What Is Different About a Twin Pregnancy?

Twins are a double blessing, say their mothers. But your pregnancy may be a little different, and you probably have many questions …

• Am I pregnant with twins?
• What are twin pregnancy symptoms?
• I’ve just found out I’m having twins, what should I expect from during a twin pregnancy?

Due to multiple and twin pregnancies being less common than single child pregnancies, there is some extra information that a multiple child carrying mother will need to know so they are prepared for their pregnancy.

How to know if you’re pregnant with twins

There are many mums who have been pregnant with twins say they ‘felt’ or ‘sensed’ the multiple birth, and then there are others who have the news of a twin pregnancy come as a complete surprise.

The only way to be sure you are carrying twins is to identify two separate heartbeats. They can be detected by abdominal ultrasound at around 10-12 weeks or by vaginal ultrasound as early as six weeks. An ultrasound scan provides a picture of the inside of the womb using sound waves, they are generally painless and non-invasive. Other tests can also help identify twins, but not as definitive: for example, Doppler heartbeat count, elevated hCG levels, an abnormal AFT test and measuring larger for gestational age. All of these tests are performed by a doctor.

What are the early signs of a twin pregnancy?

Many parents may wish to know the signs of a dual pregnancy before booking in for their ultrasound, just keep in mind that many of the potential signs of a twin pregnancy mimic that of a standard pregnancy and only after conducting some tests will someone be able to confidently determine if they are pregnant with twins.

Potential early signs and symptoms of a twin pregnancy

• Rapid weight gain and belly growth earlier in the pregnancy compared to a single pregnancy;
• Increased morning sickness or nausea;
• More frequent urination;
• Excessive fatigue and tiredness;
• Elevated levels of certain pregnancy-related hormones like hCG.

How does birth with twins differ to a standard birth?

One of the key factors that differentiates a birth with twins over a single baby birth is that your due date could be earlier. Twins often are born prematurely because their combined weight may speed the onset of labour. Most likely you will deliver your twins at 37 weeks or earlier, contrary to mothers with single babies who on average deliver at 40 weeks.

An earlier birth can be more complicated than a single pregnancy, so it is usually recommended you seek specialist antenatal care with an obstetrician and midwife in hospital. Additional appointments and tests during pregnancy can pick up any complications as early as possible and as such treat them sooner.  Extra tests usually just mean more ultrasounds, and the frequency of these will depend on what kind of twin pregnancy you have. The frequency can vary, for example if you have twins with separate placentas, ultrasounds will be at 12-13 weeks, 20 weeks, then every 4 weeks. Whereas if you have a twin pregnancy with shared placenta, your ultrasounds will be more likely be at 12 weeks, then every 2 weeks from then. Being aware of the early signs of pregnancy is important.

In addition to your pregnancy, birth with twins may differ to a single birth as well. 

• Expect more hospital staff to be present in the room during the birth – more hands make light work with two little joys arriving at once.
• Choose a hospital with close access to a special care nursery.  It is more common for multiple births to arrive earlier than ‘term’ (37-38 weeks) so there will be comfort in knowing you have access to the special care nursery for your little ones to ensure they get the support they need while they prepare for their new world.
• As your obstetrician will be monitoring you regularly throughout your pregnancy, make sure they keep you up to date about whether vaginal birth or caesarean birth will be better for you and your twins. 

Is a caesarean section needed for a twin pregnancy?

Did you know that about 75% of multiple births will be via a caesarean delivery? So, whilst a caesarean birth may not be required, it’s really important to discuss this option with your doctor so you’re aware of what is involved, and are more prepared if you do end up delivering this way.

Potential reasons for a caesarean section birth when pregnant with twins

• Position of the babies: If the first baby (twin A) is not in a head-down position (breech or transverse);
• Placenta complications: If there are issues with the position or function of the placenta(s), such as placenta previa or placental abruption;
• Foetal distress: If one or both babies show signs of distress during labour, such as an abnormal heart rate pattern;
• Cord prolapse: If the umbilical cord slips through the cervix ahead of the baby, cutting off the blood and oxygen supply;
• Failure to progress: If labour is not progressing adequately or if the second twin is not descending properly, a c-section may be performed to ensure a safe delivery.
• Maternal health concerns: If the mother has certain medical conditions or complications that make a vaginal delivery risky.

It's important to remember that the decision for a c-section is made on a case-by-case basis, considering the specific circumstances of each pregnancy. Consult with your obstetrician to understand the individual factors that may influence the need for a c-section in your twin pregnancy.

How to prepare for a twin pregnancy and birth.

First of all, try not to worry yourself over what ‘may’ happen – consult your doctor if you have any concerns. Be a pro-active mum-to-be. Having an open and honest conversation with your obstetrician about the potential risks during pregnancy and the birth is important for preparing yourself for what lies ahead. Ask your obstetrician, or research yourself, if there are support services available in your area to support families of twins, including parent support groups where you can connect with other parents of twins to get their first-hand knowledge and experience which can help alleviate any expectant-parent nerves.

Ways to prepare for giving birth to twins

Key birthing considerations leading up to birth may include:

• Ensure all your prenatal tests are done on time, as these allow you to track your babies development and identify any potential risks as early as possible.
• Have your birthing plan ready and be prepared for the instance of a c-section birth, and the possibility of your babies being kept in a special care nursery after birth and what that might entail.
• Eat a healthy balanced diet rich in proteins, folic acid, calcium, iron, iodine and essential fatty acids. While it’s not quite like eating for three, you will find you need to concentrate on your diet a little more closely to ensure you’re meeting the needs of both yourself and your growing two.
• Exercise moderately. The larger bulge in your tummy should not stop you from going for your regular walks and exercise routines, though you should consult your doctor before varying your physical activity.

Ways to prepare for raising twins

Key considerations when it comes to raising multiple newborns may include:

• Being open to additional support from your partner, family, friends, and health professionals, as you recover and heal (both mentally and physically) from the strain of giving birth to twins.
• Having your support network in place for when you get home and throughout the first few months in particular, as you settle into a new routine with your little ones.
• Seeking support for breastfeeding as you need it. Juggling two baby’s on the breast can take some practice and planning.
• Keeping your energy up. Breastfeeding twins requires more than 2000 extra kilojoules every day. Eating a healthy balanced diet rich in proteins, folic acid, calcium, iron, iodine and essential fatty acids will ensure your able to support your milk supply. Have extra snacks and nourishing drinks on hand to help you meet your extra kilojoule needs.
• Staying as calm and cheerful as possible. Retain energy, because your little ones are going to demand a lot from you.

Are there any additional risks when giving birth to twins?

It’s always good to know what you’re in for with any pregnancy so you can be well prepared for what lies ahead. A twin pregnancy is an exciting time for both parents, however, giving birth to two babies at once may increase the risk of complications. For example, approximately 60% of twin births are preterm (before 37 weeks) and therefore risks associated with birthing premature twins are more common.

Potential risks and complications as part of a twin pregnancy

Some of the risks involved with a multiple pregnancy may include:

• A greater chance of early labour, your babies may be born prematurely. Premature babies can be more vulnerable and may require special care after their delivery.
• You may be likely to experience more physical changes and feel more tired and uncomfortable. Try to stay calm and build up your strength.
• There are some medical conditions that you may be at increased risk of while pregnant with twins.  Some examples include preeclampsia, anaemia, and gestational diabetes. You should consult your doctor to discuss any of these risks as they will vary for each mum and it’s important you know what’s relevant to your pregnancy.
• As more twins are born via c-section, the risks and complications associated with a c-section are also a consideration. Talk to your healthcare professional to understand these risks and if there are any precautions you can take to reduce your risks of complications.

Frequently asked questions about pregnancy and twins

What not to do when you're pregnant with twins

For the most part, a pregnancy with twins won’t differ from a pregnancy with a single baby.  Foods to avoid will be the same, items you’ll need to buy will be the same (just double in most cases), and always consult your healthcare professional for personalised advice and guidance throughout your twin pregnancy journey. Never ignore medical advice; avoid overexertion and excessive physical activity; avoid a poor diet including no alcohol, drugs and smoking; and never ignore signs of preterm labour.

What are the symptoms of twins in early pregnancy?

For a twin pregnancy you may experience elevated hCG levels (higher levels of the pregnancy hormone hCG may be detected in blood or urine tests); More intense nausea and vomiting compared to a singleton pregnancy; a noticeable increase in weight and a larger abdomen earlier than expected; and feeling excessively tired and fatigued, as carrying twins can be more physically demanding.

What to do differently when pregnant with twins.

For the most part, a pregnancy with twins won’t differ from a pregnancy with a single baby. Always consult your healthcare professional for personalised advice and guidance throughout your twin pregnancy journey, as all pregnancies are different.

How early do you show with twins?

In a twin pregnancy, it is common for the belly to start showing earlier compared to a singleton pregnancy. Women can begin to show signs of a baby bump as early as the first trimester, around 10-12 weeks. However, the exact timing and extent of showing can vary depending on various factors, including the mother's body type, the position of the babies, and the number of previous pregnancies. It's important to remember that every pregnancy is unique, and the size and appearance of the belly can vary from person to person. Make sure to check with your healthcare professional if you are concerned about your baby belly growth.