What does evidence say about multiples and vaginal birth?

Disclaimer: I am not a medical professional.  I am merely a mom doing some basic research.

This post won't be anything you will write home about saying it changed your life, ha!  It is meant to simply be informative.  It is not at all exhaustive of the research that is out there regarding multiples and birth.

I think there is a belief that a multiples pregnancy must always result in a cesarean.  This is just not true and frankly not completely supported by evidence.  This doesn't mean that a mom can't choose to have a cesarean.  In general, a vaginal birth should still be on the table.  Now I understand that with each additional baby other factors must be taken into consideration.  And from the limited research I've done thus far there is more data on twins than triplets.

I think it's often wise to see what ACOG says about a particular birth option.  The ACOG bulletinon multiple gestation states the following:

“The route of delivery for twins should be determined by the position of the fetuses, the ease of fetal heart rate monitoring and the maternal and fetal status.”6

So, if baby A is position right and is looking good that should determine the birth route not the fact that it is a multiple.

According to an article in Reviews in OB/GYN if your first birth was a cesarean and you find yourself pregnant with twins a VBAC is not contraindicated.  The data indicates that a mom attempting a twin VBAC is at no greater risk for uterine rupture than a singleton VBAC.  

Ok, now for some triplet specific articles:
Preliminary experience with a prospective protocol for planned vaginal delivery of triplet gestations.:  In selected cases vaginal delivery of triplet gestations can be accomplished without increased maternal or neonatal morbidity and mortality and may significantly decrease maternal hospital stay and postoperative morbidity.

Neonatal outcomes in triplet gestations after a trial of labor:  Our experience suggests that offering vaginal delivery is an acceptable management plan for triplet gestations.

Birth in triplet pregnancies. Vaginal delivery--how often is it possible?:  In terms of fetal outcome cesarean section in triplets is not superior to a policy of vaginal delivery. Vaginal delivery may be suggested when there are no obvious obstetrical contraindications.

I will leave it at that for tonight, this mama is exhausted.  As you can see from this very small pool of evidence that a vaginal birth is not contraindicated.  For what it's worth, I didn't have to go on a great expedition to find this data, nor did I skip over articles that didn't agree with my point.  I merely read the first few articles that appeared in my search.  I would say that's rather encouraging.  What is also encouraging is that my OB has asked me to share articles that I find!