Having twins, triplets or even quadruplets can be exciting, but it may also bring worries and concerns for you, your partner and family members. If you are expecting more than one baby, it is important that you are well prepared for the changes that will take place both during your pregnancy and after the babies’ birth.
Here is everything you need to know to be prepared!
What is a multiple pregnancy?
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.
What are the different kinds of multiple pregnancy?
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:
- Dichorionic-Diamniotic (DCDA) – if two eggs are fertilized or if one egg splits soon after fertilization, each baby has its own placenta with its own outer membrane called a ‘chorion’ and its own amniotic sac
- Monochorionic Diamniotic (MCDA) – if the fertilized egg splits a little later, the babies share a placenta and chorion but they each have their own amniotic sac; these babies are always identical
- Monochorionic Monoamniotic (MCMA) – much less commonly, the fertilized egg splits later still and the babies share the placenta and chorion and are inside the same amniotic sac; these babies are always identical; this is rare and carries additional risks.
Similarly, triplets can be Tri-chorionic (each baby has a separate placenta and chorion), Di-chorionic (two of the three babies share a placenta and chorion and the third baby is separate), or Mono-chorionic (all three babies share a placenta and chorion).
What does a multiple pregnancy mean for my babies and me?
For you: 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:
- anemia – this is usually caused by a shortage of iron because developing babies use up a lot of iron
- pre-eclampsia – a condition that causes high blood pressure and protein in your urine
- a higher chance of bleeding more heavily than normal after the birth
- a higher chance of needing a caesarean section or assisted vaginal delivery to deliver your babies
For your babies: You are more likely to have premature babies 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.
Also, having twins increases the chance of the placenta not working as well as it should. This can affect the babies’ growth and wellbeing. 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. This is called 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.
How will my pregnancy be managed?
You will be under the care of a specialist healthcare team and will be advised to have your babies in a consultant-led maternity unit that has a neonatal unit. Your team will usually include an Obstetrician who specializes in multiple pregnancies, Fetal medicine expert, Nutritionist, Lactation consultant and an excellent Neonatal Team.
- 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. It could be as frequent as every 2 weeks from 16 weeks of pregnancy.
- You may be advised to take iron tablets and folic acid each day throughout your pregnancy. Also, if there are risk factors for pre-eclampsia, you may be advised to take low-dose aspirin from 12 weeks of pregnancy onwards to reduce the risk.
- Ultrasound / clinical assessments of the cervix may be done at regular intervals for measuring the length since a short cervical length is found to be associated with a higher chance of premature delivery. In case of a short cervix length, a cervical cerclage is done to suture the cervical opening.
How will I deliver my babies?
Delivery depends on many factors including fetal positions, gestational age, the health of the mother and babies. If both the babies are in a head down positions and there are no other complications a vaginal delivery is possible.
Caesarean delivery is for babies that are in abnormal positions, who are discordant in growth, or in higher order multiples, like triplets and more. In latter case, the babies are usually delivered by cesarean section unless you are in very premature labor or you give birth to the first baby very quickly.
Vaginal delivery may take place in the operating room because of a greater risk of complications which may require a Caesarean Section.
Your own preference is also important and you should be given enough time to consider all of the relevant information before deciding what suits you best.
Will I be able to sufficiently breastfeed my babies?
Breast milk is best for new-born babies and your body should produce enough milk for your babies. If you encounter difficulties, our lactation expert will offer you the advice and support you need.
How will I cope with two babies at once?
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.
What is the Multi-Fetal Pregnancy Reduction?
In recent years, a procedure called multi-fetal pregnancy reduction has been used for very high numbers of fetuses, especially four or more. This procedure involves injecting one or more fetuses with medications, causing fetal death. The objective of multi-fetal reduction is that by reducing the number of fetuses in the pregnancy, the remaining fetuses may have a better chance for health and survival.