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Twin Pregnancy

Twin Pregnancy questions answered.

How can I tell if I am in labour?

Pregnant woman

• Your waters may break resulting in either a trickle of fluid or it gushing
• You may have contractions 10 mins or less apart getting progressively stronger and more frequently.
• You may experience a ‘show’ in your underwear.This is a mucus plug which may be pink or bloodstained.
• You may have vomiting and / or diarrhoea

If you think you may be in labour call your labour suite for advice. The number should be on your antenatal notes.

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Things to do before the birth of twins.

• Pack your hospital bag by about 32 weeks

• Put the number of the labour suite in your phone or write it down an put it near your land line telephone so you can access it quickly if necessary

• Find the number of your local taxi company and put it in your phone. Even if you’re hoping to go to hospital by car, it is handy to have a taxi number to hand just in case!

• Put some loose change into a separate purse ready for the vending machine, the taxi etc. Put this in or on top of the hospital bag.

• Plan who is going to look after your older children, feed your cat, walk the dog and water your house plants whilst you are in hospital.

• Prepare a list of who you want your partner to call when the babies are born. Make sure he has the numbers to hand.

• Set up the baby equipment you have bought.

• Write your birth plan detailing whether you want no pain relief, pain relief on demand, all the pain relief available! Also detail what you want to happen after the birth do you want the babies handing straight to you if possible, do you want them washing before you have them brought to you. Do you want Dad to cut the umbilical cords if possible.

• Stock up the freezer with easy to prepare meals for the first week or two when you get back with your babies.

• Set up online banking, and learn how to order groceries online!

• Create direct debits for your utility bills (if you haven’t already done so!)

• Plan where you’re going to feed your babies both during the day and at night time and set up comfortable ‘feeding’ zones so you have everything to hand exactly where you want to feed them!

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Preparing for a Multiple Birth

Options for giving birth to twins. Some questions answered.

Is it possible to have twins vaginally? Yes it can be possible to give birth to twins vaginally depending how your twins are progressing and how they’re lying in the uterus. If they are progressing well, you and your twins don’t have any medical complications, and one of them has his/her head down and engaged towards the end of the pregnancy, you may be encouraged to try a vaginal birth.
It is likely that you will be encouraged to have an epidural so that should they need to top your pain relief up to full strength during the birth so you can have an emergency caesarean they can do so easily.

However it’s more common for monozygotic monoaminotic twins to be given a caesarean due to possible complications but if you wish to discuss your options with your consultant or midwife then that’s fine. It’s important that you understand the reasoning behind whatever decisions you have to make regarding the birth.
Will I have to have a caesarean with twins? Not necessarily. It depends on a number of factors, including how urgently your twins need to be born, how they are presented (how they are laying in the uterus) and if there are any other medical factors to be considered.

If there are complications, or the babies are in distress, the twins are laying in an awkward position, are monozygotic monoamniotic or are breech, you may be advised to have them by caesarean section.

If you attempt vaginal delivery and the labour does not progress as expected, or if there are any difficulties, or the twins need to be born quickly, you might have an emergency caesarean after attempting labour. I’ve had a caesarean with my older child, does this mean that I have to have another one with my twins? Not necessarily. It can be possible to have a VBAC (vaginal birth after caesarean). If you would like to try this please ask your obstetrician for advice.

How will a twin birth differ from that of a singleton? If you have them vaginally you will go through the pushing stages twice, but the first stage (the dilation) and the third stage (delivery of the after birth) is the same.
With a twin birth the midwife/ obstetrician is likely to want to monitor your twins hearts closely for signs of distress which may limit how mobile you are during the birth.

You may be discouraged from having a home birth, or a water birth. However it is always worth discussing with your health team what options are available to you.

How long does it take to give birth to twins? Around the same length of time as with singletons, the only bit that is longer is the pushing bit. It may only take 10-30 mins longer than giving birth to a singleton.

With a caesarean the babies are lifted out quickly so again it shouldn’t take much longer than with a singleton

.There are lots of junior staff wanting to watch but I don’t want them to, what shall I do?
You might find that you have lots of staff present, particularly senior staff such as a consultant or senior midwife which can be reassuring. However you may also find that you have lots of student doctors and midwives wanting to watch for training purposes. If you would prefer that junior staff are not present for the birth please politely say so at the beginning of your labour. If you are happy for them to stay then that is equally fine but at the end of the day, it’s up to you what you want to happen.

