I’m pregnant…and it’s twins!

Finding out you are pregnant is an exciting time but finding out you are having TWO (or more!) babies is even more exciting. However, while it is double the joy, it may also bring double the worry as your brain goes into overdrive about the pregnancy risks and practicalities of juggling two newborns. 

Multiple births are becoming more common in the UK as more couples are using fertility drugs or IVF to get pregnant. The likelihood also increases as a woman gets older, if she is a twin herself or has a history of twins on the maternal side of her family.

There are three types of twin pregnancy:

a)    Dichorionic-diamniotic (DCDA) - twins who have their own placentas and amniotic sacs. These twins will be non-identical because they are formed from two eggs which have been fertilised by two separate sperm. They are known as fraternal twins and will be no more alike than any other siblings.

b)   Monochorionic diamniotic (MCDA) - twins who share a single placenta but have different sacs. Known as monozygotic twins, this occurs when a single egg splits into two (or very rarely, three) creating two identical babies with the same genes, features and sex.

c)    Monochorionic monoamniotic (MCMA) - these are the rarest type and occur in 1 in 10,000 pregnancies. The twins will share a placenta and amniotic sac. This is the riskiest type of twin pregnancy because there is a danger the twins could get their cords tangled around their necks.

Pregnancy symptoms:

Twin mums-to-be will experience many of the same symptoms as mums carrying singletons.

Some research has found that women carrying multiples may be more likely to experience morning sickness or nausea.

The main issue in twin pregnancy is that the woman will be carrying more weight. The babies may be smaller than in a single pregnancy but the added weight of an extra placenta (if the babies are DCDA) plus amniotic fluid can make things very uncomfortable. The pressure may increase the risk of pelvic girdle pain or SPD and backache. You may also be at a higher risk of your feet swelling, piles and varicose veins.

Indigestion and heartburn may also be an issue because of the pressure from the womb onto your stomach.

One in four multiple mothers in a Twins Trust survey reported some vaginal bleeding or spotting in pregnancy. Tell your doctor straight away if you are experiencing bleeding.

There is a greater risk of anaemia, gestational diabetes and pre-eclampsia for mothers carrying twins. You will be given extra blood tests to check for anaemia and iron supplements if you need them. Your blood pressure and urine will be checked for signs of pre-eclampsia which can be a dangerous condition if it is not monitored closely.

As with singleton pregnancies it is recommended that you take regular exercise and try to stay healthy with a balanced diet.

Antenatal checks:

Many women will not find out they are having twins until they go to their first scan at 12 weeks. It will come as a shock to most couples but you will be in safe hands, most hospitals have specialist midwives and consultants who deal with twin pregnancies every day.

If your pregnancy is DCDA you will be given a scan every 4 weeks to check on the growth of both babies and their position in the womb.

If you are carrying MCMA twins you will have more frequent scans to check for any cord entanglement.

Premature delivery may be recommended if one or more of your babies is small.

Twin-to-twin transfusion syndrome (TTTS):

This is a rare but life-threatening condition which affects 10-15% of identical twins which share a placenta (MCDA twins).

In TTTS a blood transfusion occurs from one twin (the donor) to the other (the recipient). The donor twin will become smaller and suffer from anaemia while the recipient twin is put under strain. The donor twin may have less amniotic fluid but the recipient has lots and this can cause the mother’s belly to become larger than expected.

If TTTS is diagnosed you will need extra scans to check on the babies’ growth. If necessary, you may be offered laser ablation therapy to separate the blood vessels in the placenta.

If you are carrying MCDA twins you can expect more scans and monitoring to check for TTTS.

Birth choices:

Most multiple pregnancies are healthy with healthy babies born at the end of them. However, twins have a higher likelihood of being born prematurely (before 37 weeks) and having a low birth weight. According to the NHS, around 6 in 10 twins are born before 37 weeks and almost 8 in 10 triplets before 35 weeks.

It might be a good idea to have your hospital bag packed early on, just in case.

It is likely that you will be offered a planned birth, depending on what type of twin pregnancy you have. This will be at 37 weeks for twins with a placenta each and 36 weeks for identical twins sharing a placenta. It is possible to turn down an offer of a planned birth, in which case you will be offered weekly appointments and scans to check on the babies. The longer the pregnancy goes on the higher the risk of placental abruption which is why many obstetricians recommend a planned birth.

A planned birth will either be an induction for a natural labour or a planned c-section. Over half of all twin babies in the UK arrive by caesarean section and almost all triplets

The type of birth may depend on the position of Twin 1. If this baby is head down you may be able to have a natural delivery. However, if Twin 1 is breech (feet or bottom down) or transverse (across your uterus) you may be told by a consultant that a caesarean is the safest way of delivering the babies.

If you are having a natural delivery it may be that Twin 1 arrives in a straightforward way but that Twin 2 needs some assistance with forceps or ventouse. In some cases the baby may have to be turned manually, either externally or internally, or if that doesn’t work, it will be born feet first. It is usually less than 20 minutes between the birth of Twin 1 and Twin 2.

