Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomised controlled trial.
OBJECTIVE
To compare outcomes at 3 months post partum for women randomised to give birth by planned caesarean section (CS) or by planned vaginal birth (VB) in the Twin Birth Study (TBS).


METHODS
We invited women in the TBS to complete a 3-month follow-up questionnaire.


METHODS
Two thousand and eight hundred and four women from 25 countries.


METHODS
Two thousand and five hundred and seventy women (92% response rate).


METHODS
Women randomised between 13 December 2003 and 4 April 2011 in the TBS completed a questionnaire and outcomes were compared using an intention-to-treat approach.


METHODS
Breastfeeding, quality of life, depression, fatigue and urinary incontinence.


RESULTS
We found no clinically important differences between groups in any outcome. In the planned CS versus planned VB groups, breastfeeding at any time after birth was reported by 84.4% versus 86.4% (P = 0.13); the mean physical and mental Short Form (36) Health Survey (SF-36) quality of life scores were 51.8 versus 51.6 (P = 0.65) and 46.7 versus 46.0 (P = 0.09), respectively; the mean Multidimensional Assessment of Fatigue score was 20.3 versus 20.8 (P = 0.14); the frequency of probable depression on the Edinburgh Postnatal Depression Scale was 14.0% versus 14.8% (P = 0.57); the rate of problematic urinary incontinence was 5.5% versus 6.4% (P = 0.31); and the mean Incontinence Impact Questionnaire-7 score was 20.5 versus 20.4 (P = 0.99). Partner relationships, including painful intercourse, were similar between the groups.


CONCLUSIONS
For women with twin pregnancies randomised to planned CS compared with planned VB, outcomes at 3 months post partum did not differ. The mode of birth was not associated with problematic urinary incontinence or urinary incontinence that affected the quality of life. Contrary to previous studies, breastfeeding at 3 months was not increased with planned VB.


CONCLUSIONS
Planned mode of birth for twins doesn't affect maternal depression, wellbeing, incontinence or breastfeeding.
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
E K
EK
Hutton
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
M E
ME
Hannah
Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
S
S
Ross
Obstetrics and Gynaecology and School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
K S
KS
Joseph
Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
A
A
Ohlsson
Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.
E V
EV
Asztalos
Ontario Child Health Support Unit, Sickkids Research Institute and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
A R
AR
Willan
Pediatrics, IWK Health Center, Dalhousie University, Halifax, NS, Canada.
A C
AC
Allen
Obstetrics and Gynecology, IWK Health Center, Dalhousie University, Halifax, NS, Canada.
B A
BA
Armson
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
A
A
Gafni
Center for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
K
K
Mangoff
Center for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
J J
JJ
Sanchez
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
J F
JF
Barrett
D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000523:psychology / Q000706:statistics & numerical data*; D019052:Depression, Postpartum / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008425:Maternal Behavior / Q000523:psychology*; D009034:Mother-Child Relations; D017060:Patient Satisfaction; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D014549:Urinary Incontinence / Q000453:epidemiology
Breastfeeding; incontinence; maternal outcomes; postpartum depression; twin pregnancy