Multiple (or Twin) Pregnancy

What is Multiple Pregnancy?

A multiple pregnancy is when you are pregnant with twins, triplets or more. Discovering that you are pregnant with twins can be incredibly exciting.  It can also be daunting, and anxiety-provoking.  These feelings may be even more exaggerated if you are having triplets or more.  Different women may feel very differently about the news that they are having twins.  Even within couples, it is not unusual for the two partners to have different thoughts and emotions.

Signs of Multiple Pregnancy

Many women dealing with multiple pregnancies will often suspect they are carrying more than one child before it is even confirmed by the doctor - however, this is not always the case. While women pregnant with twins or more often experience the same pregnancy symptoms as women pregnant with only one baby, the symptoms are often heightened and may include:

• Severe morning sickness
• Extreme fatigue
• Foetal movements as early as 16-weeks
• Extra weight gain and larger tummy size are also common in late pregnancy

Risk Factors of Multiple Pregnancy

There is no doubt that having a multiple pregnancy is a very special event.  The joy of knowing that you are expecting two (or more!) babies may be exhilarating.  However multiple pregnancies also carry increased risks for both mothers and babies compared to pregnancies with only one baby, and it is important that you know what to expect. Your own health and circumstances, as well as some aspects of the pregnancy itself influence the type and degree of problems that you may be exposed to. Common risks of multiple pregnancies include:

• Preterm labour and birth. More than 60% of twins and nearly all higher-number multiples are born early (before 37 weeks). The more fetuses, the greater risk a mother has for early birth. Multiple birth babies more often require neonatal intensive care after birth.
• Gestational hypertension or high blood pressure is common in women carrying multiple fetuses and could pose a risk during labour.
• Anemia.
• Birth defects and congenital abnormalities are higher risk for babies of multiples.
• Twin-to-twin transfusion is a condition developed when twins share a placenta and can cause serious problems.

Potential Outcomes of a Multiple Pregnancy

One of the most important factors determining the chances of successful pregnancy outcomes is the type of multiple pregnancy that you have.  Often family members will want to know whether they are having “identical” or “non-identical” (“fraternal”) twins.

It is not always possible for obstetricians to answer this question with certainty prior to the birth of the babies. Obstetricians instead talk about multiple pregnancies in relation to the number of placentas (chorionicity) and sacs (amnionicity) that are present. Not only are these features easily determined using ultrasound, but they provide a very good guide as to the type and frequency of complications that may occur during the pregnancy. This is the most important information that is needed about your pregnancy, and is best determined by ultrasound early in your pregnancy.

Multiple Pregnancy Care Plan

Your care during a multiple pregnancy will be different, and more complex than care during a pregnancy with a single baby.  You will have more visits, and also more ultrasounds - the frequency of these will vary depending on the type of multiple pregnancy, and also any problems that may arise. It is also very important to optimise your health, diet and nutritional supplements.  The physical demands of carrying a multiple pregnancy can be quite onerous, and you will also need to discuss with your obstetrician about realistic expectations for work, exercise, etc.

When it comes to choosing the best birth option, you will need to discuss whether vaginal birth or caesarean section is better for you. Caesarean births are more common with multiple pregnancies but vaginal birth (although potentially more complex) is also an option for some women who carry twins.

For all of these reasons, if you are pregnant with a multiple pregnancy, it is important that you are cared for by someone with knowledge, skills and experience in this highly specialised field.

Antenatal Care for Multiple Pregnancy 

Being pregnant with twins can cause more physical and emotional exhaustion for the expecting mother. Multiple pregnancies also have an increased risk compared to singleton pregnancies. Whether you choose to engage, a private obstetrician, or a public hospital to look after you, it’s always helpful to get reliable antenatal care to support you throughout your pregnancy. Attending regular antenatal appointments will help the doctor to pick up potential complications and take any preventative measures to protect you and your babies. Other than that, your doctor will also examine your general health, address your concerns, discuss any medications that you are taking, or provide advice on your diet and lifestyle choices. 

