If you have any questions or enquiries please feel free to contact us on the following details provided below or alternatively you can complete our online enquiry form also located below and we will get back to you as soon as possible...

Let’s Talk About Twins, Part 1

Welcome to my “Let’s Talk“ series. “Let’s Talk” is aimed at improving general knowledge about pregnancy and touching on some of the interesting or challenging issues that women who are pregnant, or contemplating pregnancy, may face.

Today, Lets Talk…. Twins!

It’s common to hear comments such as “twins are so cute”, or “Oh, I’d love to have twins”, and it’s absolutely true that seeing two happy healthy twins sitting in a pram or giggling together is adorable. I have a set of twins of my own (teenagers now!), and I certainly agree that they were very cute together as babies – and also a lot of hard work!

Twin pregnancies can also be very challenging, and the risk of problems is significantly higher for twin pregnancies than for pregnancies where there is only one baby. This means obstetricians generally take a fairly cautious approach to twins, paying extra attention and planning additional visits and scans.

This blog post is an introduction to twin pregnancies. Further posts will focus in more detail on some of the specific issues and problems that may be associated with twin pregnancies.

Types of Twins

Firstly, it is important to understand some of the different terms used when discussing twins. One of the most common questions people ask, is “are they fraternal or identical?”.

Fraternal twins are: Dizygous. This comes from the word “zygote” – the name for the cell created by the joining of an egg and a sperm. Dizygous twins occur when two eggs are released from the ovaries instead of one, and both are fertilised, so they come from two zygotes. They are effectively siblings who share the same time in the uterus (womb), and usually the same birthday. They can be as similar or different as any other siblings.

Identical twins are: Monozygous. They come from an individual zygote and occur when a single egg is fertilised. After fertilisation, the early embryo splits in two. Monozygous twins are genetically identical, although they can sometimes look different at birth, particularly if they have been growing at different rates in the womb.

Fraternal vs. Identical Twins

Twins occur in about 1 in every 65 pregnancies in Australia.

Most of these are Dizygous (fraternal) twins. Monozygous (identical) twins occur in about 1 in every 300 pregnancies. Fertility treatments, such as ovulation induction or IVF, increase the rate of both dizygous and monozygous twins. Other factors such as ethnicity, family history, maternal age, maternal BMI, and some medical conditions may also increase the frequency of twins.

Dizygous twins always (NB: like most “always” in medicine, there are some very rare exceptions) have separate placentas and amniotic sacs. They can be either the same sex or different sexes.

Monozygous twins are more complicated. They can sometimes have separate placentas, but more often they share a single placenta. Usually they will each have their own amniotic sac. Rarely will they share the same placenta and the same amniotic sac. It is even more rare that they will be conjoined twins.

It is not always clear during a pregnancy whether twins are fraternal or identical. For this reason, obstetricians more commonly describe them based on the arrangement of the placentas and amniotic sacs.

Related Risks

Dichorionic twins have separate placentas. They also have their own amniotic sacs. For dichorionic twins, all of the risks of pregnancy occur slightly more frequently than for singletons, but there are no specific complications that occur because of them being twins.

Monochorionic twins share the same placenta but have different sacs. Monochorionic twins have all of these risks, plus some additional risks related to sharing the placenta.

Rarely (1 in 5,000-10,000) monochorionic twins may share both the same placenta and the same sac. They are known as monochorionic monoamniotic twins, or MoMo twins. These twins are at even higher risk of complications.

The significantly higher complication rates for monochorionic twins, and the complexity of managing these complications, means that if you have monochorionic twins you should definitely be cared for by an obstetrician experienced at managing these types of pregnancies.

The specific complications that can occur in Monochorionic twins are discussed in a separate blog – “Let’s talk Monochorionic Twins”.

Dealing with a Twin Pregnancy

Once you have come down to earth after discovering you are having twins, there are a few things you need to consider.

Firstly, you will need to think about how you will be cared for during your pregnancy. Twin pregnancies are usually considered higher risk pregnancies and require specialised care from a specialist obstetrician – either in a public hospital or private practice.

Monochorionic twins are generally more complex and the situation can sometimes change very quickly. It is important that you are looked after by an obstetrician experienced in managing these sorts of pregnancies.

If you have private health insurance and are covered for private obstetric care, you will have the option of receiving care from a private obstetrician. If you don’t have that cover, most people will choose to receive care through a public hospital, as the costs of private hospital care are quite substantial if you are paying for them out-of-pocket.

Remember that twin pregnancies often require additional ultrasounds and tests. Sometimes extra time in the hospital may be necessary as well, so it’s important be prepared for these additional costs.

Choosing Your Obstetrician

When choosing your obstetrician, take some time and do your research.

Look for someone experienced in looking after twin pregnancies. Think about which hospital you would like to give birth at, and whether you are interested in a vaginal birth or caesarean section. This isn’t something you have to lock in initially, but it may help you choose your obstetrician, as not all obstetricians are comfortable with vaginal birth for twins.

Also, look for someone who aligns with your values and communication style. Don’t be afraid to have an appointment with more than one obstetrician in the early stages of your pregnancy. You should feel comfortable asking them questions that you think are important.

Once you have chosen your obstetrician or hospital, you will have a lot of additional things to think about.

Understanding the schedule of visits, and the types of tests required will be important. These will vary depending on the type of twins you’re carrying and any specific circumstances relating to your pregnancy. Don’t rely on what your friends, family, or even Google tells you – speak to your obstetrician first.

Even seemingly minor variations between pregnancies can lead to differences in the potential issues you may have to deal with, and differences in the way your pregnancy is managed. Certainly make an effort to be well informed, but also make sure you discuss the plans with your obstetrician to ensure you are getting advice that is specific to your situation.

Things like frequency of ultrasounds and other tests may vary. Depending on your situation you may need to spend some time in hospital. Different types of twins, and different problems with twins can also have a big impact on timing of delivery. Whether a vaginal twin birth or a caesarean birth is advised will also vary depending on your circumstances.

It is also important to note that many twins are born preterm. There is a chance that your babies will need to be admitted to special-care nurseries, sometimes for an extended period of time.

Contact Dr Stephen Cole Today for Additional Information on Twin Pregnancies

Hopefully this explanation has made twin pregnancies a little clearer. If you are having a twin pregnancy, you may feel excited. You may feel daunted or even a bit frightened. There are many different emotions that women and families experience – often more than one at the same time!

If you are embarking on a twin pregnancy, make sure you are as well informed as you can be. Do your research. Ask your doctor about your specific circumstances. Clarify things that are unclear. Be aware of the potential problems that can develop, but also focus on the excitement of having two babies!

Stay tuned for further information on twin pregnancies, in my up-coming blogs.

Dr Stephen Cole, Specialist Obstetrician

Since 2001, I have been an obstetrician in East Melbourne providing care for women with both low and high-risk pregnancies. As an MFM (Maternal-Fetal Medicine) specialist, I see women with a wide range of pregnancy situations. The odds are that your pregnancy will be low risk and go smoothly; however, should complications arise, you can be confident that I am well equipped to handle even the most high-risk pregnancies and unexpected complications. Private hospitals where I work include Epworth Freemasons, Frances Perry House, and St. Vincent’s Private. I strive to provide woman-centred care, and I am supportive of my patients’ choices. Many obstetricians claim to be “high risk” specialists, but only MFM specialists have undergone the training and assessment needed to manage all pregnancies, from the simplest through the most complex. Please contact me with any questions or concerns on (03) 9495 6411 or via my online contact form.