The Birth.
You may spontaneously go into labour, you may have to be induced or for a health concern you may have to have a caesarean, either an elective caesarean on a set date that you’ve prearranged, or as an emergency.

If you are induced this involves them inserting a pessary into your vagina which (hopefully) stimulates labour. You then lay down for about 10 minutes to let it take effect. If the first one does not work they may give you a second one about 12 hours after the first one.Spontaneous labour. This is where you start labour without any medical intervention.

 How will you know if you are in labour?  As soon as you notice any of these symptoms please contact your labour suite for advice. Once you get into hospital you will have an internal examination to see how far dilated you are.

If labour is becoming established you will be monitored, probably offered an epidural and moved to a delivery room. The room you are in is likely to double up as an operating theatre if necessary, just to be on the safe side.

You may be offered other forms of pain relief, including a tens machine, pethidine (an injection) or Gas and Air (entonox). See what you need during the labour, if you need more than one kind of pain relief that is fine, tell your midwife so she can organize it. Will I have to go through labour twice if I am having twins?No.

Once you get to the pushing stage you will do the pushing stage twice, but the rest of your labour is the same as having a singleton (apart from getting two babies at the end, obviously!)  After the birth you will deliver the placenta, the babies umbilical cords will be cut, they will be checked over and then handed to you as long as they have no urgent medical issues. After this you are likely to be given a cup of tea and some toast, and shown how to breastfeed if you’re planning on breastfeeding them.

Having a caesarean.
If your caesarean is elective (i.e pre-arranged) you will be able to plan for the birth. You may be offered a choice of having a general anaesthetic where you will be unconscious (asleep) for the birth or a local anaesthetic where you will be conscious during the birth. A caesarean involves having an incision in the abdomen, both babies being carefully lifted out and the abdomen stitched back up again. This is a major operation and takes a little while to recover from. You will be expected to stay in hospital for a few days to recover.

Recovering from a twin birth
Whichever method you use to give birth, you will need time to recover afterwards. Rest is important as is eating well and drinking plenty of fluids. Taking short walks even if it is just up and down the corridor in the hospital is a good idea too as soon as you’re able to.

If you have stitches from an episiostomy ( a cut to your perineum) you may be sore for a few days. If it hurts whilst you urinate (wee) try soothing the area with some warm water and drink plenty, this will dilute your urine and make it sting less.

If you have a caesarean you will need extra help picking up your twins for feeding /changing etc. You will also be monitored to make sure you are recovering after your operation and have your dressings changed and your wound checked.If you’re feeling particularly sad or unwell please contact your health team for advice.

After the birth you will bleed (a bit like a heavy period) for 4-6 weeks. This is known as lochia. If you notice large clots of blood, are very heavy or notice an offensive smell, please contact your hospital immediately.

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bag

What to pack in your hospital bag if you’re having twins

 

Pack the following for yourself:
• An old baggy t-shirt or nighty for the birth.
• Breast pads
• Tissues
• Your toiletries bag with soap, shampoo, conditioner, moisturiser, toothbrush, tooth paste, deodorant, comb, brush. Buy travel size bottles of shampoo, deodorant, etc rather than full size ones. Saves you lugging your whole bathroom cabinet with you!
• An old flannel
• 2x hand towels
• Maternity Pads (or heavy flow sanitary towels)
• Old knickers (not g-strings or anything very skimpy. Big granny pants are best) or disposable maternity pants
• Dressing gown
• Slippers
• Fresh nighty/ Pyjamas. Pyjamas will be fine even after a c-section because they sit higher up than your scar.
• Maternity/Nursing bra
• Mobile phone and/ or camera
• Socks

For the babies
• 2 packs of newborn nappies (if they come in a double pack already one pack should be enough for now!) It’s important not to over do it, because sometimes twins can be surprisingly big/small and need a different size of nappy to what you might think!
• 4 pairs of scratch mitts
• 12 body suits (vests)
• 12 baby grows (sleep suits)
• 2 baby hats
• 2 towels
• 2 cardigans
• Nappy sacks
• Sensitive wipes (check they are suitable from newborn)
• Pleat of cotton wool
• Baby soap, shampoo etc (check if suitable for newborn)
• 6 bibs
• Muslin squares (optional)
• Carrier bags to put dirty clothes in.

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What is a birth plan?

A birth plan is a document that you create to let your health team know what you would like to happen during the birth, on it you can outline who you want as a birth partner, whether you want no pain relief, or if you’re open to having some /all pain relief offered, whether you want lots of junior medical staff present or not.