Multiple check-ups and scans for preventative measure

Generally, women with multiple pregnancies need to have more frequent ultrasounds to monitor the development of their babies. The number of tests and scans you need to attend will depend on the type of twins or triplets you’re carrying. For example, if you’re having twins with separate placentas, your ultrasound appointments will take place at 12 or 13 weeks, 20 weeks, then approximately once a month until your babies are born. If you are having twins that share a placenta, you will have more frequent ultrasounds - often every two week or more.  If your pregnancy doesn’t have complications, you may not have extra appointments until you get to the end of your second trimester, where there is a higher risk of pre-eclampsia and pre-term labour. 

FAQs

Is it necessary to increase my caloric intake during a twin pregnancy?

Not necessarily. People often assume that being pregnant with twins means that you need to double your food intake to provide enough nutrients for your babies. That is usually not correct. What’s more important is implementing a balanced diet and consuming foods with sufficient vitamins and minerals. It’s best to consult your doctor to choose the best diet for you during a twin or multiple pregnancy. 

Do I need to take prenatal supplements?

Your doctor may recommend taking prenatal vitamins such as folic acid, iodine, or iron. It’s also important to figure out the best and safest way for you to get the right amount of vitamins that your body needs. 

Do I have to see a maternal-fetal medicine specialist to monitor my pregnancy?

Not all multiple pregnancies need to be cared for by a maternal-fetal medicine specialist, but if a twin pregnancy becomes complicated, referral to a maternal-fetal medicine specialist may be recommended.  

Maternal-fetal medicine specialists are experienced at managing very complicated pregnancies, including complicated multiple pregnancies.  If your pregnancy is becoming complicated, you should discuss with your doctor whether referral to a maternal-fetal medicine specialist is necessary.  

Are all twin pregnancies delivered early?

Almost more than half of twin pregnancies end in pre-term delivery (usually before reaching 37 weeks). Unfortunately, preventing pre-term labour with multiple babies is more challenging than with a single baby. 

Even if your pregnancy is uncomplicated, delivery before your due date is usually recommended.

Will my labour and delivery with multiple babies be significantly different?

Labour generally feels the same for multiple or single pregnancies, however, you can usually find significant differences when it comes to the delivery process. 

Most women planning to have a vaginal delivery of twins will be advised to have an epidural for their labour.  This increases the chances of both twins being delivered safely.

Even if you choose vaginal delivery, you may go to an operating room for delivery as a safety precaution. After the delivery of the first baby, there is a small risk of an emergency C-section to deliver the second baby. 

Caesarean section is more common for twins, and there are some circumstances where caesarean birth is strongly recommended.  You should discuss with your doctor whether vagainal or caesarean birth is recommended.  As part of that discussion you should let them know your preferences, and then consider the advice you are given.

My Practice 

Multiple pregnancies are equally exciting and overwhelming, and it’s helpful to seek the right care and support from the beginning of your pregnancy. As a qualified specialist in Maternal-Fetal Medicine, I am trained and experienced in managing multiple pregnancies of all types, including the most complex pregnancies. If you’re looking to engage a trustworthy twin obstetrician in Melbourne, you can rely on my expertise to have a safe and healthy pregnancy.

I have been working in the field of multiple pregnancy for over 15 years, and am Head of the Multiple Pregnancy Clinic at the Royal Women’s Hospital. In my private practice I also look after a high proportion of multiple pregnancy patients, including extremely complicated pregnancies, and am experienced and comfortable in the management of vaginal delivery of twins – something many obstetricians no longer have the experience to perform. 

In addition, I helped establish and continue to work in the Victorian Fetal Therapy Service, where I am one of a small group of experts with the skills to treat severe twin complications such as twin-twin transfusion syndrome using laser therapy in the womb.

What’s more, having had twin boys of my own, I have my own personal experience with multiple pregnancies. I am committed to providing you with the best care, knowledge, and support to prepare you for your motherhood journey.