Need-to-Know: Twin Pregnancy

How soon can a doctor tell if you are having twins?
Planned or Unintended Pregnancy
Stages of Twin Pregnancies & Life Hacks
What is a high-risk pregnancy?
Reactions to a Twin Pregnancy Announcement
When will my twins arrive?
Preparing for a Twin Delivery — Vaginal Birth or C-Section?
Postnatal Recovery and Breastfeeding Twins
Raising Twins — Organising Helpers
Raising Twins as a Single Mum
Support for Parents of Multiples: Financial Aid and Practical Help
Conflicted about a Twin Pregnancy

Twin pregnancies are usually detected during one of the first ultrasound examinations. When you are six weeks along, doctors can generally tell whether there is more than one amniotic sac. Sometimes this can be discerned as early as the 4th week of pregnancy. Moreover, between the 8th and 12th week, it is possible to see whether the twins are identical (monozygotic) or fraternal (dizygotic). About two-thirds of twins are fraternal.
In rare cases, their positioning in the womb allows twins to go undetected until much later. 

🌱 Wondering how twins happen? Find out by going to How Do You Get Pregnant?

ℹ️ An unusually high hCG level in the mother’s blood during early pregnancy may indicate the presence of multiples. However, this is not a definitive sign. A sure method of confirming multiple pregnancies is via ultrasound.

Seeing two amniotic sacs on the ultrasound does not necessarily mean that you will give birth to twins. Sometimes, one of the sacs vanishes. Vanishing Twin Syndrome is a type of miscarriage in multiple pregnancies where two or more sacs or embryos are visible on an ultrasound, but a later ultrasound shows one embryo less. The tissue of the missing embryo is absorbed by the surviving embryo and the mother. Vanishing Twin Syndrome is seen in 36% of twin pregnancies and 50% of pregnancies involving more than two gestational sacs, and can happen anytime within the first trimester.

If you had been trying for a baby, you were probably excited to find out you were expecting. You may already have one or more children and had hoped for one more.
Understandably, you may not initially be thrilled with this unexpected turn of events.
The question would undoubtedly arise, 'How will I cope with two babies?'

If this is your first pregnancy, everything is exciting and new. Mentally preparing for this 'double pack' can be overwhelming.

🙌 You are not alone! Our goal is to provide you with the most crucial information, allowing you to discover creative solutions necessary to thrive. 

An unplanned pregnancy can be confounding. Your carefully laid plans seem to be in disarray. Maybe it resulted from casual sex, or you are in a new relationship.

The news of twins may feel like the last straw. You may be thinking: 'I might have been able to manage one baby, but two?!' Or 'What if I become a single mum?'

🙌 You're not alone! We strive to provide you with information and counsel, allowing you to assess your thoughts and emotions and discern a way forward.

Twin pregnancies are automatically classified as high-risk. This may sound concerning, but a high-risk status provides you with closer monitoring. More frequent check-ups will allow you to keep closer tabs on the babies’ growth and health.

👍 Twin pregnancy risk assessments are taken as a precautionary measure and to provide timely interventions when necessary.

What risks am I being monitored for?

• Miscarriage is more common when expecting multiples. Especially in the early weeks of pregnancy, one twin may stop developing and 'quietly vanish.' Vanishing Twin Syndrome often goes unnoticed. Later in pregnancy, intrauterine foetal demise (IUFD) is also possible with very few or no tangible symptoms. The second twin is usually normal and healthy.

• In general, identical twin pregnancies are associated with more possible complications centred around whether the placenta (and amniotic sac) are shared.
• Twins are more likely to be premature. This is because two babies run out of room faster than a singleton, creating greater pressure on the cervix.
• The added weight can lead to cervical insufficiency, which is why physical exertion and intensive sports should be avoided.

Your doctor will closely monitor the twins’ development and assess for unequal weight gain at regular check-ups.

Twins are usually born slightly before their due date (around the 37th week) and have a low birth weight. Usually, twins also differ slightly in weight.

💕While mindfulness is essential in recognising your physical needs and symptoms, try to strike a healthy balance between being concerned and relaxed. Talk to your doctor or midwife about any medical concerns that might come up.

The reactions of others can be intimidating. Perhaps you have been met with pity rather than joy so far. No one is calling it a 'double blessing.'

Others may have a hard time putting themselves in your shoes. But your friends’ and family’s reactions may also stem from loving concern because they are aware of the challenges — especially early on.

In time, mothers of multiples usually receive all the more recognition and admiration. They are typically given the support and respect they are due.

However, if you are not met with support right now, know that you can prove them wrong.

🧡 Tips:

• Decide to what extent you want to engage with unsupportive reactions or predictions. Sometimes you might fare better by ignoring them.
• You may find it more beneficial to focus on the unique aspects of having twins: when they get a bit older, they can be playmates, entertaining themselves rather than depending as much on you.
• Organisations provide support specifically to mothers of twins. Check the web for specifics. Skip to some resources listed below.

Twins are often born earlier than singletons.
On average, twins are delivered in week 37 or 38, weighing approx. 2.5kg.
Full-term deliveries at 40 weeks are also possible.

An earlier birth is more likely if the twins share a placenta (monochorionic) and even more so if they share the same sac (monochorionic-monoamniotic). Then, twins may be born as early as weeks 32 to 36.

🙌 You will be medically monitored according to the kind of twins you are expecting. Your doctor will prepare you for each step.

Having twins does not automatically mean having preemies. Twins are considered full-term at 38 weeks. If born earlier, they are likely to spend some time in an incubator — the duration depends on their week of gestation and birth weight.

👍 Our tip: be ready by packing your hospital bag around week 30.

1. Take part in a prematurity prevention program/pre-term birth prevention clinic. Ask your doctor or search the web to find out where this is offered in your area.
2. Twins are usually delivered in hospitals to ensure that you and your babies are well taken care of. Find out whether a hospital near you specialises in multiple births and has a NICU in case your babies are pre-term or have special health needs. Even if your hospital is not specialised in twin deliveries, any maternity ward is usually well-equipped to meet your needs.
3. Sign up for a childbirth class for twins. This will help you to be better equipped during pregnancy, birth and beyond. Search the web for courses near you. Two organisations that frequently offer classes are Twiniversity and The Bump.
4. Writing a birth plan will help things go as you envision. This may include whom you would like to invite into the delivery room, whether you would like to be offered pain control, and whether you desire to breastfeed.
5. Consider hiring a doula. Professional birth support can set you up for success during the birth process and beyond.

Vaginal births of twins are possible and common. Nevertheless, C-sections are more frequent in twin pregnancies than with singletons. A caesarean may become medically necessary, for example, if the presenting baby is in a breech position or if the second twin is in a transverse position. Vaginal births are also not recommended if the twins share a placenta and amniotic sac.

No matter the type of delivery, expect more staff than during a singleton birth. Your doctor and nurse will be present, and a nurse for each baby. If the twins are premature, NICU staff will also be in attendance.

If the thought of having a C-section makes you feel anxious, planning the process may give you a stronger sense of control:

• Who do you want to have with you in the operating room? The baby's father? Your mother? A doula? Anticipating this emotional support can make a huge difference.
• How would you envision an ideal delivery — even if it must be a C-section? Would you like to request a clear drape rather than an opaque one so that you can witness the birth?  Who would you want to be with the babies if you are not ready for them immediately after delivery?
• Is there anyone you can ask about their caesarean? Perhaps even a mother of twins? Hearing their stories may put your mind at ease.

👩‍⚕️If your doctor is pressuring you to have a scheduled C-section, feel free to get a second opinion. It is usually possible to switch medical practitioners during your pregnancy.

Every woman’s experience with breastfeeding is unique. Some mother-baby teams quickly get the hang of it without a glitch; other women and their babies undergo a longer learning curve. Sometimes women also learn that breastfeeding is not possible for them.

Please be patient with yourself! Breastfeeding is a learned skill. Give yourself and your babies time!

It is up to you whether and how frequently you want to breastfeed. The most important thing is that you do what works for you.

Most hospitals have lactation consultants who will teach you the ins and outs of breastfeeding so that you can be a pro by the time you are discharged. Make use of this resource by asking for your lactation consultant.

You can also contact La Leche League International for further advice.

What is unique about nursing twins?

• Especially if the twins are premature, it may take a little while for your milk to come in. Your little ones may also still lack the strength to feed.
• Consider investing in a breastfeeding pillow for twins, allowing you to breastfeed both babies simultaneously.
• In many cases, the mother’s milk production is insufficient to breastfeed twins exclusively. Breastmilk is then supplemented by formula.

The first few weeks after delivery are an extraordinary time.

You finally get to meet and hold your babies! But the weeks following the birth also need to be set apart for your recovery. Ideally, you would have support to use this time to rest, stay in bed and recharge your batteries.

In addition to the physical exertion of childbirth, you are also dealing with hormonal changes triggered by the delivery and the onset of milk production. Many women feel more emotional and sensitive, maybe even weepy, during this period. This is also a natural part of postnatal adjustment.

During your recovery period, draw clear boundaries on whether and whom you would like to receive as visitors. Your well-being is what matters most right now.

• In the UK, maternity leave is not altered by the number of babies. Maternity leave is granted for one year, and Statutory Maternity Pay is given for nine months. There is no additional time granted to the mother of twins.

➡️ Twin Hack: instead of (or additionally to) having a baby shower, ask people to make meals for you. You can even coordinate it through TakeThemAMeal.com.

🙌 Take time to prepare for the first six weeks after your twins’ arrival.

• Will your partner be able to take some time off work to support you?
• If possible, get grandparents and aunts involved. Tip: let them take care of the household and the grocery shopping, freeing you up to take care of the babies. Of course, you can also hand off the babies to take a nap. 
• If you already have children, could childcare be helpful during the initial adjustment? Are your friends able to help out?
• Networking and communicating with other parents of multiples can be beneficial in feeling understood and learning what worked for others. Pick your favourite blog among these 70 top twin bloggers from around the globe. You may also like one of these top 15 preemie blogs.

Perhaps you are not in a committed relationship or may be concerned about becoming a single mum. Maybe you and your partner broke up recently, and now you are expecting twins.
While you may still be reeling from the breakup, you are probably more focused on what lies ahead. Of course, anyone in your shoes would long for an extra set of hands.

Having support is essential in this situation. For specifics, go to Support for Twin Moms.

You are not alone! Other single mums are walking the same road and have found what works (and what doesn't). You may benefit from joining the Single Moms of Multiples Facebook group or checking out the Raising Twins as a Single Mom blog.

• 📗 Find more single mum hacks here.
• 💌 Pregnant and no one is happy for you? This letter was written with you in mind!
• 🧔🏻‍♂️ Test: How Do I Respond If He Does Not Want the Babies?

Two babies at the same time: do I need two of everything? And how am I to afford it?

It makes sense that you would expect to need duplicates of everything. But as a rule, you only need two of everything used simultaneously, such as car seats. 

You may also want to invest in some specialty items:

• A breastfeeding pillow for twins (if you're going to breastfeed both at once).
• A twin pram, which you can probably find cheaply secondhand.

Any shareable items, such as a changing table, a bathtub, or a swing, need not be purchased twice. Likewise, their clothes do not have to be matching.

Even a cot can be shared, provided you follow safety guidelines, such as placing the babies on their backs to sleep and avoiding pillows, blankets, and stuffed animals.

😉 Of course, you will need more nappies, care products and food.

• Your leave and maternity pay are unchanged with multiples.
• Sure Start Maternity Grant: £500 for twins, £1,000 for triplets.
• Best Start Grant (for Scotland)
• Child benefit for the firstborn twin will be £21.80 per week. The second-born will receive £14.45 per week. These rates will be lower if you already claim child benefits for older children.

For more information about financial support, go to Financial Aid for Parents.

• Twins Trust
• Twins Trust in Northern Ireland
• Twins Online
• Join a local Twins Club!
• Multiple Births Foundation
• Home Start for Twins, Triplets, and Multiple Children

For more information on practical support, go to Support Near Me.