Background Caesarean section for the second twin is uncommon, occurring in around 3% of cases.1 When discussing mode of delivery it raises considerable anxiety for parents and carries increased risks for mother and baby.

Objectives To determine the incidence of Caesarean section for the second twin when the first is delivered vaginally.

Methods A retrospective audit was conducted in the multiple pregnancy clinic at Leeds General Infirmary (2004-2011).

Results 411 sets of twins were delivered of which 190 (46%) achieved a vaginal delivery for at least one twin. 218 were primigravidae (53%). There were 11 Caesarean sections for the second twin (2.7%).

Conclusions Caesarean sections for the second twin occurred in 2.7% of twin deliveries. It seems to occur more often in primigravidae and is associated with lower Apgars.