Breech and Transverse Twins: What Expecting Parents Should Know

How smoothly labor and delivery of twins goes, is largely dependent on their position in the womb. While many twins adopt favorable positions for vaginal delivery, others may present in less ideal ways, such as breech or transverse positions. These orientations can lead to complications, requiring careful monitoring and planning. Understanding the implications of these positions, how they relate to breech babies in general, and the potential for medical errors ensures that expectant parents are better prepared for delivery.

What Are Breech and Transverse Twins?

The term “breech” refers to a baby positioned with its buttocks or feet facing the birth canal instead of the head. “Transverse” describes a baby lying sideways across the uterus. In twin pregnancies, one or both babies can be in these positions, complicating the delivery process.

Twins can be positioned in the uterus a number of different ways:

1. Both twins head-down (cephalic): Ideal for vaginal delivery.
2. One twin breech, the other head-down: Often manageable with a vaginal delivery for the first twin.
3. One twin transverse, the other head-down: Typically requires additional monitoring and intervention.
4. Both twins breech or transverse: Likely necessitates a cesarean section for a safe delivery.

These positions are assessed during routine ultrasounds, particularly in the third trimester.

Why Twin Positions Matter

The positions of twins significantly influence the delivery approach. When both twins are in a favorable position, such as head-down, vaginal delivery may proceed relatively smoothly. However, breech and transverse twins introduce risks like:

• Head entrapment: In breech deliveries, the baby’s head can become stuck in the birth canal, especially if the body delivers first.
• Cord prolapse: A transverse position can increase the risk of the umbilical cord slipping into the birth canal, potentially cutting off oxygen to the baby.
• Fetal distress: Abnormal positions may lead to oxygen deprivation during labor.

These complications require close monitoring and timely intervention by healthcare providers.

Diagnosing Twin Positions

The fetal lie for twins is typically determined through regular ultrasounds starting in the second trimester. By 32 weeks pregnant, the positions of both babies are more stable, allowing doctors to assess the likelihood of a natural delivery versus the need for interventions like an external cephalic version (ECV) or a cesarean section. Monitoring remains critical up until labor, as twins can shift positions even late in pregnancy.

Causes of Breech and Transverse Positions in Twins

Several factors contribute to abnormal positions in twin pregnancies, including:

• Limited space: With two babies sharing the womb, there is less room for each to move into a head-down position.
• Uterine abnormalities: Structural issues like fibroids or a bicornuate uterus can restrict movement.
• Excess or low amniotic fluid: Too much fluid allows more movement, while too little can inhibit it.
• Placenta previa: When the placenta covers the cervix, it can prevent one or both twins from moving into a favorable position.

These factors highlight the importance of consistent prenatal care to monitor for potential complications.

Managing Breech and Transverse Twins

External Cephalic Version (ECV)

An ECV is a procedure where doctors apply external pressure on the abdomen to turn the baby into a head-down position. This method is often attempted after 36 weeks, but early identification of a breech position at 32 weeks allows for additional monitoring and preparation. ECV’s have a success rate of 50-60% but may not be suitable for all pregnancies.

Maternal Positioning Techniques

Certain exercises, such as pelvic tilts or lying on your side opposite the baby’s back, may help encourage movement into a head-down position. While these techniques are non-invasive, they are not always effective and should be performed under medical supervision.

Cesarean Delivery

A cesarean section is often the safest delivery method for delivering breech and transverse twins. This approach helps avoid complications like head entrapment breeches and face presentation births, both of which can complicate vaginal delivery. Cesarean deliveries are especially common when both twins are in non-cephalic positions.

Potential Complications of Abnormal Twin Positions

Abnormal twin positions can lead to several complications, including:

• Prolonged labor: Irregular positions can delay progress during labor.
• Fetal distress: Abnormal positions may cause oxygen deprivation, increasing the risk of developmental delays or brain injuries.
• Delivery trauma: Breech and transverse positions heighten the chances of physical injuries to the baby during delivery.

Regular ultrasounds and close monitoring help reduce these risks by enabling timely interventions.

The Role of Medical Malpractice

In some cases, complications associated with breech and transverse twins may result from medical malpractice. Examples include:

• Failure to monitor positions: Neglecting to assess fetal positions regularly can lead to preventable emergencies during labor.
• Delayed or improper intervention: Failing to recommend or perform a cesarean delivery when necessary increases the risk of injuries.
• Mishandling breech or transverse deliveries: Errors during vaginal delivery can result in long-term complications for the baby.

Such negligence can have life-altering consequences for both the babies and the parents.

How a Medical Malpractice Lawyer Can Help

If complications arise due to medical errors during a twin pregnancy or delivery, consulting a malpractice lawyer is crucial. A skilled attorney can investigate the circumstances of the case, gather evidence, and pursue compensation for medical expenses and long-term care.

Joseph Lichtenstein, a nationally recognized malpractice attorney, has extensive experience handling birth injury cases. With over 30 years of expertise and recognition as Malpractice Attorney of the Year in New York in 2019, 2023, and 2024, he provides families with the legal support needed to secure justice and financial relief.