The subject of mode of delivery of twin pregnancies has been the topic of several journal publications. This debate was rekindled in a recent editorial where the question was raised whether all twins should be delivered by caesarean section. Most of this debate concerned the neonatal outcome of the second born twin. The second twin is at a greater risk of hypoxia because complications such as malpresentation, the longer second stage, cord prolapse and abruptio placentae are more likely to occur at delivery of the second twin. This has prompted several countries and academic centres to examine their data on neonatal outcome and mode of delivery in twin gestations.