For Multiple Birth Awareness Week we thought we would share some of the most frequently asked questions from women who see us for their care in a multiple pregnancy.
All the Eve obstetricians can care for women who are expecting more than one baby and we have approximately 25 sets of multiples born per year. We hope this information might help you if you are starting your multiples adventure with us!
How do twins happen?
Twins can happen in two ways. The first is when the woman produces two eggs and they are both fertilised, in this case each baby will develop with a separate sac of fluid and a separate placenta. It is a little like sharing the same house but with separate utilities!
The second type of twins form when there is one fertilised egg which splits early in its development. These babies will be the same gender and be identical. Depending on how early this split happens there can be twins with separate sacs and placentas or twins that have separate sacs but share the same placenta or less frequently twins in the same sac and same placenta.
An early ultrasound scan is usually the time that you discover that you are having a multiple pregnancy. We can work out which type of twins you have, and this will be the scan that helps us plan the rest of your pregnancy. For many people it is a huge surprise to hear that there are two or more babies inside. It can be a time of many emotions, not all of them as positive as you had expected to feel.
Twins often run in families and occasionally we see women who have more than one set of multiple births!
How does my care change when there is more than one baby?
Any pregnancy with more than one baby needs more care and attention than those women carrying one baby. We see women with multiple pregnancies more frequently and adjust the normal visits according to any new changes in the pregnancy.
Multiple pregnancies are more at risk of all the complications of pregnancy, the main three that we worry about are increased blood pressure or pre-eclampsia, gestational diabetes and preterm birth. Blood pressure abnormalities and diabetes are more common in multiple births as there is more placenta which produces higher levels of the placental hormones which drive these conditions. The risk of preterm birth is due to several reasons but two of the most common reasons are that the uterus is very stretched and cannot contain the pregnancy until the due date and the second reason is that sometimes the complications of the pregnancy require an early delivery.
The other risk that is special to twins who share the same placenta is unequal sharing of the placental resources. This is called Twin Twin Transfusion Syndrome (TTTS). TTTS can occur any time from the middle to the end of the pregnancy. It is most commonly diagnosed on ultrasound scan. Most women who have babies with a shared placenta will go for ultrasound scans every 2 weeks from about 14-16 weeks of pregnancy.
Otherwise the care for the pregnancy is very much the same as for those women with one baby. Everyone would be offered the Down’s syndrome testing in the early part of the pregnancy, the anatomy scan at 20 weeks, then the 28 week blood tests for diabetes and the whooping cough vaccination after 28 weeks.
Having support of others who have gone through multiple pregnancies and births is often an important part of your preparation for parenthood. There are many places that you can get this information from but one that is often recommended is the Australian Multiple Births Association https://www.amba.org.au
What things do I need to do differently from those women with one baby?
Women who are growing two or more babies have more nutritional demands on them as they progress in the pregnancy. They may be asked to have extra iron and folate tablets in addition to the routine multivitamin.
The same advice regarding safe foods in pregnancy is given. Women need to be careful not to increase their calorie intake too much and can monitor their weight gain in pregnancy with charts specific to their body type and multiple pregnancy.
Have time to organise additional supports for when you bring home more than one baby is also important. Learning about feeding options before the babies arrive can give you additional confidence.
Often women carrying more than one baby find they become more uncomfortable and their sleep is disturbed earlier than those women with one baby. It might be wise to consider finishing work or increasing rest time from earlier in the pregnancy.
What are my birth options, when there are two of them?
How and when the babies arrive depends on several factors. If there are three of them, it is recommended you have a caesarean section and this usually happens much earlier than for twins.
If you are keen to have a vaginal delivery of twins, there are several things that need to happen prior to the delivery:
- For the babies both to be well and expected to tolerate labour
- Both babies to be a similar size
- The first baby to be head first in the pelvis.
Everyone will manage labour in twins differently but almost everyone will ask that you have both babies’ heart rates monitored during the labour and many will recommend an epidural for pain relief, most for the safe delivery of the second baby.
If the above criteria are not met, you may be recommended to have a caesarean section for the birth of your babies. Some women need to have a caesarean section of other reasons, such as a previous caesarean section or surgery to the uterus.
The timing of birth is usually earlier in twins also. Most Obstetricians would recommend that twins sharing the same placenta are born from 36 weeks onwards if the pregnancy has been uncomplicated and from 37 weeks onwards for those uncomplicated twins with separate placentas.
There is a lot to think about and discuss when you are having a multiple pregnancy. Make sure you feel confident and safe with your Obstetrician. You can always see if you can have extra time to discuss the pregnancy care and any complications that you are experiencing. Most women experiencing a multiple pregnancy can still enjoy many of the same aspects of pregnancy as a single baby pregnancy. We aim to make it the most enjoyable and safe experience there can be.
Blog post by Dr Robyn Aldridge