You can also outline whether or not you want your partner to cut the umbilical cord, and whether you would like your babies handing to you straight away after the birth (assuming they don’t need special care) or whether you’d like them washing and dressing before you have your first cuddle.

Whilst it can be very useful, I would suggest you make it clear that you might change your mind on the day. Some people think they want no pain relief at all but when the day comes find they want lots of pain relief, which is fine. It should be a guide rather than set in stone! Some people don’t write a birth plan, preferring to play it by ear, it’s entirely up to you.

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Twin Pregnancy ~ what to expect when you’re pregnant with twins

You may be feeling like you’re on an emotional roller coaster right now, one minute feeling delighted, the next in floods of tears not knowing if you’ll be able to cope with one (more) baby let alone two! This is perfectly normal and totally understandable. This feeling usually passes after a while, especially when you find out more information and arm yourself with useful tips and advice from other twin parents’ who have already been there and done that! If it doesn’t, please see your GP or midwife for advice.

How will I know if I am expecting twins? The main way is to have an ultrasound dating scan  (’sonogram’) which will also tell you how many babies you’re carrying. Many women ‘just know’ they’re having twins, even before they get sent for a scan.
Signs that you *might* be pregnant with twins include:
  • Feeling very tired,
  • Extremely irritable,
  • Weepy,
  • Having very sore breasts,
  • Severe morning sickness,
  • Looking big for your dates.

Some people find that they have very severe pregnancy symptoms, but others have either very mild symptoms or none of the above. The most accurate way of telling if you are pregnant with twins is via a scan. If you think you have a likelihood of having twins, please see your GP to discuss having an early scan.

 
How long does a twin pregnancy last? Twin pregnancies are said to be ‘term’ at 37 weeks. Triplets  are said to be ‘term’ at 34 weeks. So a multiple pregnancy can be shorter than a singleton pregnancy. However, some twins do go to 40 weeks.
 
Can I be having twins, there isn’t a history of twins in the family? Absolutely! It is possible to have twins without there being a strong history of twins in the family. Especially if you’ve had assistance in some way to get pregnant, like IVF etc. However if you do have a strong history of dizygotic (non-identical or ‘fraternal’) twins in the family you do have a stronger chance of having twins.
Why am I so big for my dates?
This is because twins grow at the same rate as singletons for the first 26 weeks of pregnancy! This rate will start to slow down after 26 weeks.
I’m frightened, everything seems so daunting! Help! You can ask questions on the Twinsonline Facebook Page  and via Twitter www.twitter.com/twinsonline_uk Here you can get informal, friendly advice from other parents and adult twins that have been in a similar situation to you .
Please note if you have any medical concerns please go see your GP or contact your Midwife or Antenatal clinic urgently..

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Scans and antenatal tests in twin and multiple pregnancy

When you are expecting twins you will be offered more ultrasound scans than with a singleton. You might have scans at 6,12,16,20,24,28,32,35 wks with twins. It largely depends on where you are, and how you are and your twins are progressing.

You might find that if you’re having identical twins you get scanned weekly or fortnightly (or even daily depending on your individual circumstances) towards the end of your pregnancy.

You will also be scanned more frequently if your twins are not growing at the expected rate.It can be possible to tell whether or not your twins are identical through ultrasound scans. It can also be possible to tell whether your twins are going to be both girls, both boys or one of each! Scans are particularly vital if you’re having monochorionic twins as it checks for Twin to Twin Transfusion Syndrome.

You may also be offered a Nuchal Translucency Scan Some areas have an optional nuchal translucency scan available. This should be done at 11-14 weeks and takes measurement of the fluid in the back of the neck using detailed ultrasound technology. It can give some idea of the likelihood of your twin having Downs Syndrome (triosomy-21). It is personal choice whether or not to have it done. In some areas you might have to pay a fee.

You will be offered a range of screening tests including the Alpha-fetoprotein (AFP) test at around 16-18 weeks gestation. This is to help detect signs of a neural tube defect such as spina bifida. Discuss with your health team how the results will be affected by your multiple pregnancy as it can come back with a false positive result due to the fact you’re having twins/ triplets.You may also be offered the Triple test.

This measures hormones in the body such as human chorionic gonadotrophin (hCG) and oestriol.  It can help assess the likelihood of your babies having down’s syndrome.Attend your antenatal appointmentsYou will be expected to provide a urine sample at each appointment. This is enables your urine to be screened for signs of protein, sugar, infection and keytones. It can also be useful in detecting gestational diabetes and pre-eclampsia.

