Twins and multiple pregnancies

A woman is said to be carrying a multiple pregnancy if she is expecting two or more babies. This is something you might expect if you have undergone fertility treatment, but if you become pregnant naturally it can come as a big surprise, be it a delight or total shock.

How common are multiple pregnancies?

Multiple pregnancies account for one in every 80 pregnancies conceived naturally. With fertility treatment, the incidence of multiple pregnancies increases to one in every four pregnancies resulting from treatment.

How will I find out if I am carrying a multiple pregnancy?

This is usually diagnosed when you attend for your dating scan between 10 and 14 weeks. The scan will also help to determine the type of multiple pregnancy you are carrying, as this information is very important for the management of your pregnancy.

What are the types of multiple pregnancies?

Twin pregnancies are the most common type of multiple pregnancies accounting for about 1% of all births. Higher order multiple pregnancies, which include triplets or more, are rare. Triplets occur in one in every eight thousand.
What are the problems associated with multiple pregnancies?

  • Minor problems such as morning sickness, heartburn, ankle swelling, varicose veins, backache and tiredness can be increased
  • Anaemia (low iron)
  • Pre-eclampsia (high blood pressure with protein in urine)
  • Gestational diabetes (pregnancy related diabetes)
  • Ante-partum and post-partum haemorrhage (bleeding during pregnancy and after delivery)
  • Fetal growth restriction (one or more babies being small)
  • Preterm labour (before 37 weeks) and delivery – 60 in 100 twin pregnancies deliver before 37 weeks, and 75 in 100 triplet pregnancies deliver before 35 weeks
  • Problems with babies being born prematurely (e.g. breathing difficulties).

How will my pregnancy be managed?

A multiple pregnancy can have more complications than a singleton (single baby) one. Therefore, your pregnancy will be monitored closely to ensure that any complications are detected and treated as early as possible.

Most of your antenatal care will be in the hospital with your obstetrician, and in between these visits, your community midwife and GP will also be involved.

As additional care is needed during labour and delivery with multiple pregnancies, you will be advised to have your babies delivered in the hospital, where there will be ready access to people (midwives, obstetricians, anaesthetists and paediatricians) and resources (including the special care baby unit and theatre), should they be needed.

Antenatal care

At your antenatal visits, routine checks to determine your babies’ and your general wellbeing will be carried out. These include taking your blood pressure, testing your urine for protein, blood tests to check for anaemia and scans to check your babies’ growth.

Due to extra demand for iron and vitamins, which can lead to anaemia, you will be offered iron and folate tablets throughout your pregnancy. It is important you take adequate rest and remember to do your pelvic floor exercises.

Labour and delivery

Your doctor (obstetrician) will discuss with you the best method and appropriate time of delivering your babies. If it is felt that you may be going into premature labour or we are planning to deliver your babies early (before 37 weeks), you may be offered steroid injections to help mature your babies’ lungs. The injection helps to reduce the risk of breathing difficulties for your babies after birth.

When will my babies be delivered?

Your obstetrician will decide with you the best time, depending on the type of multiple pregnancy and how your pregnancy is progressing.

How will my babies be delivered?

It may be possible to have vaginal delivery; however twins are more likely to require medical intervention (vacuum, forceps or Caesarean section). If you are expecting triplets, or more a Caesarean section will usually be advised.

If the first baby (twin 1) is coming head first, it is usual to recommend trying for a vaginal delivery. However, if twin 1 is breech (bottom first) at the time of delivery, then a Caesarean operation may be recommended as the safest option. Caesarean section may also be advised if there are other concerns about the babies, such as a significant size difference.

There is a small chance that a Caesarean section may be required for the delivery of your second baby (twin 2), even if your first baby (twin 1) is born vaginally. This may be due to twin 2 being in a position not suitable for vaginal delivery, or due to an abnormality in the heart tracing which would require urgent delivery.

Heart trace monitoring is advised for all multiple pregnancies to help midwives and medical staff manage your labour and delivery safely. Around two-thirds of women who plan for a vaginal delivery will achieve that, but a caesarean section delivery may become advisable.

What about pain relief in labour?

There are different types of pain relief available and these will be discussed with you.

Epidurals are often recommended for pain relief in labour and also in preparation for the birth of the second baby, who may need to be helped into a better position for delivery.

Post-natal care

Mothers of twins or triplets have extra needs after birth. The midwives will make an individualised plan with you to ensure your needs are met. Having one baby is tiring and having more than one, even more so.

Post-natal depression is more common with mothers with multiple births, so it is very important that you and your partner tell your midwife, GP or health visitor if you are feeling low.

Can I breastfeed my babies?

Although some mothers decide to bottle feed their twins, it is possible to breastfeed twins if you want to. Many mothers manage this very successfully. The midwives will give you advice and support. They may be able to arrange for you to meet another mother who has breastfed twins.