protocol with enhanced monitoring and contingency plans. The process is similar to a standard labor but with continuous assessment of both fetuses and readiness for operative intervention if necessary. The team discusses possible options and methods of pain relief in advance, though the final decision may change during labor. Below is a simplified scenario to help understand the sequence of events.

Admission to the maternity unit: registration, measurement of vital signs, and initial preparation.
Initial examination and assessment of cervical dilation, and the condition of the mother and both fetuses.
Connection of monitoring for continuous assessment of the fetuses’ heart rates and contractions.
Observation of contractions and the progress of labor with regular checks.
Discussion of pain relief and, if needed, consultation with and involvement of an anesthesiologist.
Management of labor by an obstetrician and a midwife, with readiness to involve a neonatologist.
Second stage (pushing): coordination of the team’s actions and support for the mother during pushing.
Birth of the first baby and an immediate initial assessment of the newborn, with assistance if necessary.
Birth of the second twin with continued monitoring and sequential assessment of its condition.
The first hours after birth: observation of the mother and babies, arranging feeding and ongoing care.

The birth plan is discussed in advance but may be adjusted as events unfold in the interest of safety. Ask the delivery team questions to understand possible scenarios and next steps.

Pain relief for this type of delivery

The question of pain relief is discussed at the antenatal consultation and during labor in order to choose a safe and realistic method for your situation. In labors where the presenting twin is in breech presentation, the team pays attention to the condition of the mother and both fetuses when deciding on anesthesia. An anesthesiologist consultation helps you understand the available options and possible limitations, but a complete absence of pain cannot be guaranteed.

Discussion of pain-relief options at the antenatal consultation with the physician and midwife/obstetrician.
Anesthesiologist consultation when planning epidural analgesia or other methods.
Epidural analgesia as a possible method, considered individually and if there are no contraindications.
Non-pharmacological support measures and comfortable positions as an adjunct to analgesia.
Medical contraindications or clinical circumstances may limit the choice of method.
Possibility of changing the pain-relief plan during labor based on monitoring results.
Availability of a backup anesthetic plan in case emergency operative intervention is required.

Discuss your expectations and concerns about pain relief in advance with the anesthesiologist and the delivery team. The team will select the safest option and explain what may change during labor.

How safety and monitoring are ensured in this situation

During labor, when the first twin is in breech presentation, safety is achieved through continuous monitoring and coordinated teamwork. Monitoring includes assessment of the mother's condition by the physician and midwife, monitoring the heart rates of both fetuses, and tracking the progress of labor. Decisions are adapted as monitoring data and the clinical picture evolve. This is a standard part of labor management designed to enable a rapid response to changes.

Continuous or intermittent monitoring of both fetuses' heart rates, and, if necessary, CTG (cardiotocography).
Assessment of the mother's condition by the physician and midwife: blood pressure, blood loss, and overall wellbeing.
Monitoring labor progress: contraction frequency, cervical dilation, and fetal descent.
The team's readiness to quickly change tactics or proceed to operative intervention.
Presence of neonatologists for initial assessment and care of the newborns.
Real-time adjustment of the birth plan based on monitoring results.
Informing the patient and partner about key decisions and next steps.

Monitoring and supervision are ways to ensure a rapid response and the safety of the mother and babies. Discuss with the team which specific monitoring methods will be used in your case.

What happens if labor doesn't go as planned

When the first twin presents breech, the birth plan may change as labor progresses depending on the condition of the mother and the babies. Changing tactics is not a mistake but a normal response by the team to new monitoring information. The whole team acts to promptly switch to a safer approach if needed.

Revising the plan based on fetal heart rate monitoring results.
Decisions are made by the team — the obstetrician and midwife — taking into account the opinions of the anesthesiologist and neonatologist.
Suspending birth partner attendance for organizational or infection-related reasons.
Switching from an upright position to another position if the clinical picture worsens.
Epidural anesthesia may be impossible if contraindicated, and alternatives will be discussed.
Use of augmentation or operative delivery if labor is difficult.
Involving a neonatologist and preparing to provide emergency care to the newborns.
Promptly informing the patient and partner about the reasons and next steps.

These changes are intended to keep the mother and babies safe and are not considered a failure. Discuss possible scenarios with your team in advance so you understand what might happen.

Possible risks and limitations

Delivery with the first twin in a breech presentation has its own limitations that should be taken into account during planning. The doctor and midwife assess risks based on the mother’s condition, the fetuses, and the course of the pregnancy in order to develop a justified plan. Some limitations only become apparent during labor and require rapid adjustments to management.

Limitations related to the mode of delivery, depending on fetal positions and the clinical picture.
Risks that depend on the mother’s condition, the course of the pregnancy, and the condition of the fetuses.
The need for operative (surgical) intervention if labor dynamics worsen.
Limitations in the choice of analgesia/anesthesia methods when there are contraindications.
The plan may change during labor for the safety of the mother and the babies.
Do not rely solely on others’ experiences — every situation is individual.

Discuss possible risks and limitations with your doctor and midwife at your pre-delivery consultation. This will help you better understand under what conditions the original plan may change.

