The Twin Pregnancy
Discovering that you are pregnant with two babies can be a shock. If this is your first pregnancy, you may have no idea what to expect. If you already have children, the idea of adding two more to the mix is an intimidating thought. Learning as much as you can about what to expect from the pregnancy, birth and beyond will help to make this a positive experience.
How are twins conceived?
There are two types of twins – identical and fraternal (non-identical).
Identical twins start as one fertilized egg. This egg splits into two fetuses with the same genetic code. Identical twins will always be the same sex. The twins will grow in the same amniotic sack.
Fraternal, or non-identical twins, form when two different sperm fertilize two different eggs. Two genetically unique babies develop. The twins are actually siblings implanted at the same time. The twins may or may not be the same sex. They will each have their own amniotic sac.
How will my pregnancy differ with twins?
Basically, a twin pregnancy is a singleton pregnancy in overdrive. This has various physical effects. Obviously, you will develop a bigger bump than if you were only carrying one child. The extra big bump means an associated upswing in size-related issues, like backache and trouble sleeping comfortably. You may also suffer from increased pregnancy symptoms, such as morning sickness and heartburn.
On the plus side, you may not be pregnant as long. An average twin pregnancy is 38 weeks, rather than 40. This is due to increased strain on your body. The rate of complications in pregnancy is increased, resulting in many twins being delivered earlier than expected. It is not abnormal for twins to be premature, as the mother struggles to produce enough nutrients for two fetuses in the long term.
Complications common in twin pregnancy
- Premature delivery – Even if the pregnancy is uncomplicated, 50% of twins are delivered before 37 weeks.
- Fetal growth restriction – This can affect one or both twins, resulting in reduced growth rate and maturity problems.
- Pre-eclampsia – Uncontrolled high blood pressure in the mother, leading to serious growth problems and oxygen shortage in the fetus.
- Anaemia – Low iron levels, leading to maternal fatigue.
- Placenta praevia – The placenta lies low, covering the cervix. Complete placenta praevia can be a very serious problem if you go into labor, with a risk of uncontrollable bleeding.
How will the birth differ with twins?
You are more likely to need a Caesarean section (C-section) to deliver your babies. The lack of space in the uterus results in the high likelihood that the positioning of the twins will be unsuited to vaginal birth. However, many women do deliver their twins vaginally, particularly if they have already birthed a baby in this way. A natural birth will not be an option if there are any additional complications. If you are given the go-ahead for a vaginal delivery, this will be reassessed if complications develop later in pregnancy, or during labor.
In a typical vaginal twin birth, the first baby is head down and delivered normally, while the second is delivered as a breech (”footling”) birth. Induction is common, ensuring a full component of medical staff is available to assist you.
Caesarean section (C-section) delivery
A Caesarean section is a safe delivery option for mothers carrying twins. The procedure is quick and relatively simple, involving an incision along the bikini line into the uterus.
A C-section will be performed in the following cases:
- The mother requests it.
- The first twin is not head down.
- Placenta praevia is diagnosed.
- Intrauterine growth restriction (IUGR) is diagnosed.
- The birth weight of twin A is 1lb (500g) greater than twin B.
- One or both of the babies has a physical abnormality.
- Twin-to-twin transfusion syndrome is present (this only affects identical twins, leaving one twin with reduced blood supply from the shared placental blood vessels).
- The babies are conjoined (“Siamese twins”).
Twins often need to be delivered before their natural due date. Even if you have no other complications, carrying two babies is very hard on your body. The placenta is often not able to provide both twins with adequate nutrition up to term. Premature babies are likely to need time in a special care unit. This stay may last several weeks, depending on their size and physical maturity level. As a rule of thumb, you can expect them to be released near to what would have been their due date.
Will I receive different antenatal care while pregnant with twins?
Yes, you will receive more specialized, frequent antenatal care while pregnant with twins. The rate of complications is increased, therefore your doctor needs to account for this risk by assessing your condition carefully and often. You may be put under the care of a doctor who specializes in complicated or multiple deliveries. You will receive more ultrasounds and blood tests than you would in a singleton pregnancy.
How will I cope once the babies arrive?
You will need help in the first few weeks, as you will be recovering from the birth on top of caring for two tiny humans. Whether you go home with your babies quickly, or they remain in hospital after you are released, you are going to be very busy and tired in the first few weeks.
Neonatal Intensive Care Unit (NICU)
If your babies are premature or have other problems, they will spend time in a neonatal intensive care unit. Your life in the first few weeks will consist of traveling back and forth between the hospital and home.
If your twins are not yet able to breastfeed, you will need to pump milk for them on a regular schedule. Many mothers choose to formula feed twins, due to the incredible workload of nursing two babies. Even if you do go the formula route, it is best to at least try to give your babies the colostrum produced by your breasts in the first few days, as it is full of additional nutrients and antibodies.
If your babies have been in hospital for any length of time, they are likely to have developed a routine of sleeping, waking and feeding. You will be familiar with this from their hospital stay, and may like to emulate it at home. This can make the translation easier. Establishing a routine early on will make your life easier in the long run. Your partner will need to help with night waking and feeding, at least for the first few weeks.
NOTE: Please be aware that the rate of postnatal depression is significantly higher after twin and multiple births. If you feel that you are not coping, there are medications and support groups out there. Don’t wait too long to ask for help!
How to Increase Your Chance of Having Twins
If you decide that a twin pregnancy would be an ideal way to start or expand your family, there are some methods you can use to increase the chance of that occurring. Before you rush headlong into trying for twins, though, keep in mind that a multiple birth carries a high risk of complications.
If you decide that you want to have twins, there are many old wives’ tales and elements of pure fiction in the information available about this topic. Some of the boosting methods are, however, based in fact.
While you can’t choose your genetic makeup, you need to be aware of how it can positively or negatively affect your chances of a twin conception.
The following genetic factors are associated with higher rates of twin births:
- Non-Caucasian ancestry. In particular, African American women have an increased chance of conceiving twins.
- A family history of non-identical twins.
- Being taller than average.
- Be a twin yourself, or have a father who is a twin. Your partner’s family history plays no role.
If you are genetically unlikely to conceive twins, there are some factors which are under your control which can increase the chances:
- Conceive when you are older. Just before a woman enters per-menopause (usually the mid to late thirties), her ovaries often start releasing more than one egg per cycle. If you are over 35, you have a higher chance of conceiving non-identical twins due to the double egg release.
- Undergo fertility treatment. Fertility drugs can stimulate the ovaries to produce more than one egg. However, you are not going to be given fertility drugs unless you have a proven problem conceiving naturally.
- Have already been pregnant or had children. With every conception, your chances of a twin pregnancy go up. This is true whether or not the baby is carried to term. This is why it is common for families to go from 3 to 5 children unintentionally!
- Fall pregnant on the Pill. Alright, so this isn’t really an option that you want to try, but if you are taking the Pill and unexpectedly fall pregnant, it is more likely that you will have twins.
- Try for a baby straight after you stop taking the Pill. As your body is adjusting to the change in hormones, a double release of eggs can occur.
- Already have a set of twins. If you’ve had one set, there is an increased likelihood of having more.
- Put on weight. Having a BMI of 30 or over is linked to twin pregnancies. However, this would mean that you would fall into the obese category, which raises a whole load of health concerns.
- Take folic acid. If you start taking it before you plan to conceive, you decrease your chances of serious fetal problems. Many twin pregnancies miscarry early, so this advice is more about maintaining a twin pregnancy than causing one.
- Ensure your partner gets enough zinc. Zinc increases sperm production. Healthier sperm means a greater chance of two sperm fertilizing an egg. If he wants to take supplements, 14mg per day is the recommendation.
- Eat sweet potatoes or yams. In areas where yams are an important part of the daily diet, the rate of twins increases. Yams contain a chemical that assists the functioning of the ovaries.
- Breastfeed for as long as possible. If you are still producing prolactin by breastfeeding, you have more chance of conceiving twins.
Old Wives’ Tales
Myths about twins and suggestions for conceiving twins abound. However, some have been disproved or have no supporting evidence. Some examples are:
- Twins skip a generation. This is not factual. Each family is different. Even in families with a massively increased chance of twin conception, there is no discernible pattern to twin births.
- Eat a diet of dairy and meat to increase your chances of conceiving twins. There is no indication that this protein overload aids in the conception of twins.
- Using alternative therapies. There is absolutely no evidence to support the use of naturopathy, aromatherapy, chiropractic, acupuncture or flower essences to increase fertility or increase your chance of having twins.
What can I expect as my twins grow up?
The joy of twins
Having two children at once can be a great blessing, as they are each born with a friend for life. Your children will never be lonely. One of the joys of twins is watching the incredible bond that develops between them. Some twins create their own words for things, giving them a language only the two of them can understand.
Celebrate their individuality
It may be tempting to dress your twins the same and treat them as a unit. Remember that even if they share the same genetic code (when identical) they are individuals, with their own hopes, desires and dislikes. Be sensitive to their unique nature.
American College of Obstetrics and Gynecologists. (2005). Your pregnancy and birth.
Regan, Lesley. (2005). Your Pregnancy Week by Week: What to expect from conception to birth.