Twins Pregnancy Planning

What It’s Like to Be Pregnant with Twins

Twins are by far the most common mulitples pregnancies. Around 90% of all multiples pregnancies will be made up of twins, with the remaining 10% being triplets, quadruplets, quintuplets and so on. Even if twins don’t run in your family, you could still have them! It’s estimated that as many as 5% of all pregnancies involve a twin at 12 weeks of gestation, but unfortunately, not all of these progress to term.

It’s important to remember that every pregnancy is unique. Even when a woman has had a twin pregnancy before, the next one may be very different. Something they will all share is a sense of anticipation and perhaps some worry for themselves and their twins.

Common twin pregnancy symptoms

Here are a few of the most common twin pregnancy symptoms:

Earlier pregnancy symptoms. This is due to the high levels of human chorionic gonadotrophin (hCG) hormone, which is responsible for many early pregnancy symptoms such as nausea and vomiting.
Running to the toilet to urinate more often. This is because of the weight of the uterus sitting on top of the bladder. Until it lifts higher into the pelvis, the full uterus doesn’t leave much room for urine volume to collect before the bladder needs to be emptied.
Lots of fetal movements, including early “quickening” and fluttering; perhaps even earlier than 15 weeks.
Showing earlier than normal. Mothers who are pregnant with twins tend to look pregnant earlier than those who are carrying one baby.
Later in the pregnancy, the mother can experience respiratory symptoms, such as not breathing as easily. This is because the twins have grown so much that they start to occupy the space in which her lungs would normally expand.
Varicose veins, hemorrhoids, aching legs, fluid retention and difficulty walking.

How different is a twin pregnancy?

A twin pregnancy can be very different to a pregnancy involving only one baby. Every pregnancy symptom can be exacerbated. The likelihood of complications increases as well. But just because you’re carrying two babies does not mean you will automatically have problems. Many mothers of twins have a fabulous pregnancy and say they really enjoy it. Having twins does mean that you, your pregnancy, and the growth of your babies will be carefully monitored by your health care professionals. Until you have an ultrasound, you may not know if you are pregnant with monozygotic (identical) twins or dizygotic (non-identical) twins, though this should not really make a difference to your pregnancy symptoms. It may influence the risks of twin pregnancy complications. One factor that increases the odds of conceiving twins is advanced maternal age. For older mothers who have other children, the experience of a twin pregnancy may be very different than that of a mother who is younger and pregnant for the first time. Tiredness and fatigue can be all-encompassing during any pregnancy, but this is especially the case when a mother is carrying two babies.

Complications of twin pregnancy

The risks to pregnant mothers and their babies are lot higher with twin rather than singleton pregnancies. These risks tend to increase with every week of gestation as the babies grow bigger and the mother’s body adjusts to the demands of a twin pregnancy. A few complications include:

Miscarriage of one or both twins.
Premature birth. This is much more common during twin pregnancy. It is estimated that less than 50% of all twin pregnancies extend beyond 38 weeks.
Abnormalities in the twins, though this is more common in monozygotic (identical) twins than dizygotic (non-identical) twins.
Conjoined twins, though parents are usually advised of this diagnosis during pregnancy ultrasound.
Small for gestational age or intra-uterine growth restriction. Twins are generally much smaller and lighter in birth weight than singleton babies of the same gestational age.
Increased risk of needing to have a Caesarian section delivery or an assisted delivery, including the use of forceps or vacuum extraction. Mothers who have a vaginal delivery with twins generally need to have an epidural and an episiotomy. This is because the birth needs to be controlled by the doctor and midwife so that complications are minimized. Vaginal birth is only considered if the first twin is cephalic (head down) and the second twin is not significantly bigger or heavier than the first twin.
Twin-to-twin transfusion syndrome (TTTS). This is when one twin becomes bigger than the other because there is an uneven sharing of blood flow between them. The likelihood is around 15% of monozygotic twins will have some degree of TTTS.
Death of one twin. This can occur at any stage of the pregnancy, but the period of highest gestational risk is within the first and third trimesters.
There is an increased risk of developing gestational diabetes, preeclampsia, pregnancy-induced hypertension, polyhydramnios (extra amniotic fluid) and iron deficiency anemia.
Umbilical cord prolapse and presentation, where the cord presents before the baby. Blood flow to one or both of the babies can be cut off.

Extra care during twin pregnancy

You will probably find that you have more ultrasounds and checkups during your twin pregnancy than if you were carrying one baby. The fetal screening scan at 18 weeks will be more thorough and time consuming, especially if the babies are not being cooperative by lying in the best positions. You may also need to have Doppler studies to examine the blood flow through each of the baby’s umbilical cords. The amniotic fluid volume will also need to be monitored as this is one way of ensuring the babies’ kidneys are working effectively. Twins generally grow at the same rate as singleton babies until they are between 32 and 35 weeks. After this stage of gestation, space becomes a real issue—there is simply not the room for them to grow at the same rate. By this stage, mothers who are pregnant with twins can start to become very uncomfortable and feel as if they can’t move as easily as they’d like to. Stretch marks are also common in the third trimester when the collagen fibers in the skin tear because they cannot stretch anymore. You may find you are confined to bed rest at home or admitted to hospital for monitoring. This is one way of being able to monitor blood pressure regularly to reduce the risk of premature birth. If you are a negative blood group, you may need to have prophylactic Anti-D during your second and third trimesters at around 28 and 34 weeks. Your obstetrician will advise you, as there is no one consistent approach which applies to all mothers. If you are at risk of going into premature labor, you are likely to have at least one dose of corticosteroids. These help to mature the babies’ lungs so they are less likely to need breathing support when they are born.

Mothers during twin pregnancy

Because of the increased obstetric risks during a twin pregnancy, it’s easy for mothers themselves to feel overlooked. The focus of obstetric staff may be so concentrated on the pregnancy and twins that you could feel that you as a person are going unnoticed. This is why it is so important for all pregnant mothers to advocate for themselves and have a say in their care. Speak up if you feel you’ve become a “walking uterus” for hatching your twins! A few tips:

Look after yourself. Simple tasks such as eating healthy foods, getting rest, good quality sleep, regular exercise and maintaining healthy relationships is really important during any pregnancy. It is especially important when carrying two babies.
You may benefit from seeing a dietician. It’s important to ensure you have enough folate, protein, iron and nutrients to support sound pregnancy health.
Make time to chill out. Your body is working 24 hours a day to grow and support two babies towards maturity. That means there will be times when you will feel tired even though you won’t consider you’ve done much.
Join the multiple birth association in your state. Go to some meetings before your twins are born and chat with the other parents. They can be an invaluable source of information and practical advice.
Speak with your health care provider about your birth options. Read and ask lots of questions. Fear and anxiety can only be helped by being as informed as you can be.
If you have older children, organize some regular, reliable and supportive care for them. Quarantining some time with your partner before the twins are born will help both of you to focus on strengthening your relationship.

The information of this article has been reviewed by nursing experts of the Association of Women’s Health, Obstetric, & Neonatal Nurses (AWHONN). The content should not substitute medical advice from your personal healthcare provider. Please consult your healthcare provider for recommendations/diagnosis or treatment. For more advice from AWHONN nurses, visit Healthy Mom&Baby at health4mom.org.