What happens immediately after delivery

After delivery — especially if the first twin was in a breech presentation — the first hours are spent under increased monitoring. The team assesses the condition of the mother and both newborns and performs the necessary examinations. These measures are aimed at safety, supporting contact, and the initial care of the babies and mother.

Initial skin-to-skin contact when the mother and babies are stable.
CTG (cardiotocography) and neonatal examination by a neonatologist are performed immediately after birth.
Assessment of the mother’s condition: blood loss, blood pressure, and overall well‑being.
Assistance with the first latch and support for breastfeeding if desired.
Observation during the first hours with regular checks of the mother’s and newborns’ vital signs.
Transfer to the postpartum ward after stabilization and completion of necessary paperwork.
Informing the mother and partner about the course of labor and the team’s next steps.

The sequence of actions may change depending on the clinical situation; the medical team will explain the subsequent steps to you in detail.

Role of the physician and the team during labor

Labor is managed by a team of specialists, each performing a specific function to ensure the safety of the mother and the babies. When the first twin is in breech presentation, coordination and readiness to change tactics are especially important. The team assesses risks, monitors the progress of labor, and explains key decisions to the patient as needed.

- Obstetrician-gynecologist — assesses risks and makes clinical decisions during labor.
- Midwife — monitors labor activity and supports the patient during the pushing phase.
- Anesthesiologist — advises on pain relief and initiates anesthesia/analgesia when indicated.
- Neonatologist — conducts the initial examination and provides immediate care to the newborns.
- Operating room team — ready to provide operative delivery if necessary.
- Monitoring and assessment — continuous surveillance of the condition of the mother and both fetuses.
- Information and support — explain what is happening and discuss the next steps.

Teamwork aims for rapid, well-founded decision-making in the interest of safety. Do not hesitate to ask questions and clarify each specialist’s role during your consultation.

How this format benefits the patient

This delivery format provides a more predictable organization of actions and allows key management points to be discussed in advance, especially for breech presentation of the first twin. The patient gains clarity about possible labor scenarios and the criteria for changing them. This reduces uncertainty and helps with psychological and logistical preparation.

A clear plan of action with described backup scenarios.
The ability to discuss and record personal preferences in advance.
Less uncertainty thanks to pre-established decision criteria.
The option to choose and arrange for the presence of a specific physician.
Access to discussion of pain-relief options and consultation with an anesthesiologist.
Continuous monitoring of the mother and both fetuses during labor.
The team's readiness to quickly switch to an alternative scenario if necessary.

These conveniences help you better understand and accept the birth plan, while the final decision always remains subject to the clinical situation.

How a pre-delivery consultation works

A pre-delivery consultation is a structured meeting in which the team reviews your specific situation and develops a realistic plan of action. If the first twin is in a breech presentation, special attention at the appointment is given to the position of the babies and the results of investigations. Consultations often include follow-up clarifications and agreements, so a single visit may not resolve all questions.

The goal is to understand possible scenarios and agree on the next steps.

Taking the medical history and discussing previous pregnancies and deliveries.
Reviewing the maternity record and current monitoring notes.
Reviewing ultrasound findings and up-to-date laboratory tests.
Discussing your preferences and expectations regarding the birth format.
Explaining possible constraints and the criteria for changing the plan.
Jointly choosing safe scenarios and backup options.
Instructions on when and how to go to the clinic once labor starts.
Answering questions and arranging further contact with the team.

Come to the consultation with your maternity record and a list of questions that are important to you. Remember that the plan may be adjusted as new information becomes available and in the interest of safety.

Please note that online consultations are available for patients from other cities. We often receive requests from Zaporizhzhia, Pavlohrad, Kamenskoye (Dniprodzerzhinsk), Novomoskovsk (Samar), Kryvyi Rih, Nikopol, Marganets, Sinelnikovo, Pokrov, Zhovti Vody, and other cities.

Preparing for hospital admission for childbirth

Before admission, it is useful to gather the necessary documents and basic items in advance so you don't waste time when labor begins. This is especially important in the case of a breech presentation of the first twin, due to possible organizational nuances and the need for rapid coordination. Discuss with your doctor which documents and test results are required, and clarify the rules for partner presence. Try to prepare a compact set of items and documents for a comfortable and quick admission.

Identification documents and your maternity record (prenatal card) with your doctor's contact details.
Up-to-date test results and discharge summaries from recent examinations.
Personal items for the mother: a minimal set for the stay and basic hygiene.
Items for the newborn: a basic set agreed with the maternity ward.
Items for the partner, if their presence in the delivery room is planned.
A list of regularly taken medications — be sure to discuss them with your doctor.
Contact phone numbers and a clear plan for when and how to go to the clinic when labor starts.

Check everything in advance and take a list of contact numbers with you. If you have further questions, clarify details at your pre-labor consultation.

