Twins tend to do better if born vaginally, rather than by caesarean section ... But regardless of delivery mode, the first-born twin is less likely to suffer complications than the second.
... Neonatal morbidity was lower in the first than the second twin (3.0% versus 4.6%). This was also true of mortality (0.35% versus 0.6%).
In either twin there were no differences between vertex and non-vertex and attempted vaginal delivery versus planned caesarean section.
In the first twin, neonatal morbidity was lower after vaginal delivery than caesarean section (1.1% versus 2.1%).
When the first twin underwent vaginal delivery and the co-twin underwent caesarean section (combined delivery), morbidity was significantly higher in the co-twin (19.8%) than in the case of vaginal delivery (9%) or caesarean delivery of both newborns (7.2%).
"In the absence of more definitive data, our systematic review suggests that an attempt at vaginal delivery should be considered in twin pregnancies," ...
"With regard to the second twin, no differences are noted between caesarean section and vaginal delivery ...