The Mode of delivery in twin gestation has long been a matter of debate. The Twin Birth Study (TBS) supplied care givers with an answer to some of the questions. In patients with twin gestation between 32 and 38 weeks of gestation, with the first twin in cephalic presentation, that match the inclusion criteria of the TBS, the neonatal and maternal outcomes of a planned trial of a vaginal delivery are not different than those associated with a planned cesarean section. Yet, gestational age at birth, estimated fetal weight and weight difference between the twins, presentations, chorionicity, care giver’s experience – are some of the many factors that influence the decision regarding mode of delivery, and the outcome of birth in multiple pregnancy. This chapter will describe the evidence or in its absence expert view with regard to mode of delivery in uncomplicated twin pregnancy but also special circumstances such as delivery of the non-vertex second twin, combined delivery, time interval between delivery of twins, breech presenting twin, monoamniotic twins, monochorionic diamniotic twins, vaginal birth after caesarean in twins, preterm and low birthweight twins and higher order multiples.