Author ORCID Identifier

Julia M. Morris: https://orcid.org/0000-0003-2150-5078

Andrea Bertotti: https://orcid.org/0000-0002-6788-3907

Document Type

Article

Publication Title

Birth

Abstract

Background

Medical guidelines recommend vaginal delivery for low-risk twin pregnancies because cesareans increase the probability of maternal morbidity and mortality. Yet, vaginal delivery rates for twins are considerably lower than for comparable singletons. One explanation for this disparity argues that greater risk associated with twins warrants increased surgical intervention. An alternative explanation is that twin deliveries are more likely to deviate from protocols that advise vaginal birth.

Methods

Using the 2017 Natality Detail File (N = 3,197,401), we measured alignment of vaginal birth and trial of labor (TOL) with the American College of Obstetricians and Gynecologists’ guidelines for twin and singleton no-indicated-risk births. We calculated predicted probabilities for the population and by maternal race/ethnicity to assess whether low rates of vaginal births among twins are explained by associated risk factors, or by deviations from recommended delivery methods.

Results

Overall, 31.2% of twins were born vaginally compared with 79.4% of singletons. Controlling for indicated risks, the predicted probability of vaginal birth for twins was 0.49 and 0.85 for singletons. The predicted probability of TOL for twins was 0.18 and 0.47 for singletons. Maternal race/ethnicity was only weakly associated with mode of delivery. These findings indicate that no-indicated-risk twin pregnancies, across maternal racial/ethnic categories, have lower probabilities of vaginal birth and TOL than would be expected with widespread adherence to current guidelines.

Conclusions

Given the life-threatening consequences that may result from unnecessary surgical procedures, our findings highlight the need for further research to illuminate medical and nonmedical mechanisms driving nonadherence to clinical guidelines for twin births.

Pages

147-158

html

DOI

https://doi.org/10.1111/birt.12587

Volume

49

Publication Date

2-2022

Keywords

cesarean, medical protocol, twin

Disciplines

Medicine and Health | Sociology

Comments

This is the peer reviewed version of the following article: Morris JM, Bertotti AM. Protocol versus practice: Deviations from guidelines in low-risk twin deliveries in the United States. Birth. 2022; 49: 147–158, which has been published in final form at https://doi.org/10.1111/birt.12587.

ISSN

1523-536X

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Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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