About the clinic and delivery ward conditions

The Genesis Dnepr delivery unit is organized to ensure coordinated management of labor and a rapid response to any changes, including in the case of a breech presentation of the first twin. The priority is the safety of the mother and both babies, so combining comfortable conditions with necessary medical readiness is important when planning delivery. Below are the key organizational and clinical elements to consider.

Delivery rooms with monitoring capabilities and rapid access for intervention if needed.
Postpartum rooms with the option for mother and baby to stay together (rooming-in).
A neonatologist available for mandatory newborn examination and care.
An anesthesiologist available for pre-delivery consultation and urgent anesthesia if required.
The possibility of partner-supported births, subject to medical and organizational requirements.
Individual midwife support and discussion of the birth management plan.
Operating room readiness for rapid organization of emergency or planned surgical interventions.

If you have questions about specific conditions or rules of stay, clarify them at the pre-delivery consultation. The team will explain how support is organized and which options are available in your case.

When to seek urgent medical care

If you notice concerning symptoms late in pregnancy or during labor, do not delay — go to the maternity ward. During labor, especially if the first twin is in a breech presentation, rapid team response is important for safety. Below are signs that you should urgently go to a clinic or contact your doctor.

Blood-tinged or heavy vaginal bleeding of any kind.
Your water has broken, especially if the fluid is an unusual color or has a foul odor.
Regular, intensifying contractions if you were not planning to go yet.
Severe, unrelenting abdominal or pelvic pain.
A decrease or sudden absence of fetal movements compared with usual.
A marked rise in blood pressure or sudden swelling.
Severe headache, visual disturbances, or sudden changes in consciousness.
Pronounced weakness, severe dizziness, or fainting.
Fever and signs of a significant infection.
Any sudden change in how you feel that you have not experienced before.
Any doubts or anxiety about your condition or the condition of the baby/babies.

If you notice one or more of these signs, do not delay — contact your healthcare provider or go to the maternity ward immediately. The team will assess the situation and provide the necessary care.

Frequently asked questions

Question: Is it possible to plan the mode of delivery in advance if the first twin is in breech presentation?

Answer: Often you can discuss and plan a preferred approach, but the final decision depends on clinical assessment and may change during labor.

Question: Is this type of delivery suitable for all women with twins?

Answer: No — it depends on various factors such as the mother's condition, the fetuses' positions, and test results; the clinical team makes the final decision.

Question: Can the birth plan be changed during labor if something goes wrong?

Answer: Yes, the plan can and sometimes must be changed during labor in the interests of the mother’s and babies’ safety.

Question: How can I discuss the delivery plan with my doctor in advance?

Answer: At a pre-delivery consultation the doctor will review your maternity record, ultrasound and tests; you can state your preferences and agree on possible scenarios together.

Question: Can I have my partner present for this type of delivery?

Answer: In most cases partner presence is possible if medical and organizational requirements are met; check the rules in advance.

Question: Is epidural anesthesia possible for this mode of delivery?

Answer: Epidural anesthesia can be discussed and used if there are no contraindications; the anesthesiologist finalizes the decision.

Question: Who decides on pain relief?

Answer: The decision is made by you together with the obstetrician and anesthesiologist, taking into account the clinical situation and any contraindications.

Question: What if the chosen method of analgesia is unsuitable?

Answer: The anesthesiologist will propose alternative options or adjust the plan according to the situation; in rare cases some methods may be contraindicated.

Question: When should I go to the hospital when labor starts?

Answer: You should go when contractions become regular and stronger, your waters break, or other worrying symptoms occur; discuss exact instructions with your doctor.

Question: What should I take to the maternity hospital?

Answer: Take your ID and maternity record, basic items for you and the baby, and a list of any medications you take — confirm the details at your consultation.

Question: Do I need my maternity record and test results on admission?

Answer: Yes, the maternity record and up-to-date test results help the team quickly assess the situation and make decisions.

Question: Can I come to give birth with tests already completed at another clinic?

Answer: Yes, current test results from another clinic are accepted, but the doctor will assess whether they are sufficient and may order additional tests if needed.

Question: What happens if a cesarean section is required during labor?

Answer: The team will promptly arrange surgical delivery if indicated, explain the reason and next steps; this is standard care to ensure safety.

Question: How long is a typical stay in the maternity hospital after delivery?

Answer: Length of stay depends on the condition of the mother and babies; the doctor and midwife will advise on timing after assessing everyone’s condition.

Question: What happens immediately after the baby is born?

Answer: A neonatologist performs an initial examination and CTG monitoring if needed, staff assist with the first breastfeeding, and the mother and newborns are observed during the first hours.

Question: Can I meet the doctor in advance and discuss the birth management plan?

Answer: Yes, it is recommended to meet the obstetrician at a pre-delivery consultation to discuss plans, preferences and any limitations.

Question: How do I prepare my partner for the birth?

Answer: Discuss the rules for presence, his role in the delivery room and possible scenarios in advance; it can be helpful to have a brief instruction from the midwife or at your consultation.

Question: What should I do if the chosen delivery plan no longer seems possible before labor?

Answer: Inform your doctor and come to the clinic for evaluation — the team will consider alternative safe options and explain the next steps.