For most women, pregnancy is fairly standard — and when it’s over, they welcome one new blessing. But for some women, they end up with twins — or more! Having a multiple pregnancy can change a lot of things, in both your pregnancy and your parenting. Today we’re just talking about pregnancy, though. How do you know if you have a multiple pregnancy? What do you do when you find out? What will change about your prenatal care? What are your delivery options? What should you expect in general?
Help! I Think There’s More Than One!
At the beginning, most pregnancies are fairly similar. There’s no way to definitively say that you are having more than one (or not) in the very early weeks. There, are however, some signs that may alert you to a multiple pregnancy:
- More severe morning sickness
- Measuring bigger than usual
- Extreme fatigue
- High HCG levels (you won’t know this unless your doctor does a blood test, though, and even then high HCG levels can be normal or a sign of another problem)
If you suspect a multiple pregnancy, your doctor or midwife will probably want to confirm this at some point in your pregnancy. An ultrasound between 8 and 12 weeks may show a second baby, although they do tend to hide behind each other; so even if you don’t see a second baby, the possibility can’t be ruled out. A later ultrasound, especially if you are continuing to measure large, could confirm twins (or more). Please also note that measuring large may mean a large baby, more fluid than average, an unusually positioned uterus, or any number of other normal things.
For those who choose not to get ultrasounds, a fetoscope could confirm a multiple pregnancy by noting two distinctively different heart rates (making sure one isn’t mom’s!). Extra movements or external palpitations may help to confirm as well.
Of course, in some cases, twins are never discovered until birth. This happens more commonly with midwives and home or birth center births because they tend to use ultrasounds and other diagnostic tools less often. This usually is not a problem, just a surprise. (I know some of my readers have experienced this!)
Doctors and even midwives do prefer to know in advance, though, so they can prepare for the possibility of transfer or c-section and to have extra personnel on hand to help deliver and care for the babies. (I know my midwife said she’d want three fully-qualified midwives on the scene because once the babies arrived, there would be three patients to care for, and just in case something went wrong they’d need all those people to care for each of us. No, I’m not having twins, we just discussed the possibility!)
What Will the Doctor Say?
This is going to vary widely depending on how your pregnancy is going and the type of care you’re receiving. If you happen to be carrying two babies but your pregnancy is otherwise completely normal, and you are seeing midwives or other natural-minded care providers, you might be doing the exact same things as all other women (same visit schedule and tests).
If, however, you are having problems with your pregnancy (preterm labor, struggling to gain weight, etc.) and/or are seeing a doctor who is not so naturally-minded, you may be in for a lot of extra visits and tests. You might have regular non-stress tests at the end of pregnancy and you will be watched carefully for signs of preterm labor after about 32 weeks. Extra ultrasounds are also common, to check on the babies’ growth and development.
Most medical doctors assume that making it to 35 or 36 weeks is “very good” for twins and that weighing over 5 lbs. is excellent. However, every set of twins I’ve known who were delivered at home with midwives were delivered after 40 weeks, weighing over 7 lbs. each. I’ve heard of twins weighing up to 10 lbs. each, even! It is completely possible to have a normal, healthy pregnancy — even with multiples.
I would encourage you to eat extra (600 additional calories per day instead of 300), drink more water or pregnancy tea, and get extra rest. You will need to gain more weight, too! Don’t push the exercise, especially in your last month. But don’t think of yourself as necessarily fragile, unless you are having unusual symptoms. Twin pregnancies can be completely normal! Seeing a chiropractor can help with the strain on your hips and back.
If you are having higher order multiples (triplets or more), expect that you will need more doctors’ visits and more care and that you likely will deliver on the earlier side. But, unless you conceived with fertility drugs (in which case you will be seeing the doctor frequently and receiving extra care anyway), this is highly unlikely.
What Are My Delivery Options?
These days, most doctors say that twins or more are automatic c-sections. Then again, the c-section rate is through the roof; estimates put it at 30 – 40% of all births! Even the WHO says that there is no justification for a rate above 10%.
Know that if you choose a standard hospital birth with an OB, you likely will end up with a c-section (and a lot of late ultrasounds to determine the position of the babies). If you opt for a birthing center, they may refer you to the hospital just because you are having twins. Doctors are afraid of what could happen in a twin delivery (since one is very likely to be breech, and doctors don’t deliver breech babies vaginally) so they opt for a c-section because it is “safer.”
It doesn’t have to be this way. Twins can be born safely vaginally and at home. You’ll have to be checked carefully and it’s best if you are located near a hospital (within 10 minutes) in case you have to transfer. But it’s definitely possible. Breech babies who are butt-first (not feet first) can be delivered safely, too, so that’s not necessarily a reason. It’s also possible for a second twin to turn head-down after the first is born. Just make sure you have a team of people supporting you, who know their limitations and know when you would need to transfer, just in case. But, don’t discount the possibility of a normal, vaginal birth just because you are carrying twins!
If any readers have experience with twin birth, please feel free to chime in!
My Babies Are Here! …Now What?
Twins definitely do mean some big changes to your life. Any baby is going to mean big changes, but twins are even more work than single babies. It’s twice the feedings, twice the diaper changes — and maybe, twice the exhaustion! Don’t be afraid to ask for help, especially in the early weeks. You will need it! Especially if you have had a c-section.
If any readers with twin experience would like to chime in on any of this, please feel free! We’d love your insight.
I love the idea of twins, but would be double the worry wart I normally am during pregnancy.
I had my identical twin boys in the Spring of 1996. I had to be monitored the whole time due to multiple miscarriages before and (believe it or not) the inability to gain weight (At 5 mos I had only gained 2 lbs). I delivered at 38 weeks they were both well over 6 lbs. At the start of labor both were head down but after baby A was born, baby B became head up. Now my doctor, a former perinatologist, was not just supportive of my choice to do vaginal birth of multiples… but encouraged it. What was done was a procedure called "external cephalic version." Basically messaging my abdomen to make the baby turn head down again. It worked and Baby B was born 9 minutes after his brother.
My daughter's godmother, even after having 3 healthy non-complicated vaginal births, her doctor told her that her twin pregnancy HAD to be cesarean just because it was a twin birth and gave her no option. It was cesarean or try and find another doctor. As that was her OB/GYN since her first pregnancy, she trusted and had the procedure. It made me ever so grateful for my OB/GYN of my twins' birth.
I had my fraternal twins in 2000. What a joy!!!
They were delivered via C-section as the second twin was breach.
The babies were born at 35 weeks and stayed 10 days each in the NIC Unit. They were not nursing well for the first 3 months so a friend lent me a pump and I pumped and bottle fed until they got the hang of nursing.
I encourage new moms to persevere through nursing issues as the babies do eventually learn to nurse and the health benefits for babies far outweigh the effort of pumping then bottle feeding. My kids are very healthy. Praise God.
My sister-in-law went three or four day past her due date while pregnant with twins. She had healthy baby girls, both well over 7lbs. In many states it is illegal for midwives to deliver multiples at home, though some midwives are willing anyway. My sister-in-law's midwife was willing to deliver on a few conditions, but the bottom line was that the parents had to be well informed of both the pros and cons and be willing to take responsibility for their decision. Like so many things, when we are willing to take responsibility, whether for our own health, education, finances, etc. we are much more likely to have favorable outcomes.
My twins boy/girl were born in 2001. I went to 39 weeks (just a few days short of 40 weeks). I found out after the delivery that the doctors were discussing at what point someone carrying twins should be induced. That really surprised me. Their explaination was that at some point your muscles are so stretched out they don't effectively contract. I had only gained 30 lbs. I had a very non-eventful pregnancy (ya!). I delivered in the hospital after pushing 2 hours and no episiotomy. A hospital delivery was not what I wanted, but it was compromise with my husband. There was never talk of a c-section unless baby A was breech. If baby A was head down and baby B was breech it was still a go on the vaginal delivery. I didh't particularily think that my Doctors were that "natural" but they weren't pushy with the drugs. Unless there was a problem they didn't push the epidural it was our choice whether or not we got it, but…it was hightly recommended in case there were problems and the 2 needed to be delivered ASAP.
I'm not sure you "need to gain more weight" with twins. I wasn't over weight before I got pregnant and the doctors never said anything about eating more or gaining more weight. I actually weighed more prior to being pregnant with the other two and still only gained about 30 lbs or so.
Hello ladies!
I birthed twins, almost three years ago now, and would you believe it; a total surprise even at the hospital! My first three single births lasted days, (one was 60+ hours post rupture!) but the twins lasted only a few hours. Which was great because I knew I was at the end of my rope and I started freaking out cuz I’d only been in the hospital bed for maybe 15 minutes- I wondered how I would ever last the usual HOURS! Lo and behold, with three older siblings front and center between dad and doc, a second baby popped out about five minutes after Baby A, the doc with the most screwed up look on her face (calling for an ultrasound machine that was way too slow for me!)
So yeah it was a great experience! Too quick for anyone to bug me!
What many conversations fail to share with moms considering different locations for birth, the hospital near me requires baby (thus mom) to remain at hospital (IN WARD!) for at LEAST 24 hours after delivery. My first two deliveries were at a birthing center and I was back home no more than three hours later. Thank God for my own bed! I’m considering home birth now, and I’m grateful to bring all my early experience with the midwives and birthing center to fill me with confidence during my low-risk pregnancy for a home birthing tub labor.
Great articles!