Over the last 30 years there has been a gradual decrease in the vaginal delivery of twins. This may have led to a loss of obstetric intrapartum skills and confidence in some accoucheurs. Leading professional organizations recommend that all women with a cephalic presenting twin be counseled about the availability and safety of vaginal delivery. There are a number of different techniques for delivering twins and the accoucheur should be adept at all, and tailor their practice to the clinical situation in the moment, rather than relying on a single technique. Techniques for vaginal birth in multiple pregnancy have evolved in an anecdotal fashion and there is wide variation in practice throughout the world. None of the techniques are a challenge to a person of average dexterity and an Obstetrics department can safely increase the rate of vaginal delivery of twins through a program of needs assessment, education, simulation, and clinical backup. Some still advocate for the vaginal delivery of triplets, but such practice is rare and as a consequence questionable. The delivery of quadruplets and greater is by caesarean delivery.