Background: Pregnancy and giving birth to twins of different sexes is a joy for parents because once pregnant they have two children at once with different genders. This will not be the case for certain cultural groups. Twin pregnancies of different sexes or “bunny twins” in certain cultural groups are often referred to as “wrong people”. Problems arise in groups who consider pregnancy and the birth of twins of different sexes as conditions that can pollute the village, so they are required to carry out a tradition called the Manak Salah tradition. Objective: To understand the cultural values or traditions of Manak salah and their impact on a parent couple or family by conceiving or giving birth to twins of the opposite sex. Methods: A case report of one family who had given birth to twins of the opposite sex and was required to carry out the Manak ritual tradition was wrong. Results and Discussion: It was reported that a 50-year-old mother was pregnant and gave birth to twins of the opposite sex. As a result of this, their families carry out the Manak Salah tradition required by their village Awig-awig (customary law in Bali) in their yards and several public temples and have to prepare a black pig as a ritual tool. At first, there was a feeling of shock because it was the first time, I heard about such a ritual, and had to prepare a lot of budgets for it. However, the feeling of discomfort soon disappeared due to having two children at once of different sexes. At that time, in Bali, the birth of twins with twins was considered a mistake because it was considered to pollute the village, so they were required to carry out a tradition called the Manak Salah tradition. Conclusion: Pregnancy with twins in several villages in Bali is still considered a mistake so it requires certain treatment and rituals. The act of isolation and the Prayascita ritual can affect the health of the mother and or her baby. Both physically, mentally, socially, and even financially. A new approach that is rational, adaptive, and promotive is needed to deal with pregnant twins.