Every NHS trust will be different but many will not encourage couples to choose a home birth for their twins. There is a higher likelihood of intervention being needed and if the babies are premature they may need to spend some time in the NICU (neo-natal intensive care unit) or SCBU (special care baby unit).

It is possible to ask for a tour of the NICE and SCBU before you have your babies so you know what to expect from the units if your babies need to spend time there. Birth can be an overwhelming time and it might be nice to be prepared, just in case.

There is a lot of support for couples who are expecting multiples.

The Twins Trust is a charity which supports parents of twins and multiples https://twinstrust.org/ in the lead up to the birth and in the days, months and years after.

Kat, from the Happy Parents.Happy Baby digital team gave birth to twins in January 2019 and shares her experience:

I had my first son in August 2019 and the pregnancy and birth were uncomplicated and straightforward. I had a natural delivery in hospital with gas and air and my recovery was quick. When I fell pregnant a second time in June 2018 I immediately felt a lot worse than I had first time around but I put it down to being exhausted from work and chasing a toddler. I thought nothing of it thought and we attended the 12 week scan at St George’s Hospital looking forward to checking there really was a baby in there.

I talk a lot when I am nervous so I was jabbering away while the sonographer was scanning my stomach and it was only when she asked “Is there a history of twins in your family?” that I stopped. She then said: “Because there are two babies there.”

I burst into tears immediately. It was not what I expected at all and my head started going at a hundred miles an hour, thinking about our son who was not yet even two, our small house, my body, our finances… Luckily, my husband is totally chilled and the only thing he said was “We’re going to need a bigger car.” I didn’t really see the funny side at that point.

Discovering I was carrying two babies immediately meant my antenatal care would look very different to what I had imagined for my second pregnancy. I was told I would be having more midwife checks and scans every 4 weeks. Our babies were fraternal twins - this means two placentas and two amniotic sacs. We were told this was the safest type of twin pregnancy which was a relief.

We found out at our 20 week scan that we were having two boys but we were just delighted that the babies were healthy and growing at the same rate. This scan took a lot longer than usual as both babies needed to have all of their organs checked and measurements taken.

The rest of the pregnancy passed by very fast. I spent a lot of time at the hospital where there was a dedicated team for twin pregnancies who were able to talk me through the birth options and answer any of my worries. One of my main concerns was worrying about the babies coming early. I had spoken to other twin parents whose babies were born at 29 weeks and although they are now fine, it did worry me, especially as we had an older child to look after too. They tell twin mums to pack a hospital bag at 26 weeks.

With twin pregnancies obstetric teams like to make a birth plan and consultants are reluctant to let you go past 37 weeks. They told me that if Twin 1 was not head down by 32/33 weeks it was unlikely he would be in time for a natural 37-week labour. I had been really keen for a vaginal birth but the babies remained breech and transverse for most of the second half of the pregnancy. This was not only extremely uncomfortable but also meant that my only option was a planned caesarean section. I was initially very nervous about this. I had never had any type of surgery before, no general anaesthetic or anything. However, I was reassured by the twin team and other friends who had had c-sections that it would be fine and the majority of twin births are caesareans.

Delivery day was planned for 37+2 weeks, a Monday. I went to the hospital on the Friday for my pre-op checks and to be given my pre-op medication. I had all of the usual checks I had become used to - urine, blood pressure and bloods. My blood pressure was a little high so they did it a few more times and then told me to come back the next morning to have it done again. However, before I arrived on the Saturday morning I received a phone call telling me my “blood results were wild” and that I should come in straight away, with my hospital bag. When I arrived I was told that my kidney and liver results were very high and it looked like I had both pre-eclampsia and obstetric cholestasis. I had no idea, although it all made sense. I’d called the hospital the previous week because I had blurred vision - a key symptom of pre-eclampsia. I was told not to worry but to go in if I felt concerned. I didn’t.

From then on it all happened very fast and I was told I wasn’t going home and that the babies would be delivered that day. I met the surgeon who would deliver them, who told me that the pre-eclampsia symptoms would ease as soon as the babies were born and that it was safest to get them out as soon as possible. I was nil by mouth, given a steroid injection in my bum and then monitored for a few hours.

My husband arrived and the boys were born one minute apart at just after 7pm. The caesarean was a much better experience than I imagined. The worst part was the spinal but the anaesthetists were amazing and by my side throughout. There was a positive, happy vibe in the theatre and both babies came out crying which was the best sound. They weighed 4lb 8 and 5lb 2 and I was able to hold them straight away. Two babies on your chest at once while you’re lying on a operating table is quite challenging! Luckily they didn’t need any special care so we all went to recovery together.

We had great care that night with a midwife visiting every half an hour or so, helping me to feed the babies. I had to have my blood taken every six hours and blood pressure done regularly too as I was still quite unwell. We were then given a private room on the postnatal ward which was great as it meant we had some privacy and extra space. We stayed for three more nights as my blood pressure was still raised but finally went home on the Tuesday and then our twin adventure began for real!