You will also have your weight checked to ensure that you have not suddenly gained lots of weight. Your fundal height will also be measured to make sure that you bump is growing at a reasonably steady rate. You will have your blood pressure checked as raised blood pressure can indicate the onset of pre-eclampsia so it is important to have this checked regularly. Your midwife will also want to listen to the babies heart beats too.

 It is vital that you keep your antenatal appointments.

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How will my twin pregnancy differ from a singleton pregnancy?

Pregnant WomanYou will find that you will usually get bigger quicker, wear maternity clothes sooner than with a singleton pregnancy.
You may have more severe pregnancy symptoms (although not all twin mums do) You will be scanned more frequently than with a singleton, especially if you are expecting monozygotic (’identical’) twins who are sharing a chorion.

You’re more likely to be seen by a consultant. Twin pregnancy is also usually slightly shorter than a singleton pregnancy. You may need to go on Maternity Leave sooner than if you were having one baby. However it largely depends on how your pregnancy is progressing and how strenuous your job is.

What happens next? Once you’ve established your pregnant you normally get invited to a ‘booking in’ appointment where you meet the midwife at around 10-12 weeks. In this appointment you will have your blood pressure checked your urine sample will be tested and your weight checked.

Your midwife will take a blood sample to determine what blood group you are and if you are rhesus positive or negative.

You will also be asked about your family medical history and about any previous pregnancies. You might find out very early on that you are pregnant and have quite a wait before you go to your booking in appointment. If this is the case and you have questions for your midwife in the mean time please don’t hesitate to contact him/her or your GP.

If you have any health worries at all, go to your GP, midwife or A&E if appropriate. If you have vaginal bleeding, severe morning sickness, severe or prolonged headaches (especially after 20wks), any sign of swelling seek medical attention urgently.

It can be useful to buy a small notebook to jot down any questions you might have for your health team about your twin pregnancy. Make sure you leave plenty of space to jot down the answers to the questions and take a pen with you!

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When should I tell my friends and family and boss that I am having twins?

When should I tell my friends and family that I am having twins? After 12 weeks is a good time to tell them as the risk of vanishing twin syndrome and miscarriage decreases after 12 weeks. Also usually by 12 weeks you can tell if your pregnancy is going to be viable.

However if you’re suffering very badly from morning sickness, or extreme tiredness, you may have to tell them sooner.

When should I tell my boss that I am pregnant with twins? In the UK you must tell your boss you are pregnant ‘at least 15 weeks before the beginning of the week the baby is due.’  See https://www.gov.uk/working-when-pregnant-your-rights

If you’re working in an environment where you’re either expected to stand or sit for long periods of time, do heavy lifting, work with toxic chemicals, or if you have long working hours, you may be able to have your work duties adapted to suit your pregnant state. If your employer is not able to find you alternative lighter duties, you may be suspended on full pay.

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Preparing your home for the arrival of twins

Before your twins are born you will need to work out where you are planning on feeding your twins both in the day time and at night, and set up a comfortable area to do this both upstairs and downstairs.

You will also need to buy something for them to sleep in such as cots / Moses baskets for night time and bouncy chairs for daytime naps. It is also a good idea to decide whether you would prefer to breastfeed or bottle feed, as the equipment you need differs slightly between the two options.

How you arrange your home largely depends on what space you have available to you and how you currently use it. If you have space in your bedroom, that would be an ideal place to put your twins cot(s) for the first 6 months.

Not everybody has the space to do this unfortunately, so you might have to put them in a spare bedroom. Or you might decide you are going to give them a room each right from the start. If you have a little used room downstairs you could turn it into a daytime nap room / playroom. There are lots of possible options and it really is entirely up to you to figure out how to make your home work to its highest potential.

Do twins simply HAVE to share a cot/ crib? This is a matter of personal preference. Some twins seem to sleep better together, however others are  perfectly content in their own cots/cribs. If you have space for them to have one each and your budget allows you to, buy a cot /crib each. At the end of the day you have to do whatever is right for you and your family. There is no one set one-rule-fits-all policy. From a purely personal point of view I put my twins in separate cots right from the start, and didn’t bother at all with Moses Baskets. I have never had any problems with them settling.  You could potentially put both twins into the same cot at first, leaving one cot downstairs for daytime naps and the other cot upstairs in your room or the nursery. If you do let them share a cot/crib make sure you follow current sleeping safety guidelines, making sure that each child has their feet to the cot bars so they can’t shuffle under the covers and over heat/ suffocate.

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