×
A. Multiple pregnancy is the term used when you are expecting two or more babies at the same time. It occurs in about one in 80 pregnancies. Fertility treatment increases the chances of multiple pregnancy.
A. At your early ultrasound scan which confirms whether you are carrying twins or triplets, it is important to find out the ‘chorionicity’ of your pregnancy. This is to help identify whether your babies share a placenta and it is important because babies who share a placenta have a higher risk of complications.
Twins can be:
Similarly, triplets can be tri-chorionic (each baby has a separate placenta and chorion), dichorionic (two of the three babies share a placenta and chorion and the third baby is separate), or monochorionic (all three babies share a placenta and chorion).
If your babies share a placenta, they are identical or ‘monozygotic’.
Most babies who do not share a placenta are non-identical or ‘dizygotic’. However, it is possible for babies not sharing a placenta to be identical as well. This is because nearly a third of monozygotic or identical twins will each have their own placenta and hence will have the same appearance on ultrasound scans as the DCDA (non-identical or dizygotic) twins.
A. Most women who have a multiple pregnancy have healthy pregnancies and healthy babies. However, complications are more common in multiple pregnancy and having extra care during your pregnancy including more ultrasound scans reduces these risks to you and your babies.
Mother: Minor problems that many pregnant women experience, such as morning sickness, heartburn, swollen ankles, varicose veins, backache and tiredness, are more common in multiple pregnancies. They get better naturally after the babies are born.
Any problems that arise in any pregnancy are more common with twins and include:
Babies:
Prematurity: You are more likely to have your babies early if you are expecting twins or triplets:
Babies born earlier than 37 weeks of pregnancy have an increased risk of problems, particularly with breathing, feeding and infection.
The earlier your babies are born, the more likely this is to be the case.
They may need to be looked after in a neonatal unit.
You will be supported to spend as much time as you can with them and you will be encouraged to breastfeed.
Problems with growth: Having twins increases the chance of the placenta not working as well as it should. This can affect the babies’ growth and wellbeing.
Twin-to-twin transfusion syndrome (TTTS): Twins sharing a placenta (monochorionic pregnancies) also share the blood supply.
In around 15 in 100 monochorionic twin pregnancies, the blood flow may be unbalanced. We call this twin-to-twin transfusion syndrome (TTTS).
One baby, the ‘donor’, receives too little blood and has a low blood pressure while the other baby, the ‘recipient’, receives too much blood and has a high blood pressure. You will be monitored with frequent scans for signs of TTTS.
It can be mild and may not require any treatment, or it can be serious, in which case you will be offered treatment in a hospital with specialist expertise.
A. Having a multiple pregnancy means that you will need more visits to the antenatal clinic at your hospital. You will be offered extra ultrasound scans to monitor your babies’ growth more closely.
A. Like all women, you will be offered a scan at about 12–14 weeks to screen for chromosomal conditions such as Down syndrome. Even in multiple pregnancies, blood tests taken at the same time can be combined with the scan results to assess the risk of one or both of your babies having a chromosome problem.
You will also be offered another scan at around 20 weeks to look at your babies’ development. The chance of these tests finding a problem is slightly higher than if you were pregnant with only one baby.
A. You will be advised to give birth in a hospital with advanced labour monitoring equipments as well as functioning neonatal unit.
A. You may go into labour early with multiple pregnancy. Even if you don’t, you will probably be advised to have your babies before your due date (elective birth). This is done either by having labour started off (induced) or by having a caesarean section.
The exact timing of delivery for multiple pregnancy depends on individual circumstances; however, if your pregnancy has been uncomplicated, it is advised that you should be offered elective birth from:
If you have any concerns about having your babies born at these recommended times, you should talk to your obstetrician, as continuing the pregnancy beyond these dates increases the risk of harm to your babies.
A. You will be able to discuss your birth plan with your obstetrician. Your decision whether to have a vaginal birth or a caesarean section will depend on several factors including the position of the placenta(s), how the babies are growing and whether you have had a previous caesarean section.
Twins
The position of your second twin can change after the first baby is born and should not influence how you choose to give birth.
Both vaginal birth and caesarean section have benefits and risks, and it is important to consider the options carefully and to talk about your individual situation with your healthcare professionals.
If you have decided to have a caesarean section but go into labour naturally, you should go straight to hospital. The operation will be done as soon as possible. However, occasionally labour may be too advanced and it may be safer for you and your babies if they are born vaginally. If you go into labour very early in the pregnancy, you may be advised that it would be better for your twins to be born vaginally.
Triplets, quadruplets and monoamniotic twins
Your own preference is important and you should be given enough time to consider all of the relevant information before deciding what suits you best.
A. Monitoring your babies’ heartbeats during labour is recommended as it shows how well they are coping; however, it may make it less easy for you to move around.
You may wish to have an epidural for pain relief. This can be helpful if any complications arise and your babies need to be delivered by caesarean section, forceps or suction cup (vacuum/ventouse). It is not essential and the alternatives should be discussed with you.
After your first baby is born, the cord will be clamped and cut in the usual way but the placenta will stay inside the womb until your second baby has been born.
Your obstetrician will check whether your second baby is coming head-first or bottom-first by feeling your tummy, doing an internal examination and by carrying out an ultrasound scan. As your second baby comes down the birth canal, the second bag of waters may be broken. A normal birth usually follows within about 30 minutes to an hour.
Although it is uncommon for the first twin to be born vaginally and the second to be born by caesarean section, it can occur if the second baby needs to be delivered urgently and/or a vaginal birth would be unsafe. This can happen in anywhere between two and ten in 100 vaginal twin births.
A. Breast milk is best for new-born babies and your body should produce enough milk for your babies. If you encounter difficulties, you will be offered the advice and support you need.
A. Twins often come early and you will have a bigger bump than if you were having just one baby. You might consider stopping work early, possibly at around 28 weeks.
When the babies are born, it will be a very busy time for any household but it is made much easier if you are supported and accept help when it is offered. Establishing a routine as early as possible will help.
A.
You are more likely to have your babies early if you have