Pregnancy

Twins and More

The Ivy Restaurant in Manchester

A multiple pregnancy....

A huge Congratulations, you’re having a multiple pregnancy! It may all seem a little daunting - you're probably panicking at the thought of looking after 2 or even 3 babies, especially if it's your first pregnancy or if you have other small children. Don't worry - we're here to help you along the way.

As multiple pregnancies are classed as higher risk, information is key and there’s likely to be a few differences to your antenatal care that doesn’t affect single pregnancies.

  • ‍Multiple pregnancy needs careful monitoring, particularly if the babies are sharing a placenta
  • A scan between 11 and 13 weeks will indicate what type of twins or triplets you’re having
  • Vanishing twin syndrome may be detected at the 11-13-week scan. This is where one (or more) embryos failed to thrive and has been reabsorbed back into the womb. This has no effect on the remaining baby, but it’s bound to be an upsetting discovery if two foetuses or more had initially been seen on an earlier scan
  • A nuchal translucency test for Down’s Syndrome will also be offered at the 11-13-week scan
  • Depending on the types of twins or triplets you’re carrying, scans are offered every 4 weeks or more often depending on specialist treatment for possible complications. Identical twins that share a placenta will have scans and consultant appointments every 2 weeks from 16 weeks.

The 11-13-week scan is essential in multiple pregnancies, as this will not only confirm that you’re still carrying more than one baby, it also gives your antenatal care team a chance to find out if your babies are sharing a sac and a placenta, or if they’re developing in their own separate sacs with their own personal placenta! As if your body wasn’t working hard enough

Set of twins sleeping with arms under their chin's
‍My gorgeous little men Niall and Luke. Image credit: Nurtured With Love photography

Types of twins

here are three types of twins, and this also applies to triplets, although it all gets a bit complicated and your health care provider will explain the complexities of triplets in greater detail. Only 0.03% of multiple births in the UK are triplets, Quads are even rarer!

  • ‍Dichorionic Diamniotic (DCDA) twins – each baby has their own separate placenta with its own separate inner and outer membrane  
  • Monochorionic Diamniotic (MCDA) twins – the babies share a single placenta with a single outer membrane and two inner membranes
  • Monochorionic Monoamniotic (MCMA) twins – the babies share the inner and outer membranes

All non-identical twins are DCDA, and one-third of identical twins are DCDA. The other two-thirds of identical twins are MCDA, and just 1% of identical twins are MCMA.

Scans and timing of delivery

Extra care for multiple pregnancies is essential, and certain circumstances make it even more so. DCDA twins will be scanned every four weeks after 20 weeks, mainly for growth and development reasons. Twins or triplets with their own sac and placenta are normally delivered at around 37 weeks.

However, MCDA and MCMA twins will be scanned every two weeks from 16 weeks. Closer monitoring is required here as these types of twins or triplets have a higher risk of Twin-Twin Infusion Syndrome (TTTS), or umbilical cord entanglement as they’re sharing a placenta and sac.

TTTS affects identical twins sharing a placenta. This abnormality of the placenta happens when abnormal connecting blood vessels in the placenta result in one twin having a higher volume of blood than the other. This can result in serious complications for your babies, and careful monitoring and medication will be standard procedure to ensure a healthy pregnancy.

Specialist care will be offered for both MCDA and MCMA pregnancies, and babies are usually delivered between 32-36 weeks of being pregnant. These babies may spend some time in Neonatal Intensive Care to give them the very best start in life.

Pregnant women in organge clothes with hands over bump in heart sign

‍Risks and Complications in Multiple Births

No one really wants to think about complications occurring during their pregnancy, and with medical advancement as it is, many issues can happily be solved through a change in lifestyle, rest, and medication where necessary. As with all pregnancies though, health problems can arise, and when they do it’s essential you see your doctor or midwife as soon as possible.

  • Anaemia, pre-eclampsia, and gestational diabetes can be complications of any pregnancy, but you’re at higher risk of these if you’re expecting more than one baby
  • Premature birth is also a risk with multiple pregnancy, and low birth weight and breathing problems can be a complication of this
  • Working with your specialist antenatal care team will help them help you deliver happy, healthy babies
  • TTTS - For more info on Twin to Twin Transfusion Syndrome read this leaflet TAMBA have made

Other Things to Consider…

Keeping the birth plan for your multiple pregnancy as flexible as possible will cut down on disappointment if it turns out you need some assistance in delivering your babies, allowing for a few different eventualities, including suction cup and forceps delivery, or caesarean section. A hospital birth with epidural is usually recommended by your doctor and midwife, as multiple births are seen as higher risk and an emergency situation may arise.

More than half of multiple pregnancies in the UK are delivered by caesarean section. This may be elective due to possible complications (breech presentation, for example), or emergency caesarean during labour when either babies or mum are at risk and delivery has to happen quickly.

Pregnancy of any kind is both an exciting and a worrying time, but with the added risks on your mind that come with carrying more than one baby, you might find yourself feeling more than a little overwhelmed. Joining a multiple birth antenatal group may help – giving you the chance to share your concerns with other parents expecting twins or triplets.

Your hospital bag

Twins and triplets are at higher risk of delivering early, so packing your hospital bag at around 30 weeks is usually a good idea!

For you:

  • ‍Comfortable, loose clothes for during labour and a spare set for after the birth
  • Snacks, drinks, and water for yourself and your birthing partner
  • Towels and toiletries
  • Underwear and nursing bra
  • Night wear and dressing gown
  • Slippers
  • Maternity pads for after labour
  • Phone charger!
  • Comfortable outfit to go home in
Mobile knitted sheep

For baby

  • 12-15 nappies
  • Nappy bags
  • Baby wipes
  • 2-3 body suits
  • 2-3 vests
  • Scratch mittens
  • Hat
  • Socks
  • Blanket and going home outfit!

Carrying twins or triplets (or more!) is a trying time, and comes with its own separate set of worries – but it also comes with multiple magical moments when you finally hold your babies and marvel at the amazing job your body did of growing two or three tiny humans inside it! Here’s some signs of early labour to look out for:

  • ‍Lower back pain
  • Period-like pains or mild contractions
  • Tightening across your bump
  • Feeling of pressure low in the pelvic region
  • Losing mucus plug
  • Waters breaking
  • Sudden burst of energy or ‘nesting instinct’ (cleaning your house like a mad woman!)

When to head to hospital

  • ‍If you’re worried at all (ALWAYS better safe than sorry)
  •  If your waters break
  • If your contractions are strong and around 10 minutes apart

TAMBA

Twins and Multiple Births Association also offers an excellent site full of advice and anecdotes for when there’s more than one set of tiny feet stomping around on your internal organs!

Carrying twins or triplets (or more!) is a trying time, and comes with its own separate set of worries – but it also comes with multiple magical moments when you finally hold your babies and marvel at the amazing job your body did of growing two or three tiny humans inside it!