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.