Objective: The mode of birth for twin pregnancies has been a topic of debate, but vaginal birth in twin pregnancies appears both possible and safe, despite the upward trend of cesarean section. Design: This retrospective multicenter study compares outcomes before and after the implementation of a vaginal twin intervention in two Italian hospitals. Setting: In January 2021 in Pescara and in July 2022 in Florence, physicians with expertise in twin and breech vaginal birth started working in each center, and clinicians and midwives started quarterly training in these skills. Setting: The study period, divided into two equal time intervals, lasted 8 years in Pescara and 5 years in Florence. Providers were also surveyed about how the intervention affected their confidence, skill, and knowledge levels. Population: Diamniotic pregnancies with two viable twins; ≥34 weeks of gestation; cephalic presentation of the first twin were included. 278 women were evaluated, split into pre-intervention (n=131) and post-intervention (n=147). Results: Vaginal birth rates increased from 9.2% to 40.8% overall with no negative effect on maternal or neonatal outcomes. Participating providers felt more skilled, knowledgeable, and confident and agreed that the training improved vaginal birth rates as well as their vaginal breech skills. Conclusion: A rapid increase in the vaginal birth rate of twins is possible via either staff-wide training or specialist teams without adversely affecting maternal or neonatal outcomes. Simulation and skills training can improve provider confidence, knowledge, and skill levels as well as impact clinical practice in the labor ward.