This chapter concentrates on the intrapartum considerations for twin babies during labour and birth. The content includes a summary of twins, complications that can arise and the physiological and practical considerations for multiple pregnancies. Key learning points: Understand chorionicity and the implications that this has for multiple pregnancies. Ensure accurate intrapartum surveillance of both twins including clear differences in electronic fetal monitoring. Importance of early preparation of the room and equipment for twin birth. Understand that in the second stage of labour, stabilisation of the fetal lie of the second twin is essential. Understand the various manoeuvres needed to facilitate birth of the second twin. Identify situations where caesarean birth may be necessary. Recognise the increased risks of postpartum haemorrhage.

Intrapartum events have resulted in maternal and perinatal morbidity and mortality and rising medico-legal claims related to maternity. Despite rapid technological advances recently, the rates of clinical incidents such as PPH, OASI and adverse fetal outcomes have not reduced significantly. Furthermore, new intrapartum incidents such as impacted fetal head, caring for mothers with high BMI and managing extreme preterm labour are on the rise. Empowering patients and their unrealistic expectations and workforce issues further complicate this issue. Many reports have indicated more than 50% of these are preventable. Various strategies at the institutional, process and clinical levels used to minimise labour risk are discussed. Some include staff numbers, fatigue, skill mix, training, guidelines, algorithms and partnership with patents. Interventions to reduce a few clinical conditions are discussed. We made suggestions based on pilot studies on how we could improve intrapartum care using modern technology, including AI.

You are seeing a 29-year-old G2P1 with a singleton pregnancy at 34+6 weeks’ gestation for a routine prenatal visit. Pregnancy dating was confirmed by first-trimester sonography. She reports normal fetal activity and has no clinical complaints. Your colleague following her obstetric care is now on a two-month leave. Although mode of delivery was addressed early in prenatal care, your colleague left you a note to discuss a trial of vaginal birth after Cesarean delivery (VBAC) with the patient.