Twin Pregnancy and Birth

Could I be pregnant with Twins or Triplets? How can I tell?
Some people have “worse” symptoms when expecting twins or triplets, they may feel ultra tired, weepy, or very emotional. You may feel or be very sick, you may look very big for your dates. You may have very sore breasts, you may just “know” you are pregnant with twins.

However some people who have twins have a regular amount of early pregnancy symptoms, and others seem to get away with feeling the same as ever!!

I can’t be expecting twins can I, there are no twins in my family?
You just might be having twins, as there are a number of other factors which affect the ability to have twins, such as your age, your race, and whether you have had any form of assistance to get pregnant. If you have non-identical (fraternal) twins in the family you have an increased chance of having non-identical twins yourself but many people have had twins without anyone in the family having twins before them.

When will I know if it’s twins?
If you think you might be pregnant with twins or more get in touch with your health centre. They will be able to confirm your pregnancy and if necessary book you in for an early scan.

Some people find out very early on that they are expecting twins during an early dating scan, others find out towards the middle of their pregnancy.

I have been told that I have two sacs but then they said it might not be twins, I’m confused, help! 
If you find out you are having twins very early on (in the first 5-12 wks) you might be told that they can see “two sacs”. Instantly you will probably think “twins” in some cases you might even be told you are carrying twins. Sometimes however in the first crucial weeks the second sac vanishes or is reabsorbed or is miscarried, so that on a later scan there is only one sac visible. Usually by around 12 wks it is possible to tell whether or not both sacs have signs of life, and it is around then when you will find out that you really are having twins or not.

This is known as Vanishing Twin Syndrome. It is more common than you would probably imagine. It is a very emotional time for parents who are told at an early scan that they may be carrying twins only to find out from a later scan that only one sac has in fact taken. You are by far not the only parents going through this.

Historically mums were not given early scans so in the past people may have started off carrying two sacs and then gone on to have just one baby, completely oblivious to the fact that they started off with two sacs.

If you experience vaginal bleeding during twin pregnancy whether accompanied by pain or not, get medical help.

So you are having twins/ triplets?
Expecting twins and triplets can be a shock, a delight or a worry (or all three) and it is not uncommon for you to go through a cycle of emotions, one minute grinning your head off and the next being very weepy. Some of you may feel that it is a disaster, the worse thing that could happen to you, these kinds of thoughts are not uncommon.  This is all perfectly normal.

Please note that if you have any medical worries you should contact your midwife, hospital, or GP for advice, I cannot comment on medical problems.

How long does a twin pregnancy last?
Twin pregnancy generally lasts for around 37 weeks, triplet pregnancies around 34 wks (single pregnancies tend to be around 40 weeks) so a twin pregnancy is a fraction shorter than when you have only one on board!

How will a twin pregnancy differ from a single pregnancy?

• You may feel extra tired, or more sick during the first trimester (three months) as your body is having to work extra hard to produce two extra people!
• During your pregnancy you will be asked to go for more scans and ante-natal appointments than with a single birth. This is to ensure that both babies are developing at the correct rate and that you do not have high blood pressure or any signs of pre-eclampsia.  In the case of identical twins who are sharing a placenta, you will be monitored for twin to twin transfusion syndrome.
• You may be offered a more limited choice of birthing options when expecting twins, as many health teams prefer multiple births to be hospital based, so may discourage you from having a home birth. 
• Some hospitals employ the policy that mums must give birth to their twins by caesarean, but there are plenty who now favour vaginal deliveries of twins. At your first appointment with your hospital, you may want to discuss with your medical team the options available to you for the birth.
• Some hospitals encourage people who are attempting to give birth vaginally to have an epidural, which numbs the spine but allows mum to remain conscious throughout as this can be easily topped up if an additional anesthetic is needed (like in cases where an emergency caesarean or episiostomy is required)

We’re expecting twins. HELP

My partner was so shocked to find out we are having twins he hasn’t spoken since we found out, and I can’t stop crying -one minute I am elated the next minute I worry that I will never be able to cope - HELP!

Finding out you are having twins can be an enormous shock. Some of you will be delighted, others will be very daunted by the thought of raising twins. Others will be speechless, and others so incredibly happy they will have a smile on their faces for weeks after finding out. If you are worrying about having twins or worried that you won’t cope please get in touch for a few kind words of reassurance! Having twins is really not as bad as people make out. It can be great fun!

If you are feeling a bit daunted by the idea then panic not, Twinsonline is here to help you cope. If you keep crying don’t worry it is probably just your pregnancy hormones running riot in your body, in a few weeks it should all settle down again and you will feel a lot stronger! If you are worrying, try to talk to your partner and best friend about it, sometimes just telling someone how you feel helps a lot.

Will I have to have a caesarean?
This depends on

• Whether you have had a Caesarean before
• How your babies are lying in the uterus- if they are both breech you will almost definitely have to have a c-section. If one twin’s head is down and engaged towards the end of your pregnancy it is fairly likely you may be able to attempt a vaginal birth
• Your hospital’s birthing policy, some hospitals have the policy that ALL twin births are by caesarean.
• Any underlying medical reasons where attempting a vaginal birth would put the health of either you or your babies at risk.
• If you have monochorionic twins (identical twins sharing a chorion) you might be asked to have a caesarean- ask your health team if this applies to you.

If I give birth to twins vaginally will I have to go through labour twice?
No! You have the same first and third stage of labour (your cervix will dilate as normal, and you will deliver the placenta as you would with a single birth.) It is the second stage (the pushing part) that you repeat twice. Generally it does not take that long to push the second twin out, so have no fear you will not be going through the whole of labour twice.

Should I eat for three?
No! You should aim to have plenty of NUTRIENTS but this does NOT mean you should eat for three (sorry folks!) ensure everything you eat is high in nutrients and have plenty of fruit and vegetables and protein as well as some carbohydrate.

It is sensible to avoid foods high in vitamin A (such as liver and liver products, pate etc, as well as regular vitamin pills) Always wash salad carefully, avoid anything with raw or uncooked egg (home-made mayo, home-made mousse etc) Cook meat thoroughly and avoid any cheeses made with unpasteurised milk. Caffeine should be taken in very small quantities. Alcohol is best avoided if at all possible although a couple of units a week will  probably be fine.

Have a Healthy Twin Pregnancy

There are a few things that you can do to have a healthy twin pregnancy. These include:-

• Managing steady (but not excessive) weight gain
• Remaining Active without overdoing it
• Eating a sensible healthy and tasty diet
• Resting enough to allow your body to meet the extra demands a twin pregnancy places on it
• Ensuring that your body has the required amount of nutrients and supplements
• Protecting your body from disease
• Emotional health - keeping your spirits up and your mind healthy.

Steady Weight Gain
The key to sensible weight gain is to eat small meals  and snacks which are highly nutritious on a regular basis.

Snacks include

• sandwiches on wholemeal bread,
• carrot sticks,
• pieces of fruit,
• a yoghurt,
• slices of malt loaf,
• pitta bread.

Instead of having three large meals a day have three sensible sized meals and a few snacks in between never go for more than 3 hours during the day without having something to eat and drink.

 Try not to miss meals, or have large meals especially in the latter stages of your pregnancy. Avoid anything that has a high fat, salt or sugar content or that is highly processed.  Never eat for three, you do NOT need three times as many calories, you just need a sensible amount of highly nutritious food to maintain your body.

Remaining Active
Go for short walks or for a swim if your doctor agrees. Always double check first whilst pregnant as your doctor might have a good reason for you to avoid this. Whilst it is important to rest plenty whilst you are pregnant with twins it is important that you do keep having a little walk round (unless obviously you have been told to have complete bed rest) this prevents deep vein thrombosis developing.  Try to avoid heavy lifting and active contact sports (especially extreme sports)

Rest.
If you are still working you will need to create times in your day to rest or shuffle your working patterns around to suit you

If you get a chance to a have a little lie in then take it, also if you are able to have an afternoon nap after work then that would also be good. If you really must cook dinner, try putting something simple into a casserole, add jacket potatoes and put your feet up whilst it cooks. Try to have relatively early nights and try to relax as much as you can after work.

If your boss is forward thinking he or she may allow you to work from home a couple of times a week. Use the time saved commuting to work to have a lie in and the time saved on the journey home from work to have a rest even if it is with a good magazine or book. You might find that your job is not suitable for someone who is pregnant. If this is the case ask your boss to find you a job to do that is suitable

Supplementary Help!
When you first find out you are pregnant ensure you take folic acid for the first 12 weeks of your pregnancy. Avoid regular vitamin supplements as they can be high in vitamin A and also Iron.

 If you wish to take vitamins choose ones specially formulated for pregnant ladies.  Double check that any other medicines you would normally take (including the over the counter drugs you might take such as painkillers, herbal remedies etc) are suitable for use during pregnancy. If you normally use aromatherapy oils consult your therapist about which are safe to use in pregnancy as some of them like clary sage are NOT.

Protect your body from disease
Protect your body from disease by avoiding the company of anyone suffering from chicken pox, or German measles (or any other illness) ensure that you cook carefully any products containing eggs and chicken to minimise the risk of catching salmonella.

Avoid home made mayonnaise and mousse recipes as these contain raw egg.  Ensure you wash all salad items carefully (including cucumber) and avoid soft cheeses that have been made from unpasteurised milk products.

Avoid cleaning out the cat’s litter tray (if you absolutely HAVE to clean it out wear gloves and wash you hands extremely carefully afterwards) as cat poo can unfortunately carry a germ called toxoplasmosis which can cause severe problems for the baby (including blindness and stillbirth)

Relax - keep your spirits up!
Keep your spirits up by trying to relax as much as possible, think plenty of positive thoughts, see your friends as often as possible (if all else fails invite them round for coffee, get them to put the kettle on, ask them to make it and sit with your feet up having a good catch up)

If you have any concerns about your twin pregnancy don’t forget to call your doctor or obstetrician or midwife -They are PAID to help you

If you have any questions about what you need to buy, how to organize your nursery ready for the arrival of twins, how to cope with newborn twins or simply just want to talk to someone who has had twins then e-mail Twinsonline at the usual address.

Giving Birth to Twins

What are my birthing options for twins/triplets?
When you find out you are having twins/triplets ask your midwife/ obstetrician what options are open to you for the birth.

Often water births and home births are discouraged.

However if you have strong opinions about how you would like the birth to progress then say so to the hospital. You have a right to tell them how you would like to birth your twins.

Ask your health team to explain why they want you to give birth in a certain way and what risks/ benefits are involved.

Once you have talked it through you might have a re-think but it is good to discuss your options and the pros and cons of each choice. If you have strong views about how you would like to give birth to your twins/triplets please speak to your health team about your available options.

Worried about giving birth to your twins?
If you are worried about giving birth to your twins, talk to your health team -they should be able to give you reassurance.

Are all twins delivered by Caesarean?
No. Not all twins are premature or delivered by caesarean, some are delivered full term and vaginally.

If you have a straightforward twin pregnancy and are not showing any signs of medical problems you may well be able to go to term before having your twins.

Some mums are induced at around 37+ wks which involves having a hormonal pessary inserted into the vagina to spark off labour.

There are three ways you can give birth to twins:-

• Vaginally
• By caesarean section (C-section)
• Mixed (both vaginally and c-section)

What reasons might I have a caesarean?
If:-

• your babies are both breech
• you already had a caesarean *(talk to your health team they may opt to deliver your babies vaginally or by caesarean)
• your babies need to be delivered urgently due to complications
• your labour is not progressing quickly enough and your baby is distressed
• your babies are monochorionic monoamniotic - i.e. sharing a chorion and amniotic sac. Sometimes your health team prefer to deliver monoamniotic twins by caesarean due to the risk of the umbilical chords tangling during a vaginal delivery. If your twins are monoamniotic talk to your health team about birth options available to you.

Is it possible to have a vaginal delivery with twins?
It can be if your babies are lying in the right way towards the end of your pregnancy and there are no other complications which would make a caesarean delivery more suitable.

If you have one baby who is lying head first down towards the end of your pregnancy vaginal delivery may be attempted.

Giving Birth to Twins Vaginally
Whilst this may make you gulp at the thought of it, it really doesn’t take that much longer than having just one baby. Your cervix dilates as it would do for just one baby, and then you do the pushing part twice and the rest is just the same as having just one baby. You may be advised to have an epidural which numbs you from the waist down which can be ‘topped up’ if you need a caesarean.

Giving birth to Twins via C-section (caesarean)
Some of you will have an elective caesarean, this is where you are given a date for the operation and you arrive at the hospital on the appropriate day.

Caesareans can be performed under a local anaesthetic using an epidural which numbs you from the waist down. A screen will be put up so that you can’t see the actual operation.

However some of you may need an emergency caesarean for whatever reason. You may be given a general anaesthetic which means you will be asleep for the birth. If you have attempted to give birth vaginally and have an epidural in place you may be able to have this topped up and remain conscious for the birth.

Recovering from a caesarean
This takes time, it is a major operation and therefore you should go easy on yourself. For a short while you will be sore so if you can get yourself plenty of help this will make life easier.

Medical Concerns
If you have any medical worries at all, please get them checked out.

My doctor used technical terms which I don’t understand - help!
If this happens to you let them know that you haven’t understood and ask them to explain it again.

Will I always see the consultant?
Not necessarily, although twin mums are  likely to see the consultant more frequently than singleton mums. Also as your pregnancy progresses you have a greater chance of been seen by the consultant.

Am I in Labour?
If you think you might be in labour contact your Labour Ward/ Delivery Suite, and make note of timings of any contractions.

These can be found in Boots, Superdrug, and your usual supermarkets. Alternatively you can buy little bottles from chemists which you can fill with your favorite products.

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Page Last Updated

July 07, 2010 

Disclaimer:- Twinsonline is here as a guide only - anything you do you do at your own risk
 If you have a health concern please go see the relevant member of your health team (GP, Health Visitor, Midwife, Obstetrician)

Twinsonline is a UK based website and Twin Forum. For Twins and parents of twins from pregnancy